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A prospective audit of trauma patients seen or treated by the Department of General Surgery at the North Staffordshire Hospital Trauma Centre has been carried out, examining both the effect of a newly established trauma centre on overall workload and the outcome of patients admitted with severe injury. Trauma comprised approximately 2 per cent of the overall general surgical emergency workload. General surgeons were involved in the assessment of 25 per cent of severely injured patients but overall operated on fewer than 10 per cent of patients in this group. No patient died during the study period as a consequence of missed or inadequately treated intra-abdominal injury. These data suggest that there is insufficient work to justify specialist general surgical trauma surgeons in the UK. When general surgical intervention is required, however, it is usually vital and potentially life-saving.

Fifty patients with gastro-oesophageal reflux disease refractory to multiple courses of medical therapy were entered into a prospective randomized trial comparing Nissen fundoplication with the Angelchick prosthesis as a primary surgical procedure. The two groups were matched for age, sex, duration of symptoms before surgery, type of medical therapy, pattern of symptom presentation, endoscopic grade of oesophageal inflammation, manometric lower oesophageal pressure and 24-h pH profile. Twenty-five patients were randomized to each of the Nissen fundoplication and Angelchik prosthesis groups. Operation time and hospital stay were similar in both groups. Persistent dysphagia was reported in five of the patients with an Angelchik prosthesis compared with none in the Nissen fundoplication group. Three prostheses were removed because of severe dysphagia while no Nissen fundoplication required revision. No patient with preoperative dysphagia because of stricture reported swallowing difficulties after operation. At clinical assessment at 3, 6, 12 and 24 months after operation, 85-88 per cent of the patients having a Nissen fundoplication were graded Visick 1 or 2 compared with 60-72 per cent of patients in the Angelchik group.

Vertical Silastic ring gastroplasty was carried out in 71 patients as treatment for morbid obesity. The mean excess weight loss at 6 months (59 patients) and 2 years (43 patients) was 48 per cent and 65 per cent respectively. Subsequently the weight stabilized around this level with 58 per cent of the excess weight lost at 5 years (14 patients) postgastroplasty. Five patients (7 per cent) failed to lose weight. Sixteen patients (23 per cent) required revision for technical complications but continued to lose weight or to maintain a satisfactory weight. Vertical Silastic ring gastroplasty is an effective surgical method of achieving sustained weight loss.

Gastric banding was carried out in 30 patients as a treatment for morbid obesity. The mean excess weight lost at 3 months was 32.6 per cent (27 patients) and 69.7 per cent at 2 years (eight patients). Fifteen patients required 22 reoperations for technical complications. Two patients underwent removal of the band and seven patients were converted to a stapled vertical Silastic ring gastroplasty. Although gastric banding appears to be a satisfactory method of achieving weight loss, the complication and reoperation rates are unacceptable in our hands. It is recommended that this operation should no longer be used as a treatment for morbid obesity.

The Birmingham liver transplant programme started in 1982. Forty-six patients have been transplanted with a follow-up of 3 months or longer. Twenty-seven patients are still alive, of whom sixteen have lived for more than one year. The 30 day hospital mortality was 30.4 per cent and the actuarial predicted one year survival 55.5 per cent. Four patients have been regrafted for chronic rejection and graft failure. Thirteen patients have required surgery in the postoperative period for: bleeding (two), removal of abdominal packs (four), biliary leaks and obstruction (five), duodenal perforation (one) and small bowel obstruction (one). Acute rejection was common, occurring in 30 patients and progressing to chronic rejection in 4. Ten patients developed renal failure with an 80 per cent mortality and eleven patients developed grand mal fits. Severe bleeding (greater than 70 units) was associated with previous abdominal surgery and a high mortality (88.9 per cent). Opportunistic fungal infection carried a 100 per cent mortality. Although more than half of all transplanted patients will survive for more than one year, the postoperative period is still one of high morbidity and mortality.