Introduction. Stump cholecystitis is a recognised condition in which a large gallbladder remnant becomes inflamed after subtotal cholecystectomy. When this occurs, a completion cholecystectomy is indicated. Traditionally, these patients were subjected to open surgery because the laparoscopic approach was anticipated to be technically difficult. We present a case of completion cholecystectomy using basic laparoscopic equipment in a resource poor setting to demonstrate that the laparoscopic approach is feasible. Case Description. A 57-year-old woman presented with right upper quadrant pain and vomiting. She had an elective open cholecystectomy seven years before but reported remarkably similar symptoms. Abdominal ultrasound suggested calculous acute cholecystitis. MRCP confirmed the presence of a large gallbladder remnant with stones. Gastroduodenoscopy excluded other differentials. She had an uneventful laparoscopic completion cholecystectomy performed. Discussion. Although traditional dogma suggested that a completion cholecystectomy should be performed through the open approach, several small studies have demonstrated that laparoscopic completion cholecystectomy is feasible and safe. This report adds to the existing data in support of the laparoscopic approach.

Emergent LC for acute cholecystitis is effective and safe in a low-volume setting in the Caribbean. However, the operations are technically demanding and should be performed by trained laparoscopic surgeons.

Surgical operations provide opportunities for the transmission of infection between patients and healthcare workers (HCWs) and between patients. This risk may increase in under-developed and developing countries by low compliance with infection control (IC) policies and precautions. This study investigated HCWs attitude and compliance with infection control practices in the operating department (OD) of a Jamaican teaching hospital, with the objective of obtaining data to design evidence-based interventions. A single-centre, cross-sectional, descriptive study, using a self-administered questionnaire, was conducted between March and May 2009. Ninety doctors and forty-two nurses, representing 73% and 75% respectively of their total OD population, participated in the study. Reported compliance was low: only 17% of all participants were compliant with all of the seven infection control policies inquired into. The results also showed that HCWs were selective in what practices they adhered to: reported rates of compliance were high for hand-washing (100%), use of gloves (98%), use of gowns (83%) and facemasks (87%); but low for use of eye protection mask (56%), not re-sheathing needles (46%) and changing clothes when exiting and re-entering the OD (55%). Discrepancies were observed between attitude and compliance rates in such cases as 'use of facemasks'-low favourableattitude (68%) but high compliance; 'use of eye protection masks'-high favourable-attitude (100%) but low Corresponding Author

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Background:There are no published data on the outcomes of inguinal hernia repair from the Anglophone Caribbean. To the best of our knowledge, this is the first report of a series of laparoscopic inguinal hernia repairs from the region.Materials and Methods:Data was extracted from a prospectively maintained database of consecutive trans abdominal pre-peritoneal (TAPP) repairs done between June 1, 2005 and May 30, 2012. Perioperative data collected included patient demographics, hernia type, operative technique, duration of surgery, intra-operative details, morbidity, analgesia requirements, and duration of hospitalization. A telephone survey was also performed to identify late recurrences and complications. Descriptive statistics were generated using Statistical Package for Social Sciences (SPSS) Ver 12.0.Results:There were 103 consecutive TAPP procedures in 88 patients at an average age of 35.4 years ± 12.9 (standard deviation; SD) and average body mass index (BMI) of 28.9 Kg/m2 ± 2.23 (SD). The indications were bilateral (30), recurrent unilateral (24), and primary unilateral (49) inguinal hernias. The mean duration of operation was 68.5 minutes (SD ± 10.4; Range: 55-95; Median 65; Mode 65) minutes for unilateral TAPP and 89 minutes (SD ± 7.61; Range: 80-105; Median 90; Mode 90) for bilateral repairs. Post-operatively, 65/70 patients required ≤1 dose of parenteral opioid analgesia and 74 (84.1%) patients discontinued oral analgesia within 48 hours of operation. Complications were recorded in six (5.8%) cases and a recurrence in one (0.97%) case after a mean follow-up period of 3.2 years (SD ± 1.8; Range: 0.5-7).Conclusion:Laparoscopic inguinal hernia repair is a safe and effective operation in this setting.