Areas of Non-Consensus Around One Anastomosis/Mini Gastric Bypass (OAGB/MGB): A Narrative Review

One anastomosis/mini gastric bypass (OAGB/MGB) is now an established bariatric and metabolic surgical procedure with good outcomes. Despite two recent consensus statements around OAGB/MGB, there are some issues which are not accepted as consensus and need more long-term data and research

Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery

Peer reviewe

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Original Article - Comparative study of skin staples and polypropylene sutures for securing the mesh in lichtenstein’s tension free inguinal hernia repair: A Prospective randomized controlled clinical trial

BACKGROUND: The tension-free hernioplasty as introduced by Lichtenstein has gained increasing acceptance during the last decade. This study compared two methods of mesh fixation. MATERIAL AND METHODS: Fifty-four patients undergoing sixty repairs were randomized into two groups. In control group polypropylene mesh was secured with 2/0 polypropylene sutures and skin closed with 2/0 polyamide black. In study group polypropylene mesh was secured with skin staples and skin was closed with staples from the same stapler. Duration of the surgery was recorded. RESULTS: The operation was significantly shorter when staples were used (median 42 min 30 s versus 54 min 30 s, P < 0.001). There was no significant difference in the incidence of postoperative complications or pain. There were no recurrences in either group in the follow up period (median 12 months). CONCLUSION: This technique of mesh fixation is as effective as conventional fixation with polypropylene sutures with an important added advantage; significant reduction in the operative time

Original Article - Comparative study of skin staples and polypropylene sutures for securing the mesh in lichtenstein’s tension free inguinal hernia repair: A Prospective randomized controlled clinical trial

BACKGROUND: The tension-free hernioplasty as introduced by Lichtenstein has gained increasing acceptance during the last decade. This study compared two methods of mesh fixation. MATERIAL AND METHODS: Fifty-four patients undergoing sixty repairs were randomized into two groups. In control group polypropylene mesh was secured with 2/0 polypropylene sutures and skin closed with 2/0 polyamide black. In study group polypropylene mesh was secured with skin staples and skin was closed with staples from the same stapler. Duration of the surgery was recorded. RESULTS: The operation was significantly shorter when staples were used (median 42 min 30 s versus 54 min 30 s, P < 0.001). There was no significant difference in the incidence of postoperative complications or pain. There were no recurrences in either group in the follow up period (median 12 months). CONCLUSION: This technique of mesh fixation is as effective as conventional fixation with polypropylene sutures with an important added advantage; significant reduction in the operative time