In laparoscopic 'paraoesophageal hernia' (POH) repair, non-absorbable suture materials have been used to close the crural defects. More recently, various types of prosthetic mesh have been utilized to repair the defect. We conducted a systematic review with meta-analysis of the recent and up to-date studies incorporating 942 POH repairs. We examined the rates of recurrence, reoperation, and complication rates alongside operative time of these two techniques in the management POH. Randomized controlled trials (RCT) and observational studies comparing mesh hiatal hernioplasty versus Suture cruroplasty for Paraoesophageal hernia were selected by searching Medline, Embase, and Cochrane Central database published between January 1995 and December 2016. Predefined inclusion and exclusion criteria were applied to select the studies. The outcome variables analysed are recurrence of hiatal hernia, reoperation, operative time and complications. Nine studies (RCTs = 4 and Observational studies = 5) were analysed totalling 942 patients (Mesh = 517, Suture cruroplasty = 425). The pooled effect size for recurrence favoured mesh repair over suture cruroplasty (OR 0.48, 95% CI 0.32, 0.73, P < 0.05). But the operation time is significantly less in suture cruroplasty (SMD 15.40, 95% CI 7.92, 22.88, P < 0.0001). Comparable effect sizes were noted for both groups which included reoperation (OR 0.35, 95%CI 0.09, 1.31, P = 0.12) and complication rates (OR 1.30, 95%CI 0.74, 2.29, P = 0.36). Our systematic review and meta-analysis demonstrates that mesh hiatoplasty and suture cruroplasty produce comparable results with regards to reoperation rate and complications following the repair of paraoesophageal hernias (POH). Moreover, the study showed significant reduction of recurrence following mesh hiatoplasty.

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96Ann R Coll Surg Engl 2005; 87 B reast cancer is the commonest malignancy in women 1 with 29,000 new cases per year being diagnosed in England and Wales. The aggressive approach with radical surgery has changed over the years to being more conservative.2 Standard treatment for most women, now, is excision of the primary tumour (by wide local excision or mastectomy) with axillary lymphadenectomy. This permits locoregional control, staging and accurate prognostication. Suction drainage of the axilla is standard practice to prevent seroma formation 4 but practice varies about the length of time required for axillary drainage with patients frequently having a hospital stay of 5-8 days. 5A recent randomised trial 6 advocated the suturing of flaps, avoidance of drainage and early discharge with patients having a 3.31 day-stay after undergoing wide local excision and level 2 axillary clearance for breast cancer. This compared to a 4.86 day-stay for patients in the control group who had axillary suction drainage until drain output was less than 50 ml over 24 h (P < 0.05).Day-case axillary lymph node surgery (ALNS) for breast carcinoma has been performed at the University Hospital of North Tees for over 6 years. When patients are seen in the breast clinic, their ability to undergo day-case surgery is assessed by ensuring that there is no significant Results: 165 patients underwent intended day-case axillary surgery (axillary dissection level 1/2; median age, 55 years; range, 39-76 years). Of these, 16 (9.7%) were admitted overnight usually due to over-running of theatre lists (n = 13; 81%). 29 patients (17.6%) underwent axillary dissection alone, the remainder had axillary surgery combined with wide local excision (median number of lymph nodes excised 11; range, 2-18). Complications included symptomatic seroma formation in 37 patients (22%) and wound infection in 16 patients (10%). Conclusions: Day-case axillary surgery can be performed safely with surgical morbidity comparing favourably to published work of 'traditional' axillary drainage following lymphadenectomy.

Day case emergency LA is safe and effective for treating selected patients.