NICE – Clinical Guidelines

The diagnosis and management of colorectal cancer

NICE has issued clinical guidelines for the diagnosis, staging, and management of colorectal cancer

NICE, November 2011

Organ Donation for Transplantation

NICE has issued clinical guidelines to improve donor identification and consent rates for deceased organ donation

NICE, December 2011

Caesarean Section

This guideline has been developed to help ensure consistent quality care for women who have had a caesarean section (CS) in the past and are pregnant again or who have a clinical indication for a CS or who are considering a CS when there is no other indication.

NICE, November 2011

www.nice.org.uk

Journals

Randomised clinical trial of percutaneous transluminal angioplasty, supervised exercise and combined treatment

This randomised trial of 178 patients compared percutaneous transluminal angioplasty (PTA), a supervised exercise programme (SEP) and combined treatment for intermittent claudication due to femoropopliteal arterial disease. All three treatment groups demonstrated significant clinical and Quality of Life (QoL) improvements. PTA, SEP, and PTA plus SEP were all equally effective in improving walking distance and QoL after 12 months.

Mazari AK, Khan JA, Carradice D. BJS 2012; b39.

The use of lightweight versus heavyweight mesh in open inguinal hernia repair

This meta-analysis evaluated nine randomised trials containing 2310 patients comparing lightweight mesh (LWM) with heavyweight mesh (HWM) in open inguinal hernia repair. There was no difference in recurrence rate, or time to return to work between groups. The two mesh types had a similar risk of perioperative complications, but LWM was associated with a reduced risk of developing chronic groin pain (RR 0·61) and of other groin symptoms, such as stiffness and foreign body sensations (RR 0·64).

Sajid MS, Leaver C, Baig MK, Sains P. BJS 2012; b29.

Intraoperative cholangiography in cholecystectomy

This systematic review identified eight randomised trials including 1715 patients. Authors concluded that there is no robust evidence to support or abandon the use of cholangiography to prevent retained bile duct stones or bile duct injury. None of the trials, alone or in combination, was sufficiently powered to demonstrate a benefit of cholangiography.

Ford A, Soop M, Du J, et al. BJS 2012; b160.

Short-term outcomes following open vs minimally invasive esophagectomy (MIE) for cancer in England: A population-based national study

National hospital episode data were analysed from 2005 to 2010. Seven thousand five hundred and two esophagectomies were performed; of these, 1155 (15.4%) were MIE. There was no difference in 30-day mortality (4.3% vs. 4.0%) and medical morbidity (38.0% vs. 39.2%) between open and MIE groups. A higher reintervention rate was associated with the MIE group (21% vs. 17.6). Further evidence is needed to establish the long-term survival of MIE.

Mamidanna, Ravikrishna; Bottle, et al. Ann Surg 2012; 255(2): b197.

Randomised trial of fondaparinux versus heparin to prevent graft failure after coronary artery bypass grafting

Sun JC, Teoh KH, Sheth T, Landry D, Jung H, Warkentin TE, Yusuf S, Lamy A, Eikelboom JW.

This study from Harvard medical school randomised patients undergoing CABG to receive post-operative injections of fondaparinux or heparin in-hospital. There was no difference in death, MI, stroke, bleeding events, or re-operation. Based on CT angiography a similar proportion of patients treated with fondaparinux compared with heparin had at least one occluded graft at 30 days. Authors’ concluded that fondaparinux appears to be a safe alternative to heparin after CABG.

Sun JC, Teoh KH, Sheth T, et al. J Thromb Thrombolysis 2011; 32(3): b378.

Prevention of postoperative abdominal adhesions after laparotomy for adhesive small bowel obstruction

One-hundred and eighty-one patients undergoing laparotomy for adhesive bowel obstruction were randomised to the addition of icodextrin 4% (Adept) solution before abdominal closure or standard treatment. The recurrence rate for bowel obstruction was lower in the icodextrin group (2.19% vs. 11.11%) after a mean follow-up of 41.4 months. There was no difference in the need for further laparotomy. The authors’ concluded that the use of icodextrin 4% solution is safe and reduces intra-abdominal adhesion formation and risk of re-obstruction.

Catena F, Ansaloni L, Di Saverio S, et al. Catena F, Ansaloni L, Di Saverio S, Pinna AD; On Behalf of the World Society of Emergency Surgery. J Gastrointest Surg 2012; 16(2): b382.

Invitation to contribute to the Analysis section

We would like to invite readers to submit paper reviews for publication in the analysis section of Surgeons' News. Reviewed papers should have been published within the three previous months and submissions should be from a consultant, but may be co-authored with a colleague or trainee. The standard format is a summary 'in a nutshell' (170 words), followed by a 'second opinion' (170 words), and a 'verdict'.

Interested readers should contact Peter Lamb ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it or Mark Baillie ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it ) for further details.