Introduction: Minimally invasive bariatric surgery is a relatively new innovation, increasingly used in the management of severe obesity. We aim to compare the uptake of laparoscopic bariatric procedures with regards to regional socioeconomic deprivation, using cholecystectomy as a novel baseline comparator.Methods: Data were collected on all bariatric and cholecystectomy procedures conducted between 2003-2013 at a high volume specialist bariatric centre in the United Kingdom (UK). For each procedure, the Index of Multiple Deprivation (IMD 2010), a measure of socioeconomic status, was also obtained for each case.Results: 5954 cases were included in the study (4221 cholecystectomies and 1733 bariatric operations). The median IMD score for laparoscopic cholecystectomy was 24.0 and had not significantly changed over the study period (p = 0.118). Relative to cholecystectomy, the median IMD for bariatric procedures was significantly lower at 18.0 (p < 0.01). The yearly median IMD for bariatric patients was lower than that of cholecystectomy patients (p < 0.001 in 2005, p = 0.04 in 2012) but increased over the study period (p < 0.01).Conclusions: Early uptake of bariatric surgery was from more affluent areas, with later adoption taking place in more deprived areas. However patients undergoing bariatric surgery remain significantly less deprived than those undergoing cholecystectomy. In the West Midlands region of the UK, the average IMD score for laparoscopic cholecystectomy patients appears to be independent of the patient deprivation score and area of residence.

Introduction: Laparoscopic anti-reflux surgery is conventionally performed using two 10/ 12 mm ports. While laparoscopic procedures reduce post-operative pain, the use of larger ports invariably increases discomfort and affects cosmesis. We describe a new all 5 mm ports technique for laparoscopic anti-reflux surgery and present a review of our initial experience with this approach.Methods: All patients undergoing laparoscopic fundoplication over a 35 month period from February 2013 under the care of a single surgeon were included. A Lind laparoscopic fundoplication was performed using an all 5 mm port technique. Data was recorded prospectively on patient demographics, operating surgeon, surgical time, date of discharge, readmissions, complications, need for re-intervention, and reasons for admission.Results: Two hundred and five consecutive patients underwent laparoscopic fundoplication over the study period. The all 5 mm port technique was used in all cases, with conversion to a 12 mm port only once (0.49%). Median operating time was 52 min 185 (90.2%) patients were discharged as day cases. Increasing ASA grade and the presence of a hiatus hernia were associated with the need for overnight stay with admission required in 33% of patients with ASA 3, compared to 4% with ASA 1 (p = 0.001), and 29% of those with a hiatus hernia vs. 5% without (p < 0.001). No port-related complications occurred, and no patients developed recurrence of reflux symptoms. A single patient required mesh repair of a large hiatus hernia.Conclusion: The all 5 mm ports approach to laparoscopic anti-reflux surgery is a safe, efficient, and cost-effective technique which facilitates same day discharge and minimises port related complications. National commissioning guidelines in the UK should target quality improvements in anti-reflux surgery based around day-case management. This would improve the service for these patients and culminate in cost savings for the NHS. (C) 2016 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.

Introduction Post-oesophagectomy diaphragmatic hernias (PODHs) are serious complications following oesophagectomy. However, the incidence of PODHs are unknown. The aim of this study was to describe and compare the incidence of PODHs over time and analyse the outcomes of patients who develop a PODH. Method A prospective database of all oesophagectomies performed for cancer between 2001 to 2014 was analysed. Patients diagnosed with PODH were identified and data extracted regarding demographics, details of oesophagectomy, pathology, PODH symptoms, diagnosis and treatment. Results A total of 507 transthoracic oesophagectomies were carried out between 2001 and 2014. Overall, 21 patients (18 males and 3 females) developed PODH. The incidence of PODH after open 2 or 3 stage oesophagectomy was 3/221 (1.3%) compared to 14/212 (6.6%) following laparoscopic hybrid oesophagectomy and 4/68 (5.9%) following minimally invasive oesophagectomy (MIO). Median age was 63 (range 55 to 82) years. 17 (81%) had surgery for lower oesophageal or gastro-oesophageal junctional adenocarcinoma. Of those who developed a PODH, 10 (48%) patients presented as an emergency and 11 (52%) patients with outpatient symptoms. Common presenting symptoms were shortness of breath, chest pain, vomiting and cough. Five (24%) patients develop PODH within 7 days of the index surgery, a further 3 (14%) within 90 days, 8 (38%) at 2 years and 4 (24%) at 5 years. Twenty patients had corrective surgery for PODH with hiatal suture repair (n = 15), hiatal mesh repair (n = 2), and other surgical procedures (n = 3). These were performed either laparoscopically (n = 15) or as open repairs (n = 5). However, 4 patients required conversation. Median length of stay was 12 days (range 3 to 48 days); but shorter when successfully treated laparoscopically. Thirty day post-operative mortality was 10% (n = 2) and 20% (n = 4) recurred requiring further surgery. Conclusion PODH is a common complication following hybrid oesophagectomy and MIO. One hypothesis is there is less intra-abdominal adhesions formed when minimal access techniques are used. Careful thought is needed to identify surgical techniques to prevent PODH forming when minimal access oesophagectomy are performed. Disclosure of interest None Declared.