Search

Background A Health Technology Assessment was conducted to evaluate the relative clinical effectiveness and cost-effectiveness of minimally invasive techniques (foam sclerotherapy ( FS), endovenous laser ablation ( EVLA) and radiofrequency ablation ( RFA)) for managing varicose veins, in comparison with traditional surgery. Methods A systematic review of randomized clinical trials ( RCTs) was undertaken to assess the effectiveness of minimally invasive techniques compared with other treatments, principally surgical stripping, in terms of recurrence of varicose veins, Venous Clinical Severity Score ( VCSS), pain and quality of life. Network meta-analysis and exploratory cost-effectiveness modelling were performed. Results The literature search conducted in July 2011 identified 1453 unique citations: 31 RCTs (51 papers) satisfied the criteria for effectiveness review. Differences between treatments were negligible in terms of clinical outcomes, so the treatment with the lowest cost appears to be most cost-effective. Total FS costs were estimated to be lowest, and FS was marginally more effective than surgery. However, relative effectiveness was sensitive to the model time horizon. Threshold analysis indicated that EVLA and RFA might be considered cost-effective if their costs were similar to those for surgery. These findings are subject to various uncertainties, including the risk of bias present in the evidence base and variation in reported costs. Conclusion This assessment of currently available evidence suggests there is little to choose between surgery and the minimally invasive techniques in terms of efficacy or safety, so the relative cost of the treatments becomes one of the deciding factors. High-quality RCT evidence is needed to verify and further inform these findings. [ABSTRACT FROM AUTHOR]

Background The optimal management of colorectal cancer with synchronous liver metastases has not yet been elucidated. The aim of the present study was systematically to review current evidence concerning the timing and sequence of surgical interventions: colon first, liver first or simultaneous. Methods A systematic literature review was performed of clinical studies comparing the timing and sequence of surgical interventions in patients with synchronous liver metastases. Retrospective studies were included but case reports and small case series were excluded. Preoperative and intraoperative data, length of hospital stay, perioperative mortality and morbidity, and 1-, 3- and 5-year survival rates were compared. The studies were evaluated according to a modification of the methodological index for non-randomized studies ( MINORS) criteria. Results Eighteen papers were included and 21 entries analysed. Five entries favoured the simultaneous approach regarding duration of procedure, whereas three showed no difference; five entries favoured simultaneous treatment in terms of blood loss, whereas in four there was no difference; and all studies comparing length of hospital stay favoured the simultaneous approach. Five studies favoured the simultaneous approach in terms of morbidity and eight found no difference, and no study demonstrated a difference in perioperative mortality. One study suggested a better 5-year survival rate after staged procedures, and another suggested worse 1-year but better 3- and 5-year survival rates following the simultaneous approach. The median MINORS score was 10, with incomplete follow-up and outcome reporting accounting primarily for low scores. Conclusion None of the three surgical strategies for synchronous colorectal liver metastases appeared inferior to the others. [ABSTRACT FROM AUTHOR]

Background A number of published economic evaluations of elective endovascular aneurysm repair ( EVAR) versus open repair for abdominal aortic aneurysm ( AAA) have come to differing conclusions about whether EVAR is cost-effective. This paper reviews the current evidence base and presents up-to-date cost-effectiveness analyses in the light of results of four randomized clinical trials: EVAR-1, DREAM, OVER and ACE. Methods Markov models were used to estimate lifetime costs from a UK perspective and quality-adjusted life-years ( QALYs) based on the results of each of the four trials. The outcomes included in the model were: procedure costs, surveillance costs, reintervention costs, health-related quality of life, aneurysm-related mortality and other-cause mortality. Alternative scenarios about complications, reinterventions and deaths beyond the trial were explored. Results Models based on the results of the EVAR-1, DREAM or ACE trials did not find EVAR to be cost-effective at thresholds used in the UK (up to £30 000 per QALY). EVAR seemed cost-effective according to models based on the OVER trial. These results seemed robust to alternative model scenarios about events beyond the trial intervals. Conclusion These analyses did not find that EVAR is cost-effective compared with open repair in the long term in trials conducted in European centres. EVAR did appear to be cost-effective based on the OVER trial, conducted in the USA. Caution must be exercised when transferring the results of economic evaluations from one country to another. [ABSTRACT FROM AUTHOR]

Background The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity ( POSSUM) is a well validated model for the prediction of perioperative mortality and morbidity with application to surgery and intensive care medicine. The outcome measure calculations are time-consuming, complex and potentially error-prone. Nomograms are low-cost easy-to-use graphic devices that can be used to make repeated calculations to an acceptable level of accuracy for most clinical purposes. This paper describes a nomogram to aid calculation of POSSUM scores. Methods This graphic solution consists of two sections: a tally sheet to calculate physiological and operative severity scores ( PS and OS), and a nomogram to calculate mortality and morbidity. The latter was designed using standard mathematical methods, and drafted with the aid of commercially available software. Accuracy was confirmed by using a spreadsheet to generate 120 random sets of simulated values for PS and OS, and corresponding calculated values for predicted mortality and morbidity. The outcome values in each case were derived using the nomogram and compared with the spreadsheet values using Bland-Altman analysis. Results Bland-Altman analysis showed close agreement between nomogram and spreadsheet. Bias of the nomogram was −0·1 percentage points for mortality and 0·1 percentage points for morbidity, with limits of agreement of −2·1 to +1·9 and −1·4 to +1·6 percentage points for mortality and morbidity respectively. Correlation coefficients were r > 0·999 and P < 0·001 for both mortality and morbidity. Conclusion The nomogram provides a rapid, accurate, low-cost means of performing, visualizing and cross-checking POSSUM calculations. [ABSTRACT FROM AUTHOR]

