Abstract AimThe study aimed to evaluate the long‐term recurrence rates and survival following upfront laparoscopic total mesorectal excision (TME) for rectal adenocarcinoma.Patient and MethodsThis was a retrospective cohort of 94 patients with rectal adenocarcinoma undergoing upfront radical resection in New Territories West Cluster between 2010 and 2015. Tumours with safe circumferential resection margin (>1 mm) on magnetic resonance imaging (MRI) staging were selected for upfront surgery. Demographic data, tumour characteristics, operative details, and histopathological and postoperative outcomes were collected from patients' records. The primary outcome was local recurrence. Secondary outcomes were distant recurrence and overall (OS) and disease‐free survival (DFS).ResultsA total of 224 patients were diagnosed with rectal adenocarcinoma, of which 94 received upfront surgery after a multidisciplinary team discussion by surgeons and oncologists. The median follow‐up period after surgery was 60 months (range 4.7‐60.9 months), with four patients lost to follow‐up. Six patients (6.3%) developed local recurrence (two with isolated local recurrence and four with local and distant recurrence). Twelve patients (12.8%) experienced distant recurrence. The 5‐year OS and DFS rates were 84.3% and 76.2%, respectively. Possible prognostic factors for local recurrence (including distal tumour level ≤ 5 cm, clinical nodal stage, clinical threatened margin, pathological stage, harvested lymph nodes <12, distal margin <1 cm, positive extramural venous invasion, and circumferential resection margin) were evaluated by multivariable logistic regression, and were shown to be insignificant.ConclusionUpfront laparoscopic TME for MRI‐selected rectal cancer patients can achieve favourable oncological outcomes in our centre. Routine neoadjuvant treatment for all T3 or nodal positive disease is not necessary.

Aim. To identify a perspectives for using a single incision laparoscopic technologies in surgery.Materials and methods: Today we have a several questions relating to a single incision laparoscopic surgery such as the possible spectrum of their application, safety and economic efficiency. The main is: does this technologies have a perspectives in future.In paper was performed a retro and prospective analysis of the data of modern literature and authors own experience in surgical treatment using a single incision laparoscopic technologies.Results: The study included 74 patients who underwent: cholecystectomy – 64 (86,5%), nephrectomy – 4 (5,4%), ovarian cyst removal – 4 (5,4%), kidney resection – 2 (2,7 %), using various kind of ports: “X-Cone Karl Storz” (28), “Covidien” (18), “PPP” (7), and 21 cases of multi-trocar access.Conclusions: Our opinion that the perspectives for the development of single incision laparoscopy, is the further development of endoscopic devices, including robotic ones, and we believe that it will be a real future and endoscopic surgeons should be ready for this.

The work is based on the analysis of clinical cases of the incidence of intestinal coronavirus infection in the conditions of the clinic of the Bashkir State Medical University for the period from April to November 2020. The aim of the study is to elucidate the pathogenetic mechanisms of development, the peculiarities of the clinical course and effective methods of treating this disease. In these clinical cases, the positive effect of conservative therapy is noted, which confirms the absence of the need for aggressive surgical tactics.

There was rapid growth of telehealth practice during the COVID‐19 outbreak in 2020. In surgery, there were beneficial effects in terms of saving time and avoiding physical contact between healthcare professionals and patients when using telehealth in the delivery of perioperative care. As telehealth is gaining momentum, the evolving ethical and medico‐legal challenges arising from this alternative mode of doctor–patient interaction cannot be underestimated. With reference to the “Ethical Guidelines on Practice of Telemedicine” issued by the Medical Council of Hong Kong and some published court and disciplinary cases from other common law jurisdictions, this article discusses relevant ethical and medico‐legal issues in telehealth practice with emphasis on the following areas: duty of care; communication and contingency; patient‐centred care and informed consent; limitations and standard of care; keeping medical records, privacy, and confidentiality; and cross‐territory practice. Whilst existing ethical and legal obligations of practicing medicine are not changed when telehealth is used as opposed to in‐person care, telehealth practitioners are advised to familiarize themselves with the ethical guidelines, to keep abreast of the medico‐legal developments in this area, and to observe the licensure requirements and regulatory regimes of both the jurisdiction where they practice and where their patients are located.

