Internal herniation of the small bowel through a defect in the falciform ligament and subsequent small bowel obstruction is exceedingly rare with the majority of previous cases being attributed to congenital abnormalities. As laparoscopic techniques approach the forefront of modern surgery, an iatrogenic source for a falciform ligament defect has emerged over the last decade. In this case, a 50-year-old patient presented with signs of acute small bowel obstruction 10 days after a laparoscopic cholecystectomy. On diagnostic laparoscopy, part of the jejunum was found to have herniated through an opening in the falciform ligament. This was likely to have been caused by trauma during the cholecystectomy. Following relief of the obstruction, the defect was closed with polyglactin sutures.

BackgroundThe Bonebridge is an active transcutaneous bone conduction implant recommended as a surgical option for adults and children (aged 5–18 years). Successful implantation of the Bonebridge is often restricted by an insufficient amount of temporal bone to house the transducer in the paediatric patient.Method and resultsIn this unique paediatric case, bilateral Bonebridge devices were implanted simultaneously in the right sinodural angle and the left middle cranial fossa.ConclusionThe simultaneous implantation of bilateral Bonebridge devices was well tolerated in this paediatric patient, with significant improvement in her hearing. The middle cranial fossa is a viable option for housing the transducer.

Background/Aims In 2014, the Royal College of Surgeons expressed concern that a postcode lottery was determining the commissioning of procedures of limited clinical value. The research was carried out to assess whether there is variation in the clinical commissioning of hallux valgus surgery in England. Methods The commissioning policies for clinical commissioning groups were identified. Data were analysed to assess both adherence to the British Orthopaedic Association guidelines for surgery and the minimum criteria that a patient must fulfil for surgery. Results Variation was recorded in commissioning policies and in the number of criteria a patient must fulfil to be offered surgery. Conclusions There is currently no standardised national commissioning policy for hallux valgus surgery. Referral guidelines have been produced by leading national bodies but their implementation is varied. This can lead to variation in referral patterns in England for patients requiring hallux valgus surgery.