SUMMARYA 43-years-old male patient presented through general practitioner with a complaint of right scrotal mass and was operated through inguinal approach. A 4 cm mass was excised and was found to be a liposarcoma of the spermatic cord upon histopathology, which is a diagnostic dilemma and very rare entity. BACKGROUND

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Introduction: The SARS-CoV-2 (COVID-19) pandemic has brought about instability in healthcare providers worldwide; this includes rural settings that had fewer cases of COVID-19 in the first year of the pandemic. This article examines the impact of COVID-19 on the surgical services offered at the Balfour Hospital, Orkney Islands, Scotland in the UK and the impact the pandemic had indirectly on the service in 2020. Methods: The authors conducted a retrospective study concentrating on surgical services including emergency hospital presentations and the number of cancer diagnoses, specifically colorectal. Colorectal malignancies were specifically investigated as in the Balfour Hospital they are primarily diagnosed by surgeons. Focus was on diagnosis and outcomes between June 2020 and October 2020, in comparison with the previous year. This time period was chosen because surgical services reconvened after a period of inactivity due to the COVID-19 pandemic. The types of emergency admission into the Balfour Hospital during this time were examined, as well as delayed surgeries and the impact of Rural and Remote Health rrh.org.au

Objective: To present our technique of laparoscopic repair of giant para-oesophageal hernia with biological prosthesis (porcine dermis). Method: Our technique involves creating a pneumoperitoneum with standard port placement for anti-reflux surgery, mediastinal sac dissection and excision, crura-plasty, tension free placement of the biological prosthesis for hiatal reinforcement, fundoplication and gastropexy. Conclusion: Our technique of laparoscopic repair of giant paraoesophageal hernia with biological mesh is feasible and safe with acceptable morbidity and outcome.

Objectives: Acute appendicitis remains the commonest intra-abdominal surgical emergency. This study sought to identify the clinical factors that are most reliable in the diagnosis of acute appendicitis. Methods: This was a retrospective review of consecutive adult appendicectomies over a 6 months period. The frequency of different clinical parameters was assessed to determine the most reliable predictors of acute appendicitis. A simple triad of 3 of the most frequent clinical parameters was examined for diagnostic potential by calculating its sensitivity, specificity, positive predictive value and negative predictive value. Results: There were a total of 124 patients. The median age was 33 years while the gender distribution was 54 males to 70 females. The most common clinical parameters in the patients with appendicitis were right iliac fossa tenderness or peritonism (100.0%), anorexia (78.8%), nausea (75.9%), migratory abdominal pain i.e. pain migrating to right lower quadrant (55.7%), tachycardia (41.3%) and pyrexia i.e. body temperature of 37.8 degrees Celsius and above (22.1%). The simple triad of anorexia, right iliac fossa tenderness and migratory abdominal pain showed specificity for the diagnosis of acute appendicitis of 84.2% and sensitivity of 45.7%. The positive predictive value of this triad was 94.1% while the negative predictive value was 21.9%. Conclusion: Our study reveals that the positivity for this simple clinical triad strongly rules in the diagnosis of acute appendicitis. Its specificity and positive predictive value compares with the most reliable scoring systems for acute appendicitis in literature. Further approaches to diagnosis such as imaging and diagnostic laparoscopy should be considered when this triad is negative and appendicitis is suspected. This simple diagnostic approach allows for prompt diagnosis and treatment which expectedly would improve the morbidity associated with acute appendicitis.