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

{"title":"Early Screening for Confusion and Vitamin D Deficiency in Elderly Hip Fracture Patients: A Quality Improvement Initiative to Mitigate the Risk of Postoperative Delirium","authors":"Mr. Zubair Younis , Dr. Gurukiran Gurukiran , Mr. Faliq Abdullah , Mr. Mohammad bin Abdul Hamid , Dr. Kubra Farooq Wani","doi":"10.1016/j.surge.2025.04.023","DOIUrl":"10.1016/j.surge.2025.04.023","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 5","pages":"Page 330"},"PeriodicalIF":2.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050510","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":"List of editors","authors":"","doi":"10.1016/S1479-666X(25)00133-7","DOIUrl":"10.1016/S1479-666X(25)00133-7","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 5","pages":"Page i"},"PeriodicalIF":2.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050263","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":"Massive ingestion of water-absorbent polymer beads in an adult requiring surgical management.","authors":"Solange Belinha, Elizabeth Hanna, Amira Orabi, Shayanthan Nanthakumaran, Campbell Macleod","doi":"10.1016/j.surge.2025.08.006","DOIUrl":"https://doi.org/10.1016/j.surge.2025.08.006","url":null,"abstract":"<p><strong>Background: </strong>The incidence of intentional foreign body ingestion is rising in the UK, with water-absorbent polymer beads (WAPBs) increasingly implicated in children. While commonly used in horticulture and as toys, WAPBs can pose serious risks when ingested. This report details a unique case of massive WAPB ingestion in an adult, emphasizing the potential complications and management challenges.</p><p><strong>Case report: </strong>A 60-year-old male presented with severe abdominal pain, nausea, and vomiting after ingesting an estimated 25,000 WAPBs. CT imaging showed a massive volume of WAPBs throughout the gastrointestinal (GI) tract, and free fluid around the duodenum likely due to reactive pancreatitis. An emergency laparotomy was performed due to the risk of impending perforation. At laparotomy, a gastrostomy and 2 enterotomies were made to remove as many WAPBs as possible. A loop ileostomy was formed due to ongoing retention of the beads and risk of obstruction. Post-operatively, the patient was placed on total parenteral nutrition and the remaining WAPBs passed through the ileostomy. Further imaging revealed ongoing pancreatitis and a peripancreatic collection, which was managed conservatively. The patient was discharged two months after surgery.</p><p><strong>Discussion: </strong>This case represents the first documented instance of massive WAPB ingestion in an adult. It highlights the significant risks associated with ingesting large quantities of WAPBs, including GI obstruction and pancreatitis. Early surgical intervention was critical in preventing further complications, as endoscopic removal was impractical given the volume.</p><p><strong>Conclusions: </strong>Massive ingestion of WAPBs poses significant health risks and may necessitate prompt surgical management. This case underscores the importance of timely intervention to prevent severe outcomes associated with large volumes of ingested WAPBs.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056108","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":"Computed tomography scan-guided preoperative identification of the appendicular root as an indicator of the best skin incision site in open appendicectomy: a retrospective single-center study.","authors":"Toshiyuki Suzuki, Daisuke Sugiki, Takahiko Akao, Hiroshi Matsumoto","doi":"10.1016/j.surge.2025.08.007","DOIUrl":"https://doi.org/10.1016/j.surge.2025.08.007","url":null,"abstract":"<p><strong>Background: </strong>Appendicectomy is a well-established surgical procedure used for managing of acute appendicitis. In open appendicectomy, McBurney's point is the surgical landmark for locating the appendix, and it is common practice to make an incision there. However, in this study, we identified the root of the appendix via computed tomography, made an incision around that sites, and performed the appendicectomy through this incision. As such, this study aimed to assess the safety and outcomes of using the computed tomography scan-guided appendiceal root as a landmark of the incision site in open appendicectomy.</p><p><strong>Methods: </strong>This retrospective single-center study included 117 consecutive patients undergoing surgery for acute appendicitis between April 2021 and December 2023. Patients with parabdominal rectus muscle incision and interval appendectomy were excluded. The root of the appendix was identified on computed tomography scan, and open appendicectomy was performed via an oblique incision made at the center of the site. The characteristics and perioperative factors of patients who underwent open appendicectomy and laparoscopic appendicectomy were compared.</p><p><strong>Results: </strong>None of the patients required a change or widening of the incision site to identify the appendix, and there were no complications associated with using this site. The median wound size for open appendicectomy was 4 cm. Patients who underwent open appendicectomy performed comparable to those who underwent laparoscopic appendicectomy.</p><p><strong>Conclusion: </strong>Using the computed tomography scan-guided appendiceal root as a landmark for the site of skin incision in appendicectomy is safe, acceptable, and useful.