The Surgeon RSS feed: Current Issue. Since its establishment in 2003, The Surgeon has established itself as one of the leading multidisciplinary surgical titles, both in print and online. The Surgeon is published for the worldwide surgical and dental communities. The goal of the Journal is to achieve wider national and international recognition, through a commitment to excellence in original research. In addition, both Colleges see the Journal as an important educational service, and consequently there is a particular focus on post-graduate development. Much of our educational role will continue to be achieved through publishing expanded review articles by leaders in their field. Articles in related areas to surgery and dentistry, such as healthcare management and education, are also welcomed. We aim to educate, entertain, give insight into new surgical techniques and technology, and provide a forum for debate and discussion. The Surgeon has an eminent editorial advisory board under the leadership of the editor-in-chief, Professor Austin Leahy, Dublin, Ireland. All are welcome to submit manuscripts for review. The submission and review of manuscripts is now conducted entirely online, and further details may be found at the submission site: http://ees.elsevier.com/surge . The editorial office may be contacted by email: thesurgeon@elsevier.com . The 2010 impact factor for The Surgeon is 1.136 according to the 2011 Journal Citation Reports® by Thomson Reuters. It has a worldwide circulation of over 18.000 print copies and is available on-line through ScienceDirect. It is indexed by Thomson Reuters/ISI, MEDLINE/PubMed, CINAHL and SCOPUS. http://www.thesurgeon.net/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. The Surgeon1479-666X103June 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.thesurgeon.net/article/PIIS1479666X12000406/abstract?rss=yesList of editors10.1016/S1479-666X(12)00040-6The Surgeon 10, 3 (2012)2012-06-01The Surgeon2012-06-01103S1479-666X(12)X0003-9iihttp://www.thesurgeon.net/article/PIIS1479666X1200042X/abstract?rss=yesContents list10.1016/S1479-666X(12)00042-XThe Surgeon 10, 3 (2012)2012-06-01The Surgeon2012-06-01103S1479-666X(12)X0003-9iiiiiihttp://www.thesurgeon.net/article/PIIS1479666X11000308/abstract?rss=yesAbstract: Sentinel Lymph Node Biopsy has become the standard surgical procedure for the sampling of axillary lymph nodes in breast cancer. Intra-operative node assessment of these nodes would allow definitive axillary surgery to take place immediately with associated benefits for patient management. Our experimental study aims to demonstrate that a Raman spectroscopy probe system could overcome many of the disadvantages of current intra-operative methods.59 axillary lymph nodes, 43 negative and 16 positive from 58 patients undergoing breast surgery at our district general hospital were mapped using Raman micro-spectroscopy. These maps were then used to model the effect of using a Raman spectroscopic probe by selecting 5 and 10 probe points across the mapped images and evaluating the impact on disease detection.Results demonstrated sensitivities of up to 81% and specificities of up to 97% when differentiating between positive and negative lymph nodes, dependent on the number of probe points included. The results would have concurred with histopathology assessment in 89% and 91% of cases in the 5 and 10 point models respectively. Using Raman spectroscopy in this way could allow lymph node assessment within a time-frame suitable for intra-operative use.Raman spectroscopy – A potential new method for the intra-operative assessment of axillary lymph nodesJonathan D. Horsnell, Jenny A. Smith, Martina Sattlecker, Alistair Sammon, Jonathan Christie-Brown, Catherine Kendall, Nicholas Stone10.1016/j.surge.2011.02.004The Surgeon 10, 3 (2012)2011-09-15The Surgeon2011-09-15103S1479-666X(12)X0003-9Original Papers123127http://www.thesurgeon.net/article/PIIS1479666X1100031X/abstract?rss=yesAbstract: Background: Although mortality & morbidity for pancreaticoduodenectomy (PD) have improved significantly over the last two decades, the concern for elderly undergoing PD remains. This study examines the outcome of the elderly patients who had pancreaticoduodenectomy in our institution.Methods: A prospective database comprising 69 patients who underwent pancreaticoduodenectomy between 2001 and May 2008 was analyzed. Using WHO definition, elderly patient is defined as age 65 and above in this study. Two groups of patients were compared [Group 1: Age ≤65 & Group 2: Age >65].Results: The mean age of our patients was 62 ± 11 years. There were 37 (54%) patients in Group 1 and 32 (46%) patients in Group 2. There was no statistical difference between the two groups in terms of gender and race. However, there were more patients in the Group 2 with >2 comorbidities (p = 0.03).The median duration of operation was significantly longer in Group 2 (550 min vs 471 min, p = 0.04). Morbidity rate in Group 2 was higher (56% vs 44%, p = 0.04). There was higher proportion of post-operative pancreatic fistula (POPF) in the elderly group (37.5% vs 16.7%, p = 0.05). Majority of them are Grade A POPF according to the ISG definition.The median