Re-operation for failed anti-reflux surgery.

BACKGROUND: Between 1993 and 1995, 315 anti-reflux procedures were undertaken on our service. A previous antireflux procedure had been performed in 31 patients referred (10%). Previous surgery was, in the main (80%), a Nissen fundoplication. METHODS: Pre-operative investigations in all patients were manometry, 24h pH monitoring, oesophagoscopy and barium radiology. On this basis the causes of failure of the previous surgery were established as hiatal failure in 20 (65%), unrecognized oesophageal dysmotility in three (10%) and fundoplication failure (slipped and disrupted) in eight (25%). Contrary to standard recommendations for re-operation most re-operative surgery was performed transabdominally (94%). Complications occurred in 16%. RESULTS: Review was undertaken at a mean of 21 months following surgery, and 91% of patients reported a good to excellent symptomatic outcome. CONCLUSIONS: Transabdominal re-operative anti-reflux surgery has an acceptable complication rate and a surprisingly good symptomatic outcome in the medium term.

Laparoscopic repair of perforated duodenal ulcers with a falciform ligament patch.

Six patients are reported who presented with perforated duodenal ulcers. These were repaired laparoscopically by suturing the falciform ligament over the perforated ulcer. There were no complications and patients were discharged between 3 and 5 days after surgery. This technique is simpler to perform than a laparoscopic omental patch repair.

A biomechanical manikin for the evaluation of loads on the body.

A simple tool to evaluate loads at body joints is described. Its function is to analyse static tasks performed in the sagittal plane. It consists of an articulated plastic manikin placed in the required posture on a magnetic board. The manikin has a set of scales which indicate moments of forces around the elbow, shoulder, lumbosacral or knee joints generated by any force exertion. The readings take into account several percentiles of stature and body weight and any value and direction of force applied in the task. A graph also provides an estimate of the intervertebral compression forces.

Work before and after coronary artery bypass grafting.

Of 79 male Post Office employees in the UK undergoing first coronary artery bypass grafting in 1984 and 1985, 78 per cent resumed work, most within 2-6 months. By the end of the follow-up period (median 550 days) 65 per cent were working, 84 per cent of them normally. Prior to surgery 38 per cent had been able to work, 76 per cent of them normally. Return to work was more likely in younger employees and in those working until admission for surgery or who had only a short period off before surgery. A previous myocardial infarction made little difference to the likelihood of returning to work after surgery or continued working. The effect of type of work on work capability before and after surgery was also studied. All differences could not be related to physical demands of the job. Motivational and socioeconomic factors may have accounted for some differences.