Background Oesophageal perforations are associated with high mortality and morbidity rates. A spectrum of aetiologies and clinical presentations has resulted in a variety of operative and non-operative management strategies. This analysis focused on the impact of these strategies in a single specialist centre. Methods All patients with oesophageal perforation managed in a single oesophagogastric unit in the UK between January 2002 and December 2012 were identified. Gastric perforations and anastomotic leaks were excluded. Data were verified using an endoscopy database, electronic and paper records. Aetiology of perforation, management and outcomes were analysed. Results There were 101 adult patients with oesophageal perforation. Complete records were not available for five patients and they were excluded from the analysis. The median age was 69·5 years. Thoracic perforations were present in 84 per cent of patients. There were 51 spontaneous perforations, 41 iatrogenic and four related to foreign bodies. Oesophageal malignancy was present in 11 patients. Forty-four patients were managed surgically, 47 without operation and five patients were considered unfit for active treatment. The in-hospital mortality rate for treated patients was 24 per cent and median length of hospital stay was 31·5 days. Conclusion The management of oesophageal perforation requires specialist multidisciplinary input. It is best provided in an environment familiar with the range of treatment modalities. Management decisions should be guided primarily by the degree of contamination rather than the aetiology of the defect. The routine use of stents is unproven and controversial. [ABSTRACT FROM AUTHOR]

Background Pancreatic fistula ( PF) remains the most serious complication after digestive surgery. It is difficult to prevent because of the inability to visualize the leakage of pancreatic juice during surgery or to evaluate the protease activity of leaked fluid, which is responsible for PF formation. Methods The fluorescence intensities of a chymotrypsin probe (glutamyl-phenylalanine hydroxymethyl rhodamine green with added trypsin) in pancreatic juice and in intestinal or abdominal fluids drained after pancreatic resection were evaluated. The chymotrypsin probe was sprayed on to filter papers that had been placed on the resected pancreatic stump in patients undergoing pancreaticoduodenectomy or central pancreatectomy. The ability of this technique to visualize the leakage of pancreatic juice and predict postoperative PF formation was assessed. Results The fluorescence intensity of the chymotrypsin probe in 76 fluid samples correlated positively with amylase levels ( r s = 0·678, P < 0·001). The fluorescence patterns of the pancreatic stump were classified grossly into the three types: duct (fluorescence signal visualized only on the stump of the main pancreatic duct, 16 patients), diffuse (ductal stump and surrounding pancreatic parenchyma, 7) and negative (no fluorescence signal, 7). Symptomatic PFs developed in 13 of 23 patients with duct- or diffuse-type fluorescence, but in none of the seven patients with negative-type fluorescence ( P = 0·008). Conclusion The chymotrypsin probe enabled determination of the protease activity in drained pancreatic fluid samples and allowed real-time visualization of pancreatic juice leakage during surgery. [ABSTRACT FROM AUTHOR]

Background Experimental studies and small anecdotal reports have documented the potential and feasibility of transgastric appendicectomy. This paper reports the results of the new technique in a selected group of patients. Methods From April 2010 transgastric appendicectomy was offered to all patients with acute appendicitis, but without generalized peritonitis or local contraindications. Results Of 111 eligible patients 15 agreed to undergo the transgastric operation. After conversion of the first case to laparoscopy because of severe inflammation and adhesions, the following 14 consecutive transgastric procedures were completed. Two patients with initial peritonitis required laparoscopic lavage 4 days after transgastric appendicectomy, but no leaks were detected at the appendiceal stump or stomach. Conclusion These preliminary results have shown the feasibility of this innovative procedure. Additional studies, however, are required to demonstrate the specific advantages and disadvantages of this approach, and define its role in clinical surgery. [ABSTRACT FROM AUTHOR]

The following abstracts are from papers presented at the prize sessions to the 41st Annual Scientific Meeting of the Vascular Society of Great Britain and Ireland, held in Edinburgh, UK on 22-24th November 2006. The President of the Society, Mr John Wolfe was in the Chair. The BJS Prize was won by Mr MJ Bown, and the Founder's Prize was won by Mr GS McMahon. Both winners were from the University of Leicester, Leicester, UK. A complete list of the abstracts of papers presented at the meeting can be found on the BJS website ()Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This month saw the release of both the January issue of I BJS i and the entirely free to access joint special issue on perioperative care with I Anaesthesia i journal. @NIHR GSU posted two interesting threads on global surgery, one sharing their favourite papers from the 2019 I BJS i special issue on the topic, including the GlobalSurg Collaborative paper on WHO Surgical Safety Checklist use and mortality after emergency laparotomy[7]. Guidelines for treatment of umbilical and epigastric hernias from the European Hernia Society and Americas Hernia Society. [Extracted from the article]

Comments on the publication of the academic surgery paper. Effect of politics on academic publishing; Details on the authorship of the paper; Discussion on the practice of salami-slicing and duplicate publication.

The article presents abstracts on papers presented at the 100th Annual Congress of the Swiss Society of Surgery held in Berne, Switzerland from June 12-14, 2013 on topics including laparoscopic sleeve gastrectomy, complications linked with Roux-en-Y gastric bypass, and intra-operative infiltration.

