A systematic review of smartphone apps for gastro-oesophageal reflux disease: the need for regulation and medical professional involvement.

BACKGROUND: Expansion in smartphone use and mobile health (mHealth) apps has generated a large and unregulated sector. Gastro-oesophageal Reflux Disease (GORD) is a widely prevalent disease in the UK. The aim of this study is to evaluate the smartphone apps focused on GORD, available on major digital platforms, with particular emphasis on their recorded evidence base (EB) and the extent of medical professional involvement (MPI) in their constitution. METHODS: Relevant apps were extracted using defined search terms and inclusion (using a wide array of search terms) and exclusion criteria (non-English language, duplicates) were applied. Data was collected from the overview provided by the developer in the app store and from the developer website for each app, and classified according to various variables. EB and professional involvement data was obtained from the application details provided in the app stores as well as information section of individual apps. RESULTS: A vast majority of the apps (97.3%) were developed targeting the general public. Of the 73 apps, 11 (15.1%) had a documented EB. Two apps stated if healthcare professionals were involved in the development, screening or assessment of the app content, meaning only 2.73% of the apps (2/73) stated their content had been contributed by medical professionals (individual, group or organisation of health providers). Thirty-four apps had recent updates in 2019 (47%, 34/73). CONCLUSIONS: Regulation and accreditation of mHealth apps related to GORD are needed.

Laparoscopic Sleeve Gastrectomy Versus Laparoscopic Roux-en-Y Gastric Bypass in Elderly Bariatric Patients: Safety and Efficacy-a Systematic Review and Meta-analysis.

INTRODUCTION: Obesity is a chronic disease due to excess fat storage, a genetic predisposition, and environmental contribution where surgery offers a viable treatment option. The surgical treatment of obesity in the elderly population (> 55 years) remains controversial. PURPOSE: To evaluate the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in elderly bariatric patients. MATERIALS AND METHODS: Data was sourced from MEDLINE, EMBASE, CINAHL, PubMed, and Cochrane databases for peer-reviewed, randomized controlled trials, and observational studies in the English language were searched from the year 1991 until 2019. From the extracted data, early and late procedural complications and mortality were used as safety outcomes. Weight loss was the primary outcome for effectiveness while the resolution of obesity-related comorbidities was included as secondary outcomes. The Review Manager (Rev Man 5.3)™ software was used for statistical analysis. RESULTS: Of the forty-one screened studies, nine studies were included in the final analysis. There was no difference between LSG and LRYGB regarding early complications and mortality 3.6% versus 5.8% (p = 0.15) and 0.1% versus 0.8% (p = 0.27). Patients who underwent LRYGB had more late complications compared with those who underwent LSG (0.07% and 0.03%, p = 0.001). There was no difference in terms of weight loss at the end of 1 year. Patients who underwent LRYGB had a better resolution of obesity-related comorbidities, not statistically significant. CONCLUSION: LRYGB has better efficacy when compared with LSG. However, high-risk elderly patients should be considered for LSG given the lesser morbidity and comparable efficacy with LRYGB.

Uncommon cause for ileocolic fistulation and caecal perforation following multiple magnet ingestion in an adult.

Non-accidental ingestion of foreign bodies rarely occurs in adults. We report a case of multiple magnet ingestion in an adult with learning difficulties to highlight the associated abdominal complications. Multiple magnets may not pass through the gastrointestinal tract spontaneously and approach considerations should differ from those who had ingested an isolated magnet or other foreign bodies.

Current trends in the diagnosis and management of post-herniorraphy chronic groin pain.

Inguinodynia (chronic groin pain) is one of the recognised complications of the commonly performed Lichtenstein mesh inguinal hernia repair. This has major impact on quality of life in a significant proportion of patients. The pain is classified as neuropathic and non-neuropathic related to nerve damage and to the mesh, respectively. Correct diagnosis of this problem is relatively difficult. A thorough history and clinical examination are essential, as is a good knowledge of the groin nerve distribution. In spite of the common nature of the problem, the literature evidence is limited. In this paper we discuss the diagnostic tools and treatment options, both non-surgical and surgical. In addition, we discuss the criteria for surgical intervention and its optimal timing.

Inguinodynia following Lichtenstein tension-free hernia repair: a review.

Chronic groin pain (Inguinodynia) following inguinal hernia repair is a significant, though under-reported problem. Mild pain lasting for a few days is common following mesh inguinal hernia repair. However, moderate to severe pain persisting more than 3 mo after inguinal herniorrhaphy should be considered as pathological. The major reasons for chronic groin pain have been identified as neuropathic cause due to inguinal nerve(s) damage or non-neuropathic cause due to mesh or other related factors. The symptom complex of chronic groin pain varies from a dull ache to sharp shooting pain along the distribution of inguinal nerves. Thorough history and meticulous clinical examination should be performed to identify the exact cause of chronic groin pain, as there is no single test to confirm the aetiology behind the pain or to point out the exact nerve involved. Various studies have been performed to look at the difference in chronic groin pain rates with the use of mesh vs non-mesh repair, use of heavyweight vs lightweight mesh and mesh fixation with sutures vs. glue. Though there is no convincing evidence favouring one over the other, lightweight meshes are generally preferred because of their lesser foreign body reaction and better tolerance by the patients. Identification of all three nerves has been shown to be an important factor in reducing chronic groin pain, though there are no well conducted randomised studies to recommend the benefits of nerve excision vs preservation. Both non-surgical and surgical options have been tried for chronic groin pain, with their consequent risks of analgesic side-effects, recurrent pain, recurrent hernia and significant sensory loss. By far the best treatment for chronic groin pain is to avoid bestowing this on the patient by careful intra-operative handling of inguinal structures and better patient counselling pre- and post-herniorraphy.