Laparoscopic Cholecystectomy vs Endoscopic Retrograde Cholangiopancreatography With Sphincterotomy in Elderly Patients With Acute Gallstone Pancreatitis.

Background: Gallstone pancreatitis (GSP) is common in elderly patients and carries worse outcomes. Laparoscopic cholecystectomy (LC) is recommended for prevention of recurrent GSP. In frail populations, an endoscopic retrograde cholangiopancreatography with sphincterotomy (ERCP-s) is an alternative.

The impact of anticholinergic burden on clinical outcomes in older hospitalised surgical patients.

Polypharmacotherapy is an ever-increasing issue with an ageing patient population. Anticholinergic medications make up a large proportion of patient medication but cause significant side effects, contributing to well-documented issues within the older population and in hospital medicine. This review explores the documented impact of anticholinergic burden in older surgical patients on postoperative delirium, infection, length of stay and readmission, urinary retention, ileus and mortality.

The Impact of Depression in Patients Undergoing Emergency Abdominal Surgery: An Exploratory Study.

Background: Depression is associated with poorer outcomes in many disease states. However, its significance in abdominal surgery is unknown. This study investigated rates of depression in emergency abdominal surgery patients and its effects on outcomes.

A high-volume ERCP service led by surgeons is associated with good outcomes and meets national key performance indicators: results from a British district general hospital.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a common, but technically challenging procedure used in the management of hepatopancreaticobiliary (HPB) disease. It is traditionally performed by medical gastroenterologists. In 2014, the British Society of Gastroenterology (BSG) proposed key performance indicators to evaluate and set standards of ERCP practice.

Intraosseous access in the resuscitation of trauma patients: a literature review.

Purpose: Intraosseous (IO) catheters continue to be recommended in trauma resuscitation. Their utility has recently been debated due to concerns regarding inadequate flow rates during blood transfusion, and the potential for haemolysis. The objective of this review was to examine the evidence for intraosseous catheters in trauma resuscitation, and to highlight areas for future research.

The Laparoscopic Management of Median Arcuate Ligament Syndrome and Its Long-Term Outcomes.

Background: Case reports and small series of the surgical and radiological management of median arcuate ligament syndrome (MALS) have been described, however, long-term outcome data are lacking. The purpose of this study was to review our experience of the laparoscopic management of MALS, and describe the long-term outcomes after surgical intervention.

Methods: Data were collected between 2005 and 2016 in a single U.

Mechanisms Involved in Secondary Cardiac Dysfunction in Animal Models of Trauma and Hemorrhagic Shock.

Clinical evidence reveals the existence of a trauma-induced secondary cardiac injury (TISCI) that is associated with poor patient outcomes. The mechanisms leading to TISCI in injured patients are uncertain. Conversely, animal models of trauma hemorrhage have repeatedly demonstrated significant cardiac dysfunction following injury, and highlighted mechanisms through which this might occur.

Elderly patients have similar short term outcomes and five-year survival compared to younger patients after pancreaticoduodenectomy.

Background: Outcomes following pancreaticoduodenectomy (PD) in elderly patients in the United Kingdom (UK) remain uncertain. This study aimed to analyse peri-operative outcomes in the elderly, and investigate the impact of age on five-year survival following PD in a UK tertiary centre.

Materials And Methods: All patients who underwent PD in a single Hepatobiliary and Pancreatic unit in the UK between January 2007 to December 2015 were analysed from a prospectively collected database.

Mentored Trainees have Similar Short-Term Outcomes to a Consultant Trainer Following Laparoscopic Colorectal Resection.

Background: Laparoscopic colorectal surgery has a long learning curve. Using a modular-based training programme may shorten this. Concerns with laparoscopic surgery have been oncological compromise and poor surgical outcomes when training more junior surgeons.

CT screened arterial calcification as a risk factor for mortality after trauma.

Background: Arterial calcification on Computerised Tomography (CT) is a marker of cardiovascular disease. It is predictive of future adverse cardiac events and mortality in many disease states. The incidence of arterial disease and its impact on outcomes of the injured is not known.

