Multimodal rehabilitation can improve further on the excellent results of laparoscopic sigmoidectomy and decrease the postoperative hospital stay.

To determine the specific effects of working long hours in surgery and potential cardiac stress in the individual surgeon by measuring heart rate variability (HRV). Design, Setting, and Participants: This prospective study measured HRV before, during, and after a 24hour shift in a standardized resting period of 10 minutes. Measurements were repeated over 10 shifts for each participant. Eight surgeons from a high-volume innercity surgery department took part in the study. Main Outcome Measures: Time and frequency domain parameters of HRV as parameters of cardiac stress and correlations with perceived stress and fatigue on a visual analog scale. Results: Perceived fatigue increased over 24 hours (P Ͻ .001), whereas stress levels decreased slightly (P=.06). Time domain parameters of HRV increased from before the shift to after the shift (standard deviation of normal to normal intervals, square root of the mean normal to normal interval, and percentage of adjacent pairs of normal to normal intervals differing by more than 50 milliseconds: all PϽ .01), denoting more cardiac relaxation. Both the low-and high-frequency components increased (P = .04 and P Ͻ .001, respectively), showing a heightened activity of the autonomic nervous system. Conclusions: Measurements of HRV during a 24-hour surgical shift did not show an increase in cardiac stress concerning time domain parameters despite intense workloads for a median of 20 hours. Frequency components increased in parallel, though, suggesting alterations in sympathovagal balance. Perceived stress levels correlated with HRV, whereas fatigue did not. Further studies on occupational stress and its cardiac effects in surgeons are needed.

Using the "fast-track" rehabilitation programme on elderly patient is not only feasible but may also lower the number of general complications and the duration of the hospital stay.

The laparoscopic adjustable gastric band (LAGB) has become a common, usually successful treatment for morbid obesity. Complications occur in 10-20%, most commonly band slippage and port system problems, especially infection of the port area. A rare complication is penetration of the band into the stomach. We report the penetration of the tube connecting the port system with the gastric band, into the colon 1 year after treatment of a port infection.