The ARM-Net (anorectal malformation network) consortium held a consensus meeting in which the classification of ARM and preoperative workup were evaluated with the aim of improving monitoring of treatment and outcome. The Krickenbeck classification of ARM and preoperative workup suggested by Levitt and Peña, used as a template, were discussed, and a collaborative consensus was achieved. The Krickenbeck classification is appropriate in describing ARM for clinical use. The preoperative workup was slightly modified. In males with a visible fistula, no cross-table lateral X-ray is needed and an anoplasty or (mini-) posterior sagittal anorectoplasty can directly be performed. In females with a small vestibular fistula (Hegar size <5 mm), a primary repair or colostomy is recommended; the repair may be delayed if the fistula admits a Hegar size >5 mm, and in the meantime, gentle painless dilatations can be performed. In both male and female perineal fistula and either a low birth weight (<2,000 g) or severe associated congenital anomalies, prolonged preoperative painless dilatations might be indicated to decrease perioperative morbidity caused by general anesthesia. The Krickenbeck classification is appropriate in describing ARM for clinical use. Some minor modifications to the preoperative workup by Levitt and Peña have been introduced in order to refine terminology and establish a comprehensive preoperative workup.

Background and Aims: laparoscopic cholecystectomy (lc) is the gold standard for treating symptomatic cholelithiasis. conversion, however, is sometimes necessary. the aim of this study was to determine predictive factors of conversion in patients undergoing lc for various indications in elective and acute settings in a general teaching hospital. Results: conversion to open cholecystectomy was performed in 121 patients (12%). the most frequent reasons for conversion were infiltration/fibrosis of calot's triangle (30%) and adhesions (27%). in the multivariate analyses male gender (oR 1.67, 95% ci 1.07-2.59), age > 65 years (oR 2.10, 95% ci 1.32-3.34), acute cholecystitis (oR 11.8, 95% ci 6.98-20.1), recent acute cholecystitis (oR 4.71, 95% ci 2.42-9.18) and recent obstructive jaundice (oR 20.6, 95% ci 4.52-94.1) were independent predictive factors for conversion.Conclusions: male gender, age > 65 years, (recent) acute cholecystitis and recent obstructive jaundice are independent predictive risk factors for conversion. by appreciating these risk factors for conversion, preoperative patient counselling can be improved.

Angio-Seal is a frequently used vascular closure device after arterial catheterisation. Major complications are infrequently reported. We present four cases occurring within a 2-month period in our hospital with dislodgement of an Angio-Seal causing acute arterial occlusion, resulting in loss of limb in one case. Surgical intervention was necessary in all cases. Acute arterial occlusion after deployment of the Angio-Seal in patients with peripheral arterial disease might be less uncommon than the literature suggests.

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