Knowledge Hub @ Bedfordshire Hospitals NHS FT
The Knowledge Hub, managed by the Danielle Freedman Library is a digital repository - a central location for Bedfordshire Hospitals NHS Foundation Trust's research, quality improvement, education and academic output - published and unpublished.
The Knowledge Hub replaces the academic report previously published by Research & Development.
Some items are added to the repository automatically by the library team, if you do not find your item or you would like more information about submitting your work to the Knowledge Hub please contact library@besdft.nhs.uk
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Item Revisiting large complex ventral hernia repair: multimodal hybrid technique deploying preoperative Botulinum Toxin A injection, laparoscopic anterior components separation and open mesh repair(2024)Abstract In the past, various techniques had been described to repair large complex ventral hernias. Laparoscopic technique of components separation showed low complication rates and better overall outcome. Recently, Botulinum Toxin A (BTA) has shown benefit in achieving tension-free repair. We describe here our multimodal technique combining BTA injection, laparoscopic anterior components separation (LACS) and open mesh repair. Ten consecutive cases performed over 3 years were studied. A standardised technique was used with a reasonably short learning curve. Patients who generally fit for general anaesthesia were offered surgery after detailed preoperative imaging work up and informed consent. Demographic details, preoperative risk stratification, intraoperative and postoperative outcomes were recorded and analysed. A structured step by step management strategy was adopted. Total ten (n = 10) cases with median age of 42.5 years (range 28-76 years), male to female ratio of 8:2 and median BMI of 32.6 were included. Three patients had pre-existing stomas. Median diameter of hernial defect was 10 cm, IQR 4.8 cm and range of 6-20 cm. No intraoperative or immediate complications were observed. Median hospital stay was 6 days. Two seromas (20%) and two return to theatre (20%) were observed. One recurrence (10%) was observed after median follow-up of 32 months. No 90-day mortality was recorded. Multimodal technique of BTA injection, LACS and midline mesh repair is a reproducible, safe and effective option to repair large complex ventral hernias. Keywords: Components separation; Hernia; Intraperitoneal mesh; Laparoscopic; Ventral hernia. © 2024. Italian Society of Surgery (SIC). PubMed Disclaimer Similar articles Laparoscopic repair of complex ventral hernia facilitated by pre-operative chemical component relaxation using Botulinum Toxin A. Elstner KE, Jacombs AS, Read JW, Rodriguez O, Edye M, Cosman PH, Dardano AN, Zea A, Boesel T, Mikami DJ, Craft C, Ibrahim N. Hernia. 2016 Apr;20(2):209-19. doi: 10.1007/s10029-016-1478-6. Epub 2016 Mar 7. PMID: 26951247 Minimally invasive Venetian blinds ventral hernia repair with botulinum toxin chemical component separation. Chan DL, Ravindran P, Fan HS, Elstner KE, Jacombs ASW, Ibrahim N, Talbot ML. ANZ J Surg. 2020 Jan;90(1-2):67-71. doi: 10.1111/ans.15438. Epub 2019 Sep 30. PMID: 31566297 Preoperative chemical component relaxation using Botulinum toxin A: enabling laparoscopic repair of complex ventral hernia. Elstner KE, Read JW, Rodriguez-Acevedo O, Cosman PH, Dardano AN, Jacombs AS, Edye M, Zea A, Boesel T, Mikami DJ, Ibrahim N. Surg Endosc. 2017 Feb;31(2):761-768. doi: 10.1007/s00464-016-5030-7. Epub 2016 Jun 28. PMID: 27351658 Laparoscopic tension-free repair of anterior abdominal wall incisional and ventral hernias with an intraperitoneal Gore-Tex mesh: prospective study and review of the literature. Aura T, Habib E, Mekkaoui M, Brassier D, Elhadad A. J Laparoendosc Adv Surg Tech A. 2002 Aug;12(4):263-7. doi: 10.1089/109264202760268041. PMID: 12269494Review. Low-Dose Pre-Operative Botulinum Toxin A Effectively Facilitates Complex Ventral Hernia Repair: A Case Report and Review of the Literature. Mourad AP, De Robles MS, Winn RD. Medicina (Kaunas). 