40 research outputs found
Medicolegal Cases in Bariatric Surgery in the United Kingdom
No full textPURPOSE OF REVIEW: To evaluate the current state of bariatric medicolegal activity and explore the reasons of litigation in bariatric surgery. The underlying legal principles in bariatric medicolegal cases and most frequent pitfalls will also be discussed. RECENT FINDINGS: There is a growing number of litigations in bariatric surgery, particularly relating to complications and long waiting lists for bariatric surgery within the public-funded health systems. The main issues are related to consent, lack of follow-up, delayed identification of complications and lack of appropriate emergency management of complications, involving bariatric surgeons, clinicians, general practitioners and multidisciplinary team members. Appropriate multidisciplinary involvement pre- and postoperatively and robust follow-up protocols can help to mitigate the risks. Bariatric surgery requires a unique paradigm with a multidisciplinary approach both pre- and postoperatively to improve the long-term functional outcomes of patients. There is a rising incidence of medicolegal claims following bariatric surgery. The underlying reasons for this are multifactorial including an increase in the volume of surgery, high patient expectations, the incidence of long-term postoperative complications and the requirement of long-term follow-up
Bone health following paediatric and adolescent bariatric surgery: a systematic review and meta-analysisResearch in context
No full textSummary: Background: Childhood obesity is a pressing health crisis of epidemic proportions. Bariatric surgery (BS) is an effective weight loss solution however its role in the paediatric population is contentious owing to the paucity of weight specific and generalised health outcomes. This systematic review and meta-analysis aimed to assess the impact of paediatric BS on bone health. Methods: This prospectively registered systematic review (PROSPERO ID: CRD42023432035) was performed in accordance with PRISMA guidelines. We searched MEDLINE (1946–1928 September 2023), EMBASE (1947–1928 September 2023) via the Ovid platform, and the Cochrane Review Library to identify scientific publications reporting bone outcome measures in patients under the age of 18 years who underwent BS. Meta-analysis was undertaken on post-operative weight and bone parameters in paediatric patients following BS. Outcomes were reported as weighted or standardized mean difference with 95 percent confidence intervals. Subgroup analysis by intervention, quality scoring and risk of bias were assessed. Findings: Twelve studies with 681 patients across 5 countries (mean age 17 ± 0.57 years) were included. The quality of included studies was rated as high and there was substantial between-study heterogeneity for most factors included in the meta-analysis (I2 from 0% to 99.1%). Patients underwent Roux-en-Y gastric bypass (RYGB, n = 216), sleeve gastrectomy (SG, n = 257), gastric band (n = 184) or intragastric balloon placement (n = 24). BS was associated with significant weight reduction, body mass index (BMI) −12.7 kg/m2 (95% CI −14.5 to −10.9, p < 0.001), with RYGB being most effective, BMI −16.58 kg/m2 (95% CI −19.6 to −13.6, p < 0.001). Patients who underwent SG or RYGB had significantly lower lumbar bone mineral density, −0.96 g/cm2 (95% CI −0.1 to −0.03, p < 0.001), Z score, −1.132 (95% CI −1.8 to −0.45, p < 0.001) and subtotal body bone mineral density, −0.7 g/cm2 (95% CI −1.2 to −0.2, p < 0.001) following surgery. This was accompanied with higher markers of bone resorption, C-terminal telopeptide of type 1 collagen 0.22 ng/ml (95% CI 0.12–0.32, p < 0.001) and osteocalcin, 10.83 ng/ml (95% CI 6.01–15.67, p < 0.001). There was a significant reduction in calcium levels following BS, −3.78 mg/dl (95% CI −6.1 to −1.5, p < 0.001) but no difference in 25-hydroxyvitamin D, phosphate, bone alkaline phosphatase, procollagen type 1 N propeptide or parathyroid hormone. Interpretation: BS effectively reduces weight in paediatric patients, but RYGB and SG may have adverse effects on bone health in the medium term. It is crucial to monitor and support bone health through appropriate nutritional supplementation and judicious follow-up. Long-term data is needed to fully understand the clinical implications of these findings on bone outcomes. Funding: Medical Research Council (MRC), United Kingdom
