Spanish translation sectiondoi: 10.1002/bjs.11165pmid: 30811049
Article PDF first page preview Close This content is only available as a PDF. © 2019 BJS Society Ltd. Published by John Wiley & Sons 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) © 2019 BJS Society Ltd. Published by John Wiley & Sons Ltd
This month on Twitterdoi: 10.1002/bjs.11170pmid: 30811052
January was a busy month for BJS, with publication of both the monthly issue, and the much-anticipated special issue on Global Surgery, which is available free online. @bjsurgery generated 367 600 impressions, 954 retweets and 1400 likes in January, and reached 19 000 followers. The January issue attracted some thoughtful comments. @JamesAshcroftMD shared Hüttner et al.'s systematic review of RCTs in pancreatic surgery, explaining how it highlighted the importance of publishing protocols and randomization information1. Elfeki et al.'s paper on quality of life after bowel surgery sparked an important conversation about care following colorectal operations2. @DrEdFitzGerald described the Global Surgery issue as a landmark, ‘no longer the neglected stepchild of #GlobalHealth’. The paper that attracted most attention was on task shifting3; Dmitri Nepogodiev (@dnepo) suggested it ‘may be an important part of increasing access to surgery’, but further evaluation is required. @kathrineholte agreed: ‘The issue has always been there, but somehow the lack of evidence has impeded rational discussion’. Regarding the GlobalSurg Collaborative paper on the WHO checklist4, @ewenharrison explained that to reduce perioperative mortality, ‘hospitals must create systems to build strong teams, minimise unwanted variation in care, and standardise safe recovery from surgery. The checklist is one manifestation of these systems.’ The conversation continued in the global surgery tweetchat, and Twitter users can still revisit the discussion on the hashtag #bjsconnect. BJS Council Secretary @juliomayol launched a number of surgical social media initiatives, including #SoMe4Precision with Arfon Powell (@PowArG07). Members of this online community presented their favourite precision medicine papers, including the leader of the 2018 BJS special issue on Cancer Surgery in the Genomic Era5. Two old favourites resurfaced on Twitter last month: an RCT from last year on the role of chewing gum for ileus after abdominal surgery6 (tweeted by Stephen Chapman, @SJ_Chapman), and Mokhles et al.'s paper from 2016 on colorectal cancer follow-up after potentially curative resection7, discussed at the Exeter Journal Club. The Twitter consensus on the latter was that, although the evidence shows no benefit in follow-up, the ‘psychological aspect of patient reassurance cannot be underestimated’ (BJS Editor, @JohnBeynon5). As BJS Editor @des_winter stated: ‘The operation was just the beginning of a journey that is our honour to share’. Open in new tabDownload slide Finally, Steve Wigmore (BJS Council, @ProfW_edinsurg) celebrated his 100th review of a manuscript for BJS, a tremendous milestone! BJS relies on the help from reviewers and is grateful for ongoing contributions. References 1 Hüttner FJ , Capdeville L, Pianka F, Ulrich A, Hackert T, Büchler MW et al. . Systematic review of the quantity and quality of randomized clinical trials in pancreatic surgery . Br J Surg 2019 ; 106 : 23 – 31 . Google Scholar Crossref Search ADS PubMed WorldCat 2 Elfeki H , Larsen HM, Emmertsen KJ, Christensen P, Youssef M, Khafagy W et al. . Bowel dysfunction after sigmoid resection for cancer and its impact on quality of life . Br J Surg 2019 ; 106 : 142 – 151 . Google Scholar Crossref Search ADS PubMed WorldCat 3 Gajewski J , Borgstein E, Bijlmakers L, Mwapasa G, Aljohani Z, Pittalis C et al. . Evaluation of a surgical training programme for clinical officers in Malawi . Br J Surg 2019 ; 106 : e156 – e165 . Google Scholar Crossref Search ADS PubMed WorldCat 4 Collaborative GS . Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy . Br J Surg 2019 ; 106 : e103 – e112 . Google Scholar Crossref Search ADS PubMed WorldCat 5 Winter DC , Sund M. Cancer surgery in the genomic era . Br J Surg 2018 ; 105 : e12 – e13 . Google Scholar Crossref Search ADS PubMed WorldCat 6 de Leede EM , van Leersum NJ, Kroon HM, van Weel V, van der Sijp JRM, Bonsing BA, Consortium K. Multicentre randomized clinical trial of the effect of chewing gum after abdominal surgery . Br J Surg 2018 ; 105 : 820 – 828 . Google Scholar Crossref Search ADS PubMed WorldCat 7 Mokhles S , Macbeth F, Farewell V, Fiorentino F, Williams NR, Younes RN et al. . Meta-analysis of colorectal cancer follow-up after potentially curative resection . Br J Surg 2016 ; 103 : 1259 – 1268 . Google Scholar Crossref Search ADS PubMed WorldCat © 2019 BJS Society Ltd. Published by John Wiley & Sons 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) © 2019 BJS Society Ltd. Published by John Wiley & Sons Ltd
Meta-analysis of negative pressure wound therapy of closed groin incisions in arterial surgerySvensson-Björk, R; Zarrouk, M; Asciutto, G; Hasselmann, J; Acosta, S
doi: 10.1002/bjs.11100pmid: 30725478
BackgroundSurgical-site infection (SSI) after groin incisions for arterial surgery is common and may lead to amputation or death. Incisional negative pressure wound therapy (NPWT) dressings have been suggested to reduce SSIs. The aim of this systematic review with meta-analysis was to assess the effects of incisional NPWT on the incidence of SSI in closed groin incisions after arterial surgery.MethodsA study protocol for this systematic review of RCTs was published in Prospero (CRD42018090298) a priori, with predefined search, inclusion and exclusion criteria. The records generated by the systematic research were screened for relevance by title and abstract and in full text by two of the authors independently. The selected articles were rated for bias according to the Cochrane risk-of-bias tool.ResultsAmong 1567 records generated by the search, seven RCTs were identified, including 1049 incisions. Meta-analysis showed a reduction in SSI with incisional NPWT (odds ratio (OR) 0·35, 95 per cent c.i. 0·24 to 0·50; P < 0·001). The heterogeneity between the included studies was low (I2 = 0 per cent). The quality of evidence was graded as moderate. Two studies had multiple domains in the Cochrane risk-of-bias tool rated as high risk of bias. A subgroup meta-analysis of three studies of lower limb revascularization procedures only (363 incisions) demonstrated a similar reduction in SSI (OR 0·37, 0·22 to 0·63; P < 0·001; I2 = 0 per cent).ConclusionIncisional NPWT after groin incisions for arterial surgery reduced the incidence of SSI compared with standard wound dressings. The risk of bias highlighted the need for a high-quality RCT with cost-effectiveness analysis.