2020 Dec 28;57(1):14. doi: 10.3390/medicina57010014. PMID: 33379146Free PMC article.Review. See all similar articles References Ramirez OM, Ruas E, Dellon AL (1990) “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 86:519–526 - DOI - PubMed Switzer NJ, Dykstra MA, Gill RS, Lim S, Lester E, de Gara C, Shi X, Birch DW, Karmali S (2015) Endoscopic versus open component separation: systematic review and meta-analysis. Surg Endosc 29:787–795 - DOI - PubMed Hodgkinson JD, Leo CA, Maeda Y, Bassett P, Oke SM, Vaizey CJ, Warusavitarne J (2018) A meta-analysis comparing open anterior component separation with posterior component separation and transversus abdominis release in the repair of midline ventral hernias. Hernia 22:617–626 - DOI - PubMed Feretis M, Orchard P (2015) Minimally invasive component separation techniques in complex ventral abdominal hernia repair: a systematic review of the literature. Surg Laparosc Endosc Percutan Tech 25:100–105 - DOI - PubMed Tong WM, Hope W, Overby DW, Hultman CS (2011) Comparison of outcome after mesh-only repair, laparoscopic component separation, and open component separation. Ann Plast Surg 66:551–556 - DOI - PubMedItem Changes in social care after major emergency general surgery procedures(2024)Abstract Background: Emergency general surgery (EGS) is a major part of the provision of healthcare, and patients undergoing EGS are at elevated risk of morbidity and mortality. This study aimed to determine factors contributing to patients losing their independence and being discharged to residential and nursing homes having previously lived in their own residences. Methods: Our local data uploaded to the National Emergency Laparotomy Audit (NELA) (2014-2022) were analyzed. This national database encompasses all major EGS cases undertaken in the United Kingdom. The variables considered were patient demographics, American Society of Anesthesiologists score, admission and discharge dates, presenting pathology, operation type, and discharge destination. Comparative analyses segmented patients based on postdischarge EGS destinations. Multivariable logistic regression identified factors linked to residential/nursing home placement after discharge. Significance was set at P < .05. Results: Data from all patients in the NELA database (n = 1611) were analyzed. Approximately 1 in 10 patients older than 70 years never returned home. Patients requiring additional support were on average 8.6 years older (P = .008). At older than 80 years, the need for extra social support increased substantially with each increasing year in age, and those older than 85 years were more than twice as likely to require extra support than 80-year-olds (P < .001). Patients who died were 11.4 years older than those discharged without additional support (P < .001). Conclusion: A significant proportion of patients, particularly the elderly, do not return to their usual place of residence and require a higher level of care postemergency surgery. These important social factors need to be considered before operating given that they may have significant quality of life and economic implications. Keywords: Emergency general surgery; National Emergency Laparotomy Audit; Social care. Copyright © 2024. Published by Elsevier Inc. PubMed Disclaimer Similar articles Long-term survival in high-risk older adults following emergency general surgery admission. Guttman MP, Tillmann BW, Nathens AB, Saskin R, Bronskill SE, Huang A, Haas B. J Trauma Acute Care Surg. 2021 Oct 1;91(4):634-640. doi: 10.1097/TA.0000000000003346. PMID: 34252059 The Impact of Nonelective Abdominal Surgery on the Residential Status of Older Adult Patients. Davis PJ, Bailey JG, Molinari M, Hayden J, Johnson PM. Ann Surg. 2016 Feb;263(2):274-9. doi: 10.1097/SLA.0000000000001126. PMID: 25607757 Does the Emergency Surgery Score predict failure to discharge the patient home? A nationwide analysis. AlSowaiegh R, Naar L, Mokhtari A, Parks JJ, Fawley J, Mendoza AE, Saillant NN, Velmahos GC, Kaafarani HMA. J Trauma Acute Care Surg. 2021 Mar 1;90(3):471-476. doi: 10.1097/TA.0000000000002980. PMID: 33055577 Alive and at home: Five-year outcomes in older adults following emergency general surgery. Guttman MP, Tillmann BW, Nathens AB, Saskin