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 estimate the value of estrogen receptor (ER) in benign breast diseases and to find out if the response of benign breast diseases to danazol depends on the ER status of the tissue.

Design: Prospective study.

Setting: University hospital, India.

Material: Samples of tissue from benign breast lesions, 40 fibrocystic disease and 10 fibroadenomas.

Interventions: Enzyme immunoassay for the presence of cytosolic ER.

Main outcome measures: ER concentrations, and correlation with effect of treatment with danazol.

Results: Fibrocystic disease and fibroadenomas showed 30% and 40% ER positivity, respectively. The mean (SD) ER concentration was significantly higher in premenopausal than postmenopausal patients 14.75 (3.79) fmol/mgm compared with 6.2 (1.59) fmol/mg (p < 0.05). All ten patients with mastalgia who had ER-positive lesions (n = 26) responded to danazol, compared with 6 of 16 patients who had ER-negative lesions (p < 0.05). Lesions with diffuse fibrosis (n = 14) and five with lymphocytic infiltration on histology were all ER-negative.

Conclusion: The patients with ER positive breast disease responded better to danazol than patients with ER negative breast disease.

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 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.