An open mesh repair using general anaesthesia has become the repair of choice for a groin hernia in Scotland. Despite a high incidence of wound complications, patients are satisfied with this operation.

Implantation of exfoliated tumour cells can give rise to local recurrence of colorectal cancer and it has been recommended that the bowel lumen be lavaged with a tumoricidal agent. This study identified which tumoricidal agents are currently used in Scotland and investigated their efficacy in vitro and in vivo. Cytotoxic efficacy was tested in vitro by a clonogenic assay and in vivo by a rat model with viable intraluminal tumour cells. Overall 70 per cent of surgeons used a tumoricidal agent during colorectal cancer surgery. Povidone-iodine, sodium hypochlorite and chlorhexidine-cetrimide were all effective at killing tumour cells in vitro but were all inactivated by the presence of 25 per cent whole blood in vitro. With 10(5) cells in vivo povidone-iodine and sodium hypochlorite significantly (P < 0.02) reduced the incidence of tumour growth while chlorhexidine-cetrimide had no significant effect. With 10(6) cells povidone-iodine had no effect on the incidence of tumour growth. Tumoricidal agents have effective cytotoxicity in vitro but are only weakly cytotoxic in vivo.

In a randomized controlled trial, 299 patients were sent a symptoms questionnaire 1 year after laparoscopic (n = 151) or minilaparotomy (n = 148) cholecystectomy for symptomatic cholelithiasis. The response rate to the questionnaire from contactable patients was 86 per cent. In both groups, at least 90 per cent of patients reported that their symptoms were improved, and at least 93 per cent rated the success of their operation as 'excellent', 'good', or 'fair'. However, over half the patients reported abdominal pain, a quarter reported flatulence, and a quarter dyspepsia. The only difference between treatment groups was that a higher proportion of patients who underwent minilaparotomy reported heartburn (35 per cent versus 19 per cent, P = 0.005). Patients who reported a 'poor' outcome were more likely to have suffered a postoperative complication, had lower quality of life scores, and higher anxiety and depression scores. Both laparoscopic and minilaparotomy cholecystectomy result in symptomatic benefit in at least 90 per cent of patients with symptomatic cholelithiasis.

SSI after hernia repair is common and large clinical trials are required to determine whether the use of prophylactic antibiotics reduces the incidence of infection.

Early discharge following major liver resection using a 'fast-track' recovery protocol is both safe and achievable.