European Journal of Surgery最新文献

Objective: To compare stapled haemorrhoidectomy with Milligan-Morgan haemorrhoidectomy.

Design: Prospective open study.

Setting: Teaching hospital, Greece.

Patients: 85 patients with prolapsing haemorrhoids were invited to choose between stapled and Milligan-Morgan haemorrhoidectomy. 48 chose the former and 37 the latter.

Interventions: Operation. Postoperatively, the patients were given analgesics on demand, and were discharged as soon as their condition and particularly their pain had improved.

Main outcome measures: Patients' symptoms and their opinion about the procedures, which were recorded during their follow-up which lasted for 6 months.

Results: Stapling resulted in a significantly shorter operating time, and less postoperative pain and other symptoms, than Milligan-Morgan excision (p < 0.001). Postoperative complications, and mean time in hospital did not differ significantly between the two groups. During the follow-up period there was no significant difference in the incidence of recurrences between the two groups. Six months after the operation, significantly more patients in the stapled group had residual skin tags-external haemorrhoids than in the Milligan-Morgan group, and all these patients had fourth degree haemorrhoids.

Conclusions: Stapled haemorrhoidectomy is a promising method of treatment for prolapsing third degree haemorrhoids. Its effectiveness is questionable for fourth degree ones. Initially, the results are as good as after Milligan-Morgan haemorrhoidectomy, especially for third degree haemorrhoids. However, more patients and longer follow-up periods are required for its long-term efficacy to be confirmed.

Objective: To establish the influence of the peritoneal sampling technique on the measurement of fibrinolytic capacity.

Design: Clinical study.

Setting: University hospital, Germany.

Subjects: 40 peritoneal biopsy specimens were taken from 10 patients who were having elective colorectal resections.

Interventions: Peritoneal biopsy specimens were taken either with a biopsy punch (n = 20) or manually with forceps and scissors (n = 20).

Main outcome measures: Extent of agreement in fibrinolytic activities between specimens taken with biopsy punch and manually. Major endpoint—peritoneal tissue plasminogen activator (t-PA) activity. Minor endpoints—peritoneal tissue plasminogen activator concentration, and concentration and activity of plasminogen activator inhibitior type 1 (PAI-1).

Results: Intra-assay agreement and the extent of agreement between the groups were evaluated by the method of Bland and Altman. Correlation of repeated measurements of t-PA and PAI-1 concentrations and activities from the same sample using the same ELISA kit was high (r = 0.93–0.99, p < 0.01). t-PA activities and concentrations between the groups correlated poorly (r = 0.60 and 0.66, p < 0.01) while no correlation at all was seen for PAI-1 concentration and activity between the groups (r = 0.6 and 0.1, p = 0.2 and 0.9). The mean differences between the groups ranged from −27% to −4.8%.

Conclusion: The sampling technique considerably affects the measurement of peritoneal fibrinolytic activity.

Objective: To evaluate our results of haemorrhoidectomy done as an outpatient procedure.

Design: Retrospective study.

Setting: University hospital Bratislava, Slovak Republic.

Subject: 256 patients who required haemorrhoidectomy in 1996–2001.

Interventions: Milligan-Morgan haemorrhoidectomy under local (0.5% lignocaine with adrenaline 1:200000, 100 ml) or epidural (0.5 bupivacaine, marcain, 20 ml; or 1% lignocaine, 20 ml).

Main outcome measures: Mortality, morbidity, need for admission to hospital, and acceptability to patients.

Results: No patient died. All patients were observed in the recovery room for 0.5–8 hours (mean 5 hours). 23 of the 256 patients (9%) developed minor complications including bleeding (n = 6), pain (n = 15), anal discharge (n = 1), and retention of urine (n = 1). 5 patients (2%) were admitted for pain or retention of urine. During the first 3 days after operation 29 patients required increased analgesia for discomfort. 223 patients (87%) were satisfied with outpatient treatment, while the remaining would have preferred to be admitted to hospital.

Conclusion: Day case haemorrhoidectomy is a safe and effective way of reducing costs without increasing morbidity, mortality, and is acceptable to most patients.

