Staple-line leaks represent an unwanted, yet seemingly unavoidable, complication of stapling associated with bariatric surgery. Although, "folk legends" abound as to precluding leaks, little has been written based on basic research and understanding of stapling mechanics. This article reviews the history of stapling and discusses the implications of understanding the biomechanics of stapling living tissue. Finally, three leak studies evaluating ways to optimize staple-line strength are presented, and a large bariatric clinical series is reviewed.

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At otal of 675 consecutive patients who underwent primary total hip replacement in ar egional orthopaedic centre in the South West of Britain were recruited prospectively. RESULTS The median length of stay was 8d ays. The majority of patients (81.5%) left hospital within 2w eeks, 13.6% within 2-4 weeks and 4.9% after 4w eeks. On multivariate analysis, age above 70 years, ASA grades 3a nd 4, prolonged operations and long incisions were highly significantly associated with hospital stay of over 2w eeks. ORTHOPAEDICSCONCLUSIONS Prolonged stay after THA is largely predetermined by case mix and this should be taken into account when units are compared for performance and in the remuneration they receive for providing this service. Slick surgery through limited incisions may reduce the length of stay.

It is interesting to notice the diversity of structure present in the femurs of various animals. We have been led to think that bone is bone ; that long bones, and especially similar bones wherever they occurr, have the same structure because they are used for the same purposes. This is not true. Microscopical examinations of entire sections of femurs of forty-three different animals show that the structures and their arrangements are not at all the same.

Abstract:Dissociation of the polyethylene liner is a known failure mechanism of the Harris Galante I and II uncemented acetabular components. The outcomes of revision surgery for this indication and the influence of time to diagnosis are not well described.We report a series of 29 cases revised due to this failure mechanism. The median time from primary to revision surgery was 13 years.At a median of 4 years follow up, the mean OHS was 34 (range 6-48) but results were poorer (mean 29, range 6-45) when the diagnosis and revision was delayed compared to when it was not (mean 39, range 20-48). A large proportion of our patients (n=14) presented with sudden onset of symptoms with or without trauma. Osteolysis was common in this series but the cup was well fixed in 20/29 cases. There was macroscopic damage to the shell in all cases.In our experience, prompt revision of liner dissociation optimises outcomes in this group of patients and radiology reporting alone is not sufficient to identify these cases.Additional Information:Question ResponsePlease confirm that the manuscript has been seen and approved by all authors Yes, I confirm on behalf of all authors that that the manuscript has been seen and approved by all authors Please confirm that the manuscript is not under consideration for publication elsewhere in a similar form, in any language, except in abstract form