Adolescent bariatric surgery--thoughts and perspectives from the UK.

Opinions of healthcare professionals in the United Kingdom regarding bariatric surgery in adolescents are largely unknown. This study aims to explore the perspectives of medical professionals regarding adolescent bariatric surgery. Members of the British Obesity and Metabolic Surgery Society and groups of primary care practitioners based in London were contacted by electronic mail and invited to complete an anonymous online survey consisting of 21 questions. Ninety-four out of 324 questionnaires were completed. 66% of professionals felt that adolescents with a body mass index (BMI) >40 or BMI >35 with significant co-morbidities can be offered surgery. Amongst pre-requisites, parental psychological counseling was chosen most frequently. 58% stated 12 months as an appropriate period for weight management programs, with 24% regarding 6 months as sufficient. Most participants believed bariatric surgery should only be offered ≥ 16 years of age. However, 17% of bariatric surgeons marked no minimum age limit. Over 80% of the healthcare professionals surveyed consider bariatric surgery in adolescents to be acceptable practice. Most healthcare professionals surveyed feel that adolescent bariatric surgery is an acceptable therapeutic option for adolescent obesity. These views can guide towards a consensus opinion and further development of selection criteria and care pathways.

Herniation of the liver via an incisional abdominal wall defect.

Herniation of the liver through an anterior abdominal wall incisional defect has rarely been described. An 81-year-old man presented to our surgical team with acute right upper quadrant abdominal pain. He had undergone coronary artery bypass grafting via a median sternotomy 7 years previously. Examination revealed gallbladder tenderness and a non-tender incisional epigastric hernia. Cholecystitis was confirmed on ultrasound. A CT scan revealed a knuckle of liver (segment II/III) herniating through an upper midline anterior abdominal wall incisional defect.

A prospective study of isolated human hepatocyte function following liver resection for colorectal liver metastases: the effects of prior exposure to chemotherapy.

BACKGROUND/AIMS: Chemotherapy is increasingly used prior to resection of colorectal liver metastases, yet few studies have addressed its effect on the viability and function of hepatocytes. This study evaluated the effect of pre-operative chemotherapy on human hepatocytes. METHODS: Studies were carried out on isolated hepatocytes from 47 patients undergoing hepatectomy for colorectal metastases. The function of drug metabolising enzymes in hepatocytes was assessed in vitro, as well as hepatocyte integrity and culture longevity. These results were compared between patients undergoing no pre-operative chemotherapy (N = 8), 5 fluorouracil (5FU) post-bowel resection (N = 20), and neo-adjuvant 5FU alone (N = 7) or in a combination with oxaliplatin (N = 12). RESULTS: Average cell viability at isolation determined by trypan blue dye exclusion was 71% with no significant difference between the no chemotherapy or pre-resection chemotherapy groups. There was no significant difference in LDH leakage and cellular ATP content over a 96-h time course between the patient treatment groups. The function of cytochromes P450 (CYP1A2, CYP2A6, CYP2C9, CYP2D6, CYP2E1, CYP3A4) and phase II enzymes (UDP-glucuronosyltransferase and sulphotransferase) was not adversely affected by pre-operative chemotherapy. CONCLUSIONS: Pre-resection chemotherapy does not impair the function or culture integrity of hepatocytes isolated at the time of liver resection.