​Author(s): Tomlinson, Robert
Source: Journal of perioperative practice; May 2018; vol. 28 (no. 5); p. 115-119
Publication Date: May 2018
Publication Type(s): Journal Article
PubMedID: 29734935
Abstract:Reacting to a never event is difficult and often embarrassing for staff involved. East Lancashire Hospitals NHS Trust has demonstrated that treating staff with respect after a never event, creates an open culture that encourages problem solving and service improvement. The approach has allowed learning to be shared and paved the way for the trust to be the first in the UK to launch the patient centric behavioural noise reduction strategy 'Below ten thousand'.

Author(s): Hajibandeh, S.; Deering, R.; McEleney, D.; Guirguis, J.; Dix, S.; Sreh, A.; Toner, E.; El Muntasar, A.; Kausar, A.; Sheikh, G.; OShea, D.; Shafiq, A.; Kelly, A.; Khan, A.; Arumugam, D.; Evan, A.; Evans, A
Source: Hernia; Apr 2018; vol. 22 (no. 2); p. 243-248
Publication Date: Apr 2018
Publication Type(s): Academic Journal
PubMedID: 29243213
Available  at Hernia -  from EBSCO (MEDLINE Complete)
Abstract:Objectives: To determine the baseline accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of routinely collected co-morbidity data in patients undergoing abdominal wall hernia repair.
Database: CINAHL

​Author(s): Topps A.R.; Barr S.P.; Pikoulas P.; Maxwell A.J.; Pritchard S.A.
Source: Annals of Surgical Oncology; Jan 2018; vol. 25 (no. 1); p. 148-153
Publication Date: Jan 2018
Publication Type(s): Article
Abstract:Background: Pre-operative ultrasound-guided needle sampling (UNS) of abnormal axillary lymph nodes in breast cancer can identify patients with axillary metastases and therefore rationalize patient care and inform decision-making. To obtain tissue diagnosis, UNS can be performed by either fine needle aspiration (FNA) or core needle biopsy (CNB). However, few studies have compared the sensitivity of these techniques and the majority show no difference. Methods: All node-positive patients (those with micro- and macrometastases but not isolated tumor cells) treated at a tertiary referral center between January 2012 and December 2015 were retrospectively identified from pathology records. The result of the first axillary UNS performed on each patient was compared with postoperative histopathology results. The UNS method used was according to individual radiologist preference. Results: A total of 215 patients underwent FNA (1 patient had bilateral breast cancer and underwent bilateral FNA), and 92 underwent CNB. Sensitivity of CNB was significantly higher than FNA (83.7 vs. 69.0%, P = 0.008). The false-negative rate in the FNA group was therefore higher than in the CNB group by a factor of 2.5. There was no difference in inadequacy rate between the two techniques. There were no complications in the FNA group, and only one hematoma (which did not require operative intervention) in the CNB group. Conclusions: CNB is safe and should be the preferred technique for UNS to improve sensitivity. Copyright © 2017, Society of Surgical Oncology.
Database: EMBASE

​Author(s): Hajibandeh S.; Khan R.M.A.; Malik S.; Mansour M.; Kausar A.; Subar D.
Source: International Journal of Surgery; Dec 2017; vol. 48 ; p. 1-8
Publication Date: Dec 2017
Publication Type(s): Review
Abstract:Background Controversy exists regarding the best anastomotic method for pancreaticoduodenectomy (PD). We aimed to evaluate the perioperative outcomes of PD with stapled anastomosis (SA) versus hand-sewn anastomosis (HA) of gastrojejunostomy or duodenojejunostomy. Methods We conducted a systematic search of electronic information sources, including MEDLINE; EMBASE; CINAHL; the Cochrane Central Register of Controlled Trials (CENTRAL); the World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; ISRCTN Register, and bibliographic reference lists. We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases. Delayed gastric emptying (DGE), postoperative pancreatic fistula (POPF), anastomotic bleeding, anastomotic leak, intra-abdominal abscess and mortality were defined as the outcome parameters. Combined overall effect sizes were calculated using fixed-effect or random-effects models. Results We identified 1 randomised controlled trial (RCT) and 5 observational studies reporting a total of 890 patients who underwent PD with SA (n = 300) or conventional HA (n = 590). Our analysis demonstrated that SA significantly reduced postoperative DGE (OR: 0.37, 95% CI 0.25-0.54, P Copyright © 2017
Database: EMBASE

