Risk of Dumping Syndrome after Sleeve Gastrectomy and Roux-en-Y Gastric Bypass: Early Results of a Multicentre Prospective Study.

Background. Bariatric surgery is an important field of surgery. An important complication of bariatric surgery is dumping syndrome (DS). Aims. To evaluate the incidence of DS in patients undergoing bariatric surgery. Methods. 541 patients included from 5 nutrition and bariatric centers in France underwent either LSG or LRYGB. They were evaluated at 1 month (M1) and 6 months (M6) postoperatively by an interview and completion of a dumping syndrome questionnaire. Results. 268 patients underwent LSG (Group A) and 273 underwent LRYGB. From the LRYGB patients 229 had mechanical gastrojejunoanal anastomosis with 30 mm linear stapler (Group B) and 44 had manual (hand sewn) 15 mm gastrojejunal anastomosis (Group C). Overall incidence of DS was 8.5% at M1 and M6. In LSG group (Group A), only 4 patients (1.49%) reported episodes of DS at M1 and 3 (1.12%) at M6. In Group B, 41 patients (17.90%) reported episodes of DS at M1 and 43 (18.78%) at M6. Group C experienced one case (2.27%) of DS at M1 and none (0%) at M6. Conclusions. Patients undergoing LRYGB, especially with larger gastrojejunal anastomosis, are more prone to developing DS following surgery than patients undergoing LSG or LRYGB with calibrated manual anastomosis.

Laparoscopic appendicectomy: calculating the cost.

INTRODUCTION: Laparoscopic appendicectomy is a commonly performed procedure presenting a considerable cost burden. Given the additional operative costs of laparoscopic versus open appendicectomy, it is not clear whether the national tariffs are appropriate for laparoscopic appendicectomy. We conducted a study to establish the institutional costs, and to determine whether re-imbursement according to the national tariffs was sufficient. PATIENTS AND METHODS: Data were collected prospectively on patients undergoing laparoscopic appendicectomy within Leeds Teaching Hospitals Trust. Theatre and bed costs were obtained. Cost analysis was performed, and costs were compared to the re-imbursement due. RESULTS: Fifty laparoscopic appendicectomies were performed. Median operative time was 60 min. The median total operative cost of laparoscopic appendicectomy was pound906. Median equipment cost for laparoscopically completed cases was pound254. Median total in-patient cost was pound1617 (range, pound880- pound3360). This compared with a mean re-imbursement of pound1981 representing a cost benefit of pound233 per case (P = 0.0009). CONCLUSIONS: Despite a liberal use of disposable equipment, laparoscopic appendicectomy can still be performed within the confines of the national tariffs. There is a considerable variation in the cost of this procedure, and it may be possible to reduce costs by more stringent use of disposable equipment and standardising recovery protocols.

Endothelial progenitor cells as a therapeutic option in peripheral arterial disease.

BACKGROUND: Endothelial progenitor cells (EPC) are a subpopulation of bone-marrow mononuclear cells that are capable of generating new blood vessels in areas of ischaemia or infarction. This review examines the regenerative potential of EPC to ameliorate peripheral ischaemia. METHODS: An online search was done using OVID Medline Search, PubMed, and Cochrane Review Database, for all reviews and original articles in English concerning progenitor or bone-marrow mononuclear cells. RESULTS AND CONCLUSION: There are many controversies in EPC research, especially in the areas of identification, characterization, and therapeutic use. Both animal and human studies have shown benefits from using EPC to combat peripheral arterial and cerebrovascular disease. To bring EPC into wider clinical use, larger controlled clinical trials and better methods of augmenting EPC function and lifespan are required. Until then EPC should be used under robust trial conditions with ethical approval.

Stapled haemorrhoidopexy compared to Milligan-Morgan and Ferguson haemorrhoidectomy: a systematic review.

PURPOSE: The aim of this study was to perform a systematic review and meta-analysis of the short- and long-term outcomes of stapled haemorrhoidopexy. METHODS: A literature search identified randomised controlled trials comparing stapled haemorrhoidopexy with Milligan-Morgan/Ferguson haemorrhoidectomy. Data were extracted independently for each study and differences analysed with fixed and random effects models. RESULTS: Thirty-four randomised trials and two systematic reviews were identified, and 29 trials included. Stapled haemorrhoidopexy was statistically superior for hospital stay (p < 0.001) and numerically superior for post-operative pain (peri-operative and mid-term), operation time and bleeding (post-operative and long-term). Recurrent prolapse and re-intervention for recurrence were more frequent following stapled haemorrhoidopexy. No difference was observed in the rates of complications. CONCLUSIONS: Stapled haemorrhoidopexy reduces the length of hospital stay and may have an advantage in terms of decreased operating time, reduced post-operative pain and less bleeding but is associated with an increased rate of recurrent prolapse.

