British Journal of Surgery

D Saraste, J Järås, A Martling
BACKGROUND: The aim was to evaluate differences in stage, treatment and prognosis in patients aged less than 50 years with colorectal cancer compared with older age groups. METHODS: This population-based study included all patients diagnosed with colorectal cancer in Sweden, 2010-2015. Disease stage, treatment, 5-year disease-free survival (DFS) and relative survival were analysed in relation to age groups: less than 50, 50-74 and at least 75 years. RESULTS: Of 34 434 patients included, 24·1, 19·7 and 14·0 per cent of patients aged less than 50, 50-74 and at least 75 years respectively were diagnosed with stage IV disease (P < 0·001)...
January 10, 2020: British Journal of Surgery
B Carter, J Law, J Hewitt, K L Parmar, J M Boyle, P Casey, I Maitra, L Pearce, S J Moug
BACKGROUND: Older adults undergoing emergency abdominal surgery have significantly poorer outcomes than younger adults. For those who survive, the level of care required on discharge from hospital is unknown and such information could guide decision-making. The ELF (Emergency Laparotomy and Frailty) study aimed to determine whether preoperative frailty in older adults was associated with increased dependence at the time of discharge. METHODS: The ELF study was a UK-wide multicentre prospective cohort study of older patients (65 years or more) undergoing emergency laparotomy during March and June 2017...
January 10, 2020: British Journal of Surgery
N Russolillo, L Aldrighetti, U Cillo, A Guglielmi, G M Ettorre, F Giuliante, V Mazzaferro, R Dalla Valle, L De Carlis, E Jovine, A Ferrero
BACKGROUND: This study aimed to assess the best achievable outcomes in laparoscopic liver resection (LLR) after risk adjustment based on surgical technical difficulty using a national registry. METHODS: LLRs registered in the Italian Group of Minimally Invasive Liver Surgery registry from November 2014 to March 2018 were considered. Benchmarks were calculated according to the Achievable Benchmark of Care (ABC™). LLRs at each centre were divided into three clusters (groups I, II and III) based on the Kawaguchi classification...
January 10, 2020: British Journal of Surgery
T Dalager, P T Jensen, J R Eriksen, H L Jakobsen, O Mogensen, K Søgaard
BACKGROUND: It is assumed that conventional laparoscopy (LAP) and robotic-assisted laparoscopic surgery (RALS) differ in terms of the surgeon's comfort. This study compared muscle workload, work posture and perceived physical exertion of surgeons performing LAP or RALS. METHODS: Colorectal surgeons with experience in advanced LAP and RALS performed one of each operation. Bipolar surface electromyography (EMG) recordings were made from forearm, shoulder and neck muscles, and expressed relative to EMG maximum (%EMGmax )...
January 10, 2020: British Journal of Surgery
N A Henriksen, A Montgomery, R Kaufmann, F Berrevoet, B East, J Fischer, W Hope, D Klassen, R Lorenz, Y Renard, M A Garcia Urena, M P Simons
BACKGROUND: Umbilical and epigastric hernia repairs are frequently performed surgical procedures with an expected low complication rate. Nevertheless, the optimal method of repair with best short- and long-term outcomes remains debatable. The aim was to develop guidelines for the treatment of umbilical and epigastric hernias. METHODS: The guideline group consisted of surgeons from Europe and North America including members from the European Hernia Society and the Americas Hernia Society...
January 9, 2020: British Journal of Surgery
C Maulat, J-M Regimbeau, E Buc, E Boleslawski, J Belghiti, J Hardwigsen, E Vibert, J-R Delpero, E Tournay, C Arnaud, B Suc, P Pessaux, F Muscari
BACKGROUND: Biliary fistula is one of the most common complications after hepatectomy. This study evaluated the effect of transcystic biliary drainage during hepatectomy on the occurrence of postoperative biliary fistula. METHODS: This multicentre RCT was carried out from 2009 to 2016 in nine centres. Patients were randomized to transcystic biliary drainage or no transcystic drainage (control). Patients underwent hepatectomy (more than 2 segments) of non-cirrhotic livers...
January 9, 2020: British Journal of Surgery
C Hobeika, D Fuks, F Cauchy, C Goumard, O Soubrane, B Gayet, E Salamé, D Cherqui, E Vibert, O Scatton, T Nomi, N Oudafal, T Kawai, S Komatsu, S Okumura, N Petrucciani, A Laurent, P Bucur, L Barbier, B Trechot, J Nunèz, M Tedeschi, M-A Allard, N Golse, O Ciacio, G Pittau, A Sa Cunha, R Adam, C Laurent, L Chiche, P Leourier, L Rebibo, J-M Regimbeau, L Ferre, F R Souche, J Chauvat, J-M Fabre, F Jehaes, K Mohkam, M Lesurtel, C Ducerf, J-Y Mabrut, T Hor, F Paye, P Balladur, B Suc, F Muscari, G Millet, M El Amrani, C Ratajczak, K Lecolle, E Boleslawski, S Truant, F-R Pruvot, A-R Kianmanesh, T Codjia, L Schwarz, E Girard, J Abba, C Letoublon, M Chirica, A Carmelo, C VanBrugghe, Z Cherkaoui, X Unterteiner, R Memeo, P Pessaux, E Buc, E Lermite, J Barbieux, M Bougard, U Marchese, J Ewald, O Turini, A Thobie, B Menahem, A Mulliri, J Lubrano, J Zemour, H Fagot, G Passot, E Gregoire, J Hardwigsen, Y-P le Treut, D Patrice
BACKGROUND: The aim was to analyse the impact of cirrhosis on short-term outcomes after laparoscopic liver resection (LLR) in a multicentre national cohort study. METHODS: This retrospective study included all patients undergoing LLR in 27 centres between 2000 and 2017. Cirrhosis was defined as F4 fibrosis on pathological examination. Short-term outcomes of patients with and without liver cirrhosis were compared after propensity score matching by centre volume, demographic and tumour characteristics, and extent of resection...
