Revisional surgery after one anastomosis/mini gastric bypass: A narrative review.

One anastomosis gastric bypass (OAGB)/mini gastric bypass is now considered to be a safe and efficient method for morbidly obese patients but has complications and adverse events such as other surgical procedures. The present paper outlines the need for and the nature of revisional surgery in the long-term following OAGB in accordance with the preferred reporting items for systematic reviews and meta-analysis guidelines. A literature search was carried out in PubMed. All articles on OAGB for which the authors described a patient needing revisional surgery in the long term after OAGB were examined.

Impact of biliopancreatic limb length on severe protein-calorie malnutrition requiring revisional surgery after one anastomosis (mini) gastric bypass.

BACKGROUND: One anastomosis (mini) gastric bypass (OAGB) is believed to be more malabsorptive than Roux-en-Y gastric bypass. A number of patients undergoing this procedure suffer from severe protein-calorie malnutrition requiring revisional surgery. The purpose of this study was to find the magnitude of severe protein-calorie malnutrition requiring revisional surgery after OAGB and any potential relationship with biliopancreatic limb (BPL) length. METHODS: A questionnaire-based survey was carried out on the surgeons performing OAGB. Data were further corroborated with the published scientific literature. RESULTS: A total of 118 surgeons from thirty countries reported experience with 47,364 OAGB procedures. Overall, 0.37% (138/36,952) of patients needed revisional surgery for malnutrition. The highest percentage of 0.51% (120/23,277) was recorded with formulae using >200 cm of BPL for some patients, and lowest rate of 0% was seen with 150 cm BPL. These data were corroborated by published scientific literature, which has a record of 50 (0.56%) patients needing surgical revision for severe malnutrition after OAGB. CONCLUSIONS: A very small number of OAGB patients need surgical correction for severe protein-calorie malnutrition. Highest rates of 0.6% were seen in the hands of surgeons using BPL length of >250 cm for some of their patients, and the lowest rate of 0% was seen with BPL of 150 cm. Future studies are needed to examine the efficacy of a standardised BPL length of 150 cm with OAGB.

Caecal metastasis from breast cancer presenting as intestinal obstruction.

BACKGROUND: Gastrointestinal metastsasis from the breast cancer are rare. We report a patient who presented with intestinal obstruction due to solitary caecal metastasis from infiltrating ductal carcinoma of breast. We also review the available literature briefly. CASE PRESENTATION: A 72 year old lady with past history of breast cancer presented with intestinal obstruction due to a caecal mass. She underwent an emergency right hemicolectomy. The histological examination of the right hemicolectomy specimen revealed an adenocarcinoma in caecum staining positive for Cytokeratin 7 and Carcinoembryonic antigen and negative for Cytokeratin 20, CDX2 and Estrogen receptor. Eight out of 11 mesenteric nodes showed tumour deposits. A histological diagnosis of metastatic breast carcinoma was given. CONCLUSION: To the best of our knowledge, this is the first case report of solitary metastasis to caecum from infiltrating ductal carcinoma of breast. Awareness of this possibility will aid in appropriate management of such patients.

Who publishes in leading general surgical journals? The divide between the developed and developing worlds.

BACKGROUND: Most articles in top general surgical journals seem to originate from a limited few developed countries. The purpose of this study was to establish which countries publish the most in leading general surgical journals. METHODS: We analysed all the studies, reviews and case reports published in 2003-2004 in 10 leading English-language general surgical journals with the highest impact factors to obtain country-wise data with regard to the origin of articles. Editorials, historical articles, commentaries, guidelines, biographies, interviews and letters to editors were excluded from the analysis. RESULTS: A total of 5,081 articles were reviewed. Out of these, 834 were excluded as detailed above and the remaining 4,247 articles were analysed. Most of these were from USA, European countries, Japan, and Australia. It seems that the vast majority of the world's population living in the developing countries do not find adequate representation in leading general surgical journals. CONCLUSION: Very few articles are published from developing countries in leading general surgical journals. Both developing countries and medical journals need to take steps to curb this trend. Steps are suggested to improve the situation so that the developing world is also adequately represented in the surgical literature.

Peer review practices in biomedical literature: a time for change?

OBJECTIVE: The purpose of this study was to collect the opinions of a cross section of published authors on current practices concerning peer review in biomedical publishing. METHODS: A questionnaire on various aspects of peer review was emailed to authors, whose manuscripts were published in Gut or the British Journal of Surgery between 2001 and 2006. Authors were asked to base their responses on their overall experience with peer review in biomedical literature and not with that one particular journal. RESULTS: Most respondents felt that peer review is an effective quality control mechanism and does help improve manuscripts. Although some felt that it may cause delays in publication, lead to some research being lost and may not prevent all research-related fraud, most authors felt that there was still a strong role for the peer review process as it exists today. CONCLUSION: An overwhelming majority of authors in our study approved of the current peer review practices in biomedical literature. A minority did however seem concerned. We discuss here the surrounding issues.