Background Chronic pain remains a frequent complication after Lichtenstein inguinal hernia repair. As a consequence, mesh fixation using glue instead of sutures has become popular. This meta-analysis aimed to clarify which fixation technique is to be preferred for elective Lichtenstein inguinal hernia repair. Methods A meta-analysis was conducted according to the PRISMA guidelines. Articles published between January 1990 and April 2012 were searched for in MEDLINE, Embase and the Cochrane Library. Randomized controlled trials ( RCTs) comparing glue and sutured mesh fixation in elective Lichtenstein repair for unilateral inguinal hernia were included. The quality of the RCTs and the potential risk of bias were assessed using the Cochrane risk of bias tool. Results Of 254 papers found in the initial search, a meta-analysis was conducted of seven RCTs comprising 1185 patients. With the use of glue mesh fixation, the duration of operation was shorter (mean difference −2·57 (95 per cent confidence interval (c.i.) -4·88 to −0·26) min; P = 0·03), patients had lower visual analogue scores for postoperative pain (mean difference −0·75 (−1·18 to −0·33); P = 0·001), early chronic pain occurred less often (risk ratio 0·52, 95 per cent c.i. 0·31 to 0·87; P = 0·01), and time to return to daily activities was shorter (mean difference −1·17 (−2·30 to −0·03) days; P = 0·04). The hernia recurrence rate did not differ significantly. Conclusion Elective Lichtenstein repair for inguinal hernia using glue mesh fixation compared with sutures is faster and less painful, with comparable hernia recurrence rates. [ABSTRACT FROM AUTHOR]

