Occult hepatic metastases (OHMs) were detected by ultrasound and/or CT scanning in 17 of 71 (24 per cent) patients undergoing apparently curative resection for colorectal carcinoma. One of the patients with OHMs survived 5 years; in contrast, only 5 of 54 patients without evidence of OHMs at surgery died of disseminated disease. The presence or absence of OHMs at the time of surgery predicts the majority of deaths from disseminated disease following apparently curative resection for colorectal carcinoma.

Background: Laparoscopic cholecystectomy is commonly performed, and several factors increase the

More patients perform paid work after LRYGBP and LAGB than beforehand, and the number of weekly hours they work increases. After surgery, patients claim fewer state benefits.

BackgroundThe National Bariatric Surgery Registry (NBSR) is the largest bespoke database in the field in the United Kingdom.ObjectivesOur aim was to analyze the NBSR to determine whether the effects of obesity surgery on associated co-morbidities observed in small randomized controlled clinical trials could be replicated in a "real life" setting within U.K. healthcare.SettingUnited Kingdom.MethodsAll NBSR entries for operations between 2000 and 2015 with associated demographic and co-morbidity data were analyzed retrospectively.ResultsA total of 50,782 entries were analyzed. The patients were predominantly female (78%) and white European with a mean age of 45 ± 11 years and a mean body mass index of 48 ± 8 kg/m2. Over 5 years of follow-up, statistically significant reductions in the prevalence of type 2 diabetes, hypertension, dyslipidemia, sleep apnea, asthma, functional impairment, arthritis, and gastroesophageal reflux disease were observed. The "remission" of these co-morbidities was evident 1 year postoperatively and reached a plateau 2 to 5 years after surgery. Obesity surgery was particularly effective on functional impairment and diabetes, almost doubling the proportion of patients able to climb 3 flights of stairs and halving the proportion of patients with diabetes related hyperglycemia compared with preoperatively. Surgery was safe with a morbidity of 3.1% and in-hospital mortality of .07% and a reduced median inpatient stay of 2 days, despite an increasingly sick patient population.ConclusionsObesity surgery in the U.K. results not only in weight loss, but also in substantial improvements in obesity-related co-morbidities. Appropriate support and funding will help improve the quality of the NBSR data set even further, thus enabling its use to inform healthcare policy.

Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics.

The rates of growth of 29 hepatic metastases from 15 patients with primary colorectal carcinoma were studied using serial computed tomography (CT). Eleven metastases were found by the surgeon at laparotomy (overt metastases); the remaining eighteen were not evident to the surgeon at laparotomy, but were detected by CT scan during the immediate postoperative period (occult metastases). An estimate of tumour volume doubling time was obtained from a semi-logarithmic plot of tumour cell number against time. The mean doubling time for the overt metastases was 155 +/- 34 days (+/- s.e.m.) compared with 86 +/- 12 days (P less than 0.05) for the occult metastases. The age of the metastases at the time of surgery was estimated by extrapolation of the observed growth curve assuming Gompertzian kinetics. The mean age of the overt metastases was 3.7 +/- 0.9 years (+/- s.e.m.) The corresponding age of the occult metastases was 2.3 +/- 0.4 years.

Background: Stapled restorative proctocolectomy (SRP) for ulcerative colitis retains a 'cuff ' of columnar epithelium, which carries a risk of undergoing malignant change. The risk of neoplastic transformation was studied in a series of patients who underwent SRP for ulcerative colitis. Methods:One hundred and thirty-five patients who underwent SRP for ulcerative colitis between 1988 and 1998 were followed up by cuff surveillance biopsy. The median follow-up was 56 (range 12-145) months and the median time since diagnosis of ulcerative colitis was 8·8 (range 2-32) years. Results:The cuff biopsies showed no dysplasia or carcinoma. The accuracy of obtaining cuff mucosa in the biopsy was 65 per cent. Chronic inflammation was present in 94 per cent of cuff biopsies. Conclusion:This study shows no evidence of either dysplasia or carcinoma in the columnar cuff mucosa, up to 12 years after pouch formation. This suggests that cuff surveillance in the first decade after SRP, in the absence of dysplasia or carcinoma in the original colectomy specimen, may be unnecessary. Regular cuff surveillance biopsies after SRP should continue for patients with high-grade dysplasia or carcinoma in the original resection specimen.

Patients with constipation following childbirth represent a distinct subgroup with normal proximal gastrointestinal function. Gastric emptying studies may be helpful in selecting patients for surgical management of severe constipation.