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Background The optimal choice for mesh fixation in laparoscopic inguinal hernia repair (LIHR) has not been well established. This review compared the effects of glue versus mechanical mesh fixation in LIHR on incidence of chronic postoperative inguinal pain (CPIP) and other secondary outcomes, including acute pain, seroma, haematoma, hernia recurrence and other postoperative complications. Methods A systematic review of English/non-English studies using MEDLINE, the Cochrane Library, OpenGrey, OpenThesis and Web of Science, and searching bibliographies of included studies was completed. Search terms included laparoscopic, hernia, fibrin glue, Tisseel, Tissucol, cyanoacrylate, Glubran and Liquiband. Only RCTs comparing mechanical with glue-based fixation in adult patients (aged over 18 years) that examined CPIP were included. Two authors independently completed risk-of-bias assessment and data extraction against predefined data fields. All pooled analyses were computed using a random-effects model. Results Fifteen RCTs met the inclusion criteria; 2777 hernias among 2109 patients were assessed. The incidence of CPIP was reduced with use of glue-based fixation (risk ratio (RR) 0.36, 95 per cent c.i. 0.19 to 0.69; P = 0.002), with moderate heterogeneity that disappeared with sensitivity analysis (8 d.f.) for patient-blinded studies (RR 0.43, 0.27 to 0.86). Trial sequential analysis provided evidence for a relative risk reduction of at least 25 per cent. The incidence of haeamtoma was reduced by using glue-based fixation (RR 0.29, 0.10 to 0.82; P = 0.02) with no significant effects on seroma formation or hernia recurrence (RR 1.07, 0.46 to 2.47; P = 0.88). Conclusion Glue-based mesh fixation appears to reduce the incidence of CPIP and haematoma after LIHR compared with mechanical fixation, with comparable recurrence rates.

BackgroundThyroid eye disease (TED) is a potentially disfiguring and sight-threatening autoimmune (AI) orbitopathy, affecting up to 400,000 people in the UK. There are no accurate early predictors of TED severity. Although polyautoimmunity has been shown to affect AI disease severity, its influence on TED severity has never been investigated. The prevalence of polyautoimmunity among TED patients is also unclear, with discordant results reported in the literature. This study evaluates the prevalence of non-thyroid/“other” AI (OAI) conditions in an ethnically diverse TED cohort and assesses how polyautoimmunity affects TED severity and activity.MethodsA retrospective study of patients presenting to multidisciplinary TED clinics across three North-West London hospitals between 2011 and 2019. Data collected included: 1) demographics; 2) OAI conditions and management; 3) endocrine management of thyroid dysfunction; 4) details of TED and clinical activity score at presentation.ResultsTwo hundred and sixty-seven patients with a median age of 46 (35–54) years were included, 79.4% were female and 55% were Black, Asian and minority ethnic (BAME). Thirty-seven patients (13.9%) had OAI conditions, with rheumatoid arthritis (3.7%), vitiligo (3.0%) and psoriasis (3.0%) among the most prevalent. Of patients with OAI conditions, 43.2% (16/37) required immunosuppression prior to TED onset. Non-immunosuppressed patients with OAI conditions had a significantly higher clinical activity score at presentation than TED-only and previously immunosuppressed patients (p=0.02). No significant differences were observed in thyroid receptor antibody titers between these groups.ConclusionsThis study finds a 13.9% prevalence of OAI conditions among TED patients. Patients with OAI conditions overall have a tendency for more severe and significantly more clinically active TED than those without OAI conditions. Larger, prospective studies are warranted to further evaluate polyautoimmunity as an early predictor of TED severity.

Introduction: Glaucoma remains the leading cause of irreversible blindness. Although the loss of retinal ganglion cells (RGCs) is an established hallmark of glaucoma, reduction of intraocular pressure (IOP) is a widely used evidence-based management approach, even in normotensive patients. However, despite optimal pressure control, some patients progress to lose vision. Areas covered: This review provides a summary of latest methods aimed at reducing RGC loss with the objective of preserving vision, categorised by mechanism of action. We discuss both the newest ways in which IOP can be reduced, alongside 'pressureindependent' pharmacological therapies and developments in bioengineering. The conducted PubMed search included the terms: "glaucoma pathophysiology", "IOP-lowering agents", "retinal ganglion cell apoptosis", "neuroprotection", "stem cells", "imaging".

Aim Early exposure to surgery has been found to impact medical students’ decisions to pursue a career in surgery. Despite this, students are often not exposed to surgical specialties until senior years of medical school. The aim of this study was to determine if a student-led, three-month online lecture series can facilitate early exposure to surgical careers. Method Participants volunteered to complete pre- and post-lecture questionnaires. The four domains discussed across the lecture series included: what a surgical career entails, the day-to-day life of a surgeon, advances in surgery and surgical portfolio. Participants self-rated confidence in the knowledge of each of the four domains was measured on a five-step Likert scale. Changes in perceived confidence were measured using a paired Student’s t-test. Data were analysed using R 4.03 (Vienna, Austria). The threshold of significance was <0.05. Results A total of 45 respondents completed both pre- and post-lecture questionnaires. Most respondents (57.8%) were first- or second-year students. Following the course, there was a significant increase in confidence across all four domains investigated (mean rating 2.64 vs 4.07, p < 0.001). More than 9 out of 10 respondents (99.3%) gained new knowledge and (95.2%) agreed that an online event format did not hinder their learning. Conclusions Student-led online lecture series can increase knowledge of core concepts pertaining to a career in surgery for pre-clinical students. The findings provide a basis for further large-scale investigation of surgical education during early years of medical school and for the potential value of extracurricular, student- or trainee-led courses.