Background: Thoracic epidural anaesthesia (TEA) is used widely in colorectal surgery. However, there is increasing concern that epidurals are associated with postoperative hypotension, mediating a potential reduction in splanchnic flow. The aim was to review the literature on the effects of TEA on splanchnic blood flow. Methods: PubMed and Cochrane databases were searched. Search terms used were: English language, 'thoracic epidural splanchnic flow', 'thoracic epidural gut blood flow', 'thoracic epidural intestinal blood flow' and 'thoracic epidural colonic blood flow'. Abstracts were reviewed by two independent researchers and irrelevant studies excluded. The full text of the remaining articles was then retrieved. Results: Twenty-two abstracts were reviewed and three excluded. Nineteen papers were reviewed in full and seven irrelevant articles excluded. Five human studies investigated the effects of TEA on splanchnic flow. Two studies measured splanchnic flow directly and found an epidural-mediated fall in flow, unresponsive to intravenous fluids and requiring vasopressors or inotropes to restore baseline flow. The remaining three studies had inconsistent findings and haemodynamic stability was maintained. The seven animal studies identified were heterogeneous in both methodology and findings. Three suggested a protective role for thoracic epidurals in septic shock and pancreatitis. Conclusion: These findings are inconsistent; however, the two studies that investigated the effects of vasoconstrictors on splanchnic blood flow directly both found a significant epidural-mediated reduction in splanchnic blood flow that was unresponsive to fluid therapy. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Open cholecystectomy (OC) is often preferred over laparoscopic cholecystectomy (LC) in patients with liver cirrhosis and portal hypertension, but evidence is lacking to support this practice. This meta-analysis aimed to clarify which surgical technique is preferable for symptomatic cholecystolithiasis in patients with liver cirrhosis. Methods: A meta-analysis was conducted according to the PRISMA guidelines. Articles published between January 1990 and October 2011 were identified from MEDLINE, Embase and the Cochrane Library. Randomized clinical trials (RCTs) comparing outcomes of OC versus LC for cholecystolithiasis in patients with liver cirrhosis were included. The quality of the RCTs was assessed using the Jadad criteria. Results: Following review of 1422 papers by title and abstract, a meta-analysis was conducted of four RCTs comprising 234 surgical patients. They provided evidence of at least level 2b on the Oxford Level of Evidence Scale, but scored poorly according to the Jadad criteria. Some 97·0 per cent of the patients had Child-Turcotte-Pugh (CTP) grade A or B liver cirrhosis. In all, 96·6 per cent underwent elective surgery. No postoperative deaths were reported. LC was associated with fewer postoperative complications (risk ratio 0·52, 95 per cent confidence interval (c.i.) 0·29 to 0·92; P = 0·03), a shorter hospital stay (mean difference − 3·05 (95 per cent c.i. − 4·09 to − 2·01) days; P < 0·001) and quicker resumption of a normal diet (mean difference − 27·48 (−30·96 to − 23·99) h; P < 0·001). Conclusion: Patients with CTP grade A or B liver cirrhosis who undergo LC for symptomatic cholecystolithiasis have fewer overall postoperative complications, a shorter hospital stay and resume a normal diet more quickly than those who undergo OC. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Long-term overall survival after liver resection in patients with hepatocellular carcinoma (HCC) within the Milan criteria has been reported to improve in recent years. This study systematically reviewed the outcomes of surgical resection for HCC in patients with good liver function and meeting the Milan criteria for early HCC, published in the past 10 years. Methods: A literature search was conducted in PubMed for papers on outcomes of surgical resection for HCC published between January 2000 and December 2010. Cochrane systematic review methodology was used for this review. The primary outcome was overall survival. Secondary outcomes included operative mortality and disease-free survival. Studies that focused on geriatric populations, paediatric populations, a subset of the Milan criteria (such solitary tumours) or included patients with incidental tumours were excluded, as were case reports, conference abstracts, and studies with a large proportion of Child-Pugh grade C liver cirrhosis or unknown Child-Pugh status. Results: Of 152 studies reviewed, two randomized clinical trials and 27 retrospective case series were eligible for inclusion. The 5-year overall survival rate after resection of HCC ranged from 27 to 81 (median 67) per cent, and the median disease-free survival rate from 21 to 57 (median 37) per cent. There was a trend towards improved overall survival in recent years. The operative mortality rate ranged from 0 to 5 (median 0·7) per cent. Conclusion: Surgical resection offers good overall survival for patients with HCC within the Milan criteria and with good liver function, although recurrence rates remain high. Outcomes have tended to improve in more recent years. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer is a significant cause of death. Removal of precancerous adenomas, and early detection and treatment of cancer, has been shown to reduce the risk of death. The aim of this review and meta-analysis was to determine whether flexible sigmoidoscopy (FS) is an effective population screening method for reducing mortality from colorectal cancer. Methods: MEDLINE (1946 to December 2012) and Embase (1980-2012, week 15) were searched for randomized clinical trials in which FS was used to screen non-symptomatic adults from a general population, and FS was compared with either no screening or any other alternative screening methods. Meta-analysis was carried out using a random-effects Mantel-Haenzsel model. Results: Twenty-four papers met the inclusion criteria, reporting results from 14 trials. Uptake of FS was usually lower than that for stool-based tests, although FS was more effective at detecting advanced adenoma and carcinoma. FS reduced the incidence of colorectal cancer after screening, and long-term mortality from colorectal cancer, compared with no screening in a selected population. Compared with stool-based tests in a general population, FS was associated with fewer interval cancers. Conclusion: FS is efficacious at reducing colorectal cancer mortality compared with no screening. It is more effective at detecting advanced adenoma and carcinoma than stool-based tests. FS may be compromised by poorer uptake. Introduction of FS as a screening method should be done on a pilot basis in populations in which it is not currently used, and close attention should be paid to maximizing uptake. The relative risk of adverse events with FS compared with stool-based tests should be quantified, and its real-world effectiveness evaluated against the most effective stool-based tests. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Ex vivo simulation-based technical skills training has been shown to improve operating room performance and shorten learning curves for basic laparoscopic procedures. The application of such training for laparoscopic Roux-en- $\font\ss=cmss10 scaled 1000 \hbox{Y}$ gastric bypass (LRYGBP) has not been reviewed. Methods: Relevant studies were identified by one author from a search of MEDLINE and Embase databases from 1 January 1994 to 30 November 2010. Studies examining the learning curves and ex vivo training methods for LRYGBP were included; all other types of bariatric operations were excluded. A manual search of the references was also performed to identify additional potentially relevant papers. Results: Twelve studies (5 prospective and 7 retrospective case series) were selected for review. The learning curve for LRYGBP was reported to be 50-100 procedures. Bench-top laparoscopic jejunojejunostomy, anaesthetized animals and Thiel human cadavers made up the bulk of the reported models for ex vivo training. Most studies were of relatively poor quality. An evidence-based ex vivo training curriculum for LRYGBP is currently lacking. Conclusion: Better quality studies are needed to define the learning curve for LRYGBP. Future studies should focus on the design and validation of training models, and a comprehensive curriculum for training and assessment of cognitive, technical and non-technical components of competency for laparoscopic bariatric surgery. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Stapled haemorrhoidopexy is a well recognized alternative to haemorrhoidectomy, and is associated with reduced pain and earlier return to normal activity. This paper reports all published cases of life-threatening sepsis following stapled haemorrhoidopexy, identifies causative factors and makes recommendations. Methods: A systematic review of the literature was performed by searching the major electronic databases. All relevant references were reviewed for possible inclusion. All references of the relevant articles were screened for any further articles that were not identified in the initial search. Results: From 2000 to the present, 29 articles reporting complications in 40 patients were identified. Thirty-five patients underwent laparotomy with faecal diversion and a further patient was treated by low anterior resection. A specific complication was rectal perforation with peritonitis. Factors that led to life-threatening sepsis were identified in 30 patients. Despite surgical treatment and resuscitation, there were four deaths. Conclusion: Severe sepsis can complicate stapled haemorrhoidopexy. Rectal perforation and peritonitis are a particular risk of this technique and the associated mortality rate is high. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The following abstracts are from papers presented at the 46th annual scientific meeting of the Vascular Society of Great Britain and Ireland, held in Edinburgh on 24-26 November 2011. The President of the Society, Mr Peter Lamont, was in the Chair. The BJS Prize was won by S Harrison of Centre for Cardiovascular Genetics, University College, London, and the Sol Cohen (Founder's) Prize was won by RE Clough of NIHR Comprehensive Biomedical Research Centre of Guy's and St Thomas' NHS Foundation Trust and King's College London, London. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Hypothermia is commonly used for organ and tissue preservation in multiple clinical settings, but its role in the management of injured patients remains controversial. There is no doubt that temperature modulation is a powerful tool, and hypothermia has been shown to protect cells during ischaemia and reperfusion, decrease organ damage and improve survival. Yet hypothermia is a double-edged sword: unless carefully managed, its induction can be associated with a number of complications. Methods: A literature review was performed to include important papers that address the impact of hypothermia on key biological processes, and explore the potential therapeutic role of hypothermia in trauma/haemorrhage models. Results: No clinical studies have been conducted to test the therapeutic benefits of hypothermia in injured patients. However, numerous well designed animal studies support this concept. Despite excellent preclinical data, there are several potential barriers to translating hypothermia into clinical practice. Conclusion: Therapeutic hypothermia is a promising life-saving strategy. Appropriate patient selection requires a thorough understanding of how temperature modulation affects various biological mechanisms. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Despite being one of the commonest causes of cancer-related death around the world, only 20 per cent of hepatocellular carcinomas (HCCs) are amenable to curative treatment (surgical resection or liver transplantation). Radiofrequency ablation (RFA) has emerged as a popular therapy for unresectable HCC. There is evidence that the disparity in survival after curative RFA and surgery for HCC, especially tumours smaller than 3 cm in diameter, is narrowing. This review examined the survival and disease recurrence rates after RFA for HCC over the past decade. Methods: A systematic review was conducted using MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register and the Database of Abstracts of Reviews of Effects from January 2000 until November 2010. Papers reporting on patients with HCC who were treated with RFA, either in comparison or in combination with other interventions, such as surgery or percutaneous ethanol injection (PEI), were eligible for inclusion. Outcome data collected were overall survival, disease-free survival and disease recurrence rates. Only randomized controlled trials (RCTs), quasi-RCTs and non-randomized comparative studies with more than 12 months' follow-up were included. Results: Forty-three articles, including 12 RCTs, were included in the review. The majority of the articles reported the use of RFA for unresectable HCC, often in combination with other treatments such as PEI, transarterial chemoembolization and/or surgery. Overall and disease-free survival rates continue to improve, despite an increase in the size and numbers of tumours treated. More recently some clinicians have used RFA to treat selected patients with resectable HCC, with good outcomes. Conclusion: RFA provides a valuable treatment option for patients with unresectable HCC. It improves survival in those previously considered to have advanced disease. As progress continues to be made, RFA is gradually being used to treat resectable HCC. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Pilonidal disease is a common and usually minor disease. Although wide excisional surgery has been common practice, there are more simple alternatives. This review focused on the aetiology and management of pilonidal disease. Methods: A comprehensive review of the literature on pilonidal disease was undertaken. MEDLINE searches for all articles listing pilonidal disease (1980-2010) were performed to determine the aetiology and results of surgical and non-surgical treatments. Single papers describing new techniques or minor modifications of established techniques were excluded. Further articles were traced through reference lists. Results: Patients with minimal symptoms and those having drainage of a single acute abscess can be treated expectantly. Non-surgical treatments may be of value but their long-term results are unknown. There is no rational basis or need for wide excision of the abscess and sinus. Simple removal of midline skin pits, the primary cause of pilonidal disease, with lateral drainage of the abscess and sinus is effective in most instances. Hirsute patients with extensive primary disease and deep natal clefts, or with recurrent disease and unhealed midline wounds, may also require flattening of the natal cleft with off-midline skin closure. These more conservative procedures are usually done as a day case, require minimal care in the community and are associated with a rapid return to work. They also avoid the occasional debilitating complications of surgical treatment. Conclusion: Simple day-case surgery to eradicate midline skin pits without wide excision of the abscesses and sinus is rational, safe and effective for patients with pilonidal sinus disease. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The article presents a study of the issues linked with the diagnosis, treatment and prevention of venous thromboembolism (VTE). Relevant papers on VTE were selected through MEDLINE and manual research and revealed that recurrent VTE manifests itself more in cases of unprovoked thrombosis. It mentions that the anticoagulation duration may be affected by ultrasonography or D-dimer monitoring. It reveals that there is a high mortality rate related to pulmonary embolism and recurrent VTE rates.

