British Journal of Surgery

Fischer, J E

doi: 10.1046/j.1365-2168.2000.01457.xpmid: 10931013

Article PDF first page preview Close This content is only available as a PDF. © 2000 British Journal of Surgery Society Ltd This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © 2000 British Journal of Surgery Society Ltd

Rothmund, M; Fingerhut, A

doi: 10.1046/j.1365-2168.2000.01550.xpmid: 10931014

References 1 Garfield E , Willjams-Dorof A. Language use in national research: a citation analysis . Current Contents 1990 ; 33 : 5 – 17 . Google Scholar OpenURL Placeholder Text WorldCat 2 Rothmund M , Bartsch D, Lorenz W. Where should you publish your paper?. In: Troidl H et al. , eds. Surgical Research . Heidelberg : Springer , 1997 : 119 – 26 . Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC 3 International Committee of Medical Journal Editors. Uniform requirements for manuscripts to biomedical journals . N Engl J Med 1997 ; 336 : 309 – 15 . Crossref Search ADS PubMed WorldCat Article PDF first page preview Close This content is only available as a PDF. © 2000 British Journal of Surgery Society Ltd This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © 2000 British Journal of Surgery Society Ltd

doi: 10.1046/j.1365-2168.2000.01453.xpmid: 10931015

Article PDF first page preview Close This content is only available as a PDF. © 2000 British Journal of Surgery Society Ltd This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © 2000 British Journal of Surgery Society Ltd

Van Hee, R

doi: 10.1046/j.1365-2168.2000.01493.xpmid: 10931016

References 1 Périssat J , Collet D, Belliard R, Desplantez J, Magne E. Laparoscopic cholecystectomy: the state of the Art. A report on 700 consecutive cases . World J Surg 1992 ; 16 : 1074 – 82 . Google Scholar Crossref Search ADS PubMed WorldCat 2 Lezoche E , Paganini A, Guerrieri M, Carlei F, Lomanto D, Sottili M et al. Technique and results of routine dynamic cholangiography during 528 consecutive laparoscopic cholecystectomies . Surg Endosc 1994 ; 8 : 1143 – 7 . Google Scholar OpenURL Placeholder Text WorldCat 3 Cuschieri A , Shimi S, Banting S, Nathanson LK, Pietrabissa A. Intraoperative cholangiography during laparoscopic cholecystectomy. Routine vs selective policy . Surg Endosc 1994 ; 8 : 302 – 5 . Google Scholar Crossref Search ADS PubMed WorldCat 4 Rosenthal RJ , Rossi RL, Martin RF. Options and strategies for the management of choledocholithiasis . World J Surg 1998 ; 22 : 1125 – 32 . Google Scholar Crossref Search ADS PubMed WorldCat 5 Carroll BJ , Phillips EH, Rosenthal R, Gleishman S, Bray JF. One hundred consecutive laparoscopic cholangiograms. Results and conclusions . Surg Endosc 1996 ; 10 : 319 – 23 . Google Scholar Crossref Search ADS PubMed WorldCat 6 Voyles CR , Sanders DL, Hogan R. Common bile duct evaluation in the era of laparoscopic cholecystectomy: 1050 cases later . Ann Surg 1994 ; 219 : 744 – 52 . Google Scholar PubMed OpenURL Placeholder Text WorldCat 7 Ganguli SC , Pasha TM, Petersen BT. The evolving role of endoscopic retrograde cholangiography before and after cholecystectomy . Can J Gastroenterol 1998 ; 12 : 187 – 91 . Google Scholar Crossref Search ADS PubMed WorldCat Article PDF first page preview Close This content is only available as a PDF. © 2000 British Journal of Surgery Society Ltd This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © 2000 British Journal of Surgery Society Ltd