Meta-analysis of clinical trials examining the benefit of structured home exercise in patients with peripheral artery diseaseGolledge, J; Singh, T P; Alahakoon, C; Pinchbeck, J; Yip, L; Moxon, J V; Morris, D R
doi: 10.1002/bjs.11101pmid: 30791089
BackgroundSupervised exercise is recommended for the management of peripheral artery disease (PAD); however, the uptake is limited. Structured home exercise programmes may be more feasible, but their effectiveness is unclear. This systematic review and meta-analysis examined the benefit of structured home exercise programmes for treating PAD in comparison to controls not receiving an exercise programme.MethodsA literature search was conducted to identify RCTs comparing structured home exercise with controls not receiving an exercise programme among patients with PAD. To be included, studies had to report outcomes from treadmill or corridor walking tests, or objective assessment of physical activity. Inverse variance-weighted meta-analysis was performed to compare changes in maximum walking distance and intermittent claudication onset distance in treadmill tests, walking distance during a 6-min walking test, and physical activity measured using a pedometer or accelerometer. Summarized results are presented in terms of standard deviation differences.ResultsEleven randomized trials involving 807 patients were included. Follow-up ranged from 2 to 24 months; only one trial included follow-up beyond 12 months. Meta-analyses showed that structured home exercise programmes led to significant improvements in maximum walking distance (mean difference (MD) 0·32, 95 per cent c.i. 0·15 to 0·50; P < 0·001), intermittent claudication onset distance (MD 0·45, 0·27 to 0·62; P < 0·001), walking distance in a 6-min walking test (MD 0·28, 0·09 to 0·47; P = 0·004) and physical activity (MD 0·27, 0·11 to 0·43; P = 0·001).ConclusionThis meta-analysis suggests that structured home exercise programmes are effective at improving walking performance and physical activity in the short term for patients with PAD.
Meta-analysis of clinical outcome after treatment for achalasia based on manometric subtypesAndolfi, C; Fisichella, P M
doi: 10.1002/bjs.11049pmid: 30690706
BackgroundThe introduction of high-resolution manometry and the Chicago classification has made it possible to diagnose achalasia and predict treatment response accurately. The aim of this study was to compare the effect of the different treatments available on symptomatic outcomes across all achalasia subtypes.MethodsThe study was conducted according to PRISMA and MOOSE guidelines. A literature search of PubMed and MEDLINE databases was undertaken to identify all relevant articles reporting clinical outcomes of patients with achalasia after botulinum toxin injection, pneumatic dilatation, laparoscopic Heller myotomy (LHM) and peroral endoscopic myotomy (POEM) based on manometric subtypes. Patients were grouped according to the Chicago classification and the success rate in treating symptoms was measured as the primary endpoint.ResultsTwenty studies (1575 patients) were selected, and data on botulinum toxin, pneumatic dilatation, LHM and POEM were extracted. Success rates for LHM in type I, II and III achalasia were 81, 92 and 71 per cent respectively. Those for POEM were 95, 97 and 93 per cent respectively. POEM was more likely to be successful than LHM for both type I (odds ratio (OR) 2·97, 95 per cent c.i. 1·09 to 8·03; P = 0·032) and type III (OR 3·50, 1·39 to 8·77; P = 0·007) achalasia. The likelihood of success of POEM and LHM for type II achalasia was similar.ConclusionPneumatic dilatation had a lower but still acceptable success rate compared with POEM or LHM in patients with type II achalasia. POEM is an excellent treatment modality for type I and type III achalasia, although it did not show any superiority over LHM for type II achalasia.
Snapshot quizdoi: 10.1002/bjs.11040pmid: 30811048
Snapshot Quiz 19/5 Question: What is this abdominal lesion in a 78-year-old man having surveillance for colorectal malignancy? Open in new tabDownload slide The answer to the above question can be found on p. 435 of this issue of BJS. Parkin E1,2, Johnston R1,3, Selvasekar C1,2: 1Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, 2Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, and 3University of Glasgow School of Life Sciences, Wolfson Medical School, Glasgow, UK (e-mail: [email protected]). Snapshots in Surgery: to view submission guidelines, submit your snapshot and view the archive, please visitwww.bjs.co.uk © 2019 BJS Society Ltd. Published by John Wiley & Sons 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) © 2019 BJS Society Ltd. Published by John Wiley & Sons Ltd