The article presents a study which investigates when and where the manuscripts submitted to the "British Journal of Surgery" (BJS) are published after they have been rejected. The study identified the rejected 2006 manuscripts from the Manuscript Central electronic database and PubMed search was carried on through author's last name to determine if the papers are published in another journal. The result shows that 65.8% out of 926 rejected manuscripts were published in 198 different journals.

The following abstracts are from papers presented at the 44th annual scientific meeting of the Vascular Society of Great Britain and Ireland, held in Liverpool 18-20 November 2009. The President of the Society, Mr P. Taylor, was in the Chair. The BJS Prize was won by Dr R. Aggarwal from the University of Leeds, and the Founder's Prize was won by Mr R. Sharpe from Leicester Royal Infirmary. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The article presents a systematic review which investigates the relationship between ischaemic complications after laparoscopy and pneumoperitoneum. It says that 73 papers on oxidative stress and pneumoperitoneum from Medline, PubMed, and EMBASE from 1947-March 2008 were identified including clinical trials, animal studies, and case reports. Results show that a decrease in splanchnic perfusion due to pneumoperitoneum leads to oxidative stress. Ways on how to prevent oxidative stress are offered.

The article focuses on the impact of axillary lymph node dissection (ALND) which ensued the rate of axillary recurrence and better survival in women with node-negative breast cancer in the U.S. As stated, the taking out of more than ten nodes would be followed by a lower axillary recurrence rate and has also lower rates of distant metastases and better survival. Thus, several papers have asserted that there is a survival benefit after removal of normal lymph nodes for breast cancer patients.

The Annual Meeting of the Society of Academic and Research Surgery was held at the Botanical Gardens, Birmingham on 9th to 11th January 2008. The Patey Prize was awarded to Ms Dearbhaile Collins (Department of Surgical Research, RCSI & Beaumont Hospital, Dublin, Ireland) for a paper entitled 'Proteomic analysis of the proto-oncogene C-MYC unfolds a mechanism of receptor cross-talk that drives tumour recurrence'. All Patey Prize abstracts are reproduced in the British Journal of Surgery ( Br J Surg 2008; 95: 934-938). To view all other abstracts from this meeting, please click the pdf link on this page. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The article details a study which reviewed published papers from 1966 to 2007 that described genetic factors involved in modulating the risk of pancreatic cancer. It discusses the aetiology of pancreatic ductal adenocarcinoma and the role of tobacco smoking and gene-environment interaction in the progression of pancreatic cancer. It also examines the role of DNA repair in the development of pancreatic cancer.