​Author(s): Slawinski, C. G. V.; O'Reilly, D. A.
Source: British Journal of Hospital Medicine (17508460); Nov 2017; vol. 78 (no. 11)
Publication Date: Nov 2017
Publication Type(s): Academic Journal
Available  at British Journal of Hospital Medicine (17508460) -  from MAG Online Library
Abstract:The article discusses a practical guide for the management of the surgical emergency called acute pancreatitis, which covers the focus on early diagnosis and exclusion of differential diagnoses when making initial assessment and investigation, ensuring pain relief, and being clear on the goals of initial management.
Database: CINAHL

​Author(s): Barrie J.; Evans D.A.
Source: Colorectal Disease; Oct 2017; vol. 19 ; p. 37
Publication Date: Oct 2017
Publication Type(s): Conference Abstract
Available  at Colorectal Disease -  from Wiley Online Library Medicine and Nursing Collection 2018 - NHS
Abstract:Purpose: The management of locally advanced rectal tumours involves pre-operative long course chemo-radiotherapy, followed by resectional surgery. The aim of this study was to report the outcomes for patients with rectal cancer who fail to achieve a clinical complete response following this chemo-radiotherapy. Methods: This was a prospective cohort study of a consecutive series of a single surgeon (DAE). The study included 32 patients with rectal cancer who failed to achieve a clinical complete response presenting between October 2010 and February 2016. Demographics, performance status, pathology and clinical outcomes were recorded prospectively. Results: There were 32 patients (25 men and 7 women). The median age was 64 (IQR 39-78). Twenty-six patients underwent resectional surgery; three refused surgery. The thirty-day mortality rate was zero. Intra-operative tumour perforation occurred in one case. The permanent stoma rate was 75% (24/32). Six patients had a positive CRM (18%) and eight (25%) developed a local recurrence. Median follow- up was 37 months, during which time five patients died. Conclusions: Outcomes for patients who do not achieve a complete response are poor in terms of permanent stoma rate and positive margin. The extra delay introduced by the "wait and watch" programme may be a contributory factor.
Database: EMBASE

​Author(s): Barrie J.; Haque A.; Evans D.A.
Source: Colorectal Disease; Oct 2017; vol. 19 ; p. 34
Publication Date: Oct 2017
Publication Type(s): Conference Abstract
Available  at Colorectal Disease -  from Wiley Online Library Medicine and Nursing Collection 2018 - NHS
Abstract:Purpose: Extralevator abdominoperineal resection (ELAP) may be complicated by perineal wound problems. We report a consecutive series with selective use of a fasciocutaneous V-Y buttock advancement flap (BAF). Methods: Data were collected on consecutive patients undergoing ELAP for rectal cancer between August 2011 and March 2016. Demographics, management and outcomes were recorded prospectively. Perineal wound problems were considered 'major' if they required packing, otherwise being classed as 'minor'. Results: 28 patients (4 female, 24 male) underwent an ELAP. Median age was 65 (35-89). 27 had an adenocarcinoma, 1 had a malignant melanoma. 12 patients had a BAF. 19 received long-course pre-operative chemoradiotherapy. One patient received pre-operative contact radiotherapy (Papillon) and one contact radiotherapy with external beam radiotherapy. One patient had previously received radical radiotherapy for prostate cancer. Median tumour height (from the anal verge) was 30 mm (0-80). Median length of stay was 12 days (5-26). Median follow-up was 26 months (2-66). Minor wound breakdown occurred in 13. Two of the 12 patients having BAF had a major wound breakdown. One wound took 9 months to completely heal, the other is not yet healed (recent surgery). Of the 16 patients who did not have a BAF, one had a major wound breakdown which closed by 3 months. There were no perineal fistulae or chronic sinuses. There was one perineal hernia, repaired by perineal insertion of biologic mesh (Permacol)TM(Covidien, Dublin). Conclusion: Selective use of BAF in perineal closure can give good results in terms of healing and perineal hernia formation.
Database: EMBASE