Vagal Nerve Therapy in the Management of Obesity: A Systematic Review and Meta-Analysis
No full textIntroduction: The vagus nerve has an important role in satiety, metabolism, and autonomic control in upper gastrointestinal function. However, the role and effects of vagal nerve therapy on weight loss remain controversial. This systematic review and meta-analysis assessed the effects of vagal nerve therapy on weight loss, body mass index (BMI), and obesity-related conditions. Methods: MEDLINE, EMBASE, and CINAHL databases were searched for studies up to April 2022 that reported on percentage excess weight loss (%EWL) or BMI at 12 months or remission of obesity-related conditions following vagal nerve therapy from January 2000 to April 2022. Weighted mean difference (WMD) was calculated, meta-analysis was performed using random-effects models, and between-study heterogeneity was assessed. Results: Fifteen studies, of which nine were randomised controlled trials, of 1,447 patients were included. Vagal nerve therapy led to some improvement in %EWL (WMD 17.19%; 95% confidence interval [CI]: 10.94–23.44; p < 0.001) and BMI (WMD −2.24 kg/m2; 95% CI: −4.07 to −0.42; p = 0.016). There was a general improvement found in HbA1c following vagal nerve therapy when compared to no treatment given. No major complications were reported. Conclusions: Vagal nerve therapy can safely result in a mild-to-moderate improvement in weight loss. However, further clinical trials are required to confirm these results and investigate the possibility of the long-term benefit of vagal nerve therapy as a dual therapy combined with standard surgical bariatric interventions
Medicolegal litigation in general surgery: a comparison between England and the United States
No full textBackground
Clinical negligence claims represent a significant financial and reputational burden for healthcare systems worldwide. While the United States is often perceived as having a highly litigious medical culture, comparative data between the United Kingdom and United States, especially in general surgery, are limited.
Methods
Data on clinical negligence claims in general surgery were obtained through a Freedom of Information (FOI) request to NHS Resolution for England, covering financial years 2013/2014 to 2021/2022 and national databases from the United States between 2014 and 2022. Only successful claims with awarded damages were included. Population-adjusted annual means, total claim volumes and associated costs were calculated.
Results
England recorded 5829 successful claims in general surgery over 9 years, with an estimated total cost of £873 million. The United States recorded 12 162 successful claims, which adjusted for population equated to 2043 claims, with an estimated adjusted cost of £563 million. England had three times more population-adjusted successful claims than the United States and nearly double the associated costs. The most common cause of successful litigation in England was “failure or delay in treatment”. Only 6.1% of successful claims were attributed to “operator error”.
Conclusions
Despite the United States’ reputation for higher litigation, England had more successful, population-adjusted general surgery claims and costs over the study period. These findings highlight the importance of systemic, cultural and structural differences in how claims are handled and resolved in each healthcare system
Gastro-oesophageal reflux disease outcomes following roux-en-y gastric bypass surgery in patients with obesity: a systematic review and meta-analysis
No full textWe aimed to investigate the effect of primary Roux-en-Y gastric bypass (RYGB) on gastro-oesophageal reflux disease (GORD) in patients with obesity. A systematic review was performed using MEDLINE, Embase, Emcare, and CINAHL databases for studies that reported on GORD outcomes following RYGB for obesity (January 2000–November 2023). Fourteen studies with 28,027 patients underwent RYGB, with pooled analysis demonstrating a 47% (95% CI 34.0–59.0; p ≤ 0.005) improvement in GORD symptoms and 4.5% (95% CI 1.7–7.2; p ≤ 0.005) with worsening/new onset GORD. Postoperative DeMeester score improved by 16.49 points (95% CI 0.2–32.7; p ≤ 0.005) and 79.4% (95% CI 68.7–90.1; p = 0.01) completely discontinued proton-pump inhibitor therapy during the follow-up period. RYGB surgery may potentially improve GORD symptoms in patients with obesity, with an overall low incidence of de novo GORD