Carotid endarterectomy: technical practices of surgeons participating in the GALA trial.

OBJECTIVE: Recent meta-analyses confirm an advantage to patch angioplasty during carotid endarterectomy (CEA) and suggest a benefit from routine shunting. GALA Trial (RCT: general [GA] versus local [LA] anaesthesia for CEA) collaborators (non-UK [European] and UK) were surveyed to assess current practice techniques. MATERIALS AND METHODS: Postal questionnaires determined: shunt usage, monitoring techniques dictating shunt deployment, criteria for patching and the influence of anaesthetic technique upon these decisions. RESULTS: 157/216 surgeons (73%) replied. For UK surgeons (n=76) performing GA CEA a shunt was always, never, or selectively used by 73.6%, 4.2% and 22.2% respectively. Figures for non-UK surgeons (n=77) were 20.8% (p<0.0001), 26% (p<0.0002) and 53.2% (p<0.0001). When shunting selectively, fewer UK surgeons relied on stump pressure (26.4% v 48.1%; p<0.0064) with TCD more widely used (38.9% v 11.7%; p<0.0001). Shunting criteria during LA CEA were the same for both groups (impaired awake-testing). Routine patching was commoner amongst UK surgeons (GA: 76.4% v 34.2%, p<0.0001; LA: 70.1% v 31.9%, p<0.0001). CONCLUSIONS: These results indicate that more UK surgeons have adopted current suggestions for improving CEA outcomes. Future analysis of unblinded GALA Trial data may provide further information about the impact of different policies for shunting and patching.

Predictors of return to work following carotid endarterectomy.

BACKGROUND: Carotid endarterectomy (CEA) is an important part of secondary prevention in selected patients following a transient ischaemic attack or stroke. A key marker of success, return to work following surgery, was assessed in a retrospective cohort study. METHODS: Patients from the UK aged less than 65 years at operation were sent a questionnaire concerning return to work after CEA. Data were analysed using univariable tests and logistic regression. RESULTS: Some 174 (64.4 per cent) of 270 patients responded; their median age was 60 (range 35-64) years and 124 were men. Seventy-five per cent of respondents employed preoperatively returned to work following CEA. Newly retiring patients were older (62 versus 58 years; P < 0.001). Univariable analysis confirmed that age and preoperative stroke influenced return to work. The adjusted odds ratio for patients with versus without a preoperative stroke was 0.46 (95 per cent confidence interval 0.22 to 0.97) (P = 0.040). Median convalescence was 4 weeks, but was shorter in the self-employed (P = 0.039) and prolonged in patients with symptomatic cardiovascular disease (P = 0.023) and those who required postoperative critical care (P = 0.039). CONCLUSION: Return to work following CEA was influenced by age and preoperative stroke.

Bacterial contamination of central venous catheters during insertion: a double blind randomised controlled trial.

Static electricity within sterile packaging may result in bacterial contamination of central venous catheters (CVCs) prior to insertion. To prevent this, some surgeons inject saline into the pack before opening it. This trial was designed to determine the effect of this procedure. A double blind randomised controlled trial of 47 CVCs comparing injection of 2 ml of sterile saline into the pack prior to opening with no injection was performed. Five centimetre lengths cut from the tip of the catheter before and after subcutaneous tunnelling were sent for microbiological culture. Eight catheters (17%) showed evidence of bacterial contamination prior to insertion into the vein. Two (4.2%) were contaminated prior to tunnelling and seven (14.9%) afterwards. One catheter was contaminated before and after tunnelling. All but one of the contaminating bacteria were coagulase negative staphylococci. There was no significant difference in the contamination rate between catheters from packs that had been injected (5/25) and those that had not (3/22), P = 0.56. Just under one-fifth of the catheters were contaminated with bacteria prior to insertion into the vein but this was not influenced by prior injection of saline into the pack. We conclude that there is no evidence to support the practice of injecting the catheter pack prior to opening.