One in four loop ileostomies performed to defunction an elective anterior resection is not reversed, and in the presence of significant comorbidity one in three is not reversed. Only 12% is reversed within 12 weeks.

Traditionally radical hysterectomy has formed the mainstay of treatment for early stage cervical carcinoma. More recently radical trachelectomy and laparoscopic lymphadenectomy have been introduced to allow preservation of fertility. We present a new approach to fertility-sparing surgery, namely abdominal radical trachelectomy. The technique is similar to a standard radical hysterectomy and lymphadenectomy. In our technique the ovarian vessels are not ligated and, following lymphadenectomy and skeletonisation of the uterine arteries, the cervix, parametrium and vaginal cuff are excised. The residuum of the cervix is then sutured to the vagina and the uterine ateries reanastomosed.Traditionally the treatment for invasive cervical carcinoma which has progressed beyond microinvasion has been radical hysterectomy. Long term experience of radical surgery for Stage l b carcinoma has shown that it produces excellent results in terms of survival but that morbidity may be significant, and there is always loss of potential for future childbearing. Increasingly, large numbers of young women (24-35 years) are being diagnosed with cervical cancer1. Clearly, the loss of fertility in these women can be devastating.In recent years there has been a move towards more conservative approaches for the treatment of cervical carcinoma. Conisation of the cervix has become acceptable practice for the management of FIG0 classification Stage la(i) tumours. In an attempt to develop a more conservative operation for early invasive carcinoma of the cervix, Dargent et al.* described a new technique suitable for exophytic tumours of Stages l a to 2a which allowed preservation of the uterus but removed the cervix, parametrium and upper one third of the vagina.He called this procedure 'radical trachelectomy '. His patients also underwent laparoscopic pelvic lymphadenectomy, with negative histology results. The

Conversion after laparoscopic cholecystectomy is less common as consultant caseload increases. This suggests that operation should be undertaken only by surgeons with an adequate caseload. There is a wide variation in conversion rates among hospitals. This has important implications for training as well as for the organization and accreditation of cholecystectomy services on a national basis.

No abstract