BJS open June 2020 issue published!

BJSOpen is a fully-online and open access journal & is proud to publish high-quality surgical research. This month, papers span surgical oncology, methdology, benign disease, and global surgery. The full table of contents is here.

Hernia

This month features two interesting clinical reviews on conditions of interest to all general surgeons. 

The first of these addresses the role of prophylactic mesh reinforcement in prevention of incisional hernia after midline laparotomy in a predominantly elective cohort. It showed reduction in mesh use vs suture closure, regardless of where the mesh was placed. The authors also undertook a trial sequential analysis which suggested that more than enough information was available to reach this conclusion. Rates of seroma were higher with onlay mesh vs suture, and there was no difference in the rates of surgical site infection. Will this change your practice?

Umbilical hernia is another common condition, and recurrences can lead to significant disruption of the abdominal wall. Madsen et al from Copenhagen have conducted a thorough & systematic review of the literature on this topic. Essentially, mesh reduces rate of recurrence without increasing risk of chronic pain. Noteworthy in this review is the presentation of differing even rates based on RCT or cohort designs.

Oesophageal surgery

Oesophagectomy is a high stakes operation, and is technically challenging. This paper from Birmingham in the UK, examines the outcomes of 430 patients who underwent oesphagectomy over an 11 year period. They show that increasing severity complications are associated with worse overall AND worse disease free survival, particularly when Clavien Dindo II or greater.

A paper from Cardiff, Wales, looked at the effect of systemic inflammatory response in oesophageal cancer. Specifically, it looked at the relationship between neutrophil:lymphocyte ratio (NLR) and survival. Lower NLR was associated with poor response to neoadjuvant chemo, and also with worse overall survival. Read it here.

Hepatopancreatobiliary surgery

Pancreatic fistula is a recognised complication of pancreatic surgery. This cohort study reviewed outcomes of 108 patients undergoing pancreatoduodenectomy or distal pancreatectomy. They found that enterobacter was frequently found in drain fluid of patients with pancreatic fistula after surgery. Where enterobacter or multidrug resistant organisms were found, this was associated with higher grade complications.

Other studies include a study of en bloc resection of the retropancreatic portal vein in patients undergoing surgery for pancreatic adenocarcinoma. Whilst a cohort study, it suggests benefit in terms of longer disease free and overall survival compared to standard resection approaches.

What’s the role of Liver Transplant in patients with unresectable colorectal liver mets? This was investigated as part of the SECA II ‘D’ arm. Median disease‐free and overall survival was 4 and 18 months respectively.

Colorectal surgery

Anastomotic leakage is a popular topic in journals, often due to its importance to patients and clinicians. This Italian study of 1500 patients undergoing resection compared the performance of the Dutch Leakage Score, CRP alone, and Procalcitonin in predicting anastomotic leakage (amongst other things). It showed good negative predictive value of all tools on day 2,3, and 6 (approx 97%). The positive predictive value was poor (around 10-20%).

Clinical science

This really neat study looked at potential early biomarkers of sepsis (of varying degrees) in surgical patients. It looked at a panel of biomarkers of endothelial dysfunction, neutrophil degranulation, and granulopoesis. They noted that markers of endothelial dysfunction were higher in patients with sepsis vs infection, suggesting this is an early event in the development of sepsis. Definitely worth a read!

Summary

This is not all the papers from this issue, but a selection which we think will have particular appeal to a broad part of our readership. We hope you enjoy them, and look forward to discussing them with you online!