Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland最新文献

{"title":"A 10-year experience with anastomotic leaks in upper gastrointestinal surgery–Retrospective cohort study","authors":"Jia-Hao Law,&nbsp;Charmaine Zhi-Mei Ng,&nbsp;Sarah-Kei Lauw,&nbsp;Jimmy Bok Yan So,&nbsp;Guowei Kim,&nbsp;Asim Shabbir","doi":"10.1016/j.surge.2023.11.001","DOIUrl":"10.1016/j.surge.2023.11.001","url":null,"abstract":"<div><h3>Background</h3><p>Anastomotic leak (AL) in upper gastrointestinal (UGI) surgery continues to be a diagnostic challenge. We seek to identify clinical parameters that predict AL and examine the effectiveness of investigations in evaluating AL following UGI surgeries.</p></div><div><h3>Methods</h3><p>592 patients underwent UGI surgeries with an anastomosis<span> between January 2011 and January 2021. Data on patient characteristics, surgery, postoperative investigations and outcomes were prospectively collected and analysed.</span></p></div><div><h3>Results</h3><p><span>The overall occurrence of AL was 6.4 %. Tachycardia &gt;120 BPM (OR 6.959, 95 % CI 1.856–26.100, </span><em>p</em> = 0.004) and leukocyte count &gt;19 × 10⁹/L (OR 3.327, 95 % CI 1.009–10.967, <em>p</em><span> = 0.048) were independent predictors of AL. On multivariate analysis, patients whose anastomosis was deemed high risk and had pre-emptive investigation done postoperatively to exclude a leak were less likely to require intervention and were more likely to be managed conservatively (66.7 % vs 14.3 %, </span><em>p</em><span><span><span> = 0.025). Methylene blue test, oral contrast study and </span>Computed Tomography scan<span> with intravenous and oral contrast had 50.0 %, 20.0 % and 9.1 % false negative results, while </span></span>esophagogastroduodenoscopy had none. There was no misdiagnosed AL when more than 1 investigation (n = 15, 39.5 %) were performed.</span></p></div><div><h3>Conclusion</h3><p>Our study demonstrates that the presence of a triad including desaturation<span>, tachycardia and leucocytosis predicts for AL following UGI surgery and for confirmation of a leak, evaluation with 2 or more investigation is needed. A practice of evaluating high risk anastomosis prior to commencement of feeding decreased the need for surgical intervention and improves success of conservative treatment.</span></p></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139083456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions of online surgical-focused learning amongst surgeons during the COVID pandemic: A scoping review 2020–22","authors":"S.M. McHugh ,&nbsp;E. Kheirelseid ,&nbsp;S. Hyde ,&nbsp;P.F. Conway","doi":"10.1016/j.surge.2023.11.006","DOIUrl":"10.1016/j.surge.2023.11.006","url":null,"abstract":"<div><h3>Introduction</h3><p>During the COVID pandemic<span> many centres adopted e-learning as a tool to adhere to social distancing recommendations while continuing to provide ongoing postgraduate medical education. We aimed to complete this scoping review in order to map experience and perceptions amongst surgeons and surgical trainees to remote learning during the COVID pandemic.</span></p></div><div><h3>Methods</h3><p>Using Arksey and O'Malley's five step model for conducting a scoping review, a systematic search strategy was undertaken across three online databases SCOPUS, MEDLINE and Web of Science. Only original articles in English in the field of postgraduate education in surgery were included.</p></div><div><h3>Results</h3><p>44 studies were selected for review. Of these 44, 21 were studies of perception of a newly developed e-learning tool/platform. 17 were surveys of surgeon's attitudes towards e-learning during the COVID pandemic. The remaining 6 studies were studies of knowledge or skills acquired through new e-learning, which included a survey of experience. The United States was the most common country of origin with General Surgery the most represented surgical speciality. Response rates across all three study subgroups were on average &gt;60%. Surgeon's experience of e-learning was reported in only positive terms in 86% (n = 38/44) of studies.</p></div><div><h3>Conclusions</h3><p>This paper is informative in that it focuses specifically on surgeons' perceptions of a e-learning tools used in addition to skills or knowledge gained. Positive e-learning experience reported in these studies may lead to more blended learning curriculums being developed, deployed and evaluated going forward.