Understanding the influences on successful quality improvement in emergency general surgery: learning from the RCS Chole-QuIC project.

Background: Acute gallstone disease is the highest volume Emergency General Surgical presentation in the UK. Recent data indicate wide variations in the quality of care provided across the country, with national guidance for care delivery not implemented in most UK hospitals. Against this backdrop, the Royal College of Surgeons of England set up a 13-hospital quality improvement collaborative (Chole-QuIC) to support clinical teams to reduce time to surgery for patients with acute gallstone disease requiring emergency cholecystectomy.

Variation in laparoscopic anti-reflux surgery across England: a 5-year review.

Background: Laparoscopic anti-reflux surgery (LARS) remains central to the management of gastro-oesophageal reflux disease but the scale and variation in provision in England is unknown. The aims of this study were firstly to examine the processes and outcomes of anti-reflux surgery in England and compare them to national guidelines and secondly to explore potential variations in practice nationally and establish peer benchmarks.

Methods: All adult patients who underwent LARSin England during the Financial years FY 2011/2012-FY 2016/2017 were identified in the Surgeon's Workload Outcomes and Research Database (SWORD), which is based on the Hospital Episode Statistics (HES) data warehouse.

Critical review of the prognostic significance of pathological variables in patients undergoing resection for colorectal liver metastases.

Objective: The aim of this study was to identify prognostic factors, particularly pathological variables, that influence disease-free and overall survival following resection for colorectal liver metastases (CRLM).

Methods: Patients undergoing CRLM resection from January 2005 to December 2011 were included. Data analysed included information on demographics, laboratory results, operative findings, histopathological features and survival.

Outcomes in patients with indeterminate pulmonary nodules undergoing resection for colorectal liver metastases.

Objectives: This study aimed to assess outcomes in patients who underwent hepatic resection for colorectal liver metastases (CRLM) with subcentimetre indeterminate pulmonary nodules (IPN) and to devise a management pathway for these patients.

Methods: Patients undergoing CRLM resection from January 2006 to December 2010 were included. Survival differences following liver resection in patients with and without IPN were determined.

An international multicenter randomized controlled trial of G17DT in patients with pancreatic cancer.

Objectives: This study aimed to investigate G17DT, an immunogen producing neutralizing antibodies against the tumor growth factors amidated and glycine-extended forms of gastrin-17, in the treatment of pancreatic cancer.

Methods: A randomized, double-blind, placebo-controlled, group-sequential multicenter trial of G17DT in patients with advanced pancreatic cancer unsuitable for or unwilling to take chemotherapy. Inclusion criteria were a Karnofsky performance score of 60 or higher and a life expectancy of more than 2 months.

Scaffolds containing growth factors and extracellular matrix induce hepatocyte proliferation and cell migration in normal and regenerating rat liver.

Background & Aims: Intrahepatic drug delivery from implantable scaffolds is being developed as a strategy to modulate growth and enhance regeneration at the time of liver resection. In this study we examine the effects of scaffolds containing hepatocyte growth factor, epidermal growth factor, fibroblast growth factor 1, fibroblast growth factor 2, and liver-derived extracellular matrix (L-ECM) when implanted into normal and partially hepatectomized rat livers.

Methods: Scaffolds loaded with combinations of growth factors and L-ECM were implanted into normal livers (controls=L-ECM, polymer or sham) and livers following partial hepatectomy (controls=partial hepatectomy or sham).

Long-term outcome of laparoscopic Nissen and laparoscopic Toupet fundoplication for gastroesophageal reflux disease: a prospective, randomized trial.

Background: A prospective, randomized trial was performed to evaluate the long-term outcome and patient satisfaction of laparoscopic complete 360 degrees fundoplication compared with partial posterior 270 degrees fundoplication. Partial fundoplication is purported to have fewer side effects with a higher failure rate in controlling gastroesophageal reflux disease (GERD), while complete fundoplication is thought to result in more dysphagia and gas-related symptoms.

Methods: Patients were randomized to either laparoscopic Nissen (LN) or laparoscopic Toupet (LT) fundoplication.

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.

The pathological response to neoadjuvant chemotherapy with FOLFOX-4 for colorectal liver metastases: a comparative study.

FOLFOX-4 (folinic acid/5-fluorouracil/oxaliplatin) chemotherapy is used to treat patients with colorectal liver metastases. We aimed to assess hepatic histopathological responses to neoadjuvant FOLFOX-4 chemotherapy in patients with colorectal liver metastases. We selected all patients (n = 54) treated with FOLFOX-4 for colorectal liver metastases between June 2002 and June 2005.

The effect of hepatic vascular inflow occlusion on liver tissue pH, carbon dioxide, and oxygen partial pressures: defining the optimal clamp/release regime for intermittent portal clamping.

Background: The optimal duration of hepatic vascular inflow occlusion (Pringle maneuver) and reperfusion during liver resection are not defined. The aim of this study was to describe the changes that occur in liver tissue pH, partial pressure of carbon dioxide (P(L)CO(2)), and partial pressure of oxygen (P(L)O(2)) and by using the P(L)CO(2) as a predictor of hepatocellular damage define the optimal clamp/release regime for intermittent portal clamping during liver resection.

Methods: Continuous pH, P(L)CO(2), and P(L)O(2) measurements were obtained using a Paratrend multi-parameter sensor (Diametrics Medical Inc.

The position of the vermiform appendix at laparoscopy.

Background: The vermiform appendix has no constant position and the data on the variations in its position are limited. The aim of this study was to determine the frequency of the various positions of the appendix at laparoscopy.

Methods: Patients undergoing emergency or elective laparoscopy at a university teaching hospital between April and September 2004 were studied prospectively.

A prospective, randomized controlled trial comparing n-butyl cyanoacrylate tissue adhesive (LiquiBand) with sutures for skin closure after laparoscopic general surgical procedures.

The aim of this study was to compare the efficacy of n-butyl-cyanoacrylate tissue adhesive (Liquiband) with nonabsorbable monofilament sutures for laparoscopic port site closure. Adult patients having elective laparoscopic procedures were randomly allocated to wound closure with sutures or tissue adhesive. End points included skin closure time, wound dressing requirements, wound complications, and cosmesis, assessed at discharge, 4 to 6 weeks and 3 months.

Scaffolds for liver tissue engineering.

This review focuses on the expanding role for biomaterials and polymer scaffolds in liver tissue engineering. Studies are subdivided into in vitro and in vivo approaches. The in vitro section of the review discusses the challenges specific to liver tissue engineering, and how the choice of scaffold and its structure influences the success of the regenerative medicine strategy.

Percutaneous biliary metal wall stenting in malignant obstructive jaundice.

Background: Most patients with advanced stage malignant obstructive jaundice will be suitable for palliation only. Metallic stents are safe, effective and minimally invasive.

Design: A review of case notes of patients who had Wallstents inserted percutaneously from January 1996 to December 2000.

Magnetic resonance cholangiopancreatography versus endoscopic retrograde cholangiopancreatography in the diagnosis of choledocholithiasis.

Objective: Endoscopic retrograde cholangiopancreatography (ERCP) has become established as the gold standard in imaging of the biliary tree. Recently, magnetic resonance cholangiopancreatography (MRCP) has been introduced as a new, non-invasive imaging modality for the detection of bile-duct stones and other pathology related to the biliary tract and pancreas. The aim of this study was to determine how MRCP compared with ERCP in the diagnosis of choledocholithiasis.