British Journal of Surgery

Lindholt, J S

doi: 10.1046/j.1365-2168.2001.01754.xpmid: 11350431

References 1 Lindholt JS . Considerations and experiences of screening for abdominal aortic aneurysms . PhD Thesis. Copenhagen : FADL's Forlag , 1998 . Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC 2 Wilson JMG , Jungner F. Principles and Practices of Screening for Disease. Public Health Papers no. 34 . Geneva : WHO , 1968 . Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC 3 Lindholt JS , Juul S, Henneberg EW, Fasting H. Is screening for abdominal aortic aneurysm acceptable for the population? Selection and recruitment for hospital-based screening for abdominal aortic aneurysm . J Public Health Med 1998 ; 20 : 211 – 17 . Google Scholar Crossref Search ADS PubMed WorldCat 4 Lindholt JS , Henneberg EW, Fasting H, Juul S. Mass or high-risk screening for abdominal aortic aneurysm . Br J Surg 1997 ; 84 : 40 – 2 . Google Scholar PubMed OpenURL Placeholder Text WorldCat 5 Lindholt JS , Vammen S, Juul S, Henneberg EW, Fasting H. The validity of ultrasonographic scanning as screening method for abdominal aortic aneurysm . Eur J Vasc Endovasc Surg 1999 ; 17 : 472 – 5 . Google Scholar Crossref Search ADS PubMed WorldCat 6 Lindholt JS , Vammen S, Juul S, Fasting H, Henneberg EW. Interval screening and surveillance of abdominal aortic aneurysms . Eur J Vasc Endovasc Surg 2000 ; 20 : 369 – 73 . Google Scholar Crossref Search ADS PubMed WorldCat 7 Lindholt JS , Vammen S, Fasting H, Henneberg EW. Psychological consequences of screening for abdominal aortic aneurysm and conservative treatment of small abdominal aortic aneurysms . Eur J Vasc Endovasc Surg 2000 ; 20 : 79 – 83 . Google Scholar Crossref Search ADS PubMed WorldCat 8 The UK Small Aneurysm Trial Participants . Health service costs and quality of life for early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms . Lancet 1998 ; 352 : 1656 – 60 . Crossref Search ADS PubMed WorldCat 9 Lederle FA , Johnson GR, Wilson SE, Littooy FN, Krupski WC, Bandyk D et al. Yield of repeated screening for abdominal aortic aneurysm after a 4-year interval. Aneurysm Detection and Management Veterans Affair Cooperative Study Investigators . Arch Intern Med 2000 ; 160 : 1117 – 21 . Google Scholar Crossref Search ADS PubMed WorldCat 10 The UK Small Aneurysm Trial Participants . Mortality results for randomised controlled trial of early elective surgery or ultrasonographic surveillance for small abdominal aortic aneurysms . Lancet 1998 ; 352 : 1649 – 55 . Crossref Search ADS PubMed WorldCat 11 Scott RA , Wilson NM, Ashton HA, Kay DN. Influence of screening on the incidence of ruptured abdominal aortic aneurysm: 5-year results of a randomized controlled study . Br J Surg 1995 ; 82 : 1066 – 70 . Google Scholar Crossref Search ADS PubMed WorldCat Article PDF first page preview Close This content is only available as a PDF. © 2001 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) © 2001 British Journal of Surgery Society Ltd

Balladur, P; Parc, R

doi: 10.1046/j.1365-2168.2001.01753.xpmid: 11350432

References 1 Scheele J , Stangl R, Altendorf-Hofmann A, Gall FP. Indicators of prognosis after hepatic resection for colorectal secondaries . Surgery 1991 ; 110 : 13 – 29 . Google Scholar PubMed OpenURL Placeholder Text WorldCat 2 Vogt P , Raab R, Ringe B, Pichlmayr R. Resection of synchronous liver metastases from colorectal cancer . World J Surg 1991 ; 15 : 62 – 7 . Google Scholar Crossref Search ADS PubMed WorldCat 3 Nordlinger B , Jaeck D, Balladur P, Guiguet M, Paris F, Schaal JC et al. Traitement des métastases hépatiques des cancers colorectaux. In: Rapport Association Francaise de Chirurgie (94 ème Congrès) . Paris : Springer , 1992 ; 141 – 75 . Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC 4 Elias D , Detroz B, Lasser P, Plaud B, Jerbi G. Is simultaneous hepatectomy and intestinal anastomosis safe? Am J Surg 1995 ; 169 : 254 – 60 . Google Scholar Crossref Search ADS PubMed WorldCat 5 Scheele J , Stangl R, Altendorf-Hofmann A. Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history . Br J Surg 1990 ; 77 : 1241 – 6 . Google Scholar Crossref Search ADS PubMed WorldCat Article PDF first page preview Close This content is only available as a PDF. © 2001 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) © 2001 British Journal of Surgery Society Ltd