Early changes within the lymphocyte population are associated with the development of multiple organ dysfunction syndrome in trauma patients.

Background: Early survival following severe injury has been improved with refined resuscitation strategies. Multiple organ dysfunction syndrome (MODS) is common among this fragile group of patients leading to prolonged hospital stay and late mortality. MODS after trauma is widely attributed to dysregulated inflammation but the precise mechanics of this response and its influence on organ injury are incompletely understood.

The influence of peri-operative factors for accelerated discharge following laparoscopic colorectal surgery when combined with an enhanced recovery after surgery (ERAS) pathway.

Introduction: Laparoscopic surgery is well established in the modern management of colorectal disease. More recently, enhanced recovery after surgery (ERAS) protocols have been introduced to further promote accelerated discharge and faster recovery. However, not all patients are suitable for early discharge.

Obese patients have similar short-term outcomes to non-obese in laparoscopic colorectal surgery.

Aim: To determine whether obese patients undergoing laparoscopic surgery within an enhanced recovery program had worse short-term outcomes.

Methods: A prospective study of consecutive patients undergoing laparoscopic colorectal resection was carried out between 2008 and 2011 in a single institution. Patients were divided in groups based on body mass index (BMI).

Admission biomarkers of trauma-induced secondary cardiac injury predict adverse cardiac events and are associated with plasma catecholamine levels.

Background: Secondary cardiac injury and dysfunction may be important contributors to poor outcomes in trauma patients, but the pathophysiology and clinical impact remain unclear. Early elevations in cardiac injury markers have been associated with the development of adverse cardiac events (ACEs), prolonged intensive care unit stays, and increased mortality. Studies of preinjury β-blocker use suggest a potential protective effect in critically ill trauma patients.

Damage control resuscitation using blood component therapy in standard doses has a limited effect on coagulopathy during trauma hemorrhage.

Objective: To determine the effectiveness of blood component therapy in the correction of trauma-induced coagulopathy during hemorrhage.

Background: Severe hemorrhage remains a leading cause of mortality in trauma. Damage control resuscitation strategies target trauma-induced coagulopathy (TIC) with the early delivery of high-dose blood components such as fresh frozen plasma (FFP) and platelet transfusions.

Trauma-induced secondary cardiac injury is associated with hyperacute elevations in inflammatory cytokines.

Introduction: Clinical evidence supports the existence of a trauma-induced secondary cardiac injury. Experimental research suggests inflammation as a possible mechanism. The study aimed to determine if there was an early association between inflammation and secondary cardiac injury in trauma patients.

A large ventricular septal defect complicating resuscitation after blunt trauma.

A young adult pedestrian was admitted to hospital after being hit by a car. On arrival to the Accident and Emergency Department, the patient was tachycardic, hypotensive, hypoxic, and acidotic with a Glasgow Coma Scale of 3. Despite initial interventions, the patient remained persistently hypotensive.

An assessment of between-recti distance and divarication in patients with and without abdominal aortic aneurysm.

Introduction: The study assessed whether there is a greater incidence of divarication of the recti and whether between-recti distance is greater in patients with abdominal aortic aneurysm (AAA).

Patients And Methods: The study consisted of two parts: a radiological and a clinical assessment. All patients with a confirmed AAA on computerised tomography were included and compared with patients in whom AAA was excluded with imaging.

Iatrogenic and non-iatrogenic vascular trauma in a district general hospital: a 21-year review.

Background: Vascular trauma is associated with significant mortality and severe complications. Vascular injuries in the UK are infrequent, although the exact incidence remains unknown. The objective of this article is to describe patients presenting with vascular trauma to one surgeon over 21 years in a British hospital.

Perforation of a sigmoid diverticulum presenting with a pneumoscrotum and surgical emphysema.

A case of a sigmoid perforation presenting as a pneumoscrotum with progressive surgical emphysema is reported. An elderly patient presented with a grossly swollen scrotum and a distended abdomen. A computed tomography (CT) scan demonstrated sigmoid diverticulitis in conjunction with air and a subdiaphragmatic collection.