</p></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139028870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare presentation of mesenteric cyst as persistent ascites: A case report","authors":"Muhammad Danial Khan ,&nbsp;Iqra Nawaz ,&nbsp;Arooba Niazi ,&nbsp;Adil Mahmood","doi":"10.1016/j.surge.2023.11.013","DOIUrl":"10.1016/j.surge.2023.11.013","url":null,"abstract":"<div><h3>Background</h3><p><span>Mesenteric cysts have been typically described as cystic lesions of </span>mesentery<span> or omentum<span> occurring either intra-abdominally or in the retroperitoneum<span>. With no typical symptoms, the preoperative diagnosis of mesenteric cyst becomes challenging to establish.</span></span></span></p></div><div><h3>Patient and methods</h3><p><span><span>In this case report, we describe the case of a 29-year-old female who presented with abdominal distension for seven years associated with intermittent constipation. Following complete history, a meticulous physical examination was performed. Laboratory investigations and radiological </span>imaging techniques were used to facilitate the diagnosis which was confirmed on </span>laparotomy.</p></div><div><h3>Results</h3><p><span>Physical examination revealed abdominal ascites<span><span><span>. Laboratory investigations were unremarkable. Abdominal ultrasound revealed multiloculated massive ascites. A well-defined cystic area 27 × 18cm displacing abdominal viscera<span> was observed on computed tomography (abdomen and pelvis) with contrast medium. </span></span>Exploratory laparotomy revealed a massive cyst involving almost the entire </span>peritoneal cavity<span>. On histopathology, no signs of </span></span></span>malignancy were reported. The post-operative course was excellent, and the patient was discharged following surgery.</p></div><div><h3>Conclusion</h3><p>As this lesion is rarely considered preoperatively, and the clinical manifestations can be non-specific, we report this case of mesenteric cyst mimicking ascites in order to inform improved decision making among healthcare professionals regarding the timely diagnosis and appropriate management.</p></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139028807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to retire the term “high volume” and replace with “high quality” for HPB centers: A position statement from Caribbean chapter of AHPBA","authors":"Shamir O. Cawich,&nbsp;Parul J. Shukla,&nbsp;Shailesh V. Shrikhande,&nbsp;Elijah Dixon,&nbsp;Neil W. Pearce,&nbsp;Rahul Deshpande,&nbsp;Wesley Francis","doi":"10.1016/j.surge.2023.11.012","DOIUrl":"10.1016/j.surge.2023.11.012","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138886451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracapsular hip fractures: A comparative study of cemented and uncemented hemiarthroplasties in the Irish hip fracture database","authors":"","doi":"10.1016/j.surge.2023.11.011","DOIUrl":"10.1016/j.surge.2023.11.011","url":null,"abstract":"<div><h3>Background</h3><p>The aim of this study was to analyse the association between use of cement for stem fixation in hip hemiarthroplasty and the outcomes of mobility, mortality, and discharge destination.</p></div><div><h3>Methods</h3><p>The Irish Hip Fracture Database was examined from 2016 to 2020 to assess for any difference in post op mobility, 7-day, 14-day and inpatient mortality, and discharge destination.</p></div><div><h3>Results</h3><p>A total of 7109 hemi-arthroplasties were identified from 2016 to 2020. 71.6 % were cemented (n = 5,172), with 28.4 % uncemented (1,937). There was no difference in day 1 post op mobilisation (79.7 % vs 80.9 %) or cumulative ambulatory score on discharge (2.5 vs 2.4). The mortality rate was equivocal at all time points between the cemented and uncemented groups (7 day (.9 % vs 1.2 %), 14 day (1.9 % vs 2.3 %), inpatient (4 % vs 5.1 %)). There was no difference in length of stay (11 vs 12 days) or discharge to home directly (21 % vs 27 %).</p></div><div><h3>Conclusion</h3><p>The use of cement did not have any significant difference on post op mortality, mobility or discharge destination.</p></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":null,"pages":null},"PeriodicalIF":2.3,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138886450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trainees as primary operators do not significantly impact perioperative complication rates in breast surgery","authors":"Linda Vu ,&nbsp;Chaithanya Jeganathan ,&nbsp;Kallyani Ponniah ,&nbsp;Adam Ofri","doi":"10.1016/j.surge.2023.11.008","DOIUrl":"10.1016/j.surge.2023.11.008","url":null,"abstract":"<div><h3>Background</h3><p>There is a trend for specialist care in breast surgery resulting in fewer primary operative cases for general surgery trainees; and subsequently that trainees performing advanced oncoplastic techniques in breast surgery may negatively impact patient morbidity. We have reviewed the complication rates between Australian general surgery trainees and Breast Consultants.