George Kiroff

Laparoscopic adjustable gastric banding in the treatment of obesity: A systematic literature review

BACKGROUND We attempted to compare the safety and efficacy of laparoscopic adjustable gastric banding with vertical-banded gastroplasty and gastric bypass. Morbid obesity presents a serious health issue for Western countries, with a rising incidence and a strong association with increased mortality and serious comorbidities, such as diabetes, hyperlipidemia, and cardiovascular disease. Unfortunately, conservative treatment options have proven ineffective. Surgical interventions, such as vertical-banded gastroplasty (stomach stapling), Roux-en-Y gastric bypass, and, more recently, laparoscopic gastric banding have been developed with the aim of providing a laparoscopically placed device that is safe and effective in generating substantial weight loss. METHODS Electronic databases were systematically searched for references relating to obesity surgery by (1) laparoscopic adjustable gastric banding (LAGB), (2) vertical banded gastroplasty (VBG), and (3) Roux-en-Y gastric bypass (RYGB). RESULTS Only 6 studies reported comparative results for laparoscopic gastric banding and other surgical procedures. One study reported comparative results for all 3 surgical procedures, and this study was only of moderate quality. In total, 64 studies were found that reported results for LAGB and 57 studies reported results on the comparative procedures. LAGB was associated with a mean short-term mortality rate of approximately 0.05% and an overall median morbidity rate of approximately 11.3%, compared with 0.50% and 23.6% for RYGB, and 0.31% and 25.7% for VBG. Overall, all 3 procedures produced considerable weight loss in patients up to 4 years in the case of LAGB (the maximum follow-up available at the time of the review), and more than 10 years in the case of the comparator procedures. CONCLUSIONS The Australian Safety and Efficacy Register of New Interventional Procedures-Surgical Review Group concluded that the evidence base was of average quality up to 4 years for LAGB. Laparoscopic gastric banding is safer than VBG and RYGB, in terms of short-term mortality rates. LAGB is effective, at least up to 4 years, as are the comparator procedures. Up to 2 years, LAGB results in less weight loss than RYGB; from 2 to 4 years there is no significant difference between LAGB and RYGB, but the quality of data is only moderate. The long-term efficacy of LAGB remains unproven, and evaluation by randomized controlled trials is recommended to define its merits relative to the comparator procedures.

Publication bias in presentations o the Annual Scientific Congress

Background: Free papers presented to the Annual Scientific Congress (ASC) of the Royal Australasian College of Surgeons (RACS) were reviewed for the years 1994, 1995 and 1996. Reports were examined for evidence of publication bias.

Ultrasound-assisted lipoplasty.

Background: Ultrasound‐assisted lipoplasty (UAL) has been associated with particular types of complications and uncertain long‐term effects arising from interactions between ultrasonic energy and living tissue. The present review seeks to address these issues.

Comparative study on acute pancreatitis management

Background:  Guidelines have been published regarding the management of acute pancreatitis by the British Society of Gastroenterology (BSG). The aim of the present paper is to compare the management of patients with acute pancreatitis in a tertiary referral medical centre and a regional health centre in Australia during 2001, evaluate compliance with the published BSG guidelines, and compare our data with those of a similar UK study.

Domperidone, metoclopramide, and placebo: all give symptomatic improvement in gastroesophageal reflux

A double-blind crossover study was conducted of two gastric prokinetic drugs in 23 patients with gastroesophageal reflux. Patients were divided into two groups on the basis of a dual-isotope mixed-meal study of their gastric emptying (GE). Group I had normal GE and group II delayed GE. Nine gastrointestinal symptoms were assessed for frequency and severity before treatment. The trial had three 1-month treatment periods using metoclopramide 10 mg q.i.d., domperidone 20 mg q.i.d., or placebo on a random basis. Symptoms were reassessed at the end of each month. Taken as a whole, the group showed a significant symptomatic response in all three treatment periods (p less than 0.0001), but patients with delayed or normal GE did not differ significantly in their symptomatic response. Eleven patients complained of side effects with metoclopramide and three stopped therapy before the 1-month course was completed. Two patients described side effects with domperidone, including one woman with galactorrhea after 36 h of treatment. Three patients on placebo also complained of important side effects. We conclude that a significant placebo effect is present in the treatment of gastroesophageal reflux. No significant difference was demonstrated in symptomatic improvement between placebo, domperidone, and metoclopramide in this study.

Improvement of respiratory symptoms following laparoscopic Nissen fundoplication.

Background:  Laparoscopic fundoplication has become the standard of care for the management of symptomatic gastro‐oesophageal reflux disease (GORD). Although atypical and respiratory symptoms are frequently described in standard texts in association with reflux, the response of respiratory symptoms to management of GORD has not been extensively studied.

Computer‐based logbook for surgical registrars

Background: The documentation and monitoring of operative experience is an important component of advanced surgical training. The Royal Australasian College of Surgeons (RACS) monitors the adequacy of training by use of the surgical logbook. The logbook has been a paper‐based record that does not permit longitudinal evaluation of the progress of an individual trainee or comparison of different surgical units.

TISSUE COMPATIBILITY OF BIOMATERIALS: BENEFITS AND PROBLEMS OF SKIN BIOINTEGRATION

The integration of biomaterials with skin is necessary to enable infection‐free access to vasculature and body cavities. Also, integrating plastics and metals with skin increases options for the reconstruction of surgical and traumatic defects and enables the permanent implantation of robotic and electronic devices. Until now, attempts to integrate biomaterials with skin permanently have failed because of epidermal marsupialization and infection. This article reviews the general properties required of biomaterials to optimize integration with body tissues, the modifications that increase biocompatibility, focusing particularly on surface functionalization and the specific requirements for biomaterial integration into skin. Critical pathophysiological processes relating to biocompatibility are discussed with particular emphasis on the skin–biomaterial interface. Future directions are speculated on, in particular, the specific utility of subatmospheric pressure dressings in facilitating tissue integration into biomaterials.

Minimal residual marrow disease: Detection and significance of isolated tumour cells in bone marrow

Background: Detection of malignant cells in bone marrow and peripheral blood of patients with solid tumours at the time of surgery is increasingly emerging as a prognostic factor for disease progression and a way of monitoring adjuvant therapies. Furthermore, isolation and characterization of these cells provide insight into the early metastatic process, with potential therapeutic implications. This article reviews the current knowledge about the clinical significance of minimal residual marrow disease (MRMD) and its methods of detection, outlining some of their specific technical problems.

Australian and New Zealand Audit of Surgical Mortality: concordance between reported and audited clinical events and delays in management in surgical mortality patients

The Australian and New Zealand Audit of Surgical Mortality (ANZASM) is a nationwide confidential peer review of deaths associated with surgical care. This study assesses the concordance between treating surgeons and peer reviewers in reporting clinical events and delays in management.