The objective of the present study was to compare the efficacy and safety of low-dose unfractionated heparin (UFH) and a low-molecular-weight heparin (LMWH) as prophylaxis against venous thromboembolism in critically ill surgical patients undergoing major surgery. This was a randomized prospective study in which critically ill patients scheduled to undergo major elective surgery were allocated to receive subcutaneously either LMWH once daily and a placebo injection containing sterile 0.9% normal saline or 5000 IU UFH twice daily subcutaneously. Each patient was evaluated postoperatively clinically and confirmed by Doppler study for development of deep vein thrombosis (DVT). One hundred and fifty-six patients completed the protocol. There was similar efficacy of UFH as compared with LMWH in the prophylaxis of DVT. There was also no statistically significant difference in the incidence of major complications in the heparin group as compared with the LMWH group. However, minor hemorrhagic complications such as wound hematoma and surgical site bleeding were significantly more in the heparin group as compared with the LMWH group. Both UFH 5000 units subcutaneously twice daily and LMWH 40 mg once daily provide highly effective and well tolerated prophylaxis for critically ill surgical patients. Considering the advantage of once-daily dosing, a wider adoption of prophylaxis with LMWH may be justified on the basis of patient acceptability and saving of nursing time.

TUMP-LC is both feasible and safe. It can be performed with standard laparoscopic instruments, and, thus, there is minimal additional challenge to an experienced laparoscopic surgeon. With progressive experience and development in technology, TUMP-LC will probably be performed widely. But, disciplined, evidence-based investigations and randomized studies comparing it to existing techniques must be carried out before the actual place of this procedure in current surgical practice is determined.

The concept of laparoscopic single-incision surgery is an attractive and understandable innovation as laparoscopic surgery has become more commonplace. Based on our experience, we believe that the procedure is feasible without additional risk. Cosmetic benefit is clear; however, beyond the actual outcome with respect to postoperative pain and long-term complications, needs to be evaluated and compared to standard laparoscopic TAPP mesh hernioplasty.

Single-incision laparoscopy is being used to carry out a wide variety of laparoscopic operations since its introduction in 2007. Various case reports and studies have demonstrated the safety and feasibility of single-incision laparoscopic transabdominal preperitoneal (TAPP) and totally extra-peritoneal mesh hernioplasty. However, till date, its apparent advantages have been mainly cosmetic and related to patient satisfaction. We have been performing single-incision laparoscopic TAPP mesh hernioplasty since June 2009 using conventional laparoscopic instruments. Here, we describe our technique that is aimed at standardising the method.