post-operative length-of-stay (LOS) in hospital was 9 days longer in Group 2 (p = 0.01). Mortality rate between the 2 groups of patients was comparable (0% vs 3%, p = 0.28).Conclusion: Elderly patients are at increased risk of morbidity in pancreatocoduodenectomy, in particular POPF. However, morbidity and mortality rates are acceptable. It is therefore justified to offer PD to elderly patients who do not have significant cardiopulmonary comorbidities.Is pancreaticoduodenectomy justified in elderly patients?A.W.C. Kow, N.A. Sadayan, A. Ernest, B. Wang, C.Y. Chan, C.K. Ho, K.H. Liau10.1016/j.surge.2011.02.005The Surgeon 10, 3 (2012)2011-09-15The Surgeon2011-09-15103S1479-666X(12)X0003-9Original Papers128136http://www.thesurgeon.net/article/PIIS1479666X11000333/abstract?rss=yesAbstract: Purpose: Exsanguinators and tourniquets are regularly used in orthopaedic theatres. A good understanding of their application and contraindications must be ensured to prevent injury to limb or life. However, the level of staff understanding is not well documented. The aims of this study were to assess knowledge of their use between theatre personnel and assess their sterility at our institution.Methods: A previously published questionnaire was distributed to various orthopaedic theatre personnel responsible for exsanguinator and tourniquet application. Microbiology culture and sensitivity swabs were also taken.Results: Mean questionnaire score for all participants was 30.9%. None of the 74 participants scored more than 49% in the questionnaire. Exsanguinators grew more positive cultures than the tourniquets.Conclusions: Exsanguinators and tourniquets are used widely in the field of orthopaedics. Lack of their understanding amongst operating theatre personnel involved with their use strongly supports the need for providing and ensuring adequate education to provide the best patient care. In consideration of our findings, we propose a solution addressing these issues.Exsanguinators and tourniquets: Do we need to change our practice?Zubin J. Daruwalla, Fiachra Rowan, Margaret Finnegan, Jerome Fennell, Maurice Neligan10.1016/j.surge.2011.03.001The Surgeon 10, 3 (2012)2011-09-15The Surgeon2011-09-15103S1479-666X(12)X0003-9Original Papers137142http://www.thesurgeon.net/article/PIIS1479666X11000345/abstract?rss=yesAbstract: The need for emergent management of displaced paediatric supracondylar humeral fractures is being questioned in the literature. Open reduction rates of up to 46% have been reported in the non-emergent management of these injuries. At our institution these fractures are managed as operative emergencies by senior personnel. To examine the ongoing need for this policy we reviewed our results. All patients managed over a five year period with Gartland type IIB or III paeditric supracondylar humeral fractures were identified and a comprehensive chart and radiographic review undertaken. The mean time from injury to fracture reduction and stabilization was 6.6 h. Consultants performed or supervised 90% of cases. Open reduction was necessary in 5% of cases. Complications included a perioperative nerve injury rate of 6% and a superficial pin site infection rate of 3%. This study suggests that, despite the challenge to trauma on-call rostering, the emergency management of these injuries is advantageous to patients in units of our size. Based on the data presented here we continue our practice of emergent management. We suggest that units of a similar size to our own would show a benefit from an analogous policy albeit an inconvenient truth.An inconvenient truth: Treatment of displaced paediatric supracondylar humeral fracturesM. Donnelly, C. Green, I.P. Kelly10.1016/j.surge.2011.03.002The Surgeon 10, 3 (2012)2011-09-15The Surgeon2011-09-15103S1479-666X(12)X0003-9Original Papers143147http://www.thesurgeon.net/article/PIIS1479666X11000369/abstract?rss=yesAbstract: Platelet Reach Plasma (PRP) is considered to accelerate muscle and tendon healing and allow early return to elite competition, and it is often recommend as best practice for management of musculoskeletal injuries. Even though several growth factors abundant in PRPs have been extensively studied in tissue regeneration, the key factors are yet unknown. Given our rudimentary knowledge of the mechanism of action of the PRPs, it is challenging to use this technology to promote early healing, and produce improved and accelerated functional recovery. We prompt researchers to undertake appropriately powered level I studies with adequate and relevant outcome measures and clinically appropriate follow up.Platelet plasma rich products in musculoskeletal medicine: Any evidence?Nicola Maffulli, Angelo Del Buono10.1016/j.surge.2011.03.004The Surgeon 10, 3 (2012)2011-09-15The Surgeon2011-09-15103S1479-666X(12)X0003-9Original Papers148150http://www.thesurgeon.net/article/PIIS1479666X12000066/abstract?rss=yesAbstract: Dupuytren’s disease is a fibroproliferative disease of the palmar fascia which has been described for centuries, yet the aetiology and pathophysiology remain poorly understood. Surgery and collagenase injections comprise the main therapeutic options but disease recurrence is common. We explore