</p></div><div><h3>Methods</h3><p>A retrospective analysis was performed over a 5-year period (January 2016–December 2021). The key endpoints measured were relative complication rates for consultants compared to trainees, subdivided by surgery type. Surgeries were categorised as either benign, primary breast cancer surgery or re-excision.</p></div><div><h3>Results</h3><p>A total of 2646 operative cases were performed with the primary operator rate for consultants 58.35 % (n = 1544) and for trainees 41.65 %% (n = 1102). The overall complication rate was 2.83 % (n = 75); the overall rate for the consultants was 2.65 % and 3.08 % for the trainees. The complication rates were not statistically significant (p = 0.59) between the two groups. The mastectomy only complication rate was higher in the consultant group with a result of 7.3 % compared to 2.8 % for the trainees however was not statistically significant (p = 0.18). The most common complication was haematoma formation for both groups.</p></div><div><h3>Conclusions</h3><p>This study has demonstrated that trainees can safely perform advanced oncoplastic techniques without statistically elevated morbidity. In an era where breast surgery caseloads are increasing, but the exposure to breast surgery during training are decreasing, it is necessary to implement a practice where trainees can perform breast operations under supervision at a specialized unit.</p></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138716240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Life expectancy of patients with diabetic foot sepsis post-lower extremity amputation at a regional hospital in a South African setting. A retrospective cohort study","authors":"Thoriso C. Mokoala ,&nbsp;Vhusani Sididzha ,&nbsp;Etsumang D. Molefe ,&nbsp;Thifhelimbilu E. Luvhengo","doi":"10.1016/j.surge.2023.11.009","DOIUrl":"10.1016/j.surge.2023.11.009","url":null,"abstract":"<div><h3>Background</h3><p>Diabetes foot sepsis (DFS) is the leading cause of amputation of lower extremities. Over 50 % of patients who have had major lower extremity amputation due to DFS are dead within 4 years following the procedure.</p></div><div><h3>Aim</h3><p>To determine the life expectancy of patients following amputation for DFS at a regional hospital in South Africa.</p></div><div><h3>Methods</h3><p>We conducted an audit of patients who had DFS and were admitted over a 5-year period. The duration from admission to time of death was recorded in days. Occurrence of death was confirmed from family members of the deceased using structured telephonic interview questionnaires. Categorical findings were summarized using actual counts and percentages and compared using either the Chi-square or Fisher's exact test. We used the mean with standard deviation or median and range to compare parametric and non-parametric continuous data, respectively. The Shapiro-Wilk test was used to test normality of data. Multivariate logistic regression was done to establish factors that were strongly associated with the mortalities. Adjusted survival curves were added to compare the rate of occurrence of mortality between males and females with age as a confounder. Statistical significance was set at a p-value below 0.05.</p></div><div><h3>Results</h3><p>197 were found of which 100 % of participants had Type 2 diabetes mellitus and 63.5 % were males. Associated comorbidities included hypertension in 73.6 %, obesity in 66 %, alcohol use in 64.5 % and smoking in 58.4 %. 190 participants had an amputation and 19.3 % died.</p></div><div><h3>Conclusion</h3><p>DFS was more common in males and 96 % of the patients had an amputation. Mortality rate within 4 years following amputation was 19.3 % and was higher in females and individuals with multiple comorbidities.</p></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1479666X23001439/pdfft?md5=996a29e71c07e5054586a1e7bf42bb47&pid=1-s2.0-S1479666X23001439-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138716501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of post-hepatectomy long-term survival outcome between non-colorectal non-neuroendocrine and colorectal liver metastases: A population-based propensity-score matching analysis","authors":"Kelvin K.C. Ng ,&nbsp;Hon-Ting Lok ,&nbsp;Kit-Fai Lee ,&nbsp;Tan-To Cheung ,&nbsp;Nam-Hung Chia ,&nbsp;Wai-Kuen Ng ,&nbsp;Cho-Kwan Law ,&nbsp;Chung-Yeung Cheung ,&nbsp;Kai-Chi Cheng ,&nbsp;Sunny Y.S. Cheung ,&nbsp;Paul B.S. Lai","doi":"10.1016/j.surge.2023.11.007","DOIUrl":"10.1016/j.surge.2023.11.007","url":null,"abstract":"<div><h3>Background</h3><p><span>Hepatectomy<span> is an established treatment for </span></span>colorectal liver metastasis<span> (CLM) or neuroendocrine liver metastasis. However, its role in non-colorectal non-neuroendocrine liver metastasis (NCNNLM) is controversial. This study aims to compare long-term survival outcomes after hepatectomy between NCNNLM and CLM in a population-based cohort.