Laparoscopic Nissen fundoplication with or without short gastric vessel division: a meta-analysis.

OBJECTIVE: The aim of this work is to systematically analyse the prospective randomised controlled trials on laparoscopic Nissen fundoplication (LNF) with and without short gastric vessel division (SGVD) for management of gastro-oesophageal reflux disease (GORD). METHODS: After an extensive literature search, all previous trials on laparoscopic Nissen fundoplication with and without SGVD for management of GORD were assessed. Those meeting study quality criteria were analysed to generate summative data expressed by standardised mean difference (SMD) and risk ratio (RR). RESULTS: Five randomised controlled trials on 388 patients qualified for the meta-analysis. There were 194 patients in the no-SGVD group and 194 patients in the SGVD group. No-SGVD was associated with shorter operative time and length of stay. In both fixed- and random-effects models, there were no statistically significant differences in laparoscopic to open conversion rate or complications between the two groups. Three trials presented data on 1-year follow-up, with 118 patients in the no-SGVD group and 112 patients in the SGVD group. There was no statistically significant difference in heartburn, dysphagia, regurgitation or gas bloat syndrome between these two groups. Two trials presented data on 10-year follow-up, with 84 patients in the no-SGVD group and 86 patients in the SGVD group. There was no significant difference in heartburn, dysphagia, regurgitation or gas bloat syndrome between these two groups either. There was no heterogeneity between trials. CONCLUSIONS: Based on this review, SGVD in LNF is associated with longer operative time and hospital stay. However, there is no difference in terms of functional outcomes for 1- and 10-year follow-up. Routine use of SGVD may therefore not be necessary in LNF.

The role of physician reminders in faecal occult blood testing for colorectal cancer screening.

BACKGROUND: Colorectal cancer screening in the form of faecal occult blood (FOB) testing can significantly reduce the burden of this disease and has been used as early as the 1970s. Effective involvement of GPs along with reminding physicians prior to seeing a patient may improve uptake. OBJECTIVE: This article is a systematic review of published literature examining the uptake of FOB testing after physician reminders as part of the colorectal cancer screening process. METHODS: Electronic databases were searched from January 1975 to October 2010. All studies comparing physician reminders (Rem) with controls (NRem) were identified. A meta-analysis was performed to obtain a summary outcome. RESULTS: Five comparative studies involving 25 287 patients were analyzed. There were 12 641 patients were in the Rem and 12 646 in the NRem group. All five studies obtained a higher percentage uptake when physician reminders were given. However, in only two of the studies were the percentage uptake significantly higher. There was significant heterogeneity among trials (I2 = 95%). The combined increase in FOB test uptake was not statistically significant (random effects model: risk difference = 6.6%, 95% CI: -2-14.7%; z = 1.59, P = 0.112). CONCLUSION: Reminding physicians about those patients due for FOB testing may not improve the effectiveness of a colorectal cancer screening programme. Further studies are required and should focus on areas where there is a lower baseline uptake and areas with high levels of deprivation.

Elective open versus laparoscopic sigmoid colectomy for diverticular disease: a meta-analysis with the Sigma trial.

BACKGROUND: A meta-analysis of published literature comparing open versus laparoscopic elective sigmoid resections for diverticular disease was conducted. METHODS: Electronic databases were searched for data from January 1991 to March 2009. A systematic review was performed to obtain a summative outcome. RESULTS: Twenty-two comparative studies involving 10,898 patients were analyzed; 1538 patients were in the laparoscopic group and 9360 were in the open group. The operative time for laparoscopic sigmoid resection (LSR) is longer than open resections (OSR) [random-effects model: SMD = 1.94, 95% CI = (1.14, 2.74), z = 4.74, p < 0.001]. However, patients who undergo LSR have earlier return to passage of feces [random-effects model: SMD = -1.01, 95% CI (-1.80, -0.22), z = -2.50, p = 0.013] and shorter hospital stay [random-effects model: SMD = -7.65, 95% CI (-10.96, -4.32), z = -4.52, p < 0.001]. Overall morbidity was higher in the OSR group [random-effects model: RR = 0.56, 95% CI (0.40, 0.80), z = -3.24, p < 0.001] and no difference in mortality rates was observed (p = 0.81). CONCLUSIONS: Laparoscopic sigmoid resection takes longer to perform than open procedures; however, it is safe and has lower overall morbidity, earlier return of bowel function, and shorter hospital stays. This approach should be considered for elective cases but more randomized controlled trials are required to strengthen the evidence.

The role of perioperative warming in surgery: a systematic review.