​Author(s): Muntasar A.E.; Roy J.; Subar D.; Sheikh A.
Source: Colorectal Disease; Oct 2017; vol. 19 ; p. 57
Publication Date: Oct 2017
Publication Type(s): Conference Abstract
Available  at Colorectal Disease -  from Wiley Online Library Medicine and Nursing Collection 2018 - NHS
Abstract:Background: Abdominal closure with loss of tissue domain in the presence of enterocutaneous fistula, stoma or infection can be challenging. Increasing incidence of these herniae necessitates development of specialist units. We assessed the outcomes of components separation and complex abdominal wall reconstructions as a newly designed service in our unit. Methods: Data from prospectively held database was analysed from 2015 onwards when the service was set up. Patients were classified by the Ventral Hernia Working Group (VHWG) grading system. Primary endpoints were outcomes, reconstruction technique, length of stay in hospital, complications and recurrence. Secondary endpoints were service need and financial viability. Results: Ten reconstructive repairs (4 males, 6 females) were undertaken over the last year. Median age was 62 years and length of stay was 7 days. Median follow-up was 5 months (range 1-12 months). There were 9 grade III hernias and 1 grade IV hernia. All patients underwent component separation with sub and/or on-lay, synthetic mesh reinforcement (n = 2) or cross-linked porcine dermis reinforcement (n = 8). Wound infection was seen in 1 case, seroma formation in 2 cases. No early recurrence or return to theatre was demonstrable in our cohort. All patients were surveyed post procedure and rating of their outcomes was good/excellent. Conclusions: Components separation and reinforcement with biological mesh for grade III and IV hernias in our unit can be undertaken with outcomes comparable to high volume centres. Whilst service setup bears significant financial implications, patient satisfaction and outcomes of treatment in their local Trust are of paramount importance.
Database: EMBASE

​Author(s): Hajibandeh S.; Sreh A.; Khan A.; Subar D.; Jones L.
Source: Hernia; Oct 2017 ; p. 1-12
Publication Date: Oct 2017
Publication Type(s): Article In Press
Abstract:Objectives: To compare outcomes of laparoscopic repair to open repair of umbilical and paraumbilical hernias. Methods: We performed a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards. The review protocol was registered with International Prospective Register of Systematic Reviews (Registration Number: CRD42016052131). We conducted a search of electronic information sources, including MEDLINE; EMBASE; CINAHL; the Cochrane Central Register of Controlled Trials (CENTRAL); the World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; and ISRCTN Register, and bibliographic reference lists to identify all randomised controlled trials (RCTs) and observational studies comparing outcomes of laparoscopic repair to open repair of umbilical and paraumbilical hernias. We used the Cochrane risk of bias tool and the Newcastle-Ottawa scale to assess the risk of bias of RCTs and observational studies, respectively. Random effects models were applied to calculate pooled outcome data. Results: We identified three RCTs and seven retrospective cohort studies, enrolling a total of 16,549 patients. Our analyses indicated that open repair was associated with a higher risk of wound infection [Odds ratio (OR) 2.35, 95% CI 1.23-4.48, P = 0.010], wound dehiscence (OR 4.99, 95% CI 1.12-22.28, P = 0.04) and recurrence (OR 4.06, 95% CI 1.54-10.71, P = 0.005), longer length of hospital stay (MD 26.85, 95% CI 8.15-45.55, P = 0.005) and shorter operative time [Mean difference (MD) - 23.07, 95% CI - 36.78 to - 9.35, P = 0.0010] compared to laparoscopic repair. There was no difference in the risk of haematoma (OR 2.03, 95% CI 0.22-18.73, P = 0.53) or seroma (OR 0.67, 95% CI 0.19-2.32, P = 0.53) between the two groups. Conclusions: The best available evidence (randomised and non-randomised studies) suggests that laparoscopic repair of umbilical or paraumbilical hernias may be associated with a lower risk of wound infection, wound dehiscence and recurrence rate, shorter length of stay but longer operative time. Results from a limited number of RCTs showed no difference in recurrence rates. The quality of the best available evidence is moderate, and selection bias is the major concern due to non-randomised design in most of the available studies. Therefore, considering the level of available evidence, the most reliable approach for repair of umbilical or paraumbilical hernia should be based on surgeon's experience, clinical setting, patient's age and size, hernia defect size and anatomical characteristics. High quality RCTs are required.Copyright © 2017 Springer-Verlag France SAS
Database: EMBASE
 

