Background Stump appendicitis is defined as interval inflammation of any residual appendicular tissue, after an appendicectomy. We present a systematic review of case series and case reports on stump appendicitis, emphasising on risk factors, diagnosis and surgical management. Methods The English literature (1945–2018) was reviewed, using PubMed, Embase and GoogleScholar, combining the terms “appendix”, “appendicitis”, “stump”, “residual”, “recurrent” and “retained”. In total, 127 studies were included, describing 164 patients (males 59%, mean age 36 ± 17 years). Results Index surgery was open in 59% and laparoscopic in 38%. It was described as “difficult” or “complicated” in 31%. 20% of patients reported episodes of recurrent abdominal pain during the time interval between index and stump appendicitis (range 2 weeks to 60 years, median 2 years). Right lower quadrant pain was the most frequent complain (88%), leukocytosis was found in 56%, whereas 92% of patients underwent imaging testing, which was diagnostic or highly suspicious in 67.5%. Mean delay between beginning of symptoms and surgery was 2.4 ± 2.3 days. The operative approach was open in 61% and laparoscopic in 35% of cases. The operation was characterised as “difficult” or “complicated” in 45%. In the majority (88%), a completion stump appendicectomy was performed, with 11% requiring more extensive procedures. Mean length of resected stump was 3.1 ± 1.6 cm (range 0.5–10 cm). Conclusions Stump appendicitis may occur following both open and laparoscopic approach, when the residual stump is > 0.5 cm. Its clinical significance lies in the delayed diagnosis, leading to higher incidence of complications and the need for more extensive surgery.

Forty-one patients presented with jaundice or/and cholangitis after rupture of a hydatid liver cyst into the bile ducts. Preoperative diagnosis has recently been based on ultrasound and CT scan. Seventeen patients had drainage of the common bile duct by a T-tube (group A) and the remaining 24 had choledochoduodenostomy (group B). The primary liver cyst was dealt with by removal of the endocyst and either simple drainage (4 in group A, 7 in group B), or omentoplasty (6 in group A, 11 in group B). Of group A, there were 2 patients with nontreated jaundice, 7 with recurrent jaundice – 3 of whom with an external bile fistula – and 3 patients with recurrent episodes of cholangitis. Of group B, there were 2 patients with recurrent jaundice and 1 patient with recurrent episodes of cholangitis. Differences between the two groups were statistically significant (p < 0.01). Complicated cases underwent additional choledochoduodenostomy (8 patients in group A and 2 patients in group B, who had their choledochoduodenostomies revised), interventional endoscopy (4 patients) and omentoplasty (4 patients – 1 reoperation). There were 3 deaths (2 after reoperation). One patient died because of secondary biliary cirrhosis, another because of multiple intrahepatic abscesses and the third becasue of pancreatitis. It is concluded that along with the treatment of the liver cyst per se, intrabiliary rupture of a liver hydatid cyst is better treated by choledochoduodenostomy than by simple T-tube drainage of the common bile duct. The latter method results in recurrent jaundice and cholangitis, which are well treated by adding choledochoduodenostomy.

There is a variety of anatomical deformities of the posterior pelvic compartment that associate functional disorders of the anorectum. The most common are: anterior rectocele, internal rectal prolapse (recto-anal intussusception), sigmoidcele and enterocele and overt rectal prolapse. There are a number of procedures employed in the treatment of mentioned disorders. One of them is laparoscopic prosthesis ventral colpo-rectopexy. Current evidence on this procedure is rather limited, because quality of studies is of low level and comparative trials are very few. Nevertheless, it is well documented that this procedure for mentioned is a safe procedure with very low morbidity, one death reported so far, and low conversion-to-open approach rate. Complications associated with the synthetic prosthesis (erosion or sepsis) are rare, and use of biological mesh does not seem to offer any advantage. Conversion is very low and usually as a result of previous pelvic surgery. The pro ce dure is safe with low mor bid ity, short hos pital stay and very low re cur rence rate of overt rec tal pro lapse. Func tional out comes, namely con sti pa tion, ob structed def e ca tion syn drome, in con ti nence and sex ual dys func tion de crease in rates postoperatively IN TRO DUC TION