January 9, 2020: British Journal of Surgery
F Grass, M Hübner, K L Mathis, D Hahnloser, E J Dozois, S R Kelley, N Demartines, D W Larson
BACKGROUND: This study aimed to identify patients eligible for a 48-h stay after colorectal resection, to provide guidance for early discharge planning. METHODS: A bi-institutional retrospective cohort study was undertaken of consecutive patients undergoing major elective colorectal resection for benign or malignant pathology within a comprehensive enhanced recovery pathway between 2011 and 2017. Overall and severe (Clavien-Dindo grade IIIb or above) postoperative complication and readmission rates were compared between patients who were discharged within 48 h and those who had hospital stay of 48 h or more...
January 7, 2020: British Journal of Surgery
A Babber, R Ravikumar, S Onida, T R A Lane, A H Davies
BACKGROUND: Supervised exercise programmes for intermittent claudication have poor access and limited compliance. Neuromuscular electrical stimulation (NMES) may be an effective alternative. A proof-of-concept study and RCT were conducted. METHODS: In study 1, eligible patients underwent baseline assessment; treadmill testing for initial (ICD) and maximum (MCD) claudication distance; EuroQoL Five Dimensions five-level instrument (EQ-5D-5L™) and Intermittent Claudication Questionnaire (ICQ) assessment; and measurement of ultrasound haemodynamics of the superficial femoral artery...
January 7, 2020: British Journal of Surgery
S K Hyoju, C Adriaansens, K Wienholts, A Sharma, R Keskey, W Arnold, D van Dalen, N Gottel, N Hyman, A Zaborin, J Gilbert, H van Goor, O Zaborina, J C Alverdy
BACKGROUND: Both obesity and the presence of collagenolytic bacterial strains (Enterococcus faecalis) can increase the risk of anastomotic leak. The aim of this study was to determine whether mice chronically fed a high-fat Western-type diet (WD) develop anastomotic leak in association with altered microbiota, and whether this can be mitigated by a short course of standard chow diet (SD; low fat/high fibre) before surgery. METHODS: Male C57BL/6 mice were assigned to either SD or an obesogenic WD for 6 weeks followed by preoperative antibiotics and colonic anastomosis...
December 26, 2019: British Journal of Surgery
S G Parker, S Halligan, M K Liang, F E Muysoms, G L Adrales, A Boutall, A C de Beaux, U A Dietz, C M Divino, M T Hawn, T B Heniford, J P Hong, N Ibrahim, K M F Itani, L N Jorgensen, A Montgomery, S Morales-Conde, Y Renard, D L Sanders, N J Smart, J J Torkington, A C J Windsor
BACKGROUND: Nomenclature for mesh insertion during ventral hernia repair is inconsistent and confusing. Several terms, including 'inlay', 'sublay' and 'underlay', can refer to the same anatomical planes in the indexed literature. This frustrates comparisons of surgical practice and may invalidate meta-analyses comparing surgical outcomes. The aim of this study was to establish an international classification of abdominal wall planes. METHODS: A Delphi study was conducted involving 20 internationally recognized abdominal wall surgeons...
December 25, 2019: British Journal of Surgery
D S Umans, N D Hallensleben, R C Verdonk, S A W Bouwense, P Fockens, H C van Santvoort, R P Voermans, M G Besselink, M J Bruno, J E van Hooft
BACKGROUND: Occult biliary disease has been suggested as a frequent underlying cause of idiopathic acute pancreatitis (IAP). Cholecystectomy has been proposed as a strategy to prevent recurrent IAP. The aim of this systematic review was to determine the efficacy of cholecystectomy in reducing the risk of recurrent IAP. METHODS: PubMed, Embase and Cochrane Library databases were searched systematically for studies including patients with IAP treated by cholecystectomy, with data on recurrence of pancreatitis...