Author(s): Hajibandeh S.; Deering R.; McEleney D.; Guirguis J.; Dix S.; Sreh A.; Kausar A.
Source: International Journal of Colorectal Disease; Sep 2017; vol. 32 (no. 9); p. 1341-1344

Publication Date: Sep 2017

Publication Type(s): Article

Abstract:Objectives: This paper aimed to determine the baseline accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of routinely collected comorbidity data in patients undergoing any types of colectomy. Methods: All patients aged >18 who underwent right hemicolectomy, left hemicolectomy, sigmoid colectomy, subtotal colectomy, or total colectomy between 1 January 2015 and 1 November 2016 were identified. The following comorbidities were considered: hypertension, ischemic heart disease (IHD), diabetes, asthma, chronic obstructive pulmonary disease (COPD), cerebrovascular disease (CVD), chronic kidney disease (CKD), and hypercholesterolemia. The comorbidity data from clinical notes were compared with corresponding data in hospital episode statistics (HES) database in order to calculate accuracy, sensitivity, specificity, PPV, and NPV of HES codes for comorbidities. In order to assess the agreement between clinical notes and HES data, we also calculated Cohen's kappa index value as a more robust measure of agreement. Results: Overall, 267 patients comprising 2136 comorbidity codes were included. Overall, HES codes for comorbidities in patients undergoing colectomy had substandard accuracy 94% (kappa 0.542), sensitivity (39%), and NPV (89%). The HES codes were 100% specific with PPV of 100%. The results were consistent when individual comorbidities were analyzed separately. Conclusions: Our results demonstrated that HES comorbidity codes in patients undergoing colectomy are specific with good positive predictive value; however, they have substandard accuracy, sensitivity, and negative predictive value. Better documentation of comorbidities in admission clerking proforma may help to improve the quality of source documents for coders, which in turn may improve the accuracy of coding.Copyright © 2017, Springer-Verlag Berlin Heidelberg.
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Database: EMBASE

Author(s): Hajibandeh S.; Garcia-Alamino J.; Weitzendorfer M.; Emmanuel K.; Muysoms F.; Granderath F.; Chalkiadakis G.; Antoniou S.; Antoniou G.; Gioumidou M.; Iliopoulou-Kosmadaki S.; Mathioudaki M.; Souliotis K.

Source: Surgical Endoscopy and Other Interventional Techniques; Jun 2017; vol. 31 (no. 2)

Publication Date: Jun 2017

Publication Type(s): Conference Abstract

Abstract:Aim: Single-incision laparoscopic surgery (SILS) is a novel concept, aiming at further minimizing abdominal wall trauma and improving cosmesis. Concerns have been raised about the risk of trocar site hernia following SILS. This study aims at assessing the comparative risk of trocar site hernia following SILS and conventional laparo-scopic surgery, and investigating whether current evidence is conclusive. Methods: We performed a systematic search of Medline, AMED, CINAHL, CENTRAL and OpenGrey. Randomized clinical trials of SILS and conventional laparoscopic surgery providing trocar-site hernia rates were considered for inclusion. Pooled odds ratios with 95% confidence intervals were calculated using the Mantel Haenszel method. Trial sequential analysis with the Land and DeMets approach was performed to assess the possibility of type I error and to compute the information size. Results: Twenty-three articles reporting on 2471 patients were included. SILS was associated with higher odds of trocar-site hernia compared to conventional laparoscopic surgery (odds ratio 2.37, 95% confidence interval 1.25-4.50, p=0.008). There was no evidence of between study heterogeneity or small study effects. The information size was calculated at 1687 patients and the Z-curve crossed the O'Brien Fleming alpha-spending boundaries at 1137 patients, which suggests that the evidence of higher risk of trocar-site hernia following SILS compared to conventional laparoscopic surgery can be considered conclusive. Conclusion: Single-incision laparoscopic procedures through the umbilicus are associated with a higher risk of trocar-site hernia compared to conventional laparoscopic surgery.
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Database: EMBASE

Author(s): Antoniou S.A.; Chalkiadakis G.E.; Granderath F.A.; Garcia-Alamino J.M.; Hajibandeh S.; Weitzendorfer M.; Emmanuel K.; Muysoms F.E.; Antoniou G.A.; Gioumidou M.; Iliopoulou-Kosmadaki S.; Mathioudaki M.; Souliotis K.