Thomas, M L; Anthony, A A; Fosh, B G; Finch, J G; Maddern, G J

doi: 10.1046/j.1365-2168.2001.01733.xpmid: 11350433

BackgroundOesophageal pulsion diverticula, excluding pharyngeal types, are uncommon sequelae of oesophageal dysmotility. Current opinion favours myotomy as effective therapy, but the role of diverticulectomy, myotomy selection and placement, and the need for fundoplication remain unresolved.MethodsA Medline search and review of references identified relevant English language articles. Data on epidemiology, aetiology, oesophageal motility, pathology, symptomatology, investigations, surgical management and outcome were examined.ResultsData were largely retrospective. Significant morbidity and mortality were associated with pulmonary aspiration and diverticulectomy site leaks. Surgical outcome was similar whether or not a diverticulectomy was added to a myotomy, but a myotomy clearly reduced the risk of leaks. Fundoplication reduced the incidence of postcardiomyotomy reflux symptoms. Results from minimally invasive techniques were similar to those of open surgery.ConclusionSurgery should be reserved for symptomatic patients; asymptomatic patients may benefit from surveillance. Pulmonary aspiration mandates surgical intervention. Myotomy remains the mainstay of treatment and an adequate subdiverticular extension is crucial in relieving obstruction. A partial fundoplication is preferred in selected patients. Minimally invasive techniques should become the routine approach for oesophageal pulsion diverticula.

Langenhoff, B S; Krabbe, P F M; Wobbes, T; Ruers, T J M

doi: 10.1046/j.1365-2168.2001.01755.xpmid: 11350434

BackgroundThere is a growing interest in assessing the impact of a disease and the effect of a treatment on a patient's life, expressed as health-related quality of life (HRQoL). HRQoL assessment can provide essential outcome information for cancer surgery.MethodsThe core of this review is derived from a literature search of the Medline database.ResultsThree types of HRQoL instrument can be distinguished: generic, disease specific and symptom specific. There are criteria against which HRQoL instruments may be evaluated. The instrument chosen must be reliable, valid and sensitive to change.ConclusionHRQoL measurement may be useful in identifying the optimal surgical procedure. It may also be of help in deciding whether surgery in patients with limited life expectancy should still be considered. No HRQoL instrument fits all the recommended conditions or is suitable in all clinical situations. Using the appropriate instrument is essential to arrive at valid and clinically meaningful outcome measures.

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doi: 10.1046/j.1365-2168.2001.01768.xpmid: 11350435

BackgroundThis study was a pragmatic economic evaluation carried out alongside a multicentre randomized controlled trial comparing laparoscopic with open groin hernia repair. The primary economic evaluation framework employed was a cost–utility analysis.MethodsAt 26 hospitals in the UK and Ireland, 928 patients with a groin hernia were assigned randomly to laparoscopic or open repair. Cost data were identified and measured both within and outwith the trial. Cost data were combined with quality-adjusted life years (QALYs) from the EQ-5D questionnaire to obtain cost-per-QALY ratios.ResultsThe mean cost of laparoscopic hernia repair was £1112·64, compared with £788·79 for the open operation. The extra cost of £323·85 in the laparoscopic group was mainly due to additional theatre time and increased equipment and sterilization costs. The estimated incremental cost per QALY of the laparoscopic over the open method was £55 548·00 (95 per cent confidence interval £47 216·00–£63 885·00).ConclusionWhile the results show that a high cost was incurred to produce an additional QALY by using laparoscopic over open hernia repair, sensitivity analyses show that there are specific situations in which laparoscopic repair may be a viable alternative, such as when reusable equipment is employed.

