Laparoscopic Cholecystectomy with Intraoperative Cholangiogram and Antegrade Biliary Stenting in Acute Gallstone Pancreatitis: A Pilot Study.

To demonstrate feasibility and efficacy of simultaneous intraoperative cholangiogram (IOC) and antegrade biliary stenting (ABS) with laparoscopic cholecystectomy (LC) compared with preoperative biliary investigation and delayed LC in acute gallstone pancreatitis (AGP). A retrospective case-control study was performed comparing patients who had a simultaneous IOC ± ABS with LC at index admission with those who had delayed LC in the treatment of AGP. 74 patients were included in this study from January 2016 to October 2018.

Outcomes of removal of peritoneal dialysis catheter at the time of renal transplant.

There is no consensus regarding timing of peritoneal dialysis (PD) catheter removal following kidney transplant. We hypothesize that early removal of PD catheter reduces the risk of peritonitis. We conducted a prospective closed-loop audit to review existing practice in our department and determine whether a better strategy could be implemented.

Staggered Dual Kidney Transplantation.

We describe a case where a patient received a successful dual kidney transplantation in a staggered fashion. Two kidneys from a deceased donor were accepted for 2 separate primary intended recipients, however, due to unforeseen circumstances, both kidneys were eventually transplanted in a staggered fashion into an alternate single recipient. The intention behind this method was to enhance the patient's renal function and to prevent the wastage of a kidney.

Metastasectomy of pancreatic and periampullary adenocarcinoma to solid organ: The current evidence.

Purpose: Pancreatic and periampullary adenocarcinoma have not generally been included in the tumour types considered for metastasectomy. However, there is an increasing interest that metastasectomy in well-selected patients can prolong survival. This review aims to establish the recent evidence on the surgical management of oligometastatic disease and survival outcome in patients who underwent metastasectomy focusing on isolated hepatic and pulmonary metastases.

Minimally Invasive Fibrin Sealant Application in Pilonidal Sinus: A Comparative Study.

The aim of this study was to compare the filling of the pilonidal sinus tract with fibrin sealant (FS) against tract excision and primary closure (PC) as the primary procedure. Details of all patients who underwent treatment for a symptomatic first episode of pilonidal sinus disease between January 2011 and December 2015 were prospectively recorded in a custom database. Patients underwent PC (n=17) or FS (n=17) according to patient preference.

Registry report on prediction by Pocock cardiovascular score of cerebral microemboli acutely following carotid endarterectomy.

Background: Cerebral microemboli may lead to ischaemic neurological complications after carotid endarterectomy (CEA). The association between classical cardiovascular risk factors and acute cerebral microemboli following carotid surgery has not been studied. The aim of this study was to explore whether an established cardiovascular risk score (Pocock score) predicts the presence of cerebral microemboli acutely after CEA.

Avoiding emergency stoma surgery with the use of sugar.

George Theofanis, Mahmud Saedon, Soo Hua Kho, Francesk Mulita, Stylianos Germanos and Edmund Leung discuss the use of sugar as an aid to reducing a stomal prolapse.

ABCD risk score does not predict the presence of cerebral microemboli in patients with hyper-acute symptomatic critical carotid artery stenosis.

Introduction: ABCD risk score and cerebral microemboli detected by transcranial Doppler (TCD) have been separately shown to the predict risk of recurrent acute stroke. We studied whether ABCD risk score predicts cerebral microemboli in patients with hyper-acute symptomatic carotid artery stenosis.

Participants And Methods: We studied 206 patients presenting within 2 weeks of transient ischaemic attack or minor stroke and found to have critical carotid artery stenosis (≥50%).

A staged approach to treating oropharyngeal venous malformation.

We presented a staged approach to treating oropharyngeal venous malformation in Jehovah Witness patient.

Endovascular Versus Surgical Revascularization for the Management of Chronic Mesenteric Ischemia.

Background: Chronic mesenteric ischemia (CMI) can be treated with surgical revascularization (SR) or endovascular revascularization (ER).

Materials And Methods: Systematic review of 12 studies comparing ER and SR in CMI. Primary end point was perioperative (30 days) survival.

Risk stratification by pre-operative cardiopulmonary exercise testing improves outcomes following elective abdominal aortic aneurysm surgery: a cohort study.