Source: Surgical Endoscopy and Other Interventional Techniques; Jul 2017 ; p. 1-10

Publication Date: Jul 2017

Publication Type(s): Article In Press

Abstract:Background: Single-incision laparoscopic surgery (SILS) is a new technique that aims to minimize abdominal wall trauma and improve cosmesis. Concerns have been raised about the risk of trocar-site hernia following SILS. This study aims to assess the risk of trocar-site hernia following SILS compared to conventional laparoscopic surgery, and investigate whether current evidence is conclusive. Methods: We performed a systematic search of MEDLINE, AMED, CINAHL, CENTRAL, and OpenGrey. We considered randomized clinical trials comparing the risk of trocar-site hernia with SILS and conventional laparoscopic surgery. Pooled odds ratios with 95% confidence intervals (CI) were calculated using the Mantel-Haenszel method. Trial sequential analysis using the Land and DeMets method was performed to assess the possibility of type I error and compute the information size. Results: Twenty-three articles reporting a total of 2471 patients were included. SILS was associated with higher odds of trocar-site hernia compared to conventional laparoscopic surgery (odds ratio 2.37, 95% CI 1.25-4.50, p = 0.008). There was no evidence of between-study heterogeneity or small-study effects. The information size was calculated at 1687 patients and the Z-curve crossed the O'Brien-Fleming alpha-spending boundaries at 1137 patients, suggesting that the evidence of higher risk of trocar-site hernia with SILS compared to conventional laparoscopic surgery can be considered conclusive. Conclusions: Single-incision laparoscopic procedures through the umbilicus are associated with a higher risk of trocar-site hernia compared to conventional laparoscopic surgery.Copyright © 2017 Springer Science+Business Media, LLC
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Database: EMBASE

Author(s): Stott M.C.; Barrie J.; Sebastien D.; Hammill C.; Subar D.A.

Source: Surgical Laparoscopy, Endoscopy and Percutaneous Techniques; Jul 2017

Publication Date: Jul 2017

Publication Type(s): Article In Press

Abstract:The laparoscopic approach has gained acceptance in the field of hepatopancreaticobiliary surgery. It offers several advantages including reduced blood loss, reduced postoperative pain, and shorter length of stay. However, long operating times can be associated with surgeon and assistant fatigue and image tremor. Robotic camera holders have been designed to overcome these drawbacks but may come with significant costs. The aim of this study was to economically evaluate their use compared with standard assistants using a single surgeon consecutive series of laparoscopic liver resections from January 2014 to May 2015. Only use of nurse assistants with no advanced training and postgraduate year 2 doctors were cheaper than utilization of the device. We suggest the use of a robotic camera holder is cost-beneficial and may have wider service and educational benefits.Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
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Database: EMBASE

Author(s): Antoniou S.A.; Chalkiadakis G.E.; Mavridis D.; Hajibandeh S.; Antoniou G.A.; Gorter R.; Tenhagen M.; Bonjer H.J.; Koutras C.; Pointner R.; Granderath F.A.; Fragiadakis G.F.; Philalithis A.E.

Source: Surgical Endoscopy and Other Interventional Techniques; Jun 2017; vol. 31 (no. 2)

Publication Date: Jun 2017

Publication Type(s): Conference Abstract

Abstract:Aim: To investigate the relative effectiveness and provide a treatment ranking of different options for securing the appendix stump in laparoscopic appendectomy. Methods: Electronic databases were searched to identify randomized controlled trials (RCTs) comparing ligation methods of the appendix including endoloop, laparoscopic suture, endoclip or endoscopic stapler to open appendectomy, single-incision appendectomy, needlescopic appendectomy, or conservative treatment. The primary outcomes were organ/space infection and superficial surgical site infection. We performed a network meta-analysis and we estimated the pairwise relative treatment effects of the competing interventions using the odds ratio (OR) and its 95% confidence interval (CI). We R) lot suggests f incosistency between direct and indirect comparisons. in erval plot suggests obtained a hierarchy of the competing interven-tions using rankograms and the surface under the cumulative ranking curve (SUCRA). Results: Forty-three RCTs were eligible and provided data for more than 5000 patients. Suture ligation appeared to be the most effective treatment strategy, in terms of both organ/space infection and superficial surgical site infection, according to the estimated relative effects and SUCRA values. Statistical significance was reached for the comparisons of clip vs. endoloop (OR 0.56, 95% CI 0.32 to 0.96) for organ/space infection; and suture vs. clip (OR 0.20, 95% CI 0.08 to 0.55) and clip vs. endoloop (OR 2.22, 95% CI 1.56 to 3.13) for superficial surgical site infection. There was considerable uncertainty on these outcomes, because the rarity of events generally resulted in wide interval estimates. Furthermore, the network was informed primarily by indirect treatment comparisons. However, there was no evidence of incosistency between direct and indirect comparisons, but this could be masked, due to the spareness of events. Conclusions: The use of suture ligation of the appendix in laparo-scopic appendectomy seems to be superior to other methods for the composite parameters of organ/space and superficial surgical site infection.
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Database: EMBASE

