Bariatric support line: a prospective study of support line activity.

In this prospective study, we examine the workload of the North London Obesity Surgery Service Bariatric telephone support line (BTSL) and its effects on service provision. Over a 3-month period (June to August 2008), a prospective record was kept of all calls, who they were from, whether the patient was presurgery or postsurgery, the type of procedure planned or undertaken, the nature of the enquiry, and the time taken to answer the query. Seventy-five (72%) calls were related to patients who were postsurgery and 29 (28%) presurgery. Patients scheduled for or having undergone Roux-en-Y gastric bypass accounted for 46 (44%) calls; 24 (23%) were preprocedure and 22 (21%) postprocedure. Patients scheduled for or having undergone gastric banding accounted for 56 (54%) calls; five (0.5%) were preprocedure and 51 (49%) postprocedure. Patients undergoing sleeve gastrectomy accounted for two (<1%) calls. Both calls were postprocedure. The reason for the support line enquiry was psychological support in 15 (14%) patients, questions postsurgery in 26 (25%), general enquiries in 27 (26%), and clinical enquiries in 36 (36%). This study of the BTSL has allowed us to identify areas of need within our bariatric population and improve the service we deliver. The changes we have made should lead to a better use of the team's time, greater patient compliance, and satisfaction as well as reduced complaints and litigation.

Symptomatic pyloric pancreatic heterotopia: report of three cases and review of the literature.

BACKGROUND: Pancreatic heterotopia is a relatively common congenital anomaly which sometimes becomes symptomatic and mimics other upper gastrointestinal tract (GIT) pathologies. It is the presence of abnormally located pancreatic glandular tissue at sites with no structural or vascular contact with the main pancreas. It most often occurs in the proximal gastrointestinal tract. The hallmark of diagnosis is the presence of pancreatic tissue within another, anatomically different organ. CASE REPORT: We report three patients, I, II, and III, 48, 86, and 33 years of age, respectively, surgically treated for symptomatic heterotopic pancreas in the pylorus. A review of the literature on this pathology is hereby presented. Patients I and II had uneventful postoperative recovery, while patient III developed postoperative intra-abdominal sepsis due to leakage from the gastric suture line, which was treated with further surgery. Histology confirmed pancreatic heterotopia in all cases. All patients made full recovery and follow-up endoscopy showed no residual disease. CONCLUSIONS: Most pancreatic heterotopias are asymptomatic and require no treatment. This entity is extremely difficult to diagnose preoperatively as the cause of upper gastrointestinal tract symptoms and therefore requires a high index of suspicion. Symptomatic lesions should be excised, and this can be safely carried out by minimally invasive techniques depending on the size and the anatomical location.