The 2007 Annual Meeting of the Society of Academic and Research Surgery was held at Robinson College, Cambridge, UK 10-12th January 2007. The Patey Prize was won by B Modarai et al. (King's College and Imperial College, London, UK) for a paper entitled 'Adenvirus-mediated VEGF gene therapy enhances venous thrombus recanalisation and resolution'. All Patey Prize abstracts are reproduced in the British Journal of Surgery ( Br J Surg 2007; 94: 1048-1052). To view all other abstracts from this meeting, please click the pdf link on this page. [ABSTRACT FROM AUTHOR]

Background: This study aims to establish the risk of developing a metachronous contralateral inguinal hernia (MCIH) following open repair of a unilateral inguinal hernia in children. Methods: A systematic review was performed using a defined search strategy. Studies in which children undergoing open repair of a unilateral inguinal hernia without contralateral exploration and who were followed up for MCIH development were included. Results: Of 5937 titles and abstracts screened, 154 full-text articles were identified for review; 49 papers were analysed with data on 22 846 children. The incidence of MCIH was 7.2 per cent overall, 6.9 per cent in boys and 7.3 per cent in girls (P = 0.381). Children with a left-sided inguinal hernia had a significantly higher risk of developing a MCIH than those with a right-sided hernia (10.2 versus 6.3 per cent respectively; P < 0.001). Conclusion: Overall, in both boys and girls, 14 contralateral explorations are required to prevent one metachronous hernia. The risk of developing a MCIH appears unchanged in early childhood, with a slight reduction after 12 years of age. Children with a left-sided hernia have the greatest risk of developing a contralateral hernia, but ten explorations are still required to prevent one metachronous hernia. Most MCIHs occur in the first 5 years after unilateral inguinal hernia repair. [ABSTRACT FROM AUTHOR]

Background: This study investigated the volume-outcome relationship for abdominal aortic aneurysm (AAA) surgery and quantified critical volume thresholds. Methods: PubMed, EMBASE and the Cochrane library were searched for articles on the operation volume-outcome relationship in elective and ruptured AAA surgery. UK Hospital Episode Statistics data were also considered. Elective and ruptured AAA repairs were dealt with separately. The data were meta-analysed, and the odds ratios (95 per cent confidence interval) for mortality at higher- and lower-volume hospitals were compared. Volume thresholds were identified from each paper. Results: The analysis included 421 299 elective and 45 796 ruptured AAA operations. Significant relationships between mortality and annual volume were noted for both groups. Overall, the weighted odds ratio was 0.66 (0.65 to 0.67) for elective repair at a threshold of 43 AAAs per annum and (0.73 to 0.82) for ruptured aneurysm repair at a threshold of 15 AAAs per annum, both in favour of high-volume institutions. Conclusion: Higher annual operation volumes are associated with significantly lower mortality in both elective and ruptured AAA repair. This suggests that AAA surgery should be performed only at higher-volume centres. [ABSTRACT FROM AUTHOR]

Background: No randomized trial has yet studied venous thromboembolism (VTE) prophylaxis in patients undergoing surgery for breast cancer. Method: Relevant articles were identified using Medline searches. Secondary articles were identified from the reference lists of key papers. Results and conclusion: The absence of randomized trials comparing different methods of VTE prophylaxis with controls makes an evidence-based consensus among breast cancer surgeons difficult. Intermittent pneumatic compression (IPC) and graduated compression (GC) are effective in reducing VTE without the haemorrhagic complications associated with heparin; their effects are additive. The authors suggest the following strategy. All patients undergoing surgery for breast cancer should receive both IPC and GC, with heparin reserved for those at very high risk. A controlled trial should randomize women to receive heparin or not, and all women should have both IPC and GC. The primary endpoints should be the development of VTE and/or haemorrhagic complications. [ABSTRACT FROM AUTHOR]

Background: Optical techniques using previously unexploited properties of light interaction with tissue may be valuable in the detection, diagnosis and staging of colorectal neoplasia. Methods: A Medline search (1990 to present) was conducted on optical diagnostics in the detection of colorectal neoplasia. The reference list of each identified article was reviewed for further relevant papers. Results and conclusion: Chromoendoscopy is the only optical adjunct to colonoscopy that has been tested in large randomized clinical trials. It improves the detection of small and flat colorectal adenomas, and of neoplasia in chronic ulcerative colitis and hereditary non-polyposis colorectal cancer. All other techniques are the subject of ongoing research and the practicality of population screening with any of the methods has yet to be established. Optical techniques may, however, permit immediate clinical diagnosis, removing the need for histological analysis. They may also improve the diagnosis of early colonic neoplasia. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Emile's comments questioned the main outcome of our paper, selection of a process or clinical outcome I versus i a morbidity parameter. Intracorporeal anastomosis (IA) for laparoscopic right colectomy is not merely a technical option in anastomosis formation, it is a different surgical strategy. 4 Gomez M, Peralta G. A prospective observational multi-center 4 cohort study comparing robotic assisted and laparoscopic invasive right colectomy and intracorporeal anastomosis versus extracorporeal anastomosis. [Extracted from the article]

Background and method: This paper reviews the current status of radiofrequency ablation in the treatment of colorectal liver metastases. Relevant studies with at least ten patients that reported rates of complete tumour ablation, local recurrence, or survival from 1 to 5 years after treatment were included in the review. Results and conclusion: Only six studies that reported at least 3-year survival were identified, with results ranging from 37 to 58 per cent. Some of these figures are promising, given that the patients were considered to have unresectable disease. However, available evidence is limited and hepatic resection remains the standard of care when feasible; radiofrequency ablation cannot be considered an equivalent. Radiofrequency ablation does, however, appear to have a role in treating unresectable disease, and may also be used in conjunction with resection to extend its limits. [ABSTRACT FROM AUTHOR]

Background: The management of enterocutaneous fistula is challenging, with significant associated morbidity and mortality. This article reviews treatment, with emphasis on the provision and optimal route of nutritional support. Relevant articles were identified using Medline searches. Secondary articles were identified from the reference lists of key papers. Results and conclusion: Management of enterocutaneous fistula should initially concentrate on correction of fluid and electrolyte imbalances, drainage of collections, treatment of sepsis and control of fistula output. The routine use of somatostatin infusion and somatostatin analogues remains controversial; although there are data suggesting reduced time to fistula closure, there is little evidence of increased probability of spontaneous closure. Malnutrition is common and adequate nutritional provision is essential, enteral where possible, although supplemental parenteral nutrition is often required for high-output small bowel fistulas. The role of immunonutrition is unknown. Surgical repair should be attempted when spontaneous fistula closure does not occur, but it should be delayed for at least 3 months. [ABSTRACT FROM AUTHOR]