Manu, M; Buckels, J; Bramhall, S

doi: 10.1046/j.1365-2168.2000.01510.xpmid: 10931017

BackgroundPancreatic cancer is the fifth leading cause of cancer death in the Western world. Despite improvement in operative mortality rates, little impact has been made on overall 5-year survival. This review discusses the molecular changes peculiar to pancreatic cancer and how the use of molecular technology might affect detection, screening, diagnosis and treatment of the disease.MethodsA literature review was performed using the National Library of Medicine's Pubmed database; this was combined with ongoing work within the Queen Elizabeth Hospital, Birmingham.ResultsOver the past 20 years great strides have been made in our understanding of the molecular basis of disease. Advances in molecular biology are now reshaping how diseases are screened for, diagnosed, investigated and treated. In recent years collaboration between clinicians and basic scientists has revealed a unique pattern of genetic and molecular events in pancreatic cancer. This review discusses how these advances may impact on patients with this disease.ConclusionThe past decade has seen some improvement in outlook for patients with pancreatic cancer, but the ‘molecular age’ promises to deliver even better results.

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doi: 10.1046/j.1365-2168.2000.01539.xpmid: 10931018

BackgroundOpen tension-free methods of groin hernia repair have been widely adopted despite little rigorous evaluation.MethodsInformation was assimilated from all randomized or quasi-randomized trials comparing open mesh with open non-mesh methods to assess benefits and safety. Electronic databases were searched and members of the EU Hernia Trialists Collaboration consulted to identify trials. Prespecified data items were extracted from reports, and quantitative or, if not possible, qualitative meta-analysis was performed.ResultsFifteen eligible trials, which included 4005 participants, were identified. There were similar numbers of complications in each group, with few data to address short-term pain and length of stay in hospital. Return to usual activities was quicker in the mesh group for seven of ten trials (P not significant). There were fewer reported recurrences in the mesh groups: overall 21 (1·4 per cent) of 1513 versus 72 (4·4 per cent) of 1634 (odds ratio 0·39 (95 per cent confidence interval 0·25–0·59); P < 0·001).ConclusionAlthough the rigorous search maximized trial identification, formal meta-analysis was limited by the variation in trial reporting. Within the data available, mesh repair was associated with fewer recurrences.

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doi: 10.1046/j.1365-2168.2000.01540.xpmid: 10931019

BackgroundThe place of laparoscopic groin hernia repair remains controversial. Individual randomized controlled trials alone have not provided statistically reliable results when considering recurrence, potentially serious complications and chronic pain.MethodsA rigorous systematic review was performed of published data from all relevant randomized or quasi-randomized trials. Electronic databases were searched and members of the EU Hernia Trialists Collaboration consulted to identify trials. Prespecified data items were extracted from reports and, where possible, quantitative meta-analysis was performed.ResultsThirty-four published reports of eligible trials were included, involving 6804 participants. Sample sizes ranged from 20 to 1051, with follow-up from 6 weeks to 36 months. Duration of operation was longer in the laparoscopic groups (P < 0·001, Sign test). Operative complications were uncommon for both methods, but visceral and vascular injuries were more frequent in the laparoscopic group (4·7 per 1000 versus 1·1 per 1000). Postoperative pain was less among laparoscopic groups (P = 0·08). Length of hospital stay did not differ significantly between groups (P = 0·50), but return to usual activity was earlier for laparoscopic groups (P < 0·001). Chronic pain and numbness were reported for only a small minority of trials. Overall, recurrences did not differ between groups, but comparison of laparoscopic with open non-mesh repair favoured laparoscopic methods, significantly so for transabdominal preperitoneal repair (Peto odds ratio 0·56 (95 per cent confidence interval 0·33–0·93); P = 0·026).ConclusionAlthough the rigorous search maximized trial identification, variation in trial reporting made formal meta-analysis difficult. Laparoscopic repair was associated with less postoperative pain and more rapid return to normal activities, but it takes longer to perform and may increase the risk of rare, but serious, complications.

