British Hernia Society – groin hernia guidelines
The British Hernia Society has produced clinical guidelines in association with ASGBI giving best evidence in the management of groin hernia. This is aimed to help clinicians deliver a high-quality, cost-effective, evidence-based hernia service.
www.Britishherniasociety.org, May 2013
Varicose veins in the legs
NICE has published evidence-based clinical guidelines on the diagnosis and management of varicose veins
NICE clinical guideline 168, July 2013
Acute upper gastrointestinal bleeding
NICE has produced quality standards on acute upper gastrointestinal bleeding in adults. NICE quality standards are a concise set of prioritised statements designed to drive measurable quality improvements
NICE Quality Standards, QS38, July 2013
Cost-effectiveness of laparoscopic fundoplication versus continued medical management for GORD
The REFLUX trial randomized 357 patients with GORD to early laparoscopic fundoplication or continued medical management. The group randomized to surgery experienced better health outcomes in each year of follow-up, but the difference narrowed over time. The probability that surgery is the most cost-effective intervention was 0·932 at a threshold of £20 000/QALY. Authors conclude that laparoscopic fundoplication is a cost-effective alternative to continued medical management over 5 years.
Faria L. Bojke D, Epstein B, et al. Br J Surg 2013: b2012
Gastric bypass makes gut burn sugar faster
Obesity researchers at Boston Children’s Hospital are investigating the way that bariatric surgery improves diabetic control. In rats that had undergone gastric bypass surgery the Roux limb was taking up and using the sugar, perhaps to compensate for receiving fewer digested nutrients from the stomach. The team now hopes to study the process in patients who have undergone bypass surgery.Tomography imaging shows that diabetic rats take up more glucose in their intestines after gastric bypass surgery.
Stylopoulas et al. Nature News, July 2013
Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial
This multicenter trial randomized 601 patients to early surgical haematoma evacuation plus medical treatment or initial medical treatment alone. The primary outcome was a favourable or unfavourable outcome of the eight-point Extended Glasgow Outcome Scale (GOSE) obtained by questionnaires posted to patients at 6 months. A total of 59% in the early surgery group had an unfavourable outcome versus 62% in the initial conservative treatment group (absolute difference 3·7%, odds ratio 0·86; p=0·367). Authors concluded that early surgery does not increase the rate of death or disability at 6 months and might have a small but clinically relevant survival advantage for patients with spontaneous superficial intracerebral haemorrhage without intraventricular haemorrhage.
Mendelow D, Gregson BA, Rowan EN, et al. Lancet 2013; 382: b397
Risk factors for nonunion after nonoperative treatment of displaced midshaft fractures of the clavicle
This prospective study evaluated factors associated with nonunion for patients with diaphyseal clavicular fractures. A total of 125 (13%) of 941 fractures had evidence of nonunion. Significant factors on multivariate analysis were smoking (odds ratio, 3.76), comminution (odds ratio, 1.75), and fracture displacement (odds ratio, 1.17). The authors conclude that the number needed to be treated to prevent a single nonunion can be reduced by identifying those at higher risk, and tailoring treatment.
Murray IR, Foster CJ, Eros A, Robinson CM. J Bone Joint Surg 2013; 95: 1153