Randomized clinical trial of intraoperative superficial cervical plexus block versus incisional local anaesthesia in thyroid and parathyroid surgery.

BACKGROUND: Moderate wound pain and opiate analgesia requirement is reported following thyroid and parathyroid surgery. A randomized clinical trial was performed to investigate whether intraoperative superficial cervical plexus block (SCPB) would decrease postoperative pain and analgesia use. METHODS: Patients were randomized to incisional local anaesthesia (control) or incisional local anaesthesia plus intraoperative SCPB. The primary outcome measure was pain, assessed by a visual analogue scale (VAS). Secondary outcome measures were analgesia use (strong opiates defined as having potency at least as strong as that of oral morphine), respiratory rate and sedation score. Primary outcome measures were analysed with non-parametric tests, as well as with receiver operating characteristic (ROC) curves calculated as area under the curve (AUC) to discriminate between trial limbs. RESULTS: Twenty-nine patients were randomized to each group. Pain (VAS) scores were lower in patients who received intraoperative SCPB than in controls 30 min after surgery and subsequently (P < 0·020 at all time points), with a median pain score of zero on the day of operation in the SCPB group. Corresponding analysis of ROC curves showed differences between groups at 30 min (AUC = 0·722, P = 0·012), 90 min (AUC = 0·747, P = 0·005), 150 min (AUC = 0·803, P < 0·001) and 210 min (AUC = 0·849, P < 0·001) after surgery, and at 07.00 hours on postoperative day 1 (AUC = 0·710, P = 0·017). Fewer patients in the SCPB group required strong opiates (5 of 29 versus 16 of 29 in the control group; P = 0·003) and rescue opiates (6 of 29 versus 20 of 29; P < 0·001). CONCLUSION: Intraoperative SCPB reduces pain scores following thyroid and parathyroid surgery, and reduces the requirement for strong and rescue opiates. REGISTRATION NUMBER: 2009-012671-98 (https://www.clinicaltrialsregister.eu).

Shared medical appointments for bariatric surgery follow-up: a patient satisfaction questionnaire.

BACKGROUND: Shared medical appointments (SMAs) are group clinics where practitioners see several patients, with common health needs, at once. There is a great financial strain on the National Health Service (NHS) to provide bariatric surgery. The aim of this study was to review patient satisfaction with the SMA that is the default means of following up patients after bariatric surgery at one particular NHS trust. METHODS: A patient-validated questionnaire was designed and handed out at the end of the SMAs. Patients who attended an SMA earlier in 2011 were also retrospectively sent questionnaires via post. RESULTS: A total of 47 patients completed the questionnaire from seven different SMAs covering the period from January to July 2011. All patients underwent laparoscopic adjustable gastric banding. After attending an SMA, patients gave an overall mean satisfaction rating of 4.13 ± 0.163 (on a scale of 1 to 5, 1 = very poor and 5 = excellent) which represented an increase (p < 0.01) compared to preconceptions before the clinic (3.59 ± 0.175). A cost analysis estimated a yearly saving of £4,617 or 65.1% made by the SMAs compared to 1:1 appointments. CONCLUSIONS: The bariatric surgery SMA demonstrates high levels of patient satisfaction and is cost-effective.

Complications of bariatric surgery: presentation and emergency management--a review.

INTRODUCTION: The prevalence of obesity surgery is increasing rapidly in the UK as demand rises. Consequently, general surgeons on-call may be faced with the complications of such surgery and need to have an understanding about how to manage them, at least initially. Obesity surgery is mainly offered in tertiary centres but patients may present with problems to their local district hospital. This review summarises the main complications that may be encountered. MATERIALS AND METHODS: A full literature search was carried out looking at articles published in the last 10 years. Keywords for search purposes included bariatric, surgery, complications, emergency and management. CONCLUSIONS: Complications of bariatric surgery have been extensively written about but never in a format that is designed to aid the on-call surgeon. The intricate details and rare complications have been excluded to concentrate on those symptoms and signs that are likely to be encountered by the emergency team.

An overview of the management of morbid obesity.

Obesity is a modern-day epidemic with serious physical, psychological and economic implications for the patients. Tackling obesity is now a priority for most healthcare providers. Managing such patients can be complex, emotional, time consuming and often frustrating. Obesity surgery, in its various forms, has revolutionised this struggle. With appropriate selection of patients, adequate resources and a multidisciplinary team involvement, obesity can now effectively be "cured". It is vital that those who deal with obese patients know how to access these services and understand the processes involved in the journey from initial assessment to postoperative follow-up. Obesity surgery has a major impact in reducing obesity-related comorbidities such as diabetes and hypertension and contributes to society by returning patients to work. Prevention must be at the heart of any strategy to manage obesity, but, for established cases, surgery is taking centre stage and will continue to flourish as new techniques and procedures are developed.

From meeting presentation to peer-review publication--a UK review.

INTRODUCTION: Annual academic surgical meetings provide a forum for the discussion of research. For the wide-spread dissemination of this information, peer-reviewed publication is required. The aim of this study was to compare the amount of presentations which go on to publication from 4 UK-based surgical meetings. MATERIALS AND METHODS: We determined whether a presentation had led to a successful publication using PubMed, a median of 28 months following each meeting. We compared the ASGBI publication rate with the meetings of the Vascular Surgical Society (VSSGBI), the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the British Transplantation Society (BTS). We also compared the median impact factor of journals used. RESULTS: The ASGBI and BTS had a similar rate of presentations resulting in publication, with 35% and 36% at 2 years, respectively. The VSS had a significantly greater proportion of presentations resulting in publication (54% at 2 years; P = 0.004), whilst the ACPGBI had significant fewer (24% at 2 years; P = 0.006). There was no difference in the median impact factors of the journals used between the meetings (Kruskal Wallis P = 0.883). CONCLUSIONS: There is a significant variation between meetings in terms of turning presentations into publications. However, the majority of abstracts have still not been fully published within 2 years of presentation at the meeting.

Porcine dermal collagen graft in pediatric renal transplantation.

Successful closure of the anterior abdominal wall in infants following renal transplantation of adult organs may present a challenging dilemma to the transplant surgeon. Restricted volume of the recipient abdominal cavity and size discrepancy of donor adult kidney may lead to graft compromise. Pressure on the graft may be exacerbated further in the postoperative period by oedema that may lead to abdominal compartment syndrome. Donor/recipient size disparity remains the major obstacle in infant renal transplantation. We describe the use of a porcine collagen graft to facilitate closure of the abdominal wall following intra-peritoneal transplantation of an adult cadaveric kidney.