Background Hernia repairs account for millions of general surgical procedures performed each year worldwide, with a notable shift to outpatient settings over the last decades. As technical possibilities such as smartphones, tablets, and different kinds of probes are becoming more and more available, such systems have been evaluated for applications in various clinical settings. However, there have been few studies conducted in the surgical field, especially in general surgery. Objective We aimed to assess the feasibility of a tablet-based follow up to monitor activity levels after repair of abdominal wall hernias and to evaluate a possible reduction of adverse events by their earlier recognition. Methods Patients scheduled for elective surgical repair of minor abdominal wall hernias (eg, inguinal, umbilical, or trocar hernias) were equipped with a telemonitoring system, including a tablet, pulse oximeter, and actimeter, for a monitoring phase of 7 days before and 30 days after surgery. Descriptive statistical analyses were performed. Results We enrolled 16 patients with a mean overall age of 48.75 (SD 16.27) years. Preoperative activity levels were reached on postoperative day 12 with a median of 2242 (IQR 0-4578) steps after plunging on the day of surgery. The median proportion of available activity measurements over the entire study period of 38 days was 69% (IQR 56%-81%). We observed a gradual decrease in the proportion of available data for all parameters during the postoperative course. Six out of ten patients (60%) regained preoperative activity levels within 3 weeks after surgery. Overall, patients rated the usability of the system as relatively easy. Conclusions Tablet-based follow up is feasible after surgical repair of minor abdominal wall hernias, with good adherence rates during the first couple of weeks after surgery. Thus, such a system could be a useful tool to supplement or even replace traditional outpatient follow up in selected general surgical patients.

<b><i>Introduction:</i></b> Anastomotic leakage (AL) in colorectal surgery occurs with an incidence of up to 20%. Bowel perfusion is deemed to be one of the most important factors for anastomotic healing. However, not much is known about its variability during colorectal surgery and its impact on the outcome. Therefore, this study aims to evaluate serosal oxygen saturation patterns during colorectal resections with visible light spectroscopy (VLS). <b><i>Materials and Methods:</i></b> Bowel perfusion in patients undergoing left-sided colorectal resections was assessed at different timepoints during surgery using VLS on the colonic serosa. The primary outcome parameter was serosal oxygen saturation (StO₂) at the anastomosis during different timepoints of surgery. <b><i>Results:</i></b> We included 50 patients who underwent colorectal resection for bowel cancer (58%) and diverticular disease (34%). StO₂ at the proximal site of the anastomosis increased significantly throughout the surgery (mean difference 3.61%; 95% CI –6.22 to –1.00; <i>p</i> = 0.008). However, aberrancy from this identified perfusion pattern had no impact on the postoperative outcome. <b><i>Conclusion:</i></b> During colorectal resections, we could demonstrate an increase of the colonic StO₂ throughout surgery. Appearance of AL was not associated with lower StO₂, underlining the multifactorial genesis of developing AL.

Abdominal tuberculosis (TB) can affect any organ of the gastrointestinal tract, and as a result of its unspecific symptoms, it may even mimic neoplasia. Rare manifestations are difficult to detect even for the trained eye and require clinical suspicion. We report rare cases of a mechanical ileus due to peritoneal TB in a 41-year-old man and an isolated peripancreatic infection in a 54-year-old woman. While in one patient, suspected malignancy led to diagnostic laparoscopy, it led to a total pancreatectomy with splenectomy in the other case. However, both times histology ruled out malignancy and showed unexpected similarities with TB. The patients responded well to medical treatment, although one patient is struggling with pancreatogenic diabetes.

BACKGROUND The economic burden of general surgical procedures is a major contributor to health costs all over the world. To reduce these costs and to enhance patient comfort, more and more procedures are transferred to a daycase setting, already e.g. hernias of the abdominal wall are repaired without keeping the patient overnight in a lot of countries. In the future, it is very likely that more complex procedures are considered to be safe to be carried out this way too. Up to now, we cannot offer our patients any intensified monitoring, once they have left the hospital. Tablet-based telemonitoring seems to be a promising way to change this situation. OBJECTIVE The rationale for this study was to evaluate the feasibility of monitoring postoperative activity with a telemonitoring device after minor surgery of the abdominal wall. METHODS Patients aged 18 and older, scheduled for elective surgical repair of abdominal wall hernias were equipped with a telemonitoring system including a tablet, a pulse-oximeter and an actimeter for a monitoring phase of one week before and five weeks after surgery. The primary objective was the feasibility of monitoring postoperative activity, secondary objectives were monitoring of pain and the impact of wound photographs for surveillance and early detection of surgical site infections (SSI). RESULTS We enrolled 16 patients (5 (31.3%) female, 11 (68.8%) male) with an age of mean±SD (Standard Deviation) 48.75 ± 16.28 between October 2017 and September 2018 in our center. Regarding our primary objective, we were able to gather information relating to the patient activity levels in all patients, except one. This resulted in a response rate of 75 percent in the preoperative week, with declining rates over the follow-up period. The gathered steps per week showed broad variations over the study period with e.g. in the preoperative week mean±SD 27951.00 ± 21036.56 steps, mean±SD 1523.17 ± 9345.58 in the 1st postoperative week and mean±SD 21019 ± 15865.21 steps in the 5th postoperative week. Regarding the secondary objectives, the maximum VAS was mean±SD 4,24 ± 1,81 with a duration of transferred VAS-data of mean±SD 14,19 ± 8,67 days postoperatively. In the first week after the operation, VAS-data was transferred completely on 1 to 6 days, but the rate continuously decreased over the following four weeks, resulting in no data transmission at all in 62,5 percent of the cases in the 5th week. There occurred no SSI during the follow-up period. CONCLUSIONS Our study showed, in principle, the feasibility of a tablet-based follow-up after repair of small hernias of the abdominal wall. Further studies should target to optimize technical issues and focus on general surgical procedures with a higher potential for postoperative complications to evaluate a possible reduction of their impact due to earlier recognition. Moreover, smaller gadgets and mobile phones could be utilized. CLINICALTRIAL Nil