Worldwide Techniques and Outcomes in Robot-assisted Minimally Invasive Esophagectomy (RAMIE): Results From the Multicenter International Registry.

Objective: This international multicenter study by the Upper GI International Robotic Association aimed to gain insight in current techniques and outcomes of RAMIE worldwide.

Background: Current evidence for RAMIE originates from single-center studies, which may not be generalizable to the international multicenter experience.

Methods: Twenty centers from Europe, Asia, North-America, and South-America participated from 2016 to 2019.

Laparoscopically assisted versus open oesophagectomy for patients with oesophageal cancer-the Randomised Oesophagectomy: Minimally Invasive or Open (ROMIO) study: protocol for a randomised controlled trial (RCT).

Introduction: Surgery (oesophagectomy), with neoadjuvant chemo(radio)therapy, is the main curative treatment for patients with oesophageal cancer. Several surgical approaches can be used to remove an oesophageal tumour. The Ivor Lewis (two-phase procedure) is usually used in the UK.

Portomesenteric venous thrombosis: A rare but probably under-reported complication of laparoscopic surgery: A case series.

Portomesenteric venous thrombosis (PMVT) is a rare but well-reported complication following laparoscopic surgery. We present three cases of PMVT following laparoscopic surgery. Our first case is a 71-year-old morbidly obese woman admitted for elective laparoscopic giant hiatus hernia (LGHH) repair.

Routine versus selective contrast imaging to identify the need for early re-intervention following laparoscopic fundoplication: A retrospective cohort study.

Background: The prompt recognition of complications is essential in reducing morbidity following anti-reflux surgery. Consequently, many centres employ a policy of routine post-operative contrast studies. The study aimed to examine whether routine contrast studies more effectively recognised early post-operative complications following anti-reflux surgery compared with selective use.

Is C-reactive protein a useful adjunct in selecting patients for emergency cholecystectomy by predicting severe/gangrenous cholecystitis?

Unlabelled: Gangrenous cholecystitis is difficult to diagnose clinically and carries risk of morbidity and mortality if not treated urgently. Complex scoring systems exist to predict the condition. C reactive protein may be a single independent predictor as suggested in this small study.

An assessment of radiologically inserted transoral and transgastric gastroduodenal stents to treat malignant gastric outlet obstruction.

Introduction: Self-expanding metallic stents (SEMS) are used to palliate malignant gastric outlet obstruction (GOO) and are useful in patients with limited life expectancy or severe medical comorbidity, which would preclude surgery. Stenting can be performed transorally or by a percutaneous transgastric technique. Our goal was to review the outcome of patients who underwent radiological SEMS insertion performed by a single consultant interventional radiologist.

Old is still gold.

Common bile duct injury is infrequent but a serious complication of cholecystectomy. Variable biliary anatomy has an increased risk of iatrogenic injury. Intraoperative cholangiogram can be performed to provide a clearer picture of biliary anatomy.

The use of biodegradable (SX-ELLA) oesophageal stents to treat dysphagia due to benign and malignant oesophageal disease.

Background: Biodegradable (BD) oesophageal stents have been available commercially only since 2008 and previous published research is limited. Our aim was to review the use of BD stents to treat dysphagia in benign or malignant oesophageal strictures.

Methods: Patients were identified from a prospective interventional radiological database.

Gallbladder perforation: case series and systematic review.

Background: Gallbladder perforation is a serious complication of acute cholecystitis. Its management has evolved considerably since its classification by Niemeier in 1934. This review summarises the evidence surrounding the natural progression of this condition and potential problems with Niemeier's classification, and proposes a management algorithm for the more complex type II perforation.

Peritonitis from an abdominal wall biloma: a unique reason to avoid prophylactic surgical drainage.

Prophylactic drainage of the peritoneal space after major surgery is widely practised despite evidence against its efficacy. We describe the case of a 56-year-old woman who underwent a converted cholecystectomy and whose correctly sited abdominal drain resulted in the formation of a biloma between the external and internal oblique musculature. Subsequent leakage from the biloma into the abdominal cavity presented as peritonitis days after surgery, necessitating an emergency laparotomy.

Quality of Life and Symptomatology Before and After Nissen Fundoplication.

Background: Post surgical quality of life (QOL) plays an important role in the decision making process for patients. This study evaluated the subjective opinion of those that underwent Nissen fundoplication to correct their symptoms of hiatus hernia. This study was to evaluate the quality of life and symptomatology before and after in those patients that underwent Nissen fundoplication over an 8-year period.

Angelchik prosthesis with oesophageal adenocarcinoma: our surgical approach.

The Angelchik prosthesis is an incomplete doughnut-shaped device composed of silicone elastomer used in the treatment of gastro-oesophageal reflux disease (GORD). It is used to encircle the lower oesophagus at the gastro-oesophageal junction (GOJ). The ease of the operation led to the insertion of over 25,000 such prostheses world-wide.

The surgical management of pancreaticoduodenal tumours in multiple endocrine neoplasia type 1.

