Left colonic conduits placed retrosternally were safest.

BackgroundOesophageal diverticula are rare outpouchings of the oesophagus which may be classified anatomically as pharyngeal (Zenker’s), mid-oesophageal and epiphrenic. While surgery is indicated for symptomatic patients, no consensus exists regarding the optimum technique for non-Zenker’s oesophageal diverticula. The aim of this study was to determine the outcome of surgery in patients with non-Zenker’s oesophageal diverticula.MethodsPubMed, MEDLINE and the Cochrane Library (January 1990 to January 2016) were searched for studies which reported outcomes of surgery in patients with non-Zenker’s oesophageal diverticula. Primary outcome measure was the rate of staple line leakage.ResultsTwenty-five observational studies involving 511 patients (259 male, median age 62 years) with mid-oesophageal (n = 53) and epiphrenic oesophageal (n = 458) diverticula who had undergone surgery [thoracotomy (n = 252), laparoscopy (n = 204), thoracoscopy (n = 42), laparotomy (n = 5), combined laparoscopy and thoracoscopy (n = 8)] were analysed. Myotomy was performed in 437 patients (85.5%), and anti-reflux procedures were performed in 342 patients (69.5%). Overall pooled staple line leak rates were reported in 13.3% [95% c.i. (11.0–15.7), p < 0.001] and were less common after myotomy (12.4%) compared with no myotomy (26.1%, p = 0.002).ConclusionsNo consensus exists regarding the surgical treatment of non-Zenker’s oesophageal diverticula, but staple line leakage is common and is reduced significantly by myotomy.

Background: Surgeon-level operative mortality is widely seen as a measure of quality after gastric and oesophageal resection. This study aimed to evaluate this alongside a compound-level outcome analysis.Methods: Consecutive patients who underwent treatment including surgery delivered by a multidisciplinary team, which included seven specialist surgeons, were studied. The primary outcome was death within 30 days of surgery; secondary outcomes were anastomotic leak, Clavien-Dindo morbidity score, lymph node harvest, circumferential resection margin (CRM) status, disease-free (DFS), and overall (OS) survival.Results: The median number of annual resections per surgeon was 10 (range 5-25), compared with 14 (5-25) for joint consultant teams (P = 0⋅855). The median annual surgeon-level mortality rate was 0 (0-9) per cent versus an overall network annual operative mortality rate of 1⋅8 (0-3⋅7) per cent. Joint consultant team procedures were associated with fewer operative deaths (0⋅5 per cent versus 3⋅4 per cent at surgeon level; P = 0⋅027). The median surgeon anastomotic leak rate was 12⋅4 (range 9-20) per cent (P = 0⋅625 versus the whole surgical range), overall morbidity 46⋅5 (31-60) per cent (P = 0⋅066), lymph node harvest 16 (9-29) (P < 0⋅001), CRM positivity 32⋅0 (16-46) per cent (P = 0⋅003), 5-year DFS rate 44⋅8 (29-60) per cent and OS rate 46⋅5 (35-53) per cent. No designated metrics were independently associated with DFS or OS in multivariable analysis. Conclusion:Annual surgeon-level metrics demonstrated wide variations (fivefold), but these performance metrics were not associated with survival.

RFA safely eradicates IM and dysplasia and reduces the rates of progression from LGD to HGD or cancer in the short term.

Obesity is rapidly becoming one of the major challenges for health care systems. Surgery has proved to be one of the most effective methods of helping patients to achieve sustainable weight loss. Laparoscopic sleeve gastrectomy is a relatively new bariatric surgical technique. A staple line is placed in a line parallel to the lesser curve of the stomach, excluding up to 85% of the volume of the stomach. The excluded stomach is then resected leaving a 'tube' of residual stomach. Radiologists may be asked to perform and interpret imaging studies in the postoperative period and should be familiar with the normal appearances and common complications. Postoperative radiological investigations will typically be for suspected leak or obstruction. A water soluble contrast upper gastrointestinal (UGI) series should be performed in both suspected leak and obstruction if the patient is conscious and able to swallow. A normal postoperative UGI series will show free flow of contrast into the gastric remnant, which will be tubular with no spillage of contrast beyond the staple line, which is located on the caudal aspect of the gastric remnant. Stenosis or obstruction of the stomach may occur if the stomach remnant is too tight or torsion of the stomach. Stenosis is usually treated endoscopically with dilation and torsion is treated surgically. Leaks are often treated with covered stents which may be placed with endoscopic or radiological guidance. Collections may be drained under fluoroscopic, ultrasound or computed tomography guidance.