Postoperative adhesions remain one of the more challenging issues in surgical practice. Although peritoneal adhesions occur after every abdominal operation, the density, time interval to develop symptoms, and clinical presentation are highly variable with no predictable patterns. Numerous studies have investigated the pathophysiology of postoperative adhesions both in vitro and in vivo. Factors such as type and location of adhesions, as well as timing and recurrence of adhesive obstruction remain unpredictable and poorly understood. Although the majority of postoperative adhesions are clinically silent, the consequences of adhesion formation can represent a lifelong problem including chronic abdominal pain, recurrent intestinal obstruction requiring multiple hospitalizations, and infertility. Moreover, adhesive disease can become a chronic medical condition with significant morbidity and no effective therapy. Despite recent advances in surgical techniques, there is no reliable strategy to manage postoperative adhesions. We herein review the pathophysiology and clinical significance of postoperative adhesions while highlighting current techniques of prevention and treatment.

Esophageal conduit ischaemia and necrosis is an uncommon but devastating complication of esophagectomy and remains one of the most challenging issues in surgical practice. The incidence, time interval to develop symptoms, and clinical presentation are highly variable with no predictable pattern. Evidence comes from case reports and case series rather than randomized controlled trials. We describe the issues surrounding conduit necrosis affecting the stomach, jejunum and colon as an esophageal replacement and the advantages, disadvantages and challenges of each type of reconstruction. Diagnosis is challenging for the most experienced surgeon. Upper gastrointestinal endoscopy and computed tomography thorax with both oral and intravenous contrast is the gold standard. Management, either conservative or interventional is also a difficult decision. Management options include conservative treatment and more aggressive treatments such as stent insertion, surgical debridement and repair of the esophagus using jejunum, colon or a musculocutaneous flap. In spite of recent advances in surgical techniques, there is no reliable strategy to manage esophageal conduit necrosis. Our review covers the pathophysiology and clinical significance of esophageal necrosis while highlighting current techniques of prevention, diagnosis and treatment of this life-threatening condition.

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HighlightsTrichobezoar is frequently dismissed in the differential diagnosis of young female patients with a history of trichophagia and trichotillomania, chronic abdominal pain, nausea, and vomiting.MRE is useful, particularly in young people who must not be exposed to unnecessary CT radiation.Esophagoduodenogastroscopy is also helpful.Management options for the treatment of the trichobezoar include surgical removal by laparotomy or laparoscopically, while laparotomy is widely considered as the treatment of choice for complicated trichobezoars.Psychiatric review post operatively must be completed to reduce recurrence.

Key Clinical MessageGross‐dependent lower limb lymphoedema is an unusual condition which can be painful particularly if ulceration occurs. Focused history and clinical examination in addition to appropriate radiological investigation aid in the diagnosis. It is difficult to treat and requires a multidisciplinary team including vascular surgeons, dermatologists and clinical nurse specialists. The primary treatment option is compression bandaging.