Inguinal hernia repair in patients under and over 65 years of age: a district general hospital experience.

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.

Outcomes and risk factors of cholecystectomy in high risk patients: A case series.

INTRODUCTION: Many studies looked at outcomes and risk factors in laparoscopic cholecystectomies in general, including a few studies on risk factors and scoring systems in predicting conversion to open surgery. Little data has been produced on high-risk patients undergoing cholecystectomy. Identifying risk factors in this group could help stratify decision making regarding best management strategies.The aim of this study was to investigate outcomes of laparoscopic cholecystectomies in patients with ASA 3 and 4. METHODS: Data was collected and collated from a prospectively maintained database of all laparoscopic cholecystectomies performed by 13 general surgeons in a single unit. Case notes were reviewed for all patients with ASA 3 and 4 between 2013 and 2017. Data analysis was performed using R studio v 3.4. RESULTS: 244 cases were reviewed. Common bile duct was dilated in 52 cases (21.31%). Gall bladder wall was thick in 102 (41.8%) of the patients. Surgery was elective in 203 (83.2%) of the patients. ERCP was performed in 41 (16.9%) of the patients prior to surgery. 150 patients (62.2%) stayed for 1 day while 36 (14.9%) stayed for 2 days and the remaining 55 (22.9%) stayed for 3 days or more. Complications occurred in 37 (15.16%) of the patients while 23 (9.43%) of the patients were readmitted. 7 patients (2.87%) returned to theatre and 8 (3.28%) stayed in ITU post-op. Two patients died (0.82%). CONCLUSION: Laparoscopic cholecystectomies in higher risk populations are safe. Alternative methods such as cholecystostomy and ERCP may be of benefit in these patients.

Peripheral arterial disease: a literature review.

INTRODUCTION: Peripheral arterial disease (PAD) is a common vascular condition that affects both quality of life and life expectancy with an increased risk of cardiovascular events. SOURCES OF DATA: A literature search was carried out of Pub-Med, MEDLINE, the Cochrane Library and Google Scholar from the establishment of these databases up to February 2012. The search was performed by using the keywords 'peripheral arterial disease' and one of the following words: 'management', 'investigations', 'risk factors', 'epidemiology', 'revascularization', 'cryoplasty', 'atherectomy' and 'gene therapy'. Studies were limited to those published in English language. AREAS OF AGREEMENT: Aggressive risk factors modification is needed to reduce cardiovascular-related mortality in PAD patients. AREAS OF CONTROVERSY: Choice of endovascular or surgical intervention remains controversial in an ever-evolving field. GROWING POINTS: There is a rapid expansion of endovascular technologies aiming to improve the effectiveness of this modality. AREAS TIMELY FOR DEVELOPING RESEARCH: The advances in the fields of gene therapy and therapeutic angiogenesis mean these are potential future treatments. Tissue engineering is a developing area and aims to produce grafts with similar patency and infection profiles to those of autologous material. Further elucidation of the pathophysiology of atherosclerosis is required to provide new targets for pharmacotherapy.