Author(s): Mirza A.; Pannu A.; Arumugam D.; Hajibandeh S.

Source: Surgical Endoscopy and Other Interventional Techniques; 2017; vol. 31

Publication Date: 2017

Publication Type(s): Conference Abstract

Abstract:Introduction: The evidence from observational studies suggests improved postoperative outcomes associated with laparoscopic sigmoidectomy for diverticular disease. Our objective was to conduct the first meta-analysis of randomized controlled trials (RCT's) to compare the outcomes of laparoscopic and open sigmoidectomy in patients with diverticular disease. Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards, we conducted a systematic search of electronic information sources, includingMEDLINE;EMBASE; CINAHL; CENTRAL; TheWorld Health Organization International Clinical Trials Registry; ClinicalTrials.gov; ISRCTN Register, and bibliographic reference lists. We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases. The overall morbidity, mortality, and postoperative complications were defined as the primary outcome parameters. Long-term complications and length of hospital stay were secondary outcomes. The combined overall effect sizes were calculated using fixed-effect or random-effects models. Results: We identified 3 RCT's comparing outcomes of elective laparoscopic and open sigmoidectomy for diverticular disease. Our pooled analysis of 360 patients demonstrated that laparoscopic sigmoidectomy does not significantly reduce risk of overall morbidity (Odd ratio (OR):0.91, 95% CI 0.69-1.21, p=0.53), anastomotic leak (OR: 0.74, 95% CI 0.28-1.93, p=0.54), intra-abdominal abscess (OR: 0.71, 95% CI 0.16-3.15, p=0.65), wound infection (OR:0.86, 95% CI 0.52-1.43, p=0.57), and mortality (OR:0.24, 95% CI 0.03-2.07, p=0.19) when compared to open approach. Moreover, no significant differences existed in the long-term complications such as incisional hernia (OR:1.06, 95% CI 0.40-2.82, p=0.90) and bowel obstruction (OR:0.51, 95% CI 0.14-1.87, p=0.31) between both groups. Low between-study heterogeneity existed in all analysis. The available data did not allow appropriate analysis of length of hospital stay. Conclusions: Unlike previous meta-analysis on observational studies, our analysis of RCTs did not find any improved short-term and long-term outcomes associated with laparoscopic sigmoidectomy compared to open approach in patients with diverticular disease. Undoubtedly, future high quality RCT's are required to provide stronger evidence as there is a limited number of high level studies with sufficient sample size.
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Database: EMBASE
 

Author(s): Mirza A.; Arumugam D.; Hajibandeh S.; Pannu A.