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030798","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":"Transmetatarsal amputation versus multiple toes amputations for non-ischemic diabetic foot infection management.","authors":"Moustafa Mabrouk, Ahmed Fouda, Mohammed ElKassaby","doi":"10.1016/j.surge.2025.08.005","DOIUrl":"https://doi.org/10.1016/j.surge.2025.08.005","url":null,"abstract":"<p><strong>Background: </strong>The management of diabetic foot infections (DFIs) is a complex multidisciplinary process and often necessitates surgical interventions. Unfortunately, amputations such as single or multiple toes amputations (MTA) or full transmetatarsal amputation (TMA) are often the unavoidable solution. This study aimed to compare the clinical outcomes of TMA versus MTA in managing non-ischemic diabetic foot infections.</p><p><strong>Methods: </strong>This was a retrospective study on non-ischemic diabetic foot infection patients comparing the results of TMA and MTA in terms of healing, ulcer recurrence and overall complications, including further formal amputations.</p><p><strong>Results: </strong>The healing rate was substantially higher in TMA group (89.3 % vs. 74.5 %, p=0.004). TMA group exhibited a significantly lower incidence of further proximal amputation (8.7 % vs. 21.3 %, p=0.002) and ulcer recurrence (11.3 % vs. 25.3 %, p=0.002). Tissue necrosis occurred less frequently in TMA group (4.5 % vs. 12.8 %, p<0.05). No significant differences were found between the groups regarding infection, hematoma, or residual edema.</p><p><strong>Conclusions: </strong>Transmetatarsal amputation for diabetic foot infection demonstrated superior healing rates, lower ulcer recurrence, and reduced need for proximal amputation compared to multiple toe amputations for managing non-ischemic diabetic foot infections.</p><p><strong>Level of evidence: </strong>level 3 retrospective study.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008551","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":"Applied anatomy of accessory tendons of extensor hallucis longus muscle and hallux valgus deformity: a cadaveric and radiologic study.","authors":"Mustafa Aydin, Mehmet Aydin, Ayhan Comert, Emrah Koksal, Necati Salman, Emre Donmez, Omer Levent Karadamar, Begum Aslantas Kaplan, Murat Igde, Trifon Totlis, Necdet Kocabıyık","doi":"10.1016/j.surge.2025.08.004","DOIUrl":"https://doi.org/10.1016/j.surge.2025.08.004","url":null,"abstract":"<p><strong>Introduction: </strong>The accessory tendon of the extensor hallucis longus (ATEHL) represents a common anatomical variant. However, the role of ATEHL in the etiology of hallux valgus (HV) has not yet been fully elucidated. This study aimed to determine the incidence and morphology of the ATEHL in cadavers and examine its possible correlation with the HV deformity presence and the relevant angular measurements of the feet.</p><p><strong>Materials and methods: </strong>The study included 63 embalmed cadaveric feet. Following documentation of the demographic parameters of the cadavers, the dorsal aspect of the first ray was carefully dissected. The existence and morphological features of the ATEHL were recorded and analyzed. Subsequently, plain radiographs were taken to assess the hallux valgus angles (HVA) and intermetatarsal angles (IMA) without weight-bearing simulation. In this evaluation, HVA exceeding 15° and IMA exceeding 9° were characterized as hallux valgus (HV) deformity. Statistical analysis was used to examine any correlations between ATEHL existence and HV deformity presence, HVA degrees and IMA degrees.</p><p><strong>Results: </strong>An ATEHL was found in 37 out of 63 cadaveric feet (58.73 %). A HV deformity was identified in 32 out of 63 cadaveric feet (50.79 %). The prevalence of the ATEHL was significantly higher in specimens with a HV deformity (26/32, 81.25 %) compared to specimens without a HV deformity (6/32, 18.75 %) (p < 0.001). A positive correlation was found between ATEHL existence and both HVA and IMA degrees (p < 0.001).</p><p><strong>Conclusions: </strong>An ATEHL may be found in more than half of individuals. The current cadaveric and radiologic study revealed that ATEHL existence is significantly more common in feet with HV deformity and associated with increased HVA and IMA degrees. Further biomechanical studies are necessary to clarify the ATEHL role on the pathogenesis of HV deformity.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976479","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":"Moral injury and second victim syndrome in healthcare providers: A continuum","authors":"Aisling O'Donnell ,&nbsp;Michael Devine","doi":"10.1016/j.surge.2025.08.001","DOIUrl":"10.1016/j.surge.2025.08.001","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 5","pages":"Pages 326-327"},"PeriodicalIF":2.3,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849472","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":"Environmental impact of single-use items and their contamination levels in elective orthopaedic surgery","authors":"Jessica Rotaru ,&nbsp;Peggy Miller ,&nbsp;Luke McGarry ,&nbsp;John M. O'Byrne","doi":"10.1016/j.surge.2025.07.007","DOIUrl":"10.1016/j.surge.2025.07.007","url":null,"abstract":"<div><h3>Background</h3><div>Single-use items have dominated operating theatres since the 1980s, initially perceived to carry a lower risk of surgical site infection and occupational blood exposure while maintaining hospital expenditure. The topic of reusable surgical gowns and drapes has naturally emerged due to discussions regarding climate change. Considering reusable alternatives is the next step in reducing the carbon footprint of operating theatres.