Annals of The Royal College of Surgeons of England
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Published By The Royal College Of Surgeons Of England

1478-7083, 0035-8843

Author(s):  
K Nicoll ◽  
J Lucocq ◽  
T Khalil ◽  
M Khalil ◽  
H Watson ◽  
...  

Introduction We investigated all-cause mortality following emergency laparotomy at 1 and 5 years. We aimed to establish a basis from which to advise patients and relatives on long-term mortality. Methods Local data from a historical audit of emergency laparotomies from 2010 to 2012 were combined with National Emergency Laparotomy Audit (NELA) data from 2017 to 2020. Covariates collected included deprivation status, preoperative blood work, baseline renal function, age, American Society of Anesthesiologists (ASA) grade, operative time, anaesthetic time and gender. Associations between covariates and survival were determined using multivariate logistic regression and Kaplan–Meier analysis. We used patients undergoing laparoscopic cholecystectomy between 2015 and 2020 as controls. Results ASA grade was the best discriminator of long-term outcome following laparotomy (n=894) but was not a predictor of survival following cholecystectomy (n=1,834), with mortality being significantly greater in the laparotomy group. Following cholecystectomy, 95% confidence intervals for survival at 5 years were 98–99%. Following laparotomy these intervals were: ASA grade 1, 79–96%; ASA grade 2, 69–82%; ASA grade 3, 44–58%; ASA grade 4, 33–48%; and ASA grade 5, 4–51%. The majority of deaths (%) occurred after 30 days. Conclusions Emergency laparotomy is associated with a significantly increased risk of death in the following 5 years. The risk is strongly correlated to ASA. Thirty-day mortality estimation is not a good basis on which to advise patients and carers on long-term outcomes. ASA score can be used to predict long-term outcomes and to guide patient counsel.


Author(s):  
Lukoye Atwoli ◽  
Abdullah H. Baqui ◽  
Thomas Benfield ◽  
Raffaella Bosurgi ◽  
Fiona Godlee ◽  
...  
Keyword(s):  

Author(s):  
M Frountzas ◽  
N Karampetsou ◽  
C Nikolaou ◽  
D Schizas ◽  
D Tsapralis ◽  
...  

Introduction Combined heart and liver transplantation (CHLT) is one of the most complex procedures of surgery that has been implemented in the last 35 years. The aim of our meta-analysis was to investigate the safety and efficacy of CHLT. Materials The meta-analysis was designed according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) and AMSTAR (A MeaSurement Tool to Assess systematic Reviews) recommendations. A literature search was conducted up to April 2020 using the MEDLINE,® SCOPUS,® ClinicalTrials.gov, Embase™, Cochrane Central Register of Controlled Trials and Google Scholar™ databases. Results Our meta-analysis included 16 studies with 860 patients. The mortality rate following CHLT was 14.1%. One and five-year survival rates were 85.3% and 71.4% while the heart and liver rejection rates were 6.1% and 9.1% respectively. The hospital stay was 25.8 days and the intensive care unit stay was 9.9 days. Pooled values were also calculated for cardiopulmonary bypass duration, units of transfused red blood cells and fresh frozen plasma, postoperative infection rate, mechanical ventilation rate and follow-up duration. Conclusions Despite its complexity, CHLT is a safe and effective procedure for the management of lethal diseases that lead to progressive heart and/or liver failure. Nevertheless, there must be strict adherence to the indications for surgery, and future studies should compare CHLT with isolated cardiac and hepatic transplantations.


Author(s):  
DRL Morice ◽  
HA Elhassan ◽  
L Myint-Wilks ◽  
RE Barnett ◽  
A Rasheed ◽  
...  

Introduction Laryngopharyngeal reflux (LPR) is difficult to diagnose and treat owing to uncertainty relating to the underlying pathology. The initial management of LPR includes lifestyle modifications and oral medications. In patients who have failed to respond to proton pump inhibitor (PPI) therapy, anti-reflux surgery is considered; laparoscopic fundoplication is the surgery of choice. The primary aim of this review is to identify whether fundoplication is effective in improving signs and symptoms of LPR. The secondary aim is to identify whether patients who have had a poor response to PPIs are likely to have symptom improvement with surgery. The objective of the study is to establish the effect of laparoscopic fundoplication on the reflux symptom index score (RSI). Methods PubMed, Embase, Medline and Cochrane databases were used to search according to the PRISMA guidelines. Original articles assessing the efficacy of fundoplication in relieving symptoms of LPR were included. For each study, the efficacy endpoints and safety outcomes were recorded. Findings Nine studies from 844 initial records met the inclusion criteria: one prospective case control study, one retrospective case–control study, four prospective case series and three retrospective case series involving 287 fundoplications. All nine studies found fundoplication to be effective in improving symptoms of LPR (p < 0.05). Conclusion Current evidence suggests laparoscopic fundoplication is an effective treatment for LPR and should be considered if medical management is unsuccessful.


Author(s):  
S Kotecha ◽  
MA Williams ◽  
H Branford White ◽  
J Graystone ◽  
M Gibbons ◽  
...  

Author(s):  
BLK Wong ◽  
AB Addison ◽  
CE Swords ◽  
S Patil

A 62-year old woman presented with a 1-month history of left otalgia, facial palsy and hearing loss. She had a background of non-insulin-dependent diabetes mellitus and stage 2 endometrial adenocarcinoma, treated 18 months ago. Computed tomography scan showed erosion of the skull base and temporal bone. She was referred to the otolaryngology team with a diagnosis of necrotising otitis externa. On clinical examination, there was an exophytic, necrotic lesion in the ear canal arising from the posterior canal wall. A subsequent magnetic resonance imaging scan showed a lesion located in the left jugular foramen extending into the middle ear, with characteristics consistent with a glomus jugulo-tympanicum. Interestingly, histology of the lesion showed malignant cells with immunohistochemical staining suggestive of an adenocarcinoma. This is the first reported case of metastatic endometrial carcinoma involving the jugular foramen and temporal bone. Although a diagnosis is rare, it is important to consider it when other differential diagnoses are not fitting. Imaging should always be interpreted with caution, correlating to the clinical findings.


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