Does thoracoscopic mobilisation of the oesophagus during oesophageal resection result in improved outcomes as compared to open thoracotomy?

A best evidence topic was written according to structured protocol. The question addressed was in patients undergoing trans-thoracic oesophagectomy for carcinoma of oesophagus, does a thoracoscopic mobilisation result in improved outcomes as compared to open thoracotomy. 88 papers were found using the reported search strategy of which five papers were selected as representing the best evidence to answer this question are discussed. Overall the evidence on this topic is poor with no prospective randomised controlled trials. We conclude that thoracoscopic mobilisation is a safe alternative to open resection with comparable results in overall short term morbidity and mortality rates. The thoracoscopic approach may have some benefits in terms of reduced blood loss and shorter hospital stay without compromising lymph node clearance and oncological value, but more studies are required to confirm these findings.

Bilateral sternoclavicular joint septic arthritis secondary to indwelling central venous catheter: a case report.

INTRODUCTION: Septic arthritis of the sternoclavicular joint is rare, comprising approximately 0.5% to 1% of all joint infections. Predisposing causes include immunocompromising diseases such as diabetes, HIV infection, renal failure and intravenous drug abuse. CASE PRESENTATION: We report a rare case of bilateral sternoclavicular joint septic arthritis in an elderly patient secondary to an indwelling right subclavian vein catheter. The insidious nature of the presentation is highlighted. We also review the literature regarding the epidemiology, investigation and methods of treatment of the condition. CONCLUSION: SCJ infections are rare, and require a high degree of clinical suspicion. Vague symptoms of neck and shoulder pain may cloud the initial diagnosis, as was the case in our patient. Surgical intervention is often required; however, our patient avoided major intervention and settled with parenteral antibiotics and washout of the joint.

Is a T-tube necessary after common bile duct exploration?

BACKGROUND: T-tube drainage used to be standard practice after surgical choledocholithotomy, but there is now a tendency in some centers to close the common bile duct (CBD) primarily. This study was designed to review the complications associated with T-tube drainage after CBD exploration and to determine whether primary closure of the bile duct reduces postoperative morbidity. METHODS: A retrospective audit was performed on patients undergoing CBD exploration between July 1997 and March 2007, who were identified from the theatre database of one teaching hospital. Intraoperative findings and postoperative complications were recorded from the clinical notes. RESULTS: During the study period, 158 patients (97 women; median age 65 (range, 25-90) years) underwent CBD exploration. A T-tube was inserted in 91 patients (group I) and the CBD was closed primarily in 67 (group II). One or more biliary complications occurred in 26 patients (16.5%): 20 (22.0%) in group I and 6 (8.9%) in group II (p = 0.03). In group I, 15 had a biliary leak (3 needed reoperation), 2 had accidental slippage of the tube, 2 an entrapped T-tube, and 1 a retained stone. In group II, six patients had biliary leakage, two of whom were re-explored. Six patients in group I also had peritubal infection, necessitating the use of antibiotics. There were three deaths: two in group I (1 T-tube-related) and 1 in group II (p = 1, not significant). CONCLUSION: There is a lower biliary complication rate associated with primary closure of the CBD than after T-tube drainage.