R, Bronskill SE, Huang A, Haas B. J Trauma Acute Care Surg. 2021 Feb 1;90(2):287-295. doi: 10.1097/TA.0000000000003018. PMID: 33502146 Robotic Technology in Emergency General Surgery. Chen K, Zheng F, Niu W. JAMA Surg. 2024 Sep 1;159(9):1091-1092. doi: 10.1001/jamasurg.2024.2115. PMID: 38959000Review.No abstract available.Item Impact of Gastrojejunostomy Anastomosis Diameter on Weight Loss Following Laparoscopic Gastric Bypass: A Systematic Review(2024)Abstract Laparoscopic Roux-en-Y gastric bypass (RYGB) is crucial for significant weight reduction and treating obesity-related issues. However, the impact of gastrojejunostomy (GJ) anastomosis diameter on weight loss remains unclear. We investigate this influence on post-RYGB weight loss outcomes. A systematic search was conducted. Six studies met the inclusion criteria, showing varied GJ diameters and follow-up durations (1-5 years). Smaller GJ diameters generally correlated with greater short-to-medium-term weight loss, with a threshold beyond which complications like stenosis increased. Studies had moderate-to-low bias risk, emphasizing the need for precise GJ area quantification post-operation. This review highlights a negative association between smaller GJ diameters and post-RYGB weight loss, advocating for standardized measurement techniques. Future research should explore intra-operative and AI-driven methods for optimizing GJ diameter determination. Keywords: Bariatric surgery; GJ diameter; Gastroenterostomy diameter; Gastrojejunostomy diameter; Laparoscopic Roux-en-Y gastric bypass (RYGB); Outcomes; Stenosis; Weight loss. © 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature. PubMed Disclaimer Similar articles The tighter the stoma, the greater the loss: A narrower gastrojejunostomy is more beneficial for weight loss following roux-en-Y gastric bypass. Kalali K, Zandbaf T, Esparham A, Ahmadyar S, Jangjoo A, Meshkat M, Kalantari ME, Ghamari MJ, Rezapanah A, Dalili A. Clin Obes. 2025 Aug;15(4):e70013. doi: 10.1111/cob.70013. Epub 2025 May 18. PMID: 40384040 Laparoscopic adjustable gastric banding in the treatment of obesity: a systematic literature review. Chapman AE, Kiroff G, Game P, Foster B, O'Brien P, Ham J, Maddern GJ. Surgery. 2004 Mar;135(3):326-51. doi: 10.1016/S0039-6060(03)00392-1. PMID: 14976485 Three-Year Results of Comparison Between Ring- versus Non-ring-Augmented Roux-en-Y Gastric Bypass: A Randomized Control Trial. Hany M, Zidan A, Ibrahim M, Elbahrawy A, Mourad M, Abouelnasr AA, Hany ZM, Torensma B. Obes Surg. 2025 Aug;35(8):2812-2827. doi: 10.1007/s11695-025-08034-w. Epub 2025 Jul 17. PMID: 40676351Free PMC article.Clinical Trial. Comparison of metabolic outcomes in patients undergoing laparoscopic roux-en-Y gastric bypass versus sleeve gastrectomy - a systematic review and meta-analysis of randomised controlled trials. Hayoz C, Hermann T, Raptis DA, Brönnimann A, Peterli R, Zuber M. Swiss Med Wkly. 2018 Jul 5;148:w14633. doi: 10.57187/smw.2018.14633. eCollection 2018. PMID: 30035801 Outcomes of Mini vs Roux-en-Y gastric bypass: A meta-analysis and systematic review. Wang FG, Yan WM, Yan M, Song MM. Int J Surg. 2018 Aug;56:7-14. doi: 10.1016/j.ijsu.2018.05.009. Epub 2018 May 16. PMID: 29753952 See all similar articles References Small P, Mahawar K et al. The United Kingdom National Bariatric Surgery Registry 3rd Report. 2020. IFSO. Global Registry Eighth report. 2023. https://www.ifso.com/pdf/8th-ifso-registry-report-2023.pdf . Courcoulas A, Coley RY, Clark JM, et al. Interventions and operations 5 years after bariatric surgery in a cohort from the US national patient-centered clinical research network bariatric study. JAMA Surg. 2020;155(3):194. - DOI - PubMed - PMC Pucci A, Batterham RL. Mechanisms underlying the weight loss effects of RYGB and SG: similar, yet different. J Endocrinol Invest. 2019;42(2):117–28. - DOI - PubMed Kamocka A, Chidambaram S, Erridge S, et al. Length of biliopancreatic limb in Roux-en-Y gastric bypass and its impact on post-operative outcomes in metabolic and obesity surgery—systematic review and meta-analysis. Int J Obes. 2022;46(11):1983–91. - DOI
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