Effect of the learning curve on survival after laparoscopic liver resection for colorectal metastases.

Background: Laparoscopic liver resection (LLR) is a highly demanding procedure with great variability. Previously published randomized trials have proven oncological safety of laparoscopic liver resection (LLR) as compared to open surgery. However, these were started after the learning curve (LC) was established.

Preoperative liver shrinking diet for bariatric surgery may impact wound healing: a randomized controlled trial.

Background: In bariatric surgery, preoperative very low-calorie diets (VLCD) may better meet the technical demands of surgery by shrinking the liver. However, diets may affect tissue healing and influence bowel anastomosis in an as-yet-undefined manner.

Objective: This randomized controlled trial aimed to examine the effect on collagen deposition in wounds in patients on a 4-week VLCD before laparoscopic gastric bypass.

Endobarrier as a Pre Bariatric Surgical Intervention in High-Risk Patients: a Feasibility Study.

Background: Obesity surgery mortality risk scoring system (OS-MRS) classifies patients into high, intermediate and low risk, based on age, body mass index, sex and other comorbidities such as hypertension and history of pulmonary embolism. High-risk patients not only have a higher mortality but are more likely to develop post-operative complications necessitating intervention or prolonged hospital stay following bariatric surgery. Endoscopically placed duodenal-jejunal bypass sleeve (Endobarrier) has been designed to achieve weight loss and improve glycaemic control in morbidly obese patients with clinically proven effectiveness.

Laparoscopy has a therapeutic role in the management of abdominal trauma: A matched-pair analysis.

Introduction: Laparoscopy is increasingly utilised as a diagnostic tool in management of abdominal trauma; however its role in therapeutic intervention remains unexplored. The aim of this study is to compare laparoscopy with laparotomy in the treatment of abdominal trauma in haemodynamically stable patients.

Methods: A review of patients undergoing surgery for abdominal trauma between January 2004-2014 identified 25 patients who underwent laparoscopy for therapeutic intervention (TL).

Staple Line Bleeding in Sleeve Gastrectomy-a Simple and Cost-Effective Solution.

Background: Staple line bleeding (SLB) is a common intraoperative complication following resection in laparoscopic sleeve gastrectomy (SG). Opinion is divided on the best measure to deal with SLB which includes expensive reinforcement strategies, suturing the staple line or diathermy. Tranexemic acid is a relatively inexpensive drug known to reduce bleeding in trauma and surgery.

What is the Mechanism Behind Weight Loss Maintenance with Gastric Bypass?

Obesity is an epidemic on the rise. With the failure of non-surgical strategies, bariatric surgery has emerged as the most effective therapeutic option for the treatment of severe obesity. Among various surgical options, Roux-en-Y gastric bypass (RYGB) results in sustained weight loss and profound metabolic improvements.

Two hundred seventy-five single-incision laparoscopic gastric band insertions: what have we learnt?

Single-incision surgery in the morbidly obese patient has not been widely adopted, but remains a popular choice amongst patients. In the bariatric patient, it presents its own surgical challenges with hepatomegaly and increased abdominal adiposity. Here, we present our experience of 275 single-incision laparoscopic gastric bands.

Rhabdomyolysis in bariatric surgery: a systematic review.

Background: Rhabdomyolysis (RML) is a rare complication of bariatric surgery. A systematic review was performed to identify risk factors and patient outcomes in morbidly obese patients undergoing bariatric surgery who develop RML.

Methods: A comprehensive search was performed between January 1990 and March 2012 using relevant MeSH terms.

Spleen-preserving distal pancreatectomy with and without splenic vessel ligation: a systematic review.

Background: Splenic preservation during a distal pancreatectomy (SPDP) may be performed with splenic vessel ligation, known as Warshaw's Technique (WT) or splenic vessel preservation (SVP). The consensus on which approach is best is divided. A systematic review of evidence in the literature was undertaken with the aim of analysing the merits and disadvantages of both WT and SVP.

Single and multiple incision laparoscopic adjustable gastric banding: a matched comparison.

Background: Single incision laparoscopic bariatric surgery has developed over the last few years, with single incision laparoscopic adjustable gastric banding (SILS-AGB) being performed most commonly. However, there are no randomised controlled trials and few matched studies comparing SILS-AGB to conventional laparoscopic multi-port multiport adjustable gastric banding (LAGB). Our aim was to study any differences in outcome and analgesic requirements between two matched groups of gastric band patients (SILS-AGB and LAGB).

Roundworm in a chest drain.

A 19 year old man who suffered a stab injury in the epigastric region and had a chest drain was referred to our accident and emergency department. A chest x-ray showed left sided opacities with fundic gas in the region of the left hemithorax.A roundworm was seen in the chest tube.

Enormous disfiguring thyroid swelling.

A 35 year old woman presented to us with a huge thyroid swelling (17 × 11 × 14 cm) in front of her neck which she had for the last 10 years. She was not toxic or dyspnoeic. It was multinodular with areas of firmness and cystic feeling.

Formalin instillation for uncontrolled radiation induced haemorrhagic proctitis.

Background: Radiation induced haemorrhagic proctitis is a well recognized complication of pelvic radiotherapy and its treatment is quite challenging.

Aim: To evaluate the efficacy of local instillation of 4% formalin in the management of uncontrolled radiation induced haemorrhagic proctitis.

Methods: This prospective study included twenty-three patients who underwent formalin instillation.

Episiotomy endometrioma masquerading as peri-anal sepsis: surgeons beware!

A 34-year-old woman with peri-anal pain and swelling was operated in the emergency setting assuming a diagnosis of a perianal abscess. No pus was revealed. Later magnetic resonance imaging (MRI) suggested induration and a mass effect in the peri-anal region.

Concomitant tuberculosis and carcinoma colon: coincidence or causal nexus?

Two rare cases of adenocarcinoma of the caecum and ascending colon concomitant with tuberculosis at the same site are reported. The plausibility of an aetiological relationship between the two pathological conditions has been discussed along with a review of the relevant literature. Tuberculosis complicating malignant disease is a diagnostic and therapeutic challenge; and the likelihood of the two occurring together should be kept in mind especially in tuberculosis endemic areas and in patients with equivocal symptoms.

Partial fistulotomy and multiple setons in high anal fistulae.

Setons are employed in high perianal fistulae. Our study aimed to use multiple setons in addition to a partial fistulotomy in high perianal fistulae involving the sphincter complex to combine the effects of cutting and drainage of the fistulous tract. This prospective study included 16 patients over a period of 4 years who presented with high perianal fistulae.