December 25, 2019: British Journal of Surgery
E A Vega, X De Aretxabala, W Qiao, T E Newhook, M Okuno, F Castillo, M Sanhueza, C Diaz, G Cavada, N Jarufe, C Munoz, G Rencoret, M Vivanco, K Joechle, C-W D Tzeng, J-N Vauthey, E Vinuela, C Conrad
BACKGROUND: The safety and oncological efficacy of laparoscopic re-resection of incidental gallbladder cancer have not been studied. This study aimed to compare laparoscopic with open re-resection of incidentally discovered gallbladder cancer while minimizing selection bias. METHODS: This was a multicentre retrospective observational cohort study of patients with incidental gallbladder cancer who underwent re-resection with curative intent at four centres between 2000 and 2017...
December 24, 2019: British Journal of Surgery
A Karachun, L Panaiotti, I Chernikovskiy, S Achkasov, Y Gevorkyan, N Savanovich, G Sharygin, L Markushin, O Sushkov, D Aleshin, D Shakhmatov, I Nazarov, I Muratov, O Maynovskaya, A Olkina, T Lankov, T Ovchinnikova, D Kharagezov, D Kaymakchi, A Milakin, A Petrov
BACKGROUND: It remains unclear whether extended lymphadenectomy provides oncological advantages in colorectal cancer. This multicentre RCT aimed to address this issue. METHODS: Patients with resectable primary colonic cancer were enrolled in four hospitals registered in the COLD trial, and randomized to D2 or D3 dissection in a 1 : 1 ratio. Data were analysed to assess the safety of D3 dissection. RESULTS: The study included the first 100 patients randomized in this ongoing trial...
December 24, 2019: British Journal of Surgery
J C Alverdy, N Hyman
An analysis of the results and conclusions from the most recent RCTs of the role of mechanical bowel preparation before colonic surgery is presented. The results indicate a wide disparity in the methods, results and conclusion of these studies, and the lack of microbial culture confirmation to advance understanding of how to move the field forward. Controversy on bowel preparation in colorectal surgery.
December 24, 2019: British Journal of Surgery
J Bollo, V Turrado, A Rabal, E Carrillo, I Gich, M C Martinez, P Hernandez, E Targarona
BACKGROUND: Several non-randomized and retrospective studies have suggested that intracorporeal anastomosis (IA) has advantages over extracorporeal anastomosis (EA) in laparoscopic right colectomy, but scientific evidence is lacking. The aim was to compare short-term outcomes and to define the possible benefits of IA compared with EA in elective laparoscopic right colectomy. METHODS: An RCT was conducted from May 2015 to June 2018. The primary endpoint was duration of hospital stay...
December 17, 2019: British Journal of Surgery
F Munck, E W Clausen, E Balslev, N Kroman, T F Tvedskov, E V Holm-Rasmussen
BACKGROUND: Ductal carcinoma in situ (DCIS) in the breast that is diagnosed by biopsy implies a risk of upstaging to invasive carcinoma (IC) on final pathology. These patients require a sentinel lymph node biopsy (SLNB) for axillary staging. A two-stage procedure is not always feasible and precise selection of patients who should be offered SLNB is crucial. The aims were: to determine the rate of upstaging, and use of redundant and required SLNB in women with a preoperative diagnosis of DCIS; and to identify patient and tumour characteristics that increase the risk of upstaging...
December 10, 2019: British Journal of Surgery
G K Ambler, C-A Waldron, U B Contractor, R J Hinchliffe, C P Twine
BACKGROUND: The literature on antiplatelet therapy for peripheral artery disease has historically been summarized inconsistently, leading to conflict between international guidelines. An umbrella review and meta-analysis was performed to summarize the literature, allow assessment of competing safety risks and clinical benefits, and identify weak areas for future research. METHODS: MEDLINE, Embase, DARE, PROSPERO and Cochrane databases were searched from inception until January 2019...
December 6, 2019: British Journal of Surgery
H H Wasmuth, A E Faerden, T Å Myklebust, F Pfeffer, S Norderval, R Riis, O C Olsen, J R Lambrecht, H Kørner, S G Larsen, H M Forsmo, O Baekkelund, S Lavik, J C Knapp, O Sjo, G Rashid
BACKGROUND: Transanal total mesorectal excision (TaTME) for rectal cancer has emerged as an alternative to the traditional abdominal approach. However, concerns have been raised about local recurrence. The aim of this study was to evaluate local recurrence after TaTME. Secondary aims included postoperative mortality, anastomotic leak and stoma rates. METHODS: Data on all patients who underwent TaTME were recorded and compared with those from national cohorts in the Norwegian Colorectal Cancer Registry (NCCR) and the Norwegian Registry for Gastrointestinal Surgery (NoRGast)...
December 5, 2019: British Journal of Surgery
E N Kirkham, B G Main, K J B Jones, J M Blazeby, N S Blencowe
BACKGROUND: Magnetic sphincter augmentation (MSA) is reported to be an innovative alternative to antireflux surgery for patients with gastro-oesophageal reflux disease. Although used in practice, little is known about how it has been evaluated. This study aimed to systematically summarize and appraise the reporting of MSA and its introduction into clinical practice, in the context of guidelines (such as IDEAL) for evaluating innovative surgical devices. METHODS: Systematic searches were used to identify all published studies reporting MSA insertion...
December 4, 2019: British Journal of Surgery
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