British Journal of Surgery
0007-1323
1365-2168
Anh Quốc
Cơ quản chủ quản: Oxford University Press , OXFORD UNIV PRESS
Lĩnh vực:
Surgery
Phân tích ảnh hưởng
Thông tin về tạp chí
With an impact factor of 5.572, BJS is the premier surgical journal in Europe and one of the top six surgical periodicals in the world. Its international readership is reflected in the prestigious international Editorial Board, supported by a panel of over 1200 reviewers worldwide. BJS features the very best in clinical and laboratory-based research on all aspects of general surgery and related topics. Developing areas such as minimally invasive therapy and interventional radiology are strongly represented. The inclusion of Leading Articles, Reviews and Original Articles means that the BJS offers an appropriate format for any length or type of submission. In addition there are abstracts from key meetings and correspondence. BJS will be of interest not only to general surgeons, but also to specialty surgeons and those working in related fields.
Các bài báo tiêu biểu
Prospective randomized trial comparing two injection techniques for sclerosing oesophageal varices: Over-tube and free-hand Abstract
The safety, efficacy and complications of two techniques of endoscopic injection sclerotherapy were examined in 102 consecutive patients, using either a totally transparent over-tube or the free-hand technique. The choice of treatment was at random. There was a significantly higher control of variceal bleeding when the over-tube technique was used (100 per cent versus 77 per cent, P<0·05). The frequency of re-bleeding before the eradication of oesophageal varices was significantly less in the over-tube group than in the free-hand group (P<0·01), although all re-bleedings were well controlled with additional injections of 5 per cent ethanolamine oleate. There was no significant difference between the two techniques with regard to the frequency of endoscopic injection sclerotherapy for eradication of oesophageal varices. The over-tube technique is safer than the free-hand technique and takes less time to accomplish; at the initial session of treatment, time and bleeding during these techniques were 11·5 ± 2·3 mm (mean ± s.d.) and 7·3 ± 5·9 ml in the over-tube technique, and 20·4 ± 4·1 min and 45·1 ± 30·0 ml in the freehand technique (P<0·001, in both time and bleeding).
Tập 74 Số 7 - Trang 603-606 - 1987
Laparoscopic ‘physiological’ antireflux procedure: Preliminary results of a prospective symptomatic and objective study Abstract
The ‘physiological’ antireflux procedure has been shown to be as effective as Nissen fundoplication in reflux control, but with a significant reduction in the incidence of mechanical complications. This technique was attempted laparoscopically in 26 patients in a prospective study involving independent symptomatic, manometric and pH assessment performed before operation and at a mean of 5.5 months after operation. The procedure was successfully completed laparoscopically in 23 (88 per cent) patients. Mean hospital stay was 3.8 days and mean time to return to work 1.8 weeks. There was neither mortality nor reoperation; 91 per cent of patients obtained symptomatic relief (82 per cent Visick grade 1). There was no gas-bloat or inability to belch or vomit. All 14 patients who underwent objective testing had a normal oesophageal pH profile, the mean percentage total time that pH < 4 falling from 11.0 to 1.1 (P < 0.001). Lower oesophageal sphincter characteristics, including relaxation, were similar to control values. These preliminary results suggest symptomatic and objective results comparable to those following open surgery, but with the benefits of a shorter hospital stay and time off work. In addition to a lower incidence of mechanical complications, the relative ease of performance of this procedure confers an additional advantage over Nissen fundoplication when performed laparoscopically.
Tập 82 Số 5 - Trang 651-656 - 1995
Yield pressure, anatomy of the cardia and gastro-oesophageal reflux Abstract
The yield pressure at which the cardia opens in response to gastric distension was measured in 155 subjects with and without gastro-oesophageal reflux (GOR) and after Nissen fundoplication. Yield pressure was measured by endoscopy or during oesophageal manometry. The median pressure was significantly lower in subjects with GOR than in those without (P < 0.0001). After successful Nissen fundoplication this pressure increased to supranormal values (P < 0.0001). There was a close relationship between yield pressure and the presence and size of hiatus hernia and also between yield pressure and the valvular appearance of the cardia at endoscopy. There was a significant correlation between yield pressure and oesophageal acid exposure. However, no relationship was observed between yield pressure and lower oesophageal sphincter pressure or intra-abdominal length. These results suggest that yield pressure is useful for assessment of the competence of the cardia, particularly after antireflux surgery. The competence of the cardia is greatly influenced by its anatomical structure.
Tập 82 Số 7 - Trang 943-947 - 1995
Laparoscopic Nissen fundoplication is a satisfactory alternative to long-term omeprazole therapy Abstract
A total of 168 patients with proven gastro-oesophageal reflux disease (GORD) receiving long-term medical therapy underwent laparoscopic Nissen fundoplication. The operation was converted to open fundoplication in four patients. All patients reported complete (92.3 per cent) or partial (7.7 per cent) relief of reflux symptoms 1 month after surgery. There were no associated deaths and the perioperative complication rate was 8.9 per cent. The mean(s.e.m.) length of operating time was 69.9(2.4) min and mean(s.e.m.) hospital stay 2.7(0.1) days. Symptom score assessment, 24-h oesophageal pH recording and lower oesophageal sphincter pressure showed significant (P < 0.0001) improvement 6 months after surgery in 85 evaluable patients. Before operation 37.5 per cent of the patients were considered symptomatically controlled on omeprazole and had excellent symptom control after surgery. This initial experience suggests that laparoscopic Nissen fundoplication is a safe and effective treatment for patients with GORD requiring long-term medication.