OBJECTIVE: The objective of this review was to systematically analyze the trials on the effectiveness of perioperative warming in surgical patients. METHODS: A systematic review of the literature was undertaken. Clinical trials on perioperative warming were selected according to specific criteria and analyzed to generate summative data expressed as standardized mean difference (SMD). RESULTS: Twenty-five studies encompassing 3,599 patients in various surgical disciplines were retrieved from the electronic databases. Nineteen randomized trials on 1785 patients qualified for this review. The no-warming group developed statistically significant hypothermia. In the fixed effect model, the warming group had significantly less pain and lower incidence of wound infection, compared with the no-warming group. In the random effect model, the warming group was also associated with lower risk of post-anesthetic shivering. Both in the random and the fixed effect models, the warming group was associated with significantly less blood loss. However, there was significant heterogeneity among the trials. CONCLUSION: Perioperative warming of surgical patients is effective in reducing postoperative wound pain, wound infection and shivering. Systemic warming of the surgical patient is also associated with less perioperative blood loss through preventing hypothermia-induced coagulopathy. Perioperative warming may be given routinely to all patients of various surgical disciplines in order to counteract the consequences of hypothermia.

The role of perioperative warming in surgery: a systematic review / O papel do aquecimento perioperatório em cirurgia: uma revisão sistemática

OBJECTIVE: The objective of this review was to systematically analyze the trials on the effectiveness of perioperative warming in surgical patients. METHODS: A systematic review of the literature was undertaken. Clinical trials on perioperative warming were selected according to specific criteria and analyzed to generate summative data expressed as standardized mean difference (SMD). RESULTS: Twenty-five studies encompassing 3,599 patients in various surgical disciplines were retrieved from the electronic databases. Nineteen randomized trials on 1785 patients qualified for this review. The no-warming group developed statistically significant hypothermia. In the fixed effect model, the warming group had significantly less pain and lower incidence of wound infection, compared with the no-warming group. In the random effect model, the warming group was also associated with lower risk of post-anesthetic shivering. Both in the random and the fixed effect models, the warming group was associated with significantly less blood loss. However, there was significant heterogeneity among the trials. CONCLUSION: Perioperative warming of surgical patients is effective in reducing postoperative wound pain, wound infection and shivering. Systemic warming of the surgical patient is also associated with less perioperative blood loss through preventing hypothermia-induced coagulopathy. Perioperative warming may be given routinely to all patients of various surgical disciplines in order to counteract the consequences of hypothermia.

OBJETIVO: O objetivo desta revisão é analisar sistematicamente os ensaios sobre a eficácia do aquecimento perioperatório em pacientes cirúrgicos. MÉTODOS: Uma revisão sistemática da literatura foi realizada. Ensaios clínicos sobre aquecimento perioperatório foram selecionados segundo critérios específicos e analisados para gerar dados sumativo expresso na diferença média padronizada (standardized mean difference, SMD). RESULTADOS: Vinte e cinco estudos englobando 3.599 pacientes de várias disciplinas de cirurgia foram obtidos a partir de bases de dados eletrônicas. Dezenove ensaios aleatórios em 1.785 pacientes qualificados para esta revisão. Nenhum grupo de aquecimento desenvolveu estatisticamente significativa hipotermia. No modelo de efeito fixo, grupo de aquecimento tiveram significativamente menos dor e menor incidência de infecção na ferida quando comparado com o grupo de não-aquecimento. No modelo de efeito aleatório, grupo de aquecimento também foi associado a um menor risco de tremores pós-anestesia. Em ambos os modelos de efeitos fixos e aleatórios, o aquecimento foi significativamente associado com menor perda de sangue. No entanto, houve significativa heterogeneidade entre os ensaios. CONCLUSÃO: O aquecimento perioperatório de pacientes cirúrgicos é eficaz na redução da dor pós-operatória ferida, infecção ferida, e tremores. O aquecimento sistêmico do paciente cirúrgico também está associado com menor perda de sangue no perioperatório prevenindo hipotermia e induzindo coagulopatia. O aquecimento perioperatório pode ser administrado rotineiramente a todos os pacientes cirúrgicos de diversas disciplinas, a fim de neutralizar as consequências da hipotermia.

Gastric outlet obstruction from a caecal volvulus, herniated through epiploic foramen: a case report.

A 55-year-old woman presented with sudden onset upper abdominal pain and vomiting. On examination she had tender epigastric mass with "succusion splash" on auscultation. Straight abdominal x ray showed a distended and displaced stomach with another gas filled viscus around it. Subsequent computed tomography suggested caecal volvulus herniated through the epiploic foramen obstructing the gastric outlet. The patient underwent reduction of the internal hernia and right hemicolectomy. Postoperative recovery was uneventful. Herniation of caecal volvulus through the epiploic foramen is a very rare condition and its presentation as a gastric outlet obstruction has not been reported before.