The reporting of gastric band slip and related complications; a review of the literature.

Laparoscopic adjustable gastric banding is a safe and effective treatment for morbid obesity. Long-term complications include band slippage, gastric pouch dilatation and gastric erosion. Rates of band slippage reported in the literature range from less than 1% to over 20%. The aim of this review was to explore whether differences in the reporting of this complication contributed to the variability in this outcome measure. A full literature search was undertaken using EMBASE and MEDLINE search engines. Forty studies were selected for analysis based on inclusion and exclusion criteria. Each was scrutinised for outcome reporting methods and related fields. Accurate definitions for relevant terms were derived from the best available evidence. Considerable variations in device deployed, operative approach, band fixation technique, and outcome reporting mechanisms were seen between the studies. The explanation and definition of terms used within manuscripts were also seen to vary between studies. A consensus needs to be reached on how best to report complications such as gastric band slippage. We suggest which information should be included by authors to allow for accurate and reproducible reporting of such outcomes in the future.

Learning in the surgical workplace: necessity not luxury.

BACKGROUND: Surgical teaching and training has a long tradition of apprenticeship-style mentoring, which has been widely revered and respected. The teaching style and learning was feared by some, but appreciated by all. The basis of this teaching was a strong relationship between teacher and trainee that was formed over many years of close working. However, modern legislation in the form of the European Working Time Directive (EWTD) has made this relationship difficult to achieve. Shifting working patterns have broken the continuity. We need to find new ways to learn the art of surgery and to maximise the limited time that is available on the 'shop floor'. CONTEXT: The surgical standard working day is analysed in this article to highlight opportunities for learning, and how to exploit them. Every clinical encounter can be used for educational purposes. INNOVATIONS: Novel approaches to ward rounds are discussed, together with modifications to intraoperative training. These make teaching an active process, with the learner taking control and self-directing the process. IMPLICATIONS: The EWTD need not be a disaster for surgical training. We need to rationalise and re-think our approaches, but surgical training should not be seriously detrimented by the reduction in hours. Two hours of focused surgical training is worth more than 8 hours of chaotic, random educational encounters, characteristic of previous systems.

Postoperative fluid and electrolyte balance: alarming audit results.

Perioperative fluid and electrolyte management requires an understanding of physiology and fluid losses. Consequences of poor management in postoperative patients can be fatal. This audit assesses the latest consensus guidelines and applies them to a district general hospital setting. Results are concerning and demonstrate a global lack of application of knowledge and understanding. Recommendations are suggested in order to control this potentially devastating situation.

Colonic perforation following mild abdominal trauma in a patient with Crohn's disease: a case report.

Colonic perforation following mild abdominal trauma in patients with Crohn's disease is a rare occurrence. We present a case of a 21 year old Crohn's sufferer, who presented to the emergency department with signs of shock and peritonitis following minor abdominal trauma. A computed tomography (CT) scan revealed ascending colonic perforation and he underwent a subsequent right hemicolectomy. This is the first UK report of a patient with inflammatory bowel disease suffering colonic perforation following minimal trauma.

Airbag-related chest wall burn as a marker of underlying injury: a case report.

INTRODUCTION: This case of a man who sustained an airbag-induced thoracic injury and burn, highlights the potential harm that can be caused by airbags. It also serves to illustrate that a surface burn which looks small and benign can actually be a surface marker of a more serious injury. Staff working in emergency departments need to be aware of the risk of possible airbag-associated injuries. CASE PRESENTATION: A 65-year-old man was the driver in a frontal collision. He was wearing a seatbelt. The airbag was activated and caused a superficial chest wall burn. Initial chest x-rays were unremarkable but following deterioration in his condition, a computed tomography scan revealed a serious sternal fracture. The location of the fracture was marked on the surface by the burn. CONCLUSION: Airbags can cause significant chest wall injuries and burns. Surface burns at the point of impact should not be dismissed as trivial as the forces involved can cause significant injury. We recommend that all people with chest wall injuries and/or burns due to airbags should have more detailed chest imaging as initial emergency radiographs can be falsely reassuring.

Low-flow priapism needs recognition and early correct treatment.

Low-flow priapism is a rare condition whereby there is a persistent, painful erection. The patient often presents late because of embarrassment. Failure to recognise this as an emergency and instigate immediate treatment may lead to cavernosal tissue ischaemia, fibrosis and subsequent long-term impotence. A case of low-flow priapism, that demonstrated a lack of urgency and understanding is discussed. An internet-based literature search provided a treatment regimen with resolution of tumescence.