Johnson, C D; Puntis, M; Davidson, N; Todd, S; Bryce, R

doi: 10.1046/j.0007-1323.2001.01770.xpmid: 11350436

BackgroundChemotherapy for pancreatic cancer offers small survival benefits and considerable side-effects. Unsaturated fatty acids have an antitumour effect in experimental studies; in phase II studies few side-effects were seen.MethodsIn this group-sequential, open-label, randomized study, 278 patients with a diagnosis of inoperable pancreatic cancer were treated with either oral (700 mg daily for 15 days), low-dose (0·28 g/kg) or high-dose (0·84 g/kg) intravenous lithium gamolenate (LiGLA). The primary endpoint was survival time from randomization using Kaplan–Meier estimates.ResultsMedian survival after oral and low-dose intravenous treatment was 129 and 121 days respectively. Median survival after high-dose intravenous treatment was 94 days. A good Karnofsky score and the absence of metastases were associated with increased survival. Haemolysis, a marker of rapid infusion, was associated with a median survival time of 249 days in the low-dose intravenous group.ConclusionOral or low-dose intravenous LiGLA led to survival times similar to those of other treatments for pancreatic cancer although one subgroup (low-dose intravenous LiGLA with haemolysis) had longer survival. High-dose intravenous treatment appeared to have an adverse effect. Systemic treatment with LiGLA cannot be recommended for the treatment of pancreatic cancer.

Ganio, E; Altomare, D F; Gabrielli, F; Milito, G; Canuti, S

doi: 10.1046/j.0007-1323.2001.01772.xpmid: 11350437

BackgroundThe aim of this study was to compare the results of conventional open haemorrhoidectomy as currently practised in Italy (group 1) with stapled haemorrhoidectomy using a 33-mm circular stapling device (group 2).MethodsOne hundred patients with symptomatic third- and fourth-degree haemorrhoids were enrolled by five hospitals. Patients were allocated to the two groups according to a centralized randomization scheme featuring five permutated blocks of 20. Preoperative clinical examination and anorectal manometry demonstrated no features of anal incontinence. Patients had a clinical and manometric re-evaluation after operation and were asked to complete a clinical diary. After a median of 16 (range 8–19) months patients were administered a standardized questionnaire by telephone.ResultsPostoperative bleeding requiring haemostatic procedures occurred in three patients in each group. Patients in group 1 complained of moderate pain for a median of 5·3 (range 0–19) days compared with 3·1 (range 0–10) days in group 2 (P = 0·01), while severe pain was present for 2·3 (range 0–24) days in group 1 but only for 1 (range 0–14) day in group 2 (P = 0·03). The median hospital stay was 2 days in group 1 compared with 1 day in group 2 (P = 0·01). In the early days after operation, patients in group 2 had greater difficulty in maintaining normal continence to liquid stools (P = 0·01), but after 30 days the continence score was better in group 2 (P = 0·04).ConclusionStapled haemorrhoidectomy is as effective as conventional haemorrhoidectomy. Reduced postoperative pain, shorter hospital stay and a trend toward earlier return to work suggest short-term advantages for the stapled technique.

Wakai, T; Shirai, Y; Yokoyama, N; Nagakura, S; Watanabe, H; Hatakeyama, K

doi: 10.1046/j.1365-2168.2001.01749.xpmid: 11350438

BackgroundThis study was designed to address whether gallbladder cancer invading the muscle layer (stage pT1b) is a local disease and whether radical resection is necessary.MethodsA retrospective analysis of 25 patients with pT1b gallbladder tumours, 13 of whom underwent simple cholecystectomy and 12 radical resection with regional lymph node dissection, was performed. A total of 147 regional lymph nodes was examined for metastasis. The median follow-up time was 95 months.ResultsNo patient had blood vessel or perineural invasion on histology. Lymphatic vessel invasion was seen in one patient. Both overt metastasis and micrometastases were absent in all lymph nodes examined. Overall 10-year survival was 87 per cent. The outcome after simple cholecystectomy was comparable to that after radical resection (P = 0.16). Two patients who underwent radical resection died from tumour relapse in distant sites.ConclusionMost pT1b gallbladder carcinomas spread only locally. Additional radical resection is not necessary when the depth of invasion of gallbladder carcinoma is limited to the muscle layer after simple cholecystectomy.

Kemppainen, E; Mayer, J; Puolakkainen, P; Raraty, M; Slavin, J; Neoptolemos, J P

doi: 10.1046/j.1365-2168.2001.01747.xpmid: 11350439

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Leung, K F; Chui, A K K; Leung, K L; Lai, P B S; Liew, C T; Lau, W Y

doi: 10.1046/j.1365-2168.2001.01750.xpmid: 11350440

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