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Background: This study investigated adhesive intestinal obstruction (AIO) and incisional hernia (IH) in patients undergoing laparoscopically assisted and open surgery for colorectal cancer., Methods: In a case-note review of patients randomized to the Medical Research Council's Conventional versus Laparoscopic-Assisted Surgery In Colorectal Cancer (CLASICC) trial, primary and key secondary endpoints were AIO and IH admission rates respectively., Results: Of 411 patients, 11 were admitted for AIO: four (3.1 per cent) of 131 patients in the open arm of the trial versus seven (2.5 per cent) of 280 in the laparoscopic arm (difference 0.6 (95 per cent confidence interval (c.i.) - 2.9 to 4.0) per cent). Thirty-six patients developed IH: 12 (9.2 per cent) after open versus 24 (8.6 per cent) after laparoscopic surgery (difference 0.6 (95 per cent c.i. - 5.3 to 6.5) per cent). Results by actual procedure showed higher AIO and IH rates in the 24.5 per cent of patients who converted from laparoscopic to open surgery (AIO: 2.3, 2.0 and 6 per cent; IH: 8.6, 7.4 and 11 per cent-for open, laparoscopic and converted operations respectively)., Conclusion: Although this study has not confirmed that laparoscopic surgery reduces rates of AIO and IH after colorectal cancer surgery, trends suggest that a reduction in conversion to open surgery and elimination of port-site hernias may produce such an effect. Registration number for CLASICC trial: ISRCTN74883561 (http://www.controlled-trials.com)., (Copyright 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.)

Carotid endarterectomy may be complicated by damage to the adjacent cranial and cervical nerves. The true incidence and severity of these complications is rarely reported. In a prospective study of 43 carotid endarterectomies there was a 25 per cent incidence of temporary vocal cord palsy, 5 per cent incidence of hypoglossal nerve damage and anaesthesia of the greater auricular and transverse cervical nerves was found in 60 per cent and 69 per cent of patients respectively 1 week postoperatively. There was some recovery of these nerve injuries over a 6-month period.

Data, concerning general surgical research, was obtained by means of a questionnaire from 103 junior surgeons undertaking full-time research. Most posts appeared to be adequately funded, though many respondents sustained a loss of salary on appointment. Less than half the posts were advertised in the national medical journals. All but one respondent were submitting their research for a higher degree. The majority felt that they were well supervised: a minority (24 per cent) were poorly supervised. The enjoyment of research and confidence of obtaining a higher degree were related to the standard of supervision.

The aim of this study was to evaluate computed tomography (CT) in the assessment of abdominal aortic aneurysms with particular reference to their longitudinal extent. Twenty-nine patients were examined by CT, 21 of whom came to surgery. Sixteen of these 21 patients were also examined by ultrasound. At CT the relation of the aneurysm to the renal arteries proximally and the bifurcation distally was noted, along with the definition of the aortic outline. At subsequent surgery the longitudinal relations of the aneurysm and evidence of localized stretching of or leakage from the sac were assessed by an observer without knowledge of the CT scan report. Correct extent of the aneurysm in relation to the renal arteries was predicted by CT in 20 out of 21 patients who underwent surgery. CT assessment with respect to the bifurcation was correct in 16. The CT findings proved correct in one patient with localized stretching of one part of the aneurysm and in one patient where leakage was occurring. CT scanning was found to be superior to ultrasound in our preoperative assessment of the superior extent of abdominal aortic aneurysms. CT is considered to be the investigation of first choice when evaluation an abdominal aortic aneurysm.

Fasting levels of serum triglyceride, serum cholesterol, lipoprotein, uric acid, fibrinogen and carboxyhaemoglobin (COHb) were measured in 64 patients with stenosing arterial disease before reconstructive surgery, and were compared with those for normal, age- and sex-matched controls. All except fibrinogen were significantly higher in the patients with arterial disease than in the controls. The outcome of arterial reconstruction, assessed both clinically and by Doppler pressure measurement, was compared in terms of these risk factors. The reconstruction of 12 patients failed between 3 months and 5 years, leaving 52 patients with patent reconstructions at the end of the follow-up period. There was no difference between the two groups in terms of any of the risk factors, except for COHb. The COHb level (associated with inhalation of cigarette smoke) was significantly higher in the reconstruction failure group than in the reconstruction success group. We believe that patients should stop smoking cigarettes before reconstructive arterial surgery is undertaken.

In the period 1970-1983, 27 patients with end stage renal failure underwent neck exploration for hyperparathyroidism. In 1977 the operative policy changed from subtotal parathyroidectomy to total parathyroidectomy and autotransplantation. Eight patients underwent subtotal parathyroidectomy while fifteen patients underwent total parathyroidectomy and autotransplantation. All were cured of their symptoms and hypercalcaemia was resolved. There was no significant difference in the requirement for postoperative calcium and vitamin D supplements between the two groups. Recurrent hypercalcaemia developed in one patient who had undergone total parathyroidectomy and autotransplantation. Resolution followed removal of approximately half the transplant. There were four deviations from the operative policy.