BN S022 - Magnetic sphincter augmentation in the management of gastro-esophageal reflux disease: a systematic review and meta-analysis
No full textSP9.14 - Gastro-oesophageal reflux disease outcomes in patients with obesity following gastric bypass surgery: a systematic review and meta-analysis
No full textOncological outcomes of local excision versus radical surgery for early rectal cancer in the context of staging and surveillance: a systematic review and meta-analysis
No full textBACKGROUND: Local resection (LR) methods for rectal cancer are generally considered in the palliative setting or for patients deemed a high anaesthetic risk. This systematic review and meta-analysis aimed to compare oncological outcomes of LR and radical resection (RR) for early rectal cancer in the context of staging and surveillance assessment. METHODS: A literature search of MEDLINE, Embase and Emcare databases was performed for studies that reported data on clinical outcomes for both LR and RR for early rectal cancer from January 1995 to April 2023. Meta-analysis was performed using random-effect models and between-study heterogeneity was assessed. The quality of assessment was assessed using the Newcastle-Ottawa Scale for observational studies and the Cochrane Risk of Bias 2.0 tool for randomised controlled trials. RESULTS: Twenty studies with 12,022 patients were included: 6,476 patients had LR and 5,546 patients underwent RR. RR led to an improvement in 5-year overall survival (OR 1.84; 95 % CI 1.54-2.20; p < 0.0001; I2 20 %) and local recurrence (OR 3.06; 95 % CI 2.02-4.64; p < 0.0001; I2 39 %) when compared to LR. However, when staging and surveillance methods were clearly adopted in LR cases, there was an improvement in R0 rates (96.7 % vs 85.6 %), 5-year disease-free survival (93.0 % vs 77.9 %) and overall survival (81.6 % vs 79.0 %) compared to when staging and surveillance was not reported/performed. CONCLUSIONS: LR may be appropriate for selected patients without poor prognostic factors in early rectal cancer. This study also highlights that there is currently no single standardised staging or surveillance approach being adopted in the management of early rectal cancer. A more specified and standardised preoperative staging for patient selection as well as clinical and image-based surveillance protocols is needed
The effects of bariatric surgery on cardiac function: a systematic review and meta-analysis
No full textINTRODUCTION: Obesity is associated with alterations in cardiac structure and haemodynamics leading to cardiovascular mortality and morbidity. Culminating evidence suggests improvement of cardiac structure and function following bariatric surgery. OBJECTIVE: To evaluate the effect of bariatric surgery on cardiac structure and function in patients before and after bariatric surgery. METHODS: Systematic review and meta-analysis of studies reporting pre- and postoperative cardiac structure and function parameters on cardiac imaging in patients undergoing bariatric surgery. RESULTS: Eighty studies of 3332 patients were included. Bariatric surgery is associated with a statistically significant improvement in cardiac geometry and function including a decrease of 12.2% (95% CI 0.096-0.149; p < 0.001) in left ventricular (LV) mass index, an increase of 0.155 (95% CI 0.106-0.205; p < 0.001) in E/A ratio, a decrease of 2.012 mm (95% CI 1.356-2.699; p < 0.001) in left atrial diameter, a decrease of 1.16 mm (95% CI 0.62-1.69; p < 0.001) in LV diastolic dimension, and an increase of 1.636% (95% CI 0.706-2.566; p < 0.001) in LV ejection fraction after surgery. CONCLUSION: Bariatric surgery led to reverse remodelling and improvement in cardiac geometry and function driven by metabolic and haemodynamic factors
Standards for Presenting and Reporting clinical InterveNtions Televisually (SPRINT): a guideline for uploading clinical videos
No full textThe Standards for Presenting and Reporting clinical InterveNtions Televisually (SPRINT) guidelines will provide a set of minimum items that should used to direct clinicians when uploading videos, to ensure that the content of videos is of the highest quality and standard
