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AIM: The aim of this study is to compare outcomes of laparoscopic and open hernias in the over and under 65s at a district general hospital. METHODS: Data were collected retrospectively on patients who underwent a unilateral inguinal hernia repair from 2012 to 2016. Only open mesh Lichtenstein repairs and laparoscopic transabdominal pre-peritoneal (TAPP) mesh inguinal hernia repairs were included. The dataset included patients' demographics and comorbidities, type of surgery (open vs. laparoscopic), presentation (elective vs. emergency), length of stay and postoperative complications. RESULTS: 255 patients comprised the study cohort. 126 (49%) patients were under 65 years and 129 (51%) were over 65. Laparoscopic surgery was performed in 149 patients (58%), while open technique was used in 106 (42%). A higher proportion of patients over 65 underwent open surgery compared to patients under 65 (55% vs. 28%, p ≥ 0.001). Patients over 65 had a higher ASA score (p = 0.0158) and more comorbidities (COPD, DM, Anticoagulation) when compared to younger patients. The number of postop complications were 13 (10%) in the over 65s compared to 14 (11%) in the under 65s (p = 0.94). There was no statistical difference in length of stay between the over and under 65 patients (p = 0.06). CONCLUSIONS: Despite more comorbidities in the over 65s, this study shows that there is no significant difference in complication rates between laparoscopic and open inguinal hernia repair irrespective of age category. Selection bias for the type of repair and the potential for an alpha error mean larger studies are required to show equivalence.

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One of the rare side effects of chronic usage of non-steroidal anti-inflammatory drugs is colopathy, which is characterised by colonic inflammation, ulceration and formation of diaphragms in late stages. We treated a case of colonic diaphragm disease with similar findings in our unit recently. We present the case herewith, followed by a discussion of the management of this interesting rare but benign condition.

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A previously fit man was investigated for right-sided abdominal pain and an appendicular foreign body (FB) caused by ingested lead shot was found. He had associated urinary tract infection causing his symptoms and hence was treated conservatively. We present this rare case, followed by discussion of the causes, investigations, clinical significance and management of appendicular FBs.

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AIM: Diaphragmatic disease is rare. This review aims to increase awareness of this condition and its management. METHOD: A literature search was conducted using the key terms 'colon' or 'colonic' in combination with 'diaphragm' or 'diaphragm disease' for publications until August 2012. All cases of colonic diaphragm syndrome were identified and the required data were collected. RESULTS: Forty-five cases of colon diaphragm disease were included. The highest incidence was in the seventh decade of life, with a female preponderance (40F:5M). Most patients presented with chronic (median 3 months) and multiple symptoms. The median use of nonsteroidal anti-inflammatory drugs (NSAIDs) was 5 years including diclofenac as the most commonly used NSAID. Colonoscopy was the most informative investigation and the ascending colon was the most common site of diaphragm disease. Nearly two-thirds of the patients were treated by discontinuing NSAID treatment combined with other forms of treatment, mostly surgery. CONCLUSION: Diaphragm disease of the colon is a rare condition associated with long-term use of NSAIDs with a range of presentations and symptoms. Based on this review, when colon diaphragm disease is diagnosed we would recommend a trial cessation of NSAIDs. Therapeutic endoscopic techniques should be considered but surgery may be required for definitive treatment.

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Lipomas of the alimentary tract are rare tumours that can mimic malignant lesions. They are often small and asymptomatic although larger tumours can present with intusussception or as abdominal masses. We present a case of a transverse colon submucosal lipoma masquerading as a colonic adenocarcinoma leading to resection. A 74 year-old-man was referred urgently for assessment with altered bowel habits, and lower abdominal discomfort along with a positive Faecal-Occult-Blood sample. Colonoscopy demonstrated a large polypoidal lesion at the hepatic flexure with ulceration. Biopsies were inconclusive. A staging CT scan confirmed a 3.3 x 4.3 x 3.4cm Polyp with colonic wall thickening suspicious of malignancy. An extended right hemi-colectomy was performed. Histology showed a large submucosal lipoma with 12 reactive lymph nodes. Colonic lipoma often present as incidental findings detected on either imaging or endoscopically whilst investigating other symptoms. Their appearances can mimic colonic malignancy and surgical resection may be required.