Background Being an integral part of the Enhanced Recovery After Surgery methodology, the mini-invasive surgical technique is an important factor in attenuating surgical stress and minimising the risk of postoperative complications. Here we present our experience of utilising the mini-laparotomy (ML) approach in emergency surgery.Methods This prospective clinical study included adult patients operated on for acute abdominal conditions at a second-level hospital in Zambia. Thirty-four patients were explored through ML, and another 34 participants had a standard laparotomy (SL) incision. The size of ML ranged from 6 to 12 cm, with the median being 10.5 cm. ML was not attempted in abdominal malignancy, generalised peritonitis, and as an approach for the relaparotomy procedures. Length of hospital of stay (LOS) and morbidity/mortality were primary endpoints. Secondary outcomes of interest included operating time (OT) and post-operative pain control. Continuous variables were presented as mean with standard deviation or median with ranges; categorical data were given as proportions and percentages. Associations between data were estimated using the t-test and chi-square analysis, as appropriate. LOS was compared by log-rank test and presented graphically by Kaplan-Meier survival curves. A p-value < 0.05 was considered statistically significant.Results The most common procedures performed through ML were resection of the small bowel or colon, closure of hollow viscus perforation or rupture, and adhesiolysis. Employment of ML was associated with reduced LOS (p = 0.0002), shorter OT (p = 0.0003), and minimised need for opioid analgesia (p = 0.01); however, the difference in postoperative complications was not statistically significant (ML: 21% versus SL: 27%, p = 0.57), and mortality was similar (6% in each group).Conclusions As our data showed, ML is a feasible and safe technique that could be used in emergency visceral surgery and abdominal trauma in well-selected patients. Having comparable postoperative morbidity with the SL approach, it might lead to reduced pain and enhanced recovery after the procedure. We proposed an algorithm for the selection of exploration method in patients presented with acute abdominal conditions that could be of help to acute care surgeon operating in a resource-limited setting.

Hiatal hernias are more common in Western countries compared to the African countries. In the Western states the frequency of hiatus hernia increases with age, from patients younger than 40 years to patients older than 70 years. This is because of muscle weakening and loss of elasticity as people age goes towards the 70s, thus this age tends to predispose to hiatus hernia. The thinking is that with decreasing tissue elasticity, the gastric cardia may not return to its normal position below the diaphragmatic hiatus following a normal swallow. Loss of muscle tone around the diaphragmatic opening also may make it more patulous. Burrkitt et al also suggest that in the Western world, fiber-depleted diet leads to a state of chronic constipation and straining during bowel movement, which could explain the higher incidence of this condition in Western countries. It is also believed that Hiatal hernias are more common in women than in men. This might relate to the intra-abdominal forces exerted in pregnancy. Para esophageal hernias generally tend to enlarge with time, and sometimes the entire stomach is found within the chest. The risk of these hernias in the West, becoming incarcerated, leading to strangulation or perforation, is approximately 5%. These tendencies are not entirely the same in Zambia . We present our findings.