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

{"title":"Sustainable surgery in Ireland: A national perspective on practices, perceptions, and challenges.","authors":"Muhammad Umair, Andrew Keane, Maria Mahmood, Camilla M Carroll","doi":"10.1016/j.surge.2025.10.011","DOIUrl":"https://doi.org/10.1016/j.surge.2025.10.011","url":null,"abstract":"<p><strong>Background: </strong>Operating theatres significantly impact healthcare's carbon footprint. Surgeons, as key decision-makers, are essential in driving sustainable practices. This study evaluates the attitudes and practices of Irish surgeons towards environmental sustainability, identifies barriers to implementation, and explores opportunities for improvement.</p><p><strong>Methodology: </strong>A cross-sectional survey was distributed to members and fellows of the Royal College of Surgeons in Ireland (RCSI). The structured questionnaire comprised demographic items, Likert-scale statements, and open-ended questions, addressing awareness of sustainability, waste management behaviours, and individual commitment to sustainable practices.</p><p><strong>Results: </strong>A total of 177 responses (response rate of 85.9 %) were received; 74 % (n = 131) of respondents were male and 55.4 % (n = 98) were consultant surgeons. While most respondents acknowledged the importance of sustainability in surgery, many reported limited familiarity with the concept. The volume of non-clinical waste generated in surgical settings was frequently underestimated. Reported barriers to implementing sustainable practices included insufficient education and awareness, financial constraints, and dependence on single-use instruments. Concerns regarding sterility and infection prevention also emerged as deterrents to adopting reusable alternatives. In addition to the quantitative findings, open-ended responses were analysed using thematic analysis, which revealed nuanced insights into surgeons' perceptions of sustainability, including underlying concerns, motivations, and system-level barriers.</p><p><strong>Conclusions: </strong>There is a clear disconnect between the perceived importance of sustainability and its practical application in surgical settings. Barriers exist at multiple levels - individual, institutional, and systemic. These findings underscore the urgent need for targeted educational and policy-driven interventions to embed sustainability into surgical practice.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145483409","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":"The epidemiology, current evidence and controversies in diagnosis and management of patients with colorectal peritoneal metastases.","authors":"John Young, Joanne Edwards, James H Park","doi":"10.1016/j.surge.2025.11.001","DOIUrl":"https://doi.org/10.1016/j.surge.2025.11.001","url":null,"abstract":"<p><strong>Background: </strong>Peritoneal metastases (PM) are a common site of spread in colorectal cancer (CRC) and are associated with poor survival outcomes. The true burden of disease is difficult to quantify due to limitations in imaging and limited symptoms until advanced disease. Systemic therapy has limited benefits and there is an increasing interest in the use of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). This narrative review summarises the current literature on epidemiology of PM in CRC and evidence based current management strategies.</p><p><strong>Methods: </strong>PubMed was search for the terms \"Peritoneal Metastases\" or \"Peritoneal carcinomatosis\" and \"Colorectal Cancer\" from inception to December 2024. Titles of all English language articles were considered and backwards referencing screening was undertaken in key articles. Inclusion criteria included all original articles with a focus on the clinical management of PM and CRC.</p><p><strong>Findings: </strong>PM occur in 5-10 % of patients with CRC. The current literature likely underestimates the true burden of disease due to reliance on accurate registry data, and little is published on UK data. Systemic therapy has limited benefit in patients with PM. The PRODIGE-7 trial highlighted the benefits of CRS in select patients but raised questions about the benefits of HIPEC. Prophylactic HIPEC remains controversial but the findings of HIPECT4 show promising results.</p><p><strong>Conclusion: </strong>The true burden of PM and CRC remains unclear particularly in the UK population. CRS has clear benefits in patients that undergo complete cytoreduction. Further work is required to determine the benefits of HIPEC and how to optimise this for patients.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145477354","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":"Outcomes of early vs delayed surgical intervention in geriatric patients with cervical spinal fractures and spinal cord injuries.","authors":"Harry Marland, Arnav Barve, Jake M McDonnell, Meadhbh Ni Mhiochain de Grae, Conor McNamee, Kielan V Wilson, Stacey Darwish, Joseph S Butler","doi":"10.1016/j.surge.2025.10.009","DOIUrl":"https://doi.org/10.1016/j.surge.2025.10.009","url":null,"abstract":"<p><strong>Background: </strong>Older adults have high rates of morbidity and mortality following traumatic spinal cord injuries (SCI) but are also at increased risk of intraoperative and postoperative complications compared to younger counterparts. This study aims to identify the optimal time to surgical intervention in elderly patients presenting with traumatic SCI.</p><p><strong>Methods: </strong>A retrospective review was carried out at our centre from 2016 to 2020 to identify geriatric patients (≥65 years old) presenting with a traumatic SCI, managed surgically. Cohorts were categorised and compared for outcomes based on their time from injury to surgery. The different time intervals assessed include: 24 h and 72 h.</p><p><strong>Results: </strong>72 patients were identified. 13/72 (18.1 %) underwent surgery within 24 h of their injury and 32/72 (44.4 %) underwent surgery within 72 h of their injury. Overall, the results favoured delayed surgical intervention for both time intervals in terms of high dependency unit (HDU) requirement (p = 0.004 and p = 0.048), intensive care unit (ICU) requirement (p = 0.001 and p = 0.015) and intraoperative complications (p = 0.043 and p = 0.02). Of the patients with preoperative American Spinal Injury Association (ASIA) Impairment Scale (AIS) A grade, those who underwent surgical decompression after 72 h had greater neurological improvement (p = 0.019) and a smaller proportion of HDU (p = 0.006) and ICU (p = 0.047) requirement.</p><p><strong>Conclusion: </strong>To the authors' knowledge, this is the first study to compare surgical outcomes in geriatric patients with traumatic spinal cord injury (SCI) based on injury-to-surgery time intervals. The findings are hypothesis-generating and suggest a potential benefit to delayed surgical intervention in a subset of these patients. Further prospective research is needed to better define optimal timing and management strategies in this complex and vulnerable population.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453543","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":"High altitude as a prognostic factor in sleeve gastrