Publications
261 results found
Iqbal M, Batch AJ, Moorthy K, et al., 2009, Outcome of surgical fundoplication for extra-oesophageal symptoms of reflux., Surg Endosc, Vol: 23, Pages: 557-561
BACKGROUND: The role of surgery in the management of extra-oesophageal symptoms of gastro-oesophageal reflux (EOR) is unclear. In this retrospective study we studied patients who had surgical fundoplication for EOR symptoms from 1995 to 2005. We analysed outcome with respect to symptomatic improvement and patient satisfaction. METHODS: From our database of 240 patients who had surgical fundoplication for gastro-oesophageal reflux disease, 51 patients who had predominantly EOR symptoms were identified. All the patients had objective evidence of reflux and had been offered surgery because of failure of medical therapy and/or of development of complications. Patients were asked to score their symptoms before and after surgery using the Reflux Symptom Index, and to record their use of medicine before and after operation, their experience with surgery and their overall quality of life using a written questionnaire. RESULTS: Forty of the 51 patients were available for analysis. Common symptoms were cough and breathlessness (32/40), throat clearing/postnasal drip (31/40), sensation of lump in the throat (29/40), and voice problems (22/40). Of these forty patients, 34 (85%) had associated classical symptoms as well. Mean follow up at the time of questionnaire was 53.3 (6-120) months. The mean Reflux Symptom Index score improved from 22.80 (SD 10.80) to 11.83 (SD 9.91) (p < 0.0001, paired t-test). Six of the 39 responders (15.3%) said they would not have had the operation knowing what they know now and that problems related to the operation outweighed any benefits. These problems included gas bloating, inability to retch and dysphagia lasting up to one year after surgery. Twenty-five percent of the 40 patients described their overall quality of life as excellent, 32.5% as good, 32.5% as satisfactory and 10% as bad. CONCLUSION: Surgery can be an effective treatment in the majority of patients with extra-oesophageal symptoms of reflux.
Haynes AB, Weiser TG, Berry WR, et al., 2009, A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population., NEW ENGLAND JOURNAL OF MEDICINE, Vol: 360, Pages: 491-499, ISSN: 0028-4793
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- Citations: 2734
Panknin HT, Haynes AB, Weiser TG, et al., 2009, Safe surgery: A WHO checklist reduces the complication rate, Hygiene + Medizin, Vol: 34, Pages: 157-160, ISSN: 0172-3790
Vincent C, Aylin P, Franklin BD, et al., 2008, Is health care getting safer?, BRITISH MEDICAL JOURNAL, Vol: 337, ISSN: 0959-8146
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- Citations: 116
Rafi M, Marudanayagam R, Moorthy K, et al., 2008, Delayed presentation of diaphragmatic rupture as intra-thoracic gastric volvulus., Minerva Chir, Vol: 63, Pages: 425-427, ISSN: 0026-4733
Diaphragmatic injuries are quite rare and result from either blunt or penetrating trauma. They are not always recognized at the time of injury and there is often a delay between the trauma and the diagnosis The diagnosis is confirmed by chest X-ray, USG, CT Scan and barium studies This case report discusses the delayed presentation of diaphragmatic rupture as an intrathoracic gastric volvulus observed in a 36-year-old man.
Nath J, Moorthy K, Taniere P, et al., 2008, Peritoneal lavage cytology in patients with oesophagogastric adenocarcinoma., Br J Surg, Vol: 95, Pages: 721-726
BACKGROUND: The aim of the study was to determine the value of performing peritoneal lavage cytology during laparoscopy in the management of oesophagogastric adenocarcinoma. METHODS: Laparoscopy combined with peritoneal cytology was performed in patients with potentially resectable oesophagogastric adenocarcinoma. Macroscopic peritoneal findings at laparoscopy and the presence of free peritoneal tumour cells were recorded. All patients were followed to death or the census point. Patients with overt peritoneal disease or positive cytology were offered palliative chemotherapy, subject to performance status. RESULTS: Forty-eight (18.8 per cent) of 255 patients had overt peritoneal metastases at staging laparoscopy. Fifteen (7.2 per cent) of the remaining 207 patients had positive cytology; these patients had a median (95 per cent confidence interval) survival of 13 (3.1 to 22.9) months, versus 9 (7.4 to 10.6) months for those with overt peritoneal metastases (P = 0.517). Of patients receiving chemotherapy, those without overt metastases had a slight survival advantage over patients with metastases (median 15 (10.8 to 19.2) versus 9 (7.4 to 10.7) months; P = 0.045). CONCLUSION: Positive peritoneal cytology in the absence of overt peritoneal metastases is not uncommon in oesophagogastric adenocarcinoma. It is a marker of poor prognosis even in the absence of overt peritoneal metastases.
Aggarwal R, Grantcharov T, Moorthy K, et al., 2008, Toward feasible, valid, and reliable video-based assessments of technical surgical skills in the operating room, ANNALS OF SURGERY, Vol: 247, Pages: 372-379, ISSN: 0003-4932
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- Citations: 139
Hawkins WJ, Moorthy KM, Tighe D, et al., 2007, With adequate supervision, the grade of the operating surgeon is not a determinant of outcome for patients undergoing urgent colorectal surgery., Ann R Coll Surg Engl, Vol: 89, Pages: 760-765
INTRODUCTION: It is essential that higher surgical trainees (HSTs) obtain adequate emergency operative experience without compromising patient outcome. The aim of this study was to compare the outcomes of patients operated by HSTs with those operated by consultants and to look at the effect of consultant supervision. PATIENTS AND METHODS: A retrospective analysis of 362 patients who underwent urgent colorectal surgery was performed. The primary outcome was 30-day mortality. Secondary outcomes were intra-operative and postoperative surgery, specific and systemic complications, and delayed complications. RESULTS: Comparison of the patients operated by a consultant (n = 190) and a HST (n = 172) as the primary surgeon revealed no significant difference between the two groups for age, gender, ASA status or indication for surgery. There was a difference in the type of procedure performed (left-sided resections: consultants 122/190, HST 91/172; P = 0.050). There was no difference between the two groups for the primary and secondary outcomes. However, HSTs operating unsupervised performed significantly fewer primary anastomoses for left-sided resections (P = 0.019) and had more surgery specific complications (P = 0.028) than those supervised by a consultant. CONCLUSIONS: HSTs can perform emergency colorectal surgery with similar outcomes to their consultants, but adequate consultant supervision is vital to achieving these results.
Munz Y, Almoudaris AM, Moorthy K, et al., 2007, Curriculum-based solo virtual reality training for laparoscopic intracorporeal knot tying: objective assessment of the transfer of skill from virtual reality to reality, AMERICAN JOURNAL OF SURGERY, Vol: 193, Pages: 774-783, ISSN: 0002-9610
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- Citations: 85
Aggarwal R, Grantcharov T, Moorthy K, et al., 2007, An evaluation of the feasibility, validity, and reliability of laparoscopic skills assessment in the operating room, ANNALS OF SURGERY, Vol: 245, Pages: 992-999, ISSN: 0003-4932
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- Citations: 128
Rodgers HC, Moorthy K, 2007, Randomized clinical trial comparing feeding jejunostomy with nasoduodenal tube placement in patients undergoing oesophagectomy (Br J Surg 2007; 94: 31-35)., Br J Surg, Vol: 94, Pages: 645-646, ISSN: 0007-1323
Moorthy K, Munz Y, Forrest D, et al., 2006, Surgical crisis management skills training and assessment - A stimulation-based approach to enhancing operating room performance, ANNALS OF SURGERY, Vol: 244, Pages: 139-147, ISSN: 0003-4932
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- Citations: 116
Moorthy K, Munz Y, Adams S, et al., 2006, Self-assessment of performance among surgical trainees during simulated procedures in a simulated operating theater, AMERICAN JOURNAL OF SURGERY, Vol: 192, Pages: 114-118, ISSN: 0002-9610
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- Citations: 77
Aggarwal R, Hance J, Undre S, et al., 2006, Training junior operative residents in laparoscopic suturing skills is feasible and efficacious, SURGERY, Vol: 139, Pages: 729-734, ISSN: 0039-6060
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- Citations: 64
Pandey V, Wolfe JHN, Moorthy K, et al., 2006, Technical skills continue to improve beyond surgical training, JOURNAL OF VASCULAR SURGERY, Vol: 43, Pages: 539-545, ISSN: 0741-5214
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- Citations: 36
Shah J, Munz Y, Manson J, et al., 2006, Objective assessment of small bowel anastomosis skill in trainee general surgeons and urologists, WORLD JOURNAL OF SURGERY, Vol: 30, Pages: 248-251, ISSN: 0364-2313
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- Citations: 15
Wetzel C, Kneebone R, Woloshynowych M, et al., 2006, The effect of stress on surgical performance, American Surgical Education
Wetzel CM, Kneebone RL, Woloshynowych M, et al., 2006, The effects of stress on surgical performance, AMERICAN JOURNAL OF SURGERY, Vol: 191, Pages: 5-10, ISSN: 0002-9610
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- Citations: 274
Aggarwal R, Grantcharov T, Moorthy K, et al., 2006, A competency-based virtual reality training curriculum for the acquisition of laparoscopic psychomotor skill, AMERICAN JOURNAL OF SURGERY, Vol: 191, Pages: 128-133, ISSN: 0002-9610
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- Citations: 152
Moorthy K, Munz Y, Adams S, et al., 2005, A human factors analysis of technical and team skills among surgical trainees during procedural simulations in a simulated operating theatre, ANNALS OF SURGERY, Vol: 242, Pages: 631-639, ISSN: 0003-4932
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- Citations: 174
Hance J, Aggarwal R, Moorthy K, et al., 2005, Assessment of psychomotor skills acquisition during laparoscopic cholecystectomy courses, AMERICAN JOURNAL OF SURGERY, Vol: 190, Pages: 507-511, ISSN: 0002-9610
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- Citations: 17
Bann S, Davis LM, Moorthy K, et al., 2005, The reliability of multiple objective measures of surgery and the role of human performance, AMERICAN JOURNAL OF SURGERY, Vol: 189, Pages: 747-752, ISSN: 0002-9610
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- Citations: 28
Aggarwal R, Moorthy K, Grantcharov T, et al., 2005, Dexterity analysis for the assessment of laparoscopic procedures in the operating theatre, Annual Meeting of the Association-of-Surgeons-of-Great-Britian-and-Ireland, Publisher: JOHN WILEY & SONS LTD, Pages: 52-52, ISSN: 0007-1323
Moorthy K, Vincent C, Darzi A, 2005, Simulation based training, BMJ-BRITISH MEDICAL JOURNAL, Vol: 330, Pages: 493-494A, ISSN: 1756-1833
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- Citations: 36
Dosis A, Bello F, Aggarwal R, et al., 2005, Synchronised video and motion analysis for the assessment of procedures in the operating theatre, Archives of Surgery, Vol: 140, Pages: 293-299
Bann S, Moorthy K, Shaul T, et al., 2005, Laparoscopic transhiatal surgery of the esophagus., JSLS, Vol: 9, Pages: 376-381, ISSN: 1086-8089
OBJECTIVE: Esophagectomy is an operation with high morbidity and mortality. Its adoption as a minimally invasive operation worldwide has been slow, but the potential benefits of reducing the trauma of surgery need to be considered. Our 30-month experience with transhiatal esophagectomy in a district general hospital is presented herein. METHODS: Patients were considered for surgery after radiological staging had excluded inoperable disease. Laparoscopic staging was initially performed. Patients with tumors of the esophagus and high-grade dysplasia in a Barrett's esophagus were included. RESULTS: Twenty-nine patients were referred for consideration for resectional surgery. Nine underwent outpatient laparoscopy only. Twenty patients (age range, 34 to 78, 15 males:5 females) underwent resectional surgery. Seventeen transhiatal resections were completed, 2 were converted to open procedures, and 1 transhiatal resection of a benign tumor was performed. Median time of surgery was 415 minutes (range, 320 to 480) and blood loss was 300 mL (range, 200 to 350). The median length of post-operative ventilation and critical care stay were 1 (range, 1 to 4) and 4 (range, 2 to 8) days. Median duration of hospitalization was 17 days (range, 10 to 28). Thirty-day mortality was 0; 1 patient who was converted to an open procedure died after a cerebrovascular event on day 34. CONCLUSION: A zero mortality rate for laparoscopic resection and a low-morbidity rate compare well with morbidity and mortality in reported series using this method and open surgery. Laparoscopic transhiatal esophagectomy is an advanced, complex procedure that can be performed safely in a district general hospital setting.
Aggarwal R, Moorthy K, Darzi A, 2004, Laparoscopic skills training and assessment, BRITISH JOURNAL OF SURGERY, Vol: 91, Pages: 1549-1558, ISSN: 0007-1323
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- Citations: 339
Moorthy K, Munz Y, Dosis A, et al., 2004, Bimodal assessment of laparoscopic suturing skills - Construct and concurrent validity, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 18, Pages: 1608-1612, ISSN: 0930-2794
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- Citations: 104
Moorthy K, Munz Y, Orchard TR, et al., 2004, An innovative method for the assessment of skills in lower gastrointestinal endoscopy, SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol: 18, Pages: 1613-1619, ISSN: 0930-2794
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- Citations: 26
Aggarwal R, Undre S, Moorthy K, et al., 2004, The simulated operating theatre: comprehensive training for surgical teams, QUALITY & SAFETY IN HEALTH CARE, Vol: 13, Pages: I27-I32, ISSN: 1475-3898
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- Citations: 115
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