Laparoscopic adrenalectomy has been shown to be as safe and effective as conventional open surgery for small and benign adrenal lesions. With increasing experience with laparoscopic adrenalectomy, this approach has become the procedure of choice for the majority of patients requiring adrenalectomy. In our department, from 2011 to 2016, a total of 28 patients with 31 adrenal tumours underwent laparoscopic adrenalectomy regardless of tumour size. Our policy in the department is to exclude adrenal tumours that are potentially malignant or metastatic adrenal tumours for laparoscopic resection. In this a retrospective study, we divided patients into two groups according to tumour size: < 5 or ≥ 5 cm, which was considered as the definition of large adrenal tumours. We compared demographic data and per- and postoperative outcomes. There was no statistical difference between the two groups for per-operative complications (16,6% vs 18,75% , P = 0.71), postoperative complications (16,6% vs 18,75% , P = 0.71), postoperative length of hospital stay (5 vs 8 days P = 0.40), mortality (0% vs 0%) or oncologic outcomes: recurrence and metastasis (8.3% vs 6.25% P = 0.70). The only statistical difference was the operating time, at a mean (SD) 194 (60) vs 237 (71) min (P = 0.039) and the conversion rate (0% vs 12.5% P < 0.01). Laparoscopic adrenalectomy can be done for all patients with adrenal tumours regardless of tumour size, even it needs more time for large tumour but appears to be safe and feasible when performed by experienced surgeons.

Access to heart surgery for smokers Denying treatment is indefensible EDrrOR,-M J Underwood and J S Bailey believe that coronary bypass surgery should not be offered to smokers.' Medical professionals tend to ignore the fact that they are appointed in the NHS to provide service to patients on the basis of their clinical needs irrespective of their shortcomings and degree of culpability. After all, it is the money of taxpayers (smokers and non-smokers) that is used to train cardiac surgeons and to pay their wages. The taxpayers, in return, expect them to provide prompt and efficient service when required. I am sure that no cardiac surgeon would refuse to operate on a smoker if he or she was paying a handsome fee as a private patient. We should all feel privileged to be in a position to make decisions affecting the lives and livelihoods of our fellow beings and resist the temptation to abuse our authority. Those who believe that smokers should not be offered necessary investigations and treatment solely on the basis of their habit, in my opinion, have an indefensible case. Gentle persuasion and counselling are the only decent ways of changing a patient's lifelong habit.

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The median hospital stay was 5 (range 3-99) days. Neither the hospital stay (children, p=063; adults, p=0-08 (Kruskal-Wallis test)) nor the frequency of postoperative complications (children, p=0-82; adults, p=0 5) increased significantly with the interval between admission and surgery. Though the conclusions of both of these studies are clinically important, the danger is that they may be used by surgeons, anaesthetists, or hospital managers as an excuse to delay surgery when the condition of a patient clearly indicates otherwise. With regard to complications, careful follow up (to 18 months 95%; to eight years 63%) showed that nearly half (49-6%) of our patients claimed to have suffered one or more postoperative problems. Despite all patients receiving a metronidazole suppository preoperatively the rate of wound infection diagnosed in hospital was 1 1-7% (29/248 cases) and the rate of wound infection first occurring after discharge was 10-9% (26/239). Although our results are possibly higher because of the inclusion of factors such as wound pain and changes in gastrointestinal, urological, or gynaecological function and the fact that most of the operations were performed by junior surgeons, we believe that the true morbidity of appendicectomy is greater than the < 5% quoted by the authors.

This is an open access article distributed under the terms of the CreativeCommons Attribution-Non Commercial-NoDerivatives License 4.0 (CC BY-NC-ND 4.0) where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. AbstractHernia surgery is the most frequent in visceral surgery. The bladder is rarely involved in groin hernia. This is when a diverticulum or a part of the bladder wall is incarcerated within the hernia. This affection is often asymptomatic. The diagnosis is made per-or post-operatively following complications. We report 2 cases of inguinal hernia involving the bladder in which the first case was diagnosed preoperatively whereas the second was diagnosed intraoperatively. ÖzFıtık cerrahisi viseral cerrahide en sık görülenidir. Mesane nadiren kasık fıtığı ile ilişkilidir. Bu, divertikülün veya mesane duvarının bir bölümünün fıtık içinde hapsedilmesidir. Bu durum genellikle asemptomatiktir. Tanı komplikasyonları takiben ameliyat sonrası veya sonrasında yapılır. Bu çalışmada iki kasık mesane fıtığı olgusunu sunuyoruz, mesane ilişkisi birinci vakada preoperatif tanı ile, ikinci vakada intraoperatif olarak teşhis edildi.