Background: In 2009, the NHS evidence adoption center and National Institute for Health and Care Excellence (NICE) published a review of the use of endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs). They recommended the development of a risk-assessment tool to help identify AAA patients with greater or lesser risk of operative mortality and to contribute to mortality prediction.A low anaerobic threshold (AT), which is a reliable, objective measure of pre-operative cardiorespiratory fitness, as determined by pre-operative cardiopulmonary exercise testing (CPET) is associated with poor surgical outcomes for major abdominal surgery.

Acute kidney injury after endovascular repair of abdominal aortic aneurysm.

Acute kidney injury (AKI) after any type of intervention negatively impacts mortality, length of hospitalization, and perhaps long-term survival. In the case of endovascular aneurysm repair (EVAR), the incidence of AKI ranges from 1% to 23% for elective and emergency procedures and is lower compared to open repair. The pathophysiology of AKI in EVAR is complex: contrast-induced nephropathy, renal microembolization, and acute tubular necrosis are all implicated.

Temporal artery biopsy for giant cell arteritis: retrospective audit.

Objectives: Temporal artery biopsy (TAB) is performed in suspected cases of sight-threatening giant cell arteritis (GCA). We aimed to determine the feasibility of TAB in patients who are suspected of having GCA.

Design, Setting And Participants: A retrospective audit of all patients undergoing TAB at a single teaching hospital between 2005 and 2011, identified from the histopathology database.

Registry report on kinetics of rescue antiplatelet treatment to abolish cerebral microemboli after carotid endarterectomy.

Background And Purpose: Cerebral microemboli signals (MES) are associated with increased risk of acute stroke syndromes. We compared the effects on cerebral microemboli after carotid endarterectomy of tirofiban with dextran-40.

Methods: We used transcranial Doppler ultrasound to study transient MES acutely after carotid endarterectomy between August 2000 and December 2010 in 128 subjects refractory to preoperative antiplatelet treatment.

The role of feedback in improving the effectiveness of workplace based assessments: a systematic review.

Background: With recent emphasis placed on workplace based assessment (WBA) as a method of formative performance assessment, there is limited evidence in the current literature regarding the role of feedback in improving the effectiveness of WBA. The aim of this systematic review was to elucidate the impact of feedback on the effectiveness of WBA in postgraduate medical training.

Methods: Searches were conducted using the following bibliographic databases to identify original published studies related to WBA and the role of feedback: Medline (1950-December 2010), Embase (1980-December 2010) and Journals@Ovid (English language only, 1996-December 2010).

Opportunities for learning in the surgical workplace and how they can be exploited: a practical guide.

Training times and the working week have been shortened but the amount needed to be learned remains the same. This article demonstrates how trainees in surgery can incorporate learning opportunities into their normal working day.

Perioperative transorbital Doppler flow imaging offers an alternative to transcranial Doppler monitoring in those patients without a temporal bone acoustic window.

Transcranial Doppler has been used to identify microembolic signals before, during and after carotid endarterectomy, but 10% to 15% of patients are reported not to have suitable temporal bone window. The aim of this study was to assess the feasibility of transorbital Doppler monitoring of patients with absent temporal bone acoustic window. Between 2005 and 2008, those patients with absent temporal bone acoustic window were assessed for a transorbital acoustic window.

Control of presacral venous bleeding during rectal surgery.

Background: Presacral venous hemorrhage is an uncommon but potentially life-threatening complication of rectal surgery. It is difficult to control presacral venous hemorrhage with conventional hemostatic measures and several alternative methods for hemostasis have been proposed. We described our experience of using the combination of a hemostatic matrix and an absorbable hemostat as an alternative method of hemostasis.

Gallstone ileus one quarter of a century post cholecystectomy.

Gallstone ileus is a rare but potentially serious complication of cholelithiasis. It is usually preceded by history of biliary symptoms. It usually occurs as a result of a large gallstone creating and passing through a cholecysto-enteric fistula.

Is there a changing trend in surgical management of gastroesophageal reflux disease in children?

Gastroesophageal reflux disease (GORD) is a pathological process in infants manifesting as poor weight gain, signs of esophagitis, persistent respiratory symptoms and changes in neurobehaviour. It is currently estimated that approximately one in every 350 children will experience severe symptomatic gastroesophageal reflux necessitating surgical treatment. Surgery for GORD is currently one of the common major operations performed in infants and children.