This comprehensive meta-analysis demonstrates that PDC after LCBDE is feasible and associated with fewer complications than TTD. Based on these results, primary duct closure may be considered as the optimal procedure for dochotomy closure after LCBDE.

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Background Closure of the appendiceal stump is a key step performed during laparoscopic appendicectomy. Inadequate management of the appendiceal stump has the potential to cause significant morbidity. Several methods of stump closure have been described, however high-level evidence is limited. We performed a systematic review evaluating clinical outcomes and quality of the evidence for the methods of appendiceal stump closure. Methods A systematic literature search was performed using Medline, Embase, Cochrane Database and Google Scholar to identify studies comparing appendiceal stump closure methods in laparoscopic appendectomy for acute appendicitis from inception to October 2019. Data regarding operative duration, peri-operative complications, length of stay and costs were collated from all included studies. Results From 160 identified studies, 19 met the inclusion criteria. Endoloops and endoclips provide equivalent clinical outcomes at lower cost, while operative duration was shortest with endoclip closure. Endostapler devices have the lowest rate of peri-operative complications (3.56%), however their cost limits their regular use in many healthcare environments. Post-operative complication rate and length of stay were similar for all stump closure methods. Conclusion: Although there are no significant differences in method of stump closure in laparoscopic appendectomy, closure with endoclips provides the shortest operative duration. There is a need for robust and standardized reporting of cost data when comparing stump closure methods, together with higher level evidence in the form of multi-centre randomized controlled trials before firm conclusions can be drawn regarding the optimal method of stump closure.

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My views seemed to me to be confirmed when I was shown a specimen (Fig. 258) by Professor Barnard. His patient was a child, aged 13, who had several other congenital deformities, and who died from perforation of a chronic ulcer into a large pulmonary vein. The specimen is similar in many ways to that depicted by Stewart and Hartfall. There are two small islets of ectopic mucosa at the top of the gullet and below these the esophageal mucosa stops short. Below the level of the arch of the aorta the mucosa is everywhere histologically gastric in type and the chronic ulcer which has perforated into one of the great vessels is a stomach ulcer. The original lesion was a congenital short esophagus, and there is no suggestion of diffuse oesophageal fibrosis or of stricture.I have also had the advantage of examining other specimens with Dr. Bratton at Archway Hospital. Some of these had typical gastric ulcers, and it had been assumed that because, upon microscopy, the mucosa around these ulcers was gastric in type that the lesions had occurred in islets of ectopic gastric mucosa. In fact, the ulcers were gastric ulcers in mediastinal extensions of .the stomach, and the patients had congenital short gullets.In conclusion, I stress that the word ' esophagitis ' is now a blunderbuss term used to cover many different pathological lesions; it should always be qualified by a descriptive adjective such as ' reflux esophagitis'. I believe that reflux esophagitis is common and that it can give rise to ulceration of the esophagus and stricture formation. In contrast with this lesion is another which has always up till now been assumed to be identical with it, and which has generally been described by pathologists-as opposed to clinicians-under the heading of ' peptic ulcer of the oesophagus'. I submit that most of these cases are in truth examples of congenital short esophagus, in which there is neither general inflammation nor stricture formation, but in which a part of the stomach extends upwards into the mediastinum -o r even to the neck-and that in this stomach a typical chronic gastric ulcer can form. I urge that, as accurate surgery must rest upon accurate pathology, we must distinguish between gastric and esophageal ulcers.

Background Never events (NEs) are serious clinical incidents that cause potentially avoidable harm and impose a significant financial burden on healthcare systems. The purpose of this study was to identify common never events. Methods We analysed the NHS England NE data from 2012 to 2020 to identify common never events category and themes. Results We identified 51 common NE themes in 4 main categories out of a total of 3247 NE reported during this period. Wrong-site surgery was the most common category (n = 1307;40.25%) followed by retained foreign objects (n = 901;27.75%); wrong implant or prosthesis (n = 425;13.09%); and non-surgical/infrequent ones (n = 614; 18.9%). Wrong-side (laterality) and wrong tooth removal were the most common wrong-site NE accounting for 300 (22.95%) and 263 (20.12%) incidents, respectively. There were 197 (15%) wrong-site blocks, 125 (9.56%) wrong procedures, and 96 (7.3%) wrong skin lesions excised. Vaginal swabs were the most commonly retained items (276;30.63%) followed by surgical swabs (164;18.20%) and guidewires (152;16.87%). There were 67 (7.44%) incidents of retained parts of instruments and 48 (5.33%) retained instruments. Wrong intraocular lenses (165; 38.82%) were the most common wrong implants followed by wrong hip prostheses (n = 94; 22.11%) and wrong knees (n = 91; 21.41%). Non-surgical events accounted for 18.9% (n = 614) of the total incidents. Misplaced naso-or oro-gastric tubes (n = 178;29%) and wrong-route administration of medications were the most common events in this category (n = 111;18%), followed by unintentional connection of a patient requiring oxygen to an air flow-meter (n = 93; 15%). Conclusion This paper identifies common NE categories and themes. Awareness of these might help reduce their incidence.