A 48-year-old man was admitted under the care of urologists with acute renal failure and septicaemia secondary to pyelonephritis. Upon investigation, he was found to have renal stone disease secondary to a parathyroid adenoma. Further tests revealed high pituitary hormone and gastrin values, confirming the diagnosis of multiple endocrine neoplasia type 1 (MEN 1) and Zollinger-Ellison syndrome.

Management of gastrointestinal stromal tumours in the Imatinib era: a surgeon's perspective.

Background: Surgical resection has remained the mainstay of treatment of GIST with a 5-year-survival of 28-35%. Tyrosine kinase inhibitor (Imatinib) has revolutionised the treatment of these tumours. The current research is directed towards expanding the role of this drug in the treatment of GIST.

Jejunal perforation caused by a feeding jejunostomy tube: a case report.

Introduction: Percutaneous endoscopic gastrostomy and feeding jejunostomy are used for providing long-term nutritional support to patients with neurological disorders. Various mechanical complications of these procedures are described.

Case Presentation: We report a case of a 17-year-old boy with cerebral injury who had a percutaneous endoscopic gastrostomy tube changed to a feeding jejunostomy tube.

Effect of cyclic hormonal changes during normal menstrual cycle on esophageal motility.

Pregnancy has an inhibitory effect on motility of the gastrointestinal tract most likely related to increased levels of circulating female sex hormones. Similar fluctuations of hormones occur during the normal menstrual cycle, but to a much lesser degree. We studied the effect of these sequential hormonal changes on esophageal motility and acid exposure by performing an ambulatory esophageal motility/pH study (AEM/pH) during the follicular (days 2-4) and luteal phases [days 4-8 after the luteinizing hormone (LH) surge] of the menstrual cycle.

Different effects of an oral anticholinergic drug on gastroesophageal reflux in upright and supine position in normal, ambulant subjects: a pilot study.

Objective: There is controversy in the literature on the effects of anticholinergic drugs on gastroesophageal reflux. Our aim was to study more extensively the effects of an oral anticholinergic drug on esophageal motility and gastroesophageal reflux in normal ambulant subjects under different circumstances: upright, supine, fed, and fasted state.

Methods: Fifteen healthy subjects (seven men, eight women), mean age 34 yr (range, 22-61 yr) underwent randomized placebo-controlled 16-h evening and overnight ambulatory esophageal motility/pH study.

Globus sensation is associated with hypertensive upper esophageal sphincter but not with gastroesophageal reflux.

Globus sensation (globus) is best described as a constant feeling of a lump or fullness in the throat. Although the etiology of globus remains unclear, it has been attributed to a hypertensive upper esophageal sphincter (UES) resting pressure and to gastroesophageal reflux (GER). The aim of this study was, therefore, to determine if significant associations existed among globus, UES resting pressure, and GER.

Laparoscopic cholecystectomy under epidural anesthesia in patients with chronic respiratory disease.

Background: Laparoscopic cholecystectomy (LC) has become firmly established as a procedure of choice for gallstone disease. The procedure usually necessitates general anaesthesia and endotracheal intubation to prevent aspiration and respiratory embarrassment secondary to the induction of pneumoperitoneum. There is a paucity of data in the literature on the procedure being performed under regional (epidural) anaesthesia, especially in patients with coexisting pulmonary disease and pregnancy, who are deemed high risk for general anaesthesia.

Experimental study of acid burden and acute oesophagitis.

Background: The relationship of the pH of oesophageal refluxate and its pepsin content to injury of oesophageal mucosa remains unclear. A study was made of the earliest morphological alterations in the oesophageal mucosa secondary to varying concentrations of hydrochloric acid with or without pepsin.

Methods: Adult cats had varying concentrations of acid with and without 1 per cent porcine pepsin infused into the oesophagus through a paediatric feeding tube placed 5 cm above the oesophagogastric junction at a rate of 1 ml/min for 30 min.

Proximal and distal esophageal contractions have similar manometric features.

The human esophagus is composed of striated muscle proximally and of smooth muscle distally with a transition zone between the two. Striated muscle contracts much faster than smooth muscle. The change in pressure over time (dP/dt) of the contraction amplitude should therefore be higher in proximal than in distal esophagus, reflecting the presence of striated muscle proximally.

Comparison of lower oesophageal sphincter pressure measurement using circumferential vs unidirectional transducers.

Unlabelled: Average values from unidirectional (UND) transducers have traditionally been used in standard manometric evaluation of lower oesophageal sphincter pressures (LOSPs). A single circumferential (CMF) transducer has recently become popular. Our aim was to compare LOSP measurements made using the two techniques.

Evaluation of the antireflux mechanism following laparoscopic fundoplication.

Background: Laparoscopic Nissen fundoplication is an effective procedure for the treatment of gastro-oesophageal reflux disease (GORD), but the underlying motility mechanisms that explain the success of this operation remain unclear.

Methods: Twenty patients with a history of GORD underwent stationary oesophageal manometry and prolonged ambulatory pH monitoring, both before and 3 months after fundoplication.

Results: Eighteen patients were completely cured of reflux symptoms and stopped all antireflux medication after operation.