Source: Surgical Endoscopy and Other Interventional Techniques; 2017; vol. 31

Publication Date: 2017

Abstract:Introduction: Controversy exists regarding the role of laparoscopic peritoneal lavage in patients with perforated diverticulitis. Our objective was to conduct the first meta-analysis of randomized controlled trials (RCT's) to compare the outcomes of patient undergoing laparoscopic peritoneal lavage with sigmoidectomy in patients with perforated diverticulitis. Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards, we conducted a systematic search of electronic information sources, including MEDLINE; EMBASE; CINAHL; CENTRAL; The World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; ISRCTN Register and bibliographic reference lists. We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases. Overall morbidity, mortality, and postoperative complications were defined as the primary outcome parameters. Procedure time and length of hospital stay were secondary outcomes. The combined overall effect sizes were calculated using fixed-effect or random-effects models. Results: We identified 4 RCT's comparing outcomes of laparoscopic peritoneal lavage and open sigmoidectomy for perforated diverticulitis. All studies included only Hinchey grade III diverticulitis. The subsequent analysis, including 390 patients, demonstrated that that laparoscopic peritoneal lavage of perforated diverticulitis was associated with significantly increased rates of overall morbidity (OR: 1.30, 95% CI 1.07-1.57, p=0.007) and intra-abdominal abscess (OR: 3.10, 95% CI 1.71-5.63, p=0.0002) compared to sigmoidectomy. However, there was no significant difference in mortality (OR: 0.86, 95% CI 0.42-1.77, p=0.69) and re-operation (OR: 1.20, 95% CI 0.36-4.02, p=0.77) rates between the two groups. Between-study heterogeneity was non-significant in all analyses, except reoperation rate (I2=79%, p=0.002). The available data did not allow an appropriate analysis of length of hospital stay and other postoperative complications. Conclusions: Our analysis of randomised trials demonstrated that laparoscopic peritoneal lavage of perforated diverticulitis may lead to more adverse events than open sigmoid resection. Future high quality RCT's are indeed required to provide stronger evidence as no definitive conclusion can be drawn considering the limited number of available RCT'S.

​Database: EMBASE
 

Author(s): Athanasiou, Christos; Robinson, Jonathan; Yiasemidou, Marina; Lockwood, Sonia; Markides, Georgios A

Source: International journal of surgery (London, England); Mar 2017

Publication Type(s): Journal Article Review

Abstract:
BACKGROUND
Transverse colon malignancies have been excluded from all randomized controlled trials comparing laparoscopic against open colectomies, potentially due to the advanced laparoscopic skills required for dissecting around the middle colic vessels and the associated morbidity. Concerns have been expressed that the laparospopic approach may compromise the oncological clearance in transverse colon cancer. This study aimed to comprehensively compare the laparoscopic (LPA) to the open (OPA) approach by performing a meta-analysis of long and short term outcomes.METHODSMedline, Embase, Cochrane library, Scopus and Web of Knowledge databases were interrogated. Selected studies were critically appraised and the short-term morbidity and long term oncological outcomes were meta-analyzed. Sensitivity analysis according to the quality of the study, type of procedure (laparoscopic vs laparoscopically assisted) and level of lymphadenectomy was performed. Statistical heterogeneity and publication bias were also investigated.

RESULTS
Eleven case control trials (1415 patients) were included in the study. There was no difference between the LPA and the OPA in overall survival [Hazard Ratio (HR)=0.83 (0.56, 1.22); P=0.34], disease free survival (p=0.20), local recurrence (p=0.81) or distant metastases (p=0.24). LPA was found to have longer operative time [Weighted mean difference (WMD)=45.00 (29.48, 60.52);P<0.00001] with earlier establishment of oral intake [WMD=-1.68 (-1.84, -1.53);P<0.00001] and shorter hospital stay [WMD =-2.94 (-4.27, -1.62);P=0.0001]. No difference was found in relation to anastomotic leakage (p=0.39), intra-abdominal abscess (p=0.25), lymph nodes harvested (p=0.17).CONCLUSIONSLPA seems to be safe with equivalent oncological outcomes to OPA and better short term outcomes in selected patient populations. High quality Randomized control trials are required to further investigate the role of laparoscopy in transverse colon cancer.
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Database: Medline

Author(s): Jones P.; Ewan H.; Lane T.; Adshead J.; Vasdev N.; Rai B.P.

Source: Journal of Clinical Urology; Mar 2017; vol. 10 (no. 2); p. 148-153

Publication Type(s): Journal: Article

Abstract:Systematic reviews provide high-quality critical appraisal and evidence-based summaries on a topic. They represent a key resource for time-pressured clinicians as they strive to deliver better patient care. Robust methodology and adhering to rigorous standards forms the foundation of this type of article. As such, writing a systematic review can prove a great challenge. This article aims to provide an overview of the methodology as well as certain tips and tricks which will help the surgeon when taking on such a project. Copyright © 2016, © British Association of Urological Surgeons 2016.

