Physiological and symptomatic outcome after laparoscopic gastric fundoplication.

The complications of open antireflux operations may be reduced by laparoscopic techniques. Fifteen patients of median age 42 (range 16-79) years with gastro-oesophageal reflux underwent laparoscopic fundoplication. Preoperative and postoperative assessment was by clinical scoring, oesophageal pH measurement and manometry. Median (range) operating time was 115 (60-210) min and hospital stay 3 (1-6) days, with no conversions to open operation and only one minor wound infection. Four patients had occasional reflux symptoms on postoperative assessment at a median of 7 weeks and nine had occasional dysphagia. Median DeMeester symptom scores improved from 4 to 1.5 (P = 0.001). There were significant increases in both lower oesophageal sphincter pressure and length. The nocturnal proportion of time at pH < 4 decreased from 9.6 to 0.05 per cent (P = 0.02), although the drop in total proportion of time at pH < 4 (10.4 to 2.2 per cent) was not statistically significant (P = 0.08). Early objective results of laparoscopic fundoplication show improved symptoms, decreased acid reflux and altered lower sphincter function. The procedure combines the benefits of early mobilization and reduced morbidity with the efficacy of the traditional open operation.

An observer blind trial of co-amoxiclav versus cefuroxime plus metronidazole in the prevention of postoperative wound infection after general surgery.

A consecutive series of 509 patients undergoing abdominal surgery were entered into a randomized, observer and patient blind, controlled, prospective, study to evaluate the efficiency of co-amoxiclav ('Augmentin', SmithKline Beecham, UK) compared with cefuroxime ('Zinacef', Glaxo, UK) plus metronidazole (Flagyl, M&B, UK) for the prevention of postoperative wound infections. One or three doses of antibiotics were given depending on the type of surgery and operative factors. Co-amoxiclav was given to 230 patients with a total wound infection rate of 5.6% and cefuroxime plus metronidazole were given to 225 patients with a total wound infection rate of 3%. The difference between infection rates was not significant. Both groups were comparable in terms of demographic details, type and duration of surgery, risk factors associated with surgical procedures and postoperative management. Although not statistically significant, a difference in the wound infection rate for those patients undergoing colorectal surgery was seen: 8/69 for the co-amoxiclav group and 2/79 for the cefuroxime/metronidazole group. The estimated cost to our hospital (October, 1993) of one dose of co-amoxiclav was less that half the cost of cefuroxime and metronidazole. This study demonstrates that co-amoxiclav is an effective prophylactic antibiotic for abdominal surgery.

Subcutaneous mastectomy with immediate reconstruction as treatment for early breast cancer.

Subcutaneous mastectomy and axillary dissection combined with immediate reconstruction was used to treat primary breast cancer in a consecutive series of 111 patients. Local recurrence occurred in 19 patients (17 per cent) during a mean follow-up of 30 (range 6-60) months. Complete control of local disease was achieved in all patients except one, who had terminal disease. Prophylactic radiotherapy was avoided for 83 per cent of patients, and good cosmetic results were obtained in 89 per cent. These results support the use of this technique in the treatment of early breast cancer.