SummaryThe objective of the study is to provide evidence‐based guidance on nutritional management and optimal care for pregnancy after bariatric surgery. A consensus meeting of international and multidisciplinary experts was held to identify relevant research questions in relation to pregnancy after bariatric surgery. A systematic search of available literature was performed, and the ADAPTE protocol for guideline development followed. All available evidence was graded and further discussed during group meetings to formulate recommendations. Where evidence of sufficient quality was lacking, the group made consensus recommendations based on expert clinical experience. The main outcome measures are timing of pregnancy, contraceptive choice, nutritional advice and supplementation, clinical follow‐up of pregnancy, and breastfeeding. We provide recommendations for periconception, antenatal, and postnatal care for women following surgery. These recommendations are summarized in a table and print‐friendly format. Women of reproductive age with a history of bariatric surgery should receive specialized care regarding their reproductive health. Many recommendations are not supported by high‐quality evidence and warrant further research. These areas are highlighted in the paper.

Patara Pharma.

Currently, insufficient data are present to recommend replacing cervical mediastinoscopy with EBUS for lung cancer staging; the negative predictive value of EBUS requires validation. However, EBUS can be recommended for initial staging as a minimally invasive option provided negative results are followed by cervical mediastinoscopy. This would also allow cervical mediastinoscopy to be reserved for re-staging. Conventional transbronchial needle aspiration has a limited role only as a first-line staging procedure but may aid diagnosis. In the future, EBUS may have a role in presurgical staging of the radiologically normal mediastinum and re-staging if prior staging is done by cervical mediastinoscopy.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) offers a minimally invasive option for staging the mediastinum in suspect lung cancer but also in the diagnosis of mediastinal lesions accessible from the airway. This review is aimed at centres considering establishing an EBUS service that may not be so familiar with the technique. It focuses primarily on technical aspects of EBUS-TBNA, training issues, cost considerations, indications, advantages and disadvantages compared with other mediastinal sampling techniques as well as some reference to its performance in clinical studies.In summary, EBUS-TBNA is primarily used for staging non-small cell lung cancer, especially for bulky mediastinal disease and discrete N2 or N3 disease on CT, but also used for the diagnosis of unexplained mediastinal lymphadenopathy. For radical treatment staging, mediastinoscopy is still used at many centres and negative EBUS-TBNA results should be corroborated by mediastinoscopy. In the future, EBUS-TBNA may be used for staging the radiologically normal mediastinum and in re-staging. It is a procedure that can be taught with ease by an experienced operator, has numerous advantages over mediastinoscopy and is potentially cost saving by reducing the number of mediastinoscopies and associated peri-operative support required.

Medical innovation is fundamental to improved patient care. EBUS can potentially reduce morbidity for lung cancer patients and save health community costs. However, with PbR the service provider delivers this at a loss as the tariffs do not reflect innovation and because of coding inaccuracies. We suggest tariffs for innovative procedures need to reflect the true cost.

There have been few reports of improved perioperative outcomes for laparoscopic gastric bypass in the surgeon's independent practice following completion of fellowship training but none from outside of USA. The aim was to evaluate the impact of fellowship training on perioperative outcomes for gastric bypass in the first year as consultant surgeon. Data of all patients undergoing primary bariatric procedures by the author were extracted from prospectively maintained database. Patients who underwent laparoscopic sleeve gastrectomy and gastric banding were excluded. Data on patient demographics, operative time, conversion to open, length of stay, 30-day complications and mortality were analysed. The Obesity Surgery Mortality Risk Score (OS-MRS) was used for risk stratification. The risk score and perioperative outcomes were compared to mentors' post-learning curve results from host training institution. Out of 83 primary bariatric procedures performed, 74 (63 females, 11 males) were gastric bypasses in first year. The mean age was 45.1 (25-66) years and body mass index was 47.7 (36-57) kg/m(2). There were no immediate postoperative complications, no conversions to open surgery and no mortality. One patient was re-admitted within 30 days (1.4%) with small bowel obstruction following internal hernia and needed re-laparoscopy. As compared with host training institution, the OS-MRS distribution and perioperative outcomes of the author did not differ significantly from that of mentors' post-learning curve results. Bariatric fellowship ensured skills acquisition for the author to safely and effectively perform gastric bypass without any learning curve and with surgical outcomes similar to that of experienced mentor at host training institution. Fellowships should be an essential part of bariatric training worldwide.

A strong trend to reduction in single port MT pleural access failure was noted with pre-MT TUS thus reducing extra procedures and the need for artificial pneumothoraces. Pre-MT TUS also reliably detects thick fibrous adhesions at MT. TUS may also detect useful ancillary features. This study provides a rationale for ultrasound-guided single port MT if a pneumothorax is not created.

Day-surgery LC is a safe procedure with an acceptable rate of patient discharge. However, intraoperative complications or age over 50 years adversely affected the same-day discharge rate and as such should be taken into consideration when planning day-case laparoscopic cholecystectomy.