Tập 82 Số 7 - Trang 938-942 - 1995
Recurrent reflux and wrap disruption after Nissen fundoplication: Detection, incidence and timing Abstract
One hundred and twenty-five patients with refractory gastro-oesophageal reflux disease underwent floppy Nissen fundoplication. Median follow-up was 52 months, and included endoscopy, manometry and prolonged pH recordings in all cases in addition to clinical assessment. Using objective criteria, 12patients (9·6per cent) developed recurrent reflux. In nine of these patients, endoscopy had suggested that the Nissen fundoplication had disrupted; wrap disruption was confirmed in seven patients who underwent reoperation. The median time to endoscopic recognition of wrap disruption was 7 months (range 3–10 months). In contrast, of 115 patients with endoscopic evidence of an intact fundoplication, only 3 (2·6 per cent) had recurrent reflux. Endoscopy allowed reliable differentiation between those with and without reflux control after operation (P< 0·007). These results suggest that recurrent reflux after Nissen fundoplication is due to wrap disruption. This phenomenon occurs within the first postoperative year and can be recognized by informed endoscopic assessment.
Tập 77 Số 5 - Trang 545-547 - 1990
Quality of life and health status before and after ileal pouch–anal anastomosis for ulcerative colitis Abstract
Background
Ileal pouch–anal anastomosis (IPAA) is considered the surgical treatment of choice for patients with ulcerative colitis. Quality of life (QoL) and health status are the most important patient-related outcomes. Studies investigating QoL are often cross-sectional and focus on health status. This longitudinal study evaluated QoL and health status after IPAA for ulcerative colitis and compared these with reference data from a healthy population.
Methods
Patients with ulcerative colitis who underwent a pouch operation between 2003 and 2008 completed validated questionnaires for QoL and health status. Questionnaires were completed before pouch surgery, and 6, 12, 24 and 36 months after operation. The effect of IPAA on QoL and health status was analysed, and data were compared with reference values from the healthy Dutch population.
Results
Data were obtained for 30 of the 32 patients. Six months after IPAA, QoL was at least comparable with that of the reference population in four of six domains. Twelve months after IPAA, overall QoL had improved, supported by findings in three QoL domains. Six months after IPAA, health status was comparable to that of the reference population in three of eight dimensions, and after 3 years it was at least comparable in five dimensions.
Conclusion
QoL and health status increased after IPAA and reached levels comparable with those of the healthy reference population in a majority of domains and dimensions. QoL was restored first after IPAA, followed by health status.
Tập 99 Số 2 - Trang 263-269 - 2012
Stapled ileo-anal anastomosis: A technique to avoid mucosal proctectomy in the ileal pouch operation Abstract
Ten patients have undergone abdominal proctocolectomy with the formation of an ileal reservoir anastomosed onto the anal canal using a stapling device. This technique avoids stripping of the rectal mucosa from the muscle tube (mucosal proctectomy) which is time consuming and often difficult. One patient is awaiting closure of her ileostomy. The remaining seven are continent and are passing between one and six motions a day.
Tập 73 Số 7 - Trang 571-572 - 1986
Causes and outcomes of pouch excision after restorative proctocolectomy Abstract
Background
Pouch failure occurs in up to 10 per cent of patients after ileal pouch–anal anastomosis (IPAA). The aims of this study were to determine the reasons for pouch excision and to evaluate the outcome of the perineal wound after pouch excision.
Methods
Between 1984 and 2002, 91 patients with severe ileal pouch dysfunction were treated. This was a retrospective analysis of data collected prospectively from 24 patients who underwent pouch excision.
Results
Patients were grouped according to the final histological diagnosis. Fourteen patients with Crohn's disease developed extensive fistulous disease and/or recurrent abscesses, of whom six had a persistent perineal sinus after pouch excision. Five patients had familial adenomatous polyposis, in three of whom desmoid tumours were the cause of failure. Three patients had chronic ulcerative colitis and developed recurrent pelvic sepsis. Finally, two patients with multiple colorectal adenocarcinoma developed recurrent cancer (one) or sepsis (one).
Conclusion
Sepsis was the principal reason for pouch excision and was usually associated with recrudescent Crohn's disease in the pouch. Perineal wound healing was problematic after pouch excision for Crohn's disease.
Tập 93 Số 1 - Trang 82-86 - 2006
Function of ileal J pouch-anal anastomosis in patients with familial adenomatous polyposis Abstract
Pouch function after proctocolectomy and ileal J pouch-anal anastomosis was assessed at 1 and 5 years in 41 patients with familial adenomatous polyposis. The mean(s.d.) stool frequency per 24 h decreased from 4·4(1·7) to 3·9(1·8) (P < 0·05), the mean(s.d.) nocturnal stool frequency fell from 0·6(1·0) to 0·3(0·6) (P < 0·05), and the number of patients having nocturnal bowel movements decreased from 16 to seven (P < 0·05). At 5 years, only one patient still followed a strict diet (versus ten at 1 year, P < 0·05) and only two needed antidiarrhoeal medication (versus ten at 1 year, P < 0·05). There were no episodes of pouchitis or late reservoir-related complications. The function of ileal pouch-anal anastomosis improves over time in patients with familial adenomatous polyposis.
Tập 80 Số 6 - Trang 765-767 - 1993