The following article from the European Journal of Surgery (incorporated into the British Journal of Surgery), ‘Prophylaxis of nausea and vomiting after laparoscopic cholecystectomy with ramosetron: randomised controlled trial’ by Y. Fujii, A. Uemura and H. Tanaka, has been retracted by agreement between the Joint Chief Editors, Professor Derek Alderson and Mr Jonothan J. Earnshaw, and John Wiley & Sons Ltd.

The retraction statement at http://onlinelibrary.wiley.com/doi/10.1002/bjs.9110/full

Objective: To report the urological complications after simultaneous renal and pancreatic transplantation.

Design: Retrospective study.

Setting: Teaching hospital, Italy.

Subjects: 143 consecutive patients having simultaneous renal and pancreatic transplantation by one of three techniques. 33 segmental pancreas with duct occlusion, 77 whole pancreas with bladder diversion, and 33 enteric diversion with systemic (n = 26) or portal venous drainage (n = 7). Urological complications were related to the pancreatic transplant, to the renal transplant, or unrelated to the transplant.

Main outcome measures: Morbidity.

Results: After occlusion of the duct and enteric diversion, there were no urological complications related to the pancreatic transplant. On the other hand, among the 77 patients with pancreatic drainage into the bladder, urological complications were common (56/77; 73%). Complications related to the renal transplant were recorded in 6/33 (18%), 26/77 (34%) and 12/33 (36%), respectively. Complications unrelated to the transplant occurred in 6/77 patients (8%) in the bladder drainage group. Five patients after bladder drainage required cystoenteric conversion.

Conclusions: Enteric diversion is a safe alternative to bladder diversion and results in significantly fewer urological complications.

Objective: To compare our results of open and laparoscopic mesh repair of incisional hernias.

Design: Retrospective cohort study.

Setting: Teaching hospitals, The Netherlands.

Subjects: All patients who had had a laparoscopic (n = 25) or an open (n = 76) mesh repair of incisional hernia between January 1996 and January 2000.

Interventions: Physical examination at the time of the study.

Main outcome measures: Morbidity and recurrence.

Results: The groups were comparable. 11 patients (14%) developed postoperative infections after open repair and 1 (4%) after laparoscopic repair (p = 0.29). Median hospital stay was 5 days (range 1–19) in the open group and 4 (range 1–11) in the laparoscopic group (p = 0.28). The 2-year cumulative incidence of recurrence was 18% after open repair (median follow-up of 17 months (range 1–46) and 15% after laparoscopic repair (median follow-up of 15 months, range 1–44). Recurrences in the laparoscopic group were all among the first 7 cases in which the mesh was fixed with staples alone.

Conclusion: There were fewer infections and hospital stay was shorter in the laparoscopic group, but not significantly so. Recurrence rates were comparable.

Objective: To investigate the effect of thalidomide given intraperitoneally on the formation of adhesions after colonic resection in rabbits.

Design: Controlled, randomised prospective study.

Setting: University hospital, Germany.

Animals: 40 female New Zealand White rabbits.

Interventions: After an end-to-end colonic anastomosis the animals were given thalidomide 200 mg/kg in 1% carboxymethylcellulose intraperitoneally or carboxymethylcellulose alone (n = 20 in each group).

Outcome measures: The adhesion score according to Tyrell on day 3 (n = 20) and day 7 (n = 20) postoperatively, weight, behaviour, and white cell count (WCC).

Results: There was no difference in behaviour or weight. On the third postoperative day WCCs and on the seventh postoperative day WCCs and adhesion scores, were lower in the thalidomide group (p < 0.01).

Conclusion: The number of postoperative adhesions was reduced in the group given thalidomide intraperitoneally. Our results suggest that thalidomide may be helpful in the prevention of postoperative adhesions.

Objective: To evaluate a simple working procedure for recording postoperative complications.

Design: Prospective cohort study.

Setting: Teaching hospital, Denmark.

Subjects: 218 of 312 patients who were operated on from March to July 1996.

Interventions: Follow up 30 days after operation by looking up the local register of complications, review of medical records and by structured telephone interview with the patient.

Main outcome measures: Morbidity.

Results: All the patients were recorded in the local register, showing a complication rate of 21% (n = 49). However the medical record and the telephone interview showed complication rates of 68 (31%) and 76 (33%), respectively.

Conclusion: It is possible to improve the quantity of the recording by a simplified working procedure, while the quality is still a challenge.