A case is presented of a totally extraperitoneal laparoscopic hernia repair complicated by internal herniation of small bowel through an inadvertent peritoneal defect.

In this review article the incidence is discussed of overwhelming post-splenectomy infection (OPSI), which is especially likely to occur in children and when splenectomy is carried out for haematological disorders. Long-term broad spectrum antibiotics or the use of polyvalent pneumococcal vaccine are often advocated as prophylactic measures under these circumstances. After mild splenic trauma, conservative surgery or partial splenectomy may be indicated in some cases. Where trauma is more severe and the spleen cannot safely be preserved there may be a place for autotransplantation of splenic slices, for example into a pocket of omentum, and there is some experimental support for this technique.

Operative time, number of complications, conversion to open and return to normal daily activities may not be affected by age or sex of patients. Hospital stay may be longer in older patients. Men appear to return to work sooner. Further analysis with validated questionnaires are required.