Misra, M C; Parshad, R

doi: 10.1046/j.1365-2168.2000.01448.xpmid: 10931020

BackgroundPatients with acute bleeding from internal haemorrhoids often have to be referred by the general practitioner to the surgeon for definitive treatment with invasive outpatient procedures. At the initial consultation, patients frequently seek postponement of immediate surgery to a more convenient time. Effective and rapid non-invasive control of acute bleeding could be of practical use in scheduling surgery to a time convenient to both patient and surgeon.MethodsIn a 90-day randomized, double-blind study treatment with a micronized purified flavonoid fraction (MPFF) was compared with placebo, in 100 outpatients who presented for treatment of acute internal haemorrhoids of less than 3 days' duration. The primary endpoint was cessation of bleeding on the third day of treatment.ResultsOf 50 patients randomized to each group, acute bleeding ceased by the third day in 40 (80 per cent) who received MPFF compared with 19 (38 per cent) who had placebo (P < 0·01). Mean(s.d.) duration of acute bleeding from onset to cessation of 4·9(1·6) days was 2·1 (95 per cent confidence interval 1·2–2·9) days less than that in patients receiving placebo (P < 0·01). Continued treatment in patients with no bleeding prevented a relapse in 30 of 47 patients, compared with 12 of 30 receiving placebo (P < 0·05).ConclusionPatients with acute internal haemorrhoids treated with MPFF had rapid cessation of bleeding and a reduced risk of relapse. This could be of value in the more convenient timing of treatment with invasive outpatient procedures.

Nilsson, G; Larsson, S; Johnsson, F

doi: 10.1046/j.1365-2168.2000.01471.xpmid: 10931021

BackgroundThere is a widespread belief that introduction of the laparoscopic technique in antireflux surgery has led to easier postoperative recovery. To test this hypothesis a prospective randomized clinical trial with blind evaluation was conducted between laparoscopic and open fundoplication.MethodsSixty patients with gastro-oesophageal reflux disease were randomized to open or laparoscopic 360° fundoplication. The type of operation was unknown to the patient and the evaluating nurses after operation.ResultsThe operating time was longer in the laparoscopy group, median 148 versus 109 min (P < 0·0001). The need for analgesics was less in the laparoscopically operated patients, 33·9 versus 67·5 mg morphine per total hospital stay (P < 0·001). There was no significant difference in postoperative nausea and vomiting. On the first day after operation patients in the laparoscopy group had better respiratory function: forced vital capacity 3·2 versus 2·2 litres (P = 0·004) and forced expiratory volume 2·6 versus 2·0 litres (P = 0·008). Postoperative hospital stay was shorter in the laparoscopic group, median (range) 3 (2–6) versus 3 (2–10) days (P = 0·021). No difference was found in the duration of sick leave.ConclusionLaparoscopic fundoplication was associated with a longer operating time, better respiratory function, less need for analgesics and a shorter hospital stay, while no reduction in the duration of postoperative sick leave was found compared with open surgery.

Tanaka, H; Hirohashi, K; Kubo, S; Shuto, T; Higaki, I; Kinoshita, H

doi: 10.1046/j.1365-2168.2000.01438.xpmid: 10931022

BackgroundPercutaneous transhepatic portal vein embolization (PTPE) increases the safety of subsequent major hepatectomy. The aim of this study was to determine the effect of PTPE on long-term prognosis after hepatectomy in patients with hepatocellular carcinoma (HCC).MethodsSeventy-one patients with HCC underwent right hepatectomy between 1984 and 1998. Preoperative PTPE was performed in 33 patients (group 1) and was not used in 38 patients (group 2). Outcome after operation was compared between the groups. The patients were further divided according to the median tumour diameter (cut-off 6 cm) and indocyanine green retention rate at 15 min (ICGR15) (cut-off 13 per cent).ResultsThe cumulative survival rate was significantly higher in group 1 than in group 2 in patients with an ICGR15 of at least 13 per cent. Tumour-free survival rates were similar in both groups. Of patients with tumour recurrence after right hepatectomy, those in group 1 were more frequently subjected to further treatment.ConclusionPreoperative PTPE improves the prognosis after right hepatectomy for HCC in patients with impaired hepatic function, although it does not prevent tumour recurrence.