</div></div><div><h3>Methods</h3><div>Clinical waste attributable to single-use items was collected from 93 cases in an elective orthopaedic hospital over four weeks, comprising knee arthroplasty and arthroscopy, hip arthroplasty, foot and ankle and upper limb. Tourniquet use, operation time and blood loss were other parameters collected in each operation. Disposable gowns were visually examined and graded by contamination level. Clinical waste was weighed using a handheld electronic scale.</div></div><div><h3>Results</h3><div>The mean waste from knee, hip and minor (upper limb, foot and ankle) operating theatres was 3533g, 3966g and 2349g respectively. The average number of gowns used per case was four, as was the number of drapes. Minor operating theatres had the lowest levels of contamination, with 84.34 % of gowns not contaminated at all. Tourniquet use was associated with less waste, carbon emissions, and gown contamination.</div></div><div><h3>Conclusion</h3><div>A large proportion of operating theatre waste is attributable to disposable items such as gowns and drapes. In the elective orthopaedic setting, these are not heavily contaminated, especially in procedures where tourniquets are utilised. Given the environmental impact of clinical waste, we advocate for the use of reusable alternatives in these procedures.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 5","pages":"Pages 296-300"},"PeriodicalIF":2.3,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849471","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":"Feasibility of pancreaticoduodenectomy for octogenarian based on safety and postoperative nutritional recovery.","authors":"Naoki Iwanaga, Hiroyuki Sugo, Takeshi Yamamoto, Takuji Noro, Michio Machida, Ikuo Watanobe","doi":"10.1016/j.surge.2025.07.005","DOIUrl":"https://doi.org/10.1016/j.surge.2025.07.005","url":null,"abstract":"<p><strong>Background: </strong>Pancreaticoduodenectomy (PD) for very elderly patients was still controversial. We evaluated the feasibility of PD for octogenarian (patients older than 80 years) from safety and postoperative nutritional changes including body composition.</p><p><strong>Methods: </strong>We included 141 consecutive patients who underwent PD: 24 patients aged ≥80 years were assigned to the octogenarian group, and the remaining 117 were assigned to the non-octogenarian group. Surgical outcomes and the change in postoperative nutritional status (body weight and serum albumin level during 12 months post-surgery) were compared. Among latest 24 patients, the change of body composition was also evaluated using bioelectrical impedance analysis.</p><p><strong>Results: </strong>Preoperatively, the octogenarian group had a significantly lower Katz index score for Activities of Daily Living (P = 0.038), higher incidence of comorbidities (P < 0.05), lower serum albumin levels (P = 0.033), and lower body weight (P = 0.017) than the non-octogenarian patients; however, the incidence of morbidity and mortality was the same in both groups. Overall survival rates were lower in the octogenarian group, even without significant difference. Multivariate analysis showed that the diagnosis of pancreatic cancer (P = 0.022), the serum albumin level (P = 0.018), and the UICC stage (P = 0.009) were useful to be an independent and significant predictor of overall survival. In assessment of postoperative nutritional status including body composition, the octogenarian group was not inferior compared to the non-octogenarian group.</p><p><strong>Conclusions: </strong>In this study, PD for octogenarian was safe and feasible including nutritional aspects. Although careful patient selection and optimal perioperative care are necessary to consider whether PD is indicated for elderly patients, the advanced age alone should not be an exclusion criterion in considering of PD.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769152","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":"Use of omental flap in left-sided hepatectomy for prevention of delayed gastric emptying: a systematic review and meta-analysis.","authors":"Stefan Simeonovski, Karim Ataya, Tsonka Lukanova, Yusuf Ahmed, Dima Salloum, Ivelin Takorov","doi":"10.1016/j.surge.2025.07.006","DOIUrl":"https://doi.org/10.1016/j.surge.2025.07.006","url":null,"abstract":"<p><strong>Background: </strong>Delayed gastric emptying (DGE) is a widespread complication after left-sided hepatectomy (LSH). The usage of omental flap (OF) in patients after LSH is thought to reduce the incidence of DGE. Therefore, a meta-analysis was performed in order these findings to be explored.</p><p><strong>Methods: </strong>Pubmed, Embase and Cochrane Central were searched for studies comparing usage of omental flap to no-OF in patients after LSH. The primary outcome was DGE. Statistical analysis was performed using Review Manager 5.4 (Cochrane Collaboration). Heterogeneity was assessed using I² statistics. Odds ratios (OR) were computed for binary endpoints using a random-effects model.</p><p><strong>Results: </strong>358 patients were included from 7 studies, of which 2 were randomized controlled trials (RCTs). Male sex was predominant (68 %). OF was used for prevention of DGE in 155 cases. In 3 of the studies the greater omentum was divided for the preparation of the flap. DGE (OR 0.10; 95 % CI 0.04-0.23; p < 0.00001; I² = 0 %) and overall morbidity (OR 0.31; 95 % CI 0.13-0.74; p = 0.008; I² = 0 %) were significantly reduced in the OF group, compared to the no-OF group.</p><p><strong>Discussion: </strong>Utilization of omental flap in patients with left-sided hepatectomy significantly reduces the incidence of DGE and overall morbidity, compared to the no-omental flap procedure.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765730","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}