Background: Pancreaticoduodenectomy is the primary, treatment for periampullary cancer. Associated morbidity is high and often related to pancreatic anastomotic failure. This paper compares rates of pancreatic fistula, morbidity and mortality, after pancreaticoduodenectomy in patients having reconstruction by pancreaticogastrostomy with those in patients having reconstruction by pancreaticojejunostomy. Methods: A meta-analysis was performed of all large cohort and randomized controlled trials carried out since 1990. Results: Eleven articles were identified for inclusion: one prospective randomized trial, two nonrandomized prospective trials and eight observational cohort studies. The meta-analysis revealed a higher rate of pancreatic fistula associated with pancreaticojejunostomy reconstruction (relative risk (RR) 2.62 (95 per cent confidence interval (c.i.) 1.91 to 3.60)). A higher overall morbidity rate was also demonstrated in this group (RR 1.43 (95 per cent c.i. 1.26 to 1.61)), as was a higher mortality rate (RR 2.51 (95 per cent c.i. 1.61 to 3.91)). Conclusion: Current literature suggests that the safer means of pancreatic reconstruction after pancreaticoduodenectomy is pancreaticogastrostomy, but much of the evidence comes from observational cohort study data. [ABSTRACT FROM AUTHOR]

Background: This systematic review examined the use of immunomodulators and the risk of postoperative complications after abdominal surgery in patients with inflammatory bowel disease. Methods: Electronic databases (PubMed, Embase, Ingenta, Zetoc and Ovid) were searched and the reference lists in all articles identified were hand-searched for further relevant papers. Studies were included if they evaluated postoperative complications and defined exposure to individual immunomodulators. Results: All 11 studies that met the inclusion criteria were observational studies; two were reported only in abstract form. Five studies reported risks associated with azathioprine, five reported risks associated with cyclosporin and three reported risks associated with infliximab. None showed an increased risk of either total or infectious complications associated with immunomodulator use. However, subgroup analysis in one study, published as an abstract, suggested increased rates of anastomotic complications and reoperation associated with azathioprine. Conclusion: Available evidence does not suggest an increased rate of postoperative complications associated with immunomodulator use. [ABSTRACT FROM AUTHOR]

Background: Endovenous laser treatment is a percutaneous technique used for the treatment of long saphenous vein (LSV) incompetence. This paper presents the results of an uncontrolled case series undertaken to assess the feasibility, safety and efficacy of this technique. Methods: Some 145 incompetent LSVs in 136 patients with saphenofemoral reflux were treated with endovenous laser. The data were evaluated prospectively. Assessment was carried out at 1 week, 3 and 12 months for LSV occlusion and symptomatic relief. Results: Primary procedural success was achieved in 124 (85.5 per cent) of 145 LSVs. Reasons for primary failure included failed cannulation, failure to pass the guidewire and patient discomfort. At 3 months' follow-up, 105 (89.7 per cent) of 117 veins were totally and nine (7.7 per cent) were partially occluded. At 12 months, 63 (76 per cent) of 83 veins were totally and 15 (18 per cent) were partially occluded. At this stage 73 (88 percent) of 83 patients remained satisfied, but 26 (31 percent) had residual or recurrent varicosities. Of these, only five required further treatment. Complications included saphenous nerve injury in one patient and superficial skin burns in a second. Conclusion: Endovenous laser treatment for LSV reflux is safe and can be carried out under local anaesthesia in an outpatient setting with good patient satisfaction and low complication rates. [ABSTRACT FROM AUTHOR]

Background: Fast track (FT) programmes optimize perioperative care in an attempt to accelerate recovery, reduce morbidity and shorten hospital stay. The aim of this review was to assess FT programmes for elective segmental colonic resections. Methods: A systematic review was performed of all randomized controlled trials and controlled clinical trials on FT colonic surgery. The main endpoints were number of applied FT elements, hospital stay, readmission rate, morbidity and mortality. Quality assessment and data extraction were performed independently by three observers. Results: Six papers were eligible for analysis (three randomized controlled and three controlled clinical trials), including 512 patients. FT programmes contained a mean of nine (range four to 12) of the 17 FT elements as defined in the literature. Primary hospital stay (weighted mean difference -1.56 days, 95 per cent confidence interval (c.i.) -2.61 to -0.50 days) and morbidity (relative risk 0.54, 95 per cent c.i. 0.42 to 0.69) were significantly lower for FT programmes. Readmission rates were not significantly different (relative risk 1.17, 95 per cent c.i. 0.73 to 1.86). No increase in mortality was found. Conclusions: FT appears to be safe and shortens hospital stay after elective colorectal surgery. However, as the evidence is limited, a multicentre randomized trial seems justified. [ABSTRACT FROM AUTHOR]

The 6th meeting of The Society of Academic and Research Surgery was held at the Royal College of Surgeons of Edinburgh, 11-13th January 2006. The Patey Prize was won by S-S Liau et al. (Eastern Deanery, UK and Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, USA) for a paper entitled 'Characterization of a novel mediator of malignant phenotype in pancreatic adenocarcinoma'. All Patey Prize abstracts are reproduced in the British Journal of Surgery ( Br J Surg 2006; 93: 896-902). To view all other abstracts from this meeting, please click the pdf link on this page. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The paper describes changes in surgical and anesthetic practice identified by the Scottish Audit of Surgical Mortality (SASM) during the first nine years of continuous, peer review audit. Adverse events were more frequently due to failures of hospital systems or process than to individual clinician errors. Fewer adverse events were identified as having contributed to or caused the death of patients over time. Failure to use deep vein thrombosis prophylaxis and failure to use high-dependency or intensive therapy units became less common, once highlighted by the SASM.