Database: EMBASE

Author(s): Shapey, I M; Jabbar, S; Khan, Z; Nicholson, J E; Watson, R J

Source: Annals of the Royal College of Surgeons of England; Feb 2017; vol. 99 (no. 2); p. 123-128

Publication Date: Feb 2017

Publication Type(s): Journal Article

Available in full text at Annals of the Royal College of Surgeons of England 

Abstract:INTRODUCTION Mini-incision focused parathyroidectomy (MI-FP) is advocated as an alternative to bilateral neck exploration (BNE), owing to its reduced morbidity. The site and side of the affected gland is identified preoperatively using a combination of ultrasound and sestamibi scans. However, the acceptable degree of inter-scan concordance required to prompt MI-FP without compromising accuracy is undetermined. METHODS Accuracy of preoperative imaging was determined both individually and in combination for all parathyroidectomies (2007-2014). A grading system (excellent, good, poor) was devised to describe the interscan concordance, which was validated by the operative and histological findings. RESULTS Eighty-nine patients (17 male, 68 female) underwent parathyroidectomy (MI-FP 44, BNE 45). The accuracy of scans interpreted individually was 53% for ultrasound and 60% for sestamibi, with no difference according to surgical technique (P = 0.43, P = 1, respectively). The proportion of interscan concordance was: excellent - 35%, good - 40%, poor 25%. Combined accuracy was 100% for both excellent and good grades but only 13% for those graded poor. Similar rates of normocalcaemia were observed for MI-FP and BNE, while postoperative hypocalcaemia was five times higher in those undergoing BNE. CONCLUSIONS Reduction in the inter-scan concordance from excellent to good does not compromise accuracy. MI-FP could be successfully performed in up to 75% of patients - 25% higher than recommended in national guidelines. Focused parathyroidectomy does not compromise surgical and endocrinological outcomes but boasts a far superior complication rate.
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Database: Medline

Source: Annals of the Royal College of Surgeons of England; Sep 2016; vol. 98 (no. 7); p. e136

Publication Type(s): Journal Article

Author(s): Seager, A; Gill, M; Jones, L S

Abstract:A 27-year-old man with a background of well controlled colitis presented with a 12-hour history of central abdominal pain, nausea, vomiting and fever. A diagnostic laparoscopy revealed an extremely large, gangrenous appendix, which had descended into the pelvis posterior to adhesions in the right iliac fossa and was torted 720°. The decision was taken to convert to a lower midline laparotomy and as the base appeared healthy, a standard appendicectomy was performed. The patient recovered well and was discharged after two days. The appendix measured 104mm x 53mm x 51mm. Histology revealed acute haemorrhagic and necrotising appendicitis with foci of impending perforation. There was no malignancy or mucocoele. Acute torsion (or volvulus) of the appendix is an unusual cause of this common general surgical emergency.

Available in full text at Annals of the Royal College of Surgeons of England

Source: Annals of the Royal College of Surgeons of England; Nov 2016 ; p. e1

Publication Type(s): Journal Article

Author(s): Manson, H J; Goh, Y M; Goldsmith, P; Scott, P; Turner, P

Abstract:Congenital diaphragmatic hernia (CDH) usually presents in infancy with respiratory failure requiring urgent surgical correction. Mortality in this group of patients remains poor and persistent pulmonary hypertension is a significant contributor. It is therefore rare for patients to reach adulthood undiagnosed. CDH is often identified incidentally in adults but when symptoms arise, they relate to the organ involved, and include gastrointestinal symptoms of dyspepsia and obstruction, as well as respiratory complaints such as dyspnoea.

We present the case of a 30-year-old woman who was admitted with non-specific symptoms of upper abdominal discomfort but whose deteriorating condition culminated in a cardiac arrest, as an unreported presentation of CDH. The patient presented initially with severe left upper quadrant pain. Her chest x-ray on admission suggested a raised left hemidiaphragm. She went on to have computed tomography (CT) of the thorax and abdomen as well as oesophagogastroduodenoscopy, which raised the suspicion of diaphragmatic eventration. Repeat CT was performed after the patient collapsed on the ward five days following admission, revealing tracheal deviation, and a strangulated Bochdalek hernia containing stomach and spleen. After transfer to the anaesthetic room, she suffered a cardiac arrest.

Advanced life support was required to return spontaneous cardiac function. She was intubated and ventilated, and a needle thoracostomy was performed to decompress the tension gastrothorax. Emergency laparotomy revealed a gangrenous stomach and spleen. Total gastrectomy with primary Roux-en-Y reconstruction, splenectomy and insertion of a feeding jejunostomy were performed. The patient recovered well postoperatively and was discharged two weeks following surgery.

Available in full text at Annals of the Royal College of Surgeons of England