the evidence underlying the current disease theories and outline other potential therapeutic options.Advances in the understanding of the aetiology of Dupuytren’s diseaseNatasha E. Picardo, Wasim S. Khan10.1016/j.surge.2012.01.004The Surgeon 10, 3 (2012)2012-02-01The Surgeon2012-02-01103S1479-666X(12)X0003-9Reviews151158http://www.thesurgeon.net/article/PIIS1479666X12000285/abstract?rss=yesAbstract: Purpose: Biological meshes are mostly used in infected fields within complex abdominal wall hernia repairs. There is no consensus, however, on the most appropriate material to be used in a given situation.Methods: A literature review of published articles reporting the utilization of biological meshes in ventral/incisional hernia repair was conducted. Data were analyzed to compare the recurrence rates obtained with biological meshes.Main findings: Only a few prospective comparative studies were identified. Most publications relate to AlloDerm®, Permacol™ and Surgisis™ with data from other meshes insufficient to draw conclusions. AlloDerm has a 0–100% recurrence rate among studies. It compares poorly with Surgisis and results in an unfavorable outcome when used as a ‘bridge prosthesis’. Permacol has consistent recurrence rates of 0–15%, whatever the patients' profiles or the context of infected fields, when considering the most relevant studies. The Surgisis results are more conflicting: the mesh exhibits low recurrence rates in clean fields, but in infected fields the recurrence rate is up to 39%.Conclusion: Taken together, these studies suggest that the cross-linked mesh, Permacol has the lowest failure rate and the longest time to failure, particularly in contaminated or infected fields. However, this data should be confirmed by large prospective randomized studies.Biological meshes: A review of their use in abdominal wall hernia repairsNeil J. Smart, Morwena Marshall, Ian R. Daniels10.1016/j.surge.2012.02.006The Surgeon 10, 3 (2012)2012-03-22The Surgeon2012-03-22103S1479-666X(12)X0003-9Reviews159171http://www.thesurgeon.net/article/PIIS1479666X12000091/abstract?rss=yesAbstract: Background: Bariatric surgery can provide efficient weight loss and improvement in obesity-related co-morbidities in adults. Laparoscopic adjustable gastric banding (LAGB) comprised 30.3% of all bariatric procedures between 2009 and 2010 in the UK. This review evaluates the level 1 evidence for change in co-morbidities, quality of life (QoL) and weight provided by LAGB compared with other bariatric procedures.Method: Systematic literature search of MEDLINE, EMBASE and CENTRAL (1988 to May 2011) was performed. Only randomised controlled trials (RCTs) were included. Studies with non-surgical comparators, open gastric banding procedures or adolescent participants were excluded. Primary outcome was change in co-morbidities. Secondary outcomes included QoL, weight loss, complications, operation time and length of stay.Results: Five RCTs met the inclusion criteria. Vertical banded gastroplasty, sleeve gastrectomy and gastric bypass were compared to LAGB. Co-morbidities were reported in two studies and QoL in one. LAGB was comparable to other procedures for both of these outcomes. All five trials showed LABG to be effective in weight loss, however all comparative procedures resulted in greater weight loss. Operative time and length of hospital stay were significantly shorter with LAGB. Short-term complications were found to be consistently lower in the LAGB group. Evidence was divided with respect to long-term complications.Conclusion: Co-morbidities and QoL are poorly reported and showed no difference between LAGB and other bariatric procedures. Evidence suggests that LAGB is not the most effective surgical procedure to reduce weight. LAGB is associated with lower early complications and shorter operative time and length of stay, and therefore may be preferable to patients.Comparison of laparoscopic adjustable gastric banding (LAGB) with other bariatric procedures; a systematic review of the randomised controlled trialsP.D. Chakravarty, E. McLaughlin, D. Whittaker, E. Byrne, E. Cowan, K. Xu, D.M. Bruce, J.A. Ford10.1016/j.surge.2012.02.001The Surgeon 10, 3 (2012)2012-03-09The Surgeon2012-03-09103S1479-666X(12)X0003-9Reviews172182http://www.thesurgeon.net/article/PIIS1479666X11000102/abstract?rss=yesCurrent opinion regarding the best management of patients relapsing post high dose chemotherapy (HDCT) is divided with no established standard chemotherapy regimen. There are very few long term survivors in this group and surgical therapy seems vital to achieve this. Therefore, the most important strategy is a multi-modality approach to these patients leading to resection of residual masses. The most frequent site of surgical resection is the retroperitoneum. However, more unusual sites require specialist surgical approaches in a small number of cases.Liver resection as part of multi-modality treatment of late relapse of germ cell cancer following high dose chemotherapyD.E. McIntosh, J. Harrington, J.D. White, G. Baxter, O.J. Garden10.1016/j.surge.2011.01.009The Surgeon 10, 3 (2012)2011-09-15The Surgeon2011-09-15103S1479-666X(12)X0003-9Correspondence: Case Report183184