Assesses all Medline-cited papers about telemanipulators used in visceral surgery. Review of robot-assisted abdominal surgery by the most advanced telemanipulator; Comparative studies of robot-assisted surgery versus standard laparoscopic or open surgery; Increase in the operating time for robot-assisted procedures; Rates of conversion, intraoperative and postoperative complications; Mortality rate; Suggestion that robot-assisted surgery is safe and feasible for certain standard surgical procedures.

Reviews relates literature regarding postoperative mortality rate following esophagectomy for the period 1990-2000. Number of papers included in the review; Fall in the operative mortality rates following esophagectomy; 30-day mortality rate and the in-hospital mortality rate.

Presents the abstracts of several papers on endocrine surgery presented to the 2003 Annual Meeting of the British Association of Endocrine Surgeons. "Cancellations For Thyroid Surgery: Unacceptable to Everyone," by R. Hughes, P.M. Mackey, A. Asderakis and D.M. Scott-Coombes; "Does Thyroidectomy Exacerbate or Relieve Globus Pharyngeus?," by D. Mather, S.L. Atkin and R.J.A. England; "Osteoprotegerin is a Survival Factor for Thyroid Cancer Cells In Vitro," by J.L. Scoffiled, B.J. Harrison and C.L. Eaton.

Background: This paper reports the outcome of surgical revision for complications following laparoscopic placement of an adjustable silicone gastric band (AGB) to treat morbid obesity. Methods: Seventy-three (19.1 per cent) of 382 patients who underwent laparoscopic AGB placement between January 1996 and March 2001 presented with complications within 6 years after operation. Revision was carried out with the intention of reinstating the functional device in all patients. Results: Successful surgical revision or gradual balloon deflation was performed in 53 patients (29 port-related complications, 14 pouch dilatations, 12 band leakages, three oesophageal dilatations, two symptomatic hernias, one late migration, one intracerebral bleed). Of these patients, 51 (96.2 per cent) had a successful outcome according to the Bariatric Analysis and Reporting Outcome System following significant additional postinterventional weight loss. AGB removal was carried out in 20 patients (13 early or late migrations, five pouch dilatations, three port-related complications, two psychiatric disorders, one band leakage). The final failure rate for complicated AGB procedures was 30.1 per cent. Conclusion: AGB placement is associated with a variety of complications. In most cases surgical complications can be treated with minimally invasive surgery, which should allow further weight loss and improvement of quality of life during long-term follow-up. Alternative bariatric procedures should be reserved for patients with poor outcome after surgical revision of the AGB. [ABSTRACT FROM AUTHOR]

Background: Trials in surgery pose some special problems. This paper examines these with reference to 10 years of methodological research sponsored by the UK National Health Service Research and Development programme. Methods: Solutions to common problems encountered in surgical studies were considered, such as issues of blinding, dependence of results on technical skill and continued evolution of technology. Results: Numerous methodological developments are described, including the tracker trial concept in which trial design can be adapted to take account of technical developments and interim results. The governance of trials, solutions to ethical conundra and the rising importance of databases are also discussed. Conclusion: Like surgery itself, the methodological toolkit for evaluation of surgical procedures continues to evolve. The rules of statistical and scientific probity provide plenty of scope for imaginative design solutions for surgical trials. [ABSTRACT FROM AUTHOR]

Background: Peritoneal mesothelial cells have a remarkable capacity to respond to peritoneal insults. They generate an intense biological response and play an important role in the formation of adhesions. This review describes these activities and comments on their relationship to surgical drainage, peritoneal lavage and laparostomy in the management of patients with peritonitis. Methods and results: Material was identified from previous review articles, references cited in original papers and a Medline search of the literature. The peritoneal mesothelium adapts to peritonitis by facilitating the clearance of contaminated fluid from the peritoneal cavity and inducing the formation of fibrinous adhesions that support the localization of contaminants. In addition, the fluid within the peritoneal cavity is a battleground in which effector mechanisms generated with the involvement of peritoneal mesothelial cells meet the contaminants. The result is a complex mix of cascading processes that have evolved to protect life in the absence of surgery. Conclusion: Future advances in the management of patients with severe peritonitis may depend upon molecular strategies that modify the activity of peritoneal mesothelial cells. [ABSTRACT FROM AUTHOR]

Background: Cyclo-oxygenase inhibition for the treatment of colorectal neoplasia has been studied with renewed interest since the discovery of cyclo-oxygenase (Cox) 2 and the introduction of specific Cox-2 inhibitors. These drugs have implications for both the prevention of colorectal carcinoma and the potential treatment of the disease. Methods and results: A Medline database search was performed for articles using the keywords 'colonic, colon or rectal and neoplasia or cancer' and 'cyclo-oxygenase or Cox-2.' Cross-references of relevant historical papers were also included. There is substantial evidence that Cox-2 plays a role in the development and progression of colorectal cancer. The specific inhibition of this enzyme has been shown to inhibit cancer growth in in vitro and in vivo models. The mechanisms of action for these effects are poorly understood and potential clinical applications at present remain under investigation. Conclusion: Cox-2 inhibitors have great promise as useful additions to current cancer treatments. There is a need for randomized clinical trials to define a role for these drugs in chemoprevention, recurrence prophylaxis, and adjuvant therapy for colorectal and other solid tumours. [ABSTRACT FROM AUTHOR]