Abstract BackgroundCoronavirus disease 2019 (COVID‐19) impacted Hong Kong in early January 2020. Quarantine and social distancing measures have been implemented to prevent disease spread.Material and MethodRetrospective cohort study was carried out in our cluster to compare the acute appendicitis cases during pandemic period, January 1, 2020 to June 30, 2020, with the same period 1 year before. Parameters including time of presentation, complicated appendicitis rate, operative time, post‐operative complication rate, and total length of stay were compared and analysed.ResultsA total number of 348 patients (160 in the pre‐COVID group versus 188 in the post‐COVID group) were included. There is no significant difference in basic demographics. The time of presentation was significantly longer in March (3.75 days vs 1.56 days, P = .031) and June 2020 (3.02 days vs 1.88 days, P = .026) compared with the pre‐COVID group, which correlate with the spike of local confirmed cases. There was a significantly higher incidence of complicated appendicitis (67% vs 52%, P = .028) and post‐operative complication rate (29% vs 7%, P = .042) in February post‐COVID group compare with the pre‐COVID group.ConclusionDuring the COVID‐19 pandemic period, more patients with acute appendicitis presented late to the hospital, with an increase in complicated appendicitis rate and post‐operative complication rate.

Abstract Triplication of small bowel is an extremely rare variant of enteric duplication with only one previously reported case in a neonate. Most enteric duplications are presented in neonates as intestinal obstruction. Herein we present a case of 3‐year‐old girl with acute abdomen due to perforation of triplicated ileum aiming to highlight the characteristic presenting features, the diagnostic difficulties and challenges of surgical intervention for this condition.

Abstract BackgroundWith school closures and social isolation imposed by the COVID‐19 pandemic, both children and parents in Hong Kong have been forced to stay at home for extended periods of time. Besides the disease itself growing globally, this pandemic has inflicted many other healthcare problems. This study aims to look at the impact of COVID‐19 pandemic on paediatric surgical accidents.MethodsA retrospective review of all patients under 18 years of age admitted to a tertiary paediatric surgical unit with accidents was done between January to May 2020 (COVID‐19 social isolation period). Comparison was made with cases between January to May 2018 and 2019. Inclusion diagnoses include foreign body ingestion (FBI), scald injury, animal bite, and fall. Demographic data including age and gender, details of injury and treatment, and length of hospitalization were recorded. Statistical analysis was performed by Fisher exact test and statistical significance was defined as P ≤ .05.ResultsA total of 35 patients were admitted during the period 1‐5/2020 compared to 28 patients in 1‐5/2019 and 16 patients in 1‐5/2018. Median age at presentation is 3 years. Diagnoses include FBI, animal bite, scald injury and fall. Thirteen required surgical intervention including oesophagogastroduodenoscopy (20%), wound debridement (13%), wound suturing (67%). Mean length of hospital stay was 2.89 days. The proportion of domestic accidents in 2020 increased compared with the same period in 2018 and 2019 (P‐values = .0001, .0259). Non‐food foreign body ingestions at home during COVID19 increased significantly (P‐values = .0018, .0223). Surgical intervention required for domestic accidents in 2020 also increased (P‐values = .1223, .107).ConclusionThe social isolation imposed by the COVID‐19 pandemic has caused an increase in paediatric domestic accidents requiring admission to our surgical ward. Governments and healthcare authorities should proactively implement appropriate intervention programs and better plan resources to prevent these domestic accidents during lockdown.

The work carried out by analyzes of the literature data on assessing the severity of acute pancreatitis and predicting its course and mortality. A comparison of traditional point scales for assessing the severity of AP was made.As a result of a comparative analysis, it was found that the most objective instrumental method for diagnosing acute pancreatitis and its complications was MSCT with the determination of the CT index of severity. Balthazar scale allows assessing the severity of the disease and forming a prognosis for the development of complications. However, computed or magnetic resonance imaging with intravenous contrast enhancement allows an accurate assessment of the severity of the disease not earlier than 72 hours and has some contraindications.Estimating and predictive systems Ranson, APACHE, Krasnorogov, Bozhenkov systems, Pugaeva and Achkasova, BISAP and HAPS allow identyfying the severity of the clinical course of acute pancreatitis, have a high sensitivity, but at the same time require significant time and resources for execution. Glasgow-Imrie, SAPS, MODS, and SOFA scales mainly calculate mortality and degree of multiple organ failure in critically ill patients; these severity assessment systems are not specific for patients with acute pancreatitis.The optimal scale for assessing the severity of AP should allow assessing the patient's condition and prognosis from the moment of admission to the outcome of the disease. The practicing surgeon will be interested in an affordable, inexpensive, easy-to-use system for determining the severity of acute pancreatitis. For surgeons, the time factor plays a key role in determining tactics, and, therefore, improves the prognosis of the disease.