Systematic review of online patient resources to support shared decision making for bariatric surgery.

BACKGROUND: Bariatric surgery is an effective treatment for obesity and the associated comorbidities but carries a number of important risks. The Royal College of Surgeons advises patients to utilise online resources as part of the shared decision-making process. The aim of this study was to assess the quality of online materials on bariatric surgery. METHODS: A systematic review was performed of online healthcare information relating to bariatric surgery. Common search terms were entered into three main search engines according to a defined search strategy. Websites were assessed according to readability (Flesch-Kincaid Reading Ease Score), quality and content (DISCERN and IPDAS Scores) and standards of accreditation (HONcode and Information Standard Certification). This systematic review was registered on the PROSPERO database CRD42019132188. RESULTS: The average readability of all sources extracted was higher than that recommended for patient literature. Over half the studies contained had received HONcode or Information Standard accreditation, suggesting a quality marker for the content. On grading of quality and content, across validated scoring tools, no source achieved the minimum recommended level. CONCLUSION: Patient information online related to bariatric surgery is of poor quality. Such resources require improvement to aid in the shared decision-making process.

Spontaneous urinary bladder rupture: a rare differential for lower abdominal pain in a female patient.

We report a rare case of spontaneous "idiopathic" rupture of the urinary bladder in a 38-year-old previously-fit and -well woman, who presented with symptoms of severe lower abdominal pain. Computed tomography of the abdomen and pelvis indicated the preliminary findings, but the final diagnosis was confirmed only at laparoscopy. The bladder was repaired. The postoperative cystogram showed excellent healing of the bladder, with no further intra-abdominal urinary leakage.

Outcome of gall bladder polypoidal lesions detected by transabdominal ultrasound scanning: a nine year experience.

AIM: To determine the outcome of polypoidal lesions within the gall bladder (PLG) diagnosed by trans-abdominal scanning. METHODS: A nine-year (1993-2002) retrospective case-note review of all patients who underwent ultrasound scanning after referral to a single Upper GI Surgeon at a District General Hospital was conducted. Patients who were diagnosed with a PLG were included in our study. A database was constructed and patient details, investigations including ultrasound scan (USS) findings, treatment and histology and final diagnosis were recorded. RESULTS: Twenty-three (out of 651) patients were diagnosed pre-operatively by USS to have a polyp-like gall bladder lesion (PLG). Post cholecystectomy histological examination revealed 12 gallstones, 7 cholesterol polyps, 3 adenocarcinomas within polyps and 1 normal gall bladder. The specificity of USS in the diagnosis of PLG was 92.3%. All the true polyps were malignant. Overall USS had 66.66% sensitivity and 100% specificity in the pre-operative suspicion of malignancy. Using size greater than 10 mm as measured on USS as a cut-off, we find 100% sensitivity and 86.95% specificity with a positive predictive value of 50% in the diagnosis of malignancy in PLG. CONCLUSION: A large number of PLG are in fact calculi within diseased gall bladder. In cases of gall bladder polyps more then 10 mm in size on USS further imaging (cross-sectional and/or EUS) is indicated prior to surgery. This will help in the optimal management of patients and avoid histological surprises.