</span></p></div><div><h3>Methods</h3><p>From 2009 to 2018, curative hepatectomy were performed in 964 patients with NCNNLM (n ​= ​133) or CLM (n ​= ​831). Propensity score (PS) matching was performed. Short-term and long-term outcomes were compared between PS-matched groups. Univariate and multivariate analyses were performed to identify prognostic factors affecting survival.</p></div><div><h3>Results</h3><p><span>There were 133 patients in the NCNNLM group and 266 patients in the CLM group. The mortality (1.5 ​% vs 1.5 ​%) and morbidity (19.5 ​% vs 20.3 ​%) rates were comparable between the two groups. There was no statistically significant difference in 5-year overall (48.9 ​% vs 39.8 ​%) and recurrence-free (25.1 ​% vs 23.4 ​%) survival rates between NCNNLM and CLM groups. A high pre-operative serum bilirubin level, severe </span>postoperative complications<span> and multiple tumors were independent prognostic factors for poor survival.</span></p></div><div><h3>Conclusion</h3><p>Hepatectomy for selected patients with NCNNLM can achieve similar long-term oncological outcomes as those with CLM. High serum bilirubin, severe postoperative complication and multiple tumors are poor prognostic factors for survival.</p></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138569912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical trainee experiences from 2013 to 2023 within the United Kingdom as reported by the General Medical Council National Training Survey","authors":"Neil Donald ,&nbsp;Tim Lindsay","doi":"10.1016/j.surge.2023.11.005","DOIUrl":"10.1016/j.surge.2023.11.005","url":null,"abstract":"<div><h3>Introduction</h3><p>The General Medical Council (GMC) issues annual surveys to all doctors within the United Kingdom (UK) in a formal postgraduate training scheme. This facilitates the monitoring of experiences for quality assurance purposes. Low job satisfaction has been associated with heightened levels of burnout and staff turnover, alongside deteriorating clinical care and productivity levels.</p></div><div><h3>Methods</h3><p>We gathered and extracted data from the publicly available online GMC reporting tool. Data ranged from 2013 to 2023 and spanned 12 postgraduate surgical training programmes across all 18 indicators available. In total, 198 individual metrics were recorded, in addition to burnout. We conducted trend analysis and yearly average mean scores for individual metrics, burnout and geographical differences for 141 individual training programmes within the 16 training regions.</p></div><div><h3>Results</h3><p>Of the 198 metrics analysed, 83 (42 ​%) were found to have statistically significant negative trends (P ​&lt; ​0.05), in comparison to 24 (12 ​%) with positive trends. 5 specialities had over 50 ​% of metrics showing a significant negative trend. Overall satisfaction was negative in all 12 programmes, with eight reaching significance (P ​&lt; ​0.05). Of 141 individual training programmes, 29 ​% showed a significantly negative trend in overall satisfaction, with 1 ​% demonstrating a significant positive trend (P ​&lt; ​0.05).</p></div><div><h3>Conclusion</h3><p>Our study is the first to explore long-term trends in trainee reported surgical training experiences within the UK. Our data have revealed widespread worsening trainee reported experiences and dissatisfaction across multiple specialities and geographical regions, especially in key areas of overall satisfaction, self-development, and clinical supervision.</p></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1479666X23001397/pdfft?md5=7e3e858221f3d4976cde3eab45ba9b3a&pid=1-s2.0-S1479666X23001397-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138569880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Making fracture fixation teaching Child's play","authors":"C. Spolton-Dean,&nbsp;C. Hunter,&nbsp;O. Donaldson","doi":"10.1016/j.surge.2023.10.011","DOIUrl":"10.1016/j.surge.2023.10.011","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138569881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}