Single-centre review of the management of intra-thoracic oesophageal perforation in a tertiary oesophageal unit: paradigm shift, short- and long-term outcomes over 15 years.

Background: Oesophageal perforation is an uncommon surgical emergency associated with high morbidity and mortality. The timing and type of intervention is crucial and there has been a major paradigm shift towards minimal invasive management over the last 15 years. Herein, we review our management of spontaneous and iatrogenic oesophageal perforations and assess the short- and long-term outcomes.

Development of consensus-derived quality indicators for laparoscopic sleeve gastrectomy operative reports.

Background: Synoptic operative reporting has been used as a solution to the poor quality of narrative reports. The aim of this study was to develop operative report quality indicators for the laparoscopic sleeve gastrectomy and to generate parameters by which these reports can be evaluated and improved.

Methods: A Delphi protocol was used to determine quality indicators for LSG.

Ultrasound Guided Laparoscopic Port Placement in a Patient with Congenital Anomaly of IVC Undergoing Sleeve Gastrectomy.

We report a patient with obesity who underwent laparoscopic sleeve gastrectomy after pre-operative ultrasound mark up to enable safe port insertion due to presence of venous collaterals in the abdominal wall as a result of congenial IVC anomaly. This patient was falsely presumed to have NASH cirrhosis. Detailed preoperative workup ruled this out and led to the discovery of congenital IVC anomaly as the cause of engorged blood vessels in the anterior abdominal wall.

A systematic review of the effect of gastric pouch and/or gastrojejunostomy (stoma) size on weight loss outcomes with Roux-en-Y gastric bypass.

Background: The effect of the gastric pouch or Gastrojejunostomy (GJ or stoma) size on weight loss outcomes after Roux-en-Y gastric bypass (RYGB) is unclear with studies reporting conflicting results. The purpose of this systematic review was to determine the impact of the gastric pouch or stoma size on weight loss outcomes with RYGB.

Methods: An online search of PubMed was carried out to identify all articles evaluating the effect of the gastric pouch and/or gastric stoma size at the time of surgery on outcomes associated with RYGB.

Systematic Review and Meta-Analysis of Randomised Controlled Trials Comparing Long-Term Outcomes of Roux-En-Y Gastric Bypass and Sleeve Gastrectomy.

Introduction: Sleeve gastrectomy (SG) has overtaken Roux-En-Y gastric bypass (RYGB) as the most common bariatric procedure worldwide. However, there is little long-term data comparing the two procedures.

Objectives: We perform a systematic review and meta-analysis comparing 5-year outcomes of randomised controlled trials (RCTs) comparing RYGB and SG.

Effect of Roux-en-Y gastric bypass on pharmacologic dependence in obese patients with type 2 diabetes.

Background: More than half the diabetes-related health care costs in Canada relate to drug costs. We aimed to determine the effect of Roux-en-Y gastric bypass (RYGB) on the use of insulin and orally administered hypoglycemic medications in patients with diabetes. We also looked to determine overall cost savings with the procedure.

Factors Predicting Length of Stay Following Bariatric Surgery: Retrospective Review of a Single UK Tertiary Centre Experience.

Background: Laparoscopic Roux Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are the most commonly performed bariatric procedures. Improvement in techniques and perioperative management of patients have resulted in shorter hospital stay and reduced overall costs. Many post-operative protocols aspire to post-operative day 1 discharge with studies showing reduction in length of stay without increasing complications.

Systematic review and retrospective validation of prediction models for weight loss after bariatric surgery.

Background: Patients often have less than realistic expectations of the weight loss they are likely to achieve after bariatric surgery. It would be useful to have a well-validated prediction tool that could give patients a realistic estimate of their expected weight loss.

Objectives: To perform a systematic review of the literature to identify existing prediction models and attempt to validate these models.

Contribution of Malabsorption to Weight Loss After Roux-en-Y Gastric Bypass: a Systematic Review.

Roux-en-Y gastric bypass (RYGB) is traditionally classified as a combined restrictive and malabsorptive operation. This notion of the operation influences its technical variations and revisions for patients who do not achieve significant weight loss after this surgery. There is an increasing body of literature suggesting a role for appetite suppression mediated by neuro-hormonal signals after RYGB.

Systematic Review and Meta-Analysis of Outcomes After Revisional Bariatric Surgery Following a Failed Adjustable Gastric Band.

Introduction: Laparoscopic adjustable gastric band (LAGB)-related complications have been reported in significant numbers of patients often leading to band removal. Increasingly revisional bariatric surgery (RBS) is offered, most commonly either band to Roux-en-Y gastric bypass (B-RYGB) or band to sleeve gastrectomy (B-SG).

Objectives: We conducted a systematic review and meta-analysis of studies to evaluate the efficacy of RBS following failed LAGB.

Systematic Review and Meta-Analysis of Occupational Outcomes after Bariatric Surgery.

Introduction: Obesity has been linked with reduced productivity in the workplace and is associated with higher levels of unemployment and absenteeism. Studies have shown improvement in functioning and enhanced activity levels in patients after bariatric surgery.

Objectives: We perform a systematic review and meta-analysis of the literature to assess the impact of bariatric surgery on occupational outcomes.

Can clinical prediction tools predict the need for computed tomography in blunt abdominal? A systematic review.

Introduction: Blunt abdominal trauma is a common reason for admission to the Emergency Department. Early detection of injuries is an important goal but is often not straightforward as physical examination alone is not a good predictor of serious injury. Computed tomography (CT) has become the primary method for assessing the stable trauma patient.

Vein graft aneurysms following popliteal aneurysm repair are more common than we think.

True infrainguinal vein graft aneurysms are reported infrequently in the literature. We sought to identify the true incidence of these graft aneurysms after popliteal aneurysm repair and identify factors which may increase the risk of such aneurysms developing. Using a prospectively compiled database, we identified patients who underwent a popliteal aneurysm repair between January 1996 and January 2011 at a single district general hospital.

Multilevel bypass grafting: is it worth it?

Background: Traditionally, multilevel arterial disease has been treated with an inflow procedure only but simultaneous multilevel bypass graft procedures have been attempted. However, these procedures are potentially high risk. We report our single-center experience of performing multilevel bypass grafts over the last 15 years.

Massive gastric dilation complicating diabetic gastroparesis.

A middle-aged man presented at 4:00 with tense distended abdomen, severe pain and numb legs. His medical background included poorly controlled insulin-dependent diabetes. Abdominal x-ray showed a massively distended, featureless viscus on the left side of the abdomen thought to be a sigmoid volvulus.

Back to basics--cutting the cord on umbilical infections.

Introduction: Surgical site infections (SSIs) are a significant cause of postoperative morbidity with laparoscopic surgery associated with lower SSI rates. However, a departmental change in our unit to increased laparoscopic colorectal surgery resulted in increased wound infection rates at umbilical specimen extraction sites, the cause of which we attempted to elucidate.

Subjects And Methods: Prospectively collected data over an 18-month period (April 2008 to September 2009) for laparoscopic colorectal operations in a busy teaching hospital were retrospectively analysed, focusing on operation performed, whether pre-operative skin cleansing was employed, nature of specimen extraction excision, and rate of umbilical wound infection.

Meckel diverticulum causing small bowel obstruction.

A 62-year-old man was admitted with generalised abdominal pain, constipation and vomiting. His abdomen was markedly distended and tender on general examination with signs of local peritonism in the left iliac fossa. He was initially diagnosed with likely acute diverticulitis and treated conservatively.