Sheraz Markar

Hand-Sewn Versus Stapled Oesophago-gastric Anastomosis: Systematic Review and Meta-analysis

ObjectiveIn this meta-analysis, data from relevant randomised controlled trials has been pooled together to gain a consensus in the comparison of outcome following hand-sewn versus stapled oesophago-gastric (OG) anastomoses.MethodsMedline, Embase, Cochrane, trial registries, conference proceedings and reference lists were searched for randomised controlled trials comparing hand-sewn and stapled OG anastomoses. Primary outcome measures were 30-day mortality, anastomotic leakage and stricture. Secondary outcomes were operative time, cardiac complications and pulmonary complications.ResultsNine randomised trials were included in this meta-analysis. There was no significant difference between the groups for 30-day mortality (pooled odds ratio = 1.71; 95% CI = 0.822 to 3.56; P = 0.15) and anastomotic leakage (pooled odds ratio = 1.06; 95% CI = 0.62 to 1.80; P = 0.83). There was a significantly increased rate of anastomotic stricture associated with stapled OG anastomosis (pooled odds ratio = 1.76; 95% CI = 1.09 to 2.86; P = 0.02).DiscussionMeta-analysis of randomised controlled trials comparing hand-sewn with stapled OG anastomosis demonstrates that a stapled anastomosis is associated with a shorter operative time but with an increased rate of post-operative anastomotic stricture.

Systematic review and meta-analysis of laparoscopic Nissen fundoplication with or without division of the short gastric vessels.

The aim of this meta‐analysis was to provide a pooled analysis of individual trials comparing clinical outcome following laparoscopic Nissen fundoplication with or without division of the short gastric vessels (SGVs).

Influence of circular stapler diameter on postoperative stenosis after laparoscopic gastrojejunal anastomosis in morbid obesity

BACKGROUND The aim of the present study was to provide a pooled analysis of individual small trials comparing 21-mm and 25-mm circular stapled laparoscopic gastrojejunal (GJ) anastomosis in morbid obesity surgery. METHODS A systematic literature search of MEDLINE, Embase, and Cochrane library databases was performed to identify all relevant studies comparing 21-mm and 25-mm circular stapled laparoscopic GJ anastomosis in morbid obesity surgery. The primary outcomes were GJ stenosis and the interval to GJ stenosis. The secondary outcomes were the estimated weight loss, GJ diameter, and the number of endoscopic dilations. Pooled odds ratios were calculated for categorical outcomes and weighted mean differences for continuous outcomes. RESULTS Five trials were included, comprising 1217 patients (393 with 21-mm and 824 with 25-mm circular GJ anastomoses). The primary outcome analysis revealed a significantly increased incidence of intraluminal stenosis associated with the 21-mm circular stapler (pooled odds ratio 3.54; P < .0001). The secondary outcome analysis revealed a significantly reduced GJ anastomotic diameter on endoscopy with the 21-mm circular stapler group (weighted mean difference -1.67; P = .002). Statistical analysis revealed no significant difference between the groups for the interval to stenosis, number of endoscopic dilations, and estimated weight loss. CONCLUSION The results of the present pooled analysis have demonstrated a significantly increased incidence of symptomatic stenosis associated with the 21-mm circular stapler compared with the 25-mm stapler. This serves as evidence to validate the preferential selection of the 25-mm circular stapler for laparoscopic GJ bypass.

Robotic hip arthroscopy in human anatomy

Robotic technology offers technical advantages that might offer new solutions for hip arthroscopy.

Hepato-biliary Cystadenoma with Intraductal Extension: Unusual Cause of Obstructive Jaundice.

Hepatobiliary cystadenoma with mesenchymal stroma was first described as a distinct histopathologic entity by Wheeler et al. [1]. These potentially malignant tumours, representing a small proportion of all cystic lesions of the liver and biliary tract, occur more commonly in women of child-bearing age [2, 3]. Complete surgical excision is the recommended treatment in view of their malignant potential [2]. Histologically, these tumours are defined by a columnar or cuboidal epithelium, an intermediary subepithelial layer of mesenchymal or fusiform cells (ovarian-like stroma) and an external layer formed by a fibroconjunctive sheath that separates it from adjacent hepatic parenchyma, making a pseudocapsule [3]. Two distinct types are recognized depending on the presence or absence of mesenchymal “ovarian-type” stroma [3]. We present an interesting case of a female patient admitted with painless obstructive jaundice. Imaging and endoscopic retrograde cholangio-pancreatography (ERCP) revealed the presence of an obstructing endobiliary lesion with extension into the liver. Histology confirmed the lesion to be a mucinous cystadenoma of the liver with ovarian type stroma.

Cystic lesions of the pancreas: current trends in approach and management

The more frequent deployment of cross-sectional imaging for various abdominal conditions has resulted in an increased detection of cystic pancreatic lesions, particularly cystic pancreatic neoplasms. Cystic pancreatic lesions may be neoplastic or non-neoplastic. They may appear radiologically similar and often present a diagnostic dilemma; they need to be diagnosed and differentiated with accuracy in order to offer optimum treatment. Some of the cystic neoplasms are potentially malignant and have a wide spectrum of histological variation from the frankly benign ‘adenomas’ to invasive adenocarcinomas .When identified, these cystic lesions need a systematic work up and a diagnostic algorithm should be followed to its logical conclusion. This article reviews these cystic lesions of the pancreas, neoplastic and pseudocysts, and aims to update readers with the current trends in their diagnosis and management.

A comparative international study on the management of acute appendicitis between a developed country and a middle income country

BACKGROUND In the past decade there has been an exponential increase in the use of Computerised Tomography (CT) imaging in the assessment of patients with acute appendicitis. The aim of this study was to compare management approaches and clinical outcomes of acute appendicitis in Sri Lanka and the United Kingdom. METHODS Data was collected prospectively from 400 patients referred to the General Surgical department with a differential diagnosis of acute appendicitis, 200 at University Kelaniya Sri Lanka (SL group), and 200 at University College London Hospital (UK group). RESULTS The groups were similar with respect to gender, but the SL group was younger. Preoperative work-up included ultrasound more commonly in SL patients, and CT more commonly in UK patients. More patients underwent appendicectomy in the SL group, however a laparoscopic approach was utilised more often in the UK group (50.5% vs. 11.9%). Post-operative complications were similarly represented in both groups, but re-admission occurred with greater frequency in the UK group (16.2% vs. 0%). Histologically confirmed appendicitis was seen in a significantly greater proportion of SL patients (93.1% vs. 79.8%). Multivariate analysis confirmed male gender, and diagnosis and treatment in Sri Lanka to be only factors significantly associated with positive appendicitis. DISCUSSION Expensive investigations such as CT do not appear to improve the diagnostic accuracy of appendicitis or prevent complications. This study suggests diagnostic and treatment algorithms in the SL hospital are more accurate and efficient in confirming appendicitis than those seen in the UK hospital under investigation.

The Role of Integrated F-18-FDG-PET Scanning in the Detection of M1 Disease in Oesophageal Adenocarcinoma and Impact on Clinical Management

IntroductionThe aim of this study was to evaluate the efficacy of F-18-fluorodeoxyglucose positron emission tomography (FDG-PET) scanning in the staging of oesophageal adenocarcinoma.MethodsOne hundred four patients with biopsy-proven adenocarcinoma underwent 18F-FDG-PET scan. FDG avid lesions were further investigated to their diagnostic conclusion.ResultsNineteen patients (18.26%) were found to have non-loco-regional FDG uptake. Of the patients, 3.84% were found to have M1 disease and 7.69% were found to have a second primary tumour. The sensitivity and specificity of FDG-PET scanning to detect metastatic disease in our series was 57.14% and 84.53%, respectively. The overall diagnostic accuracy was 82.69%.ConclusionsPET scanning improves staging and prevents unnecessary surgery in patients with M1 disease. It represents a good adjunct to computed tomography scanning and endoscopic ultrasound in the staging of oesophageal adenocarcinoma. The detection of asymptomatic coexisting synchronous cancers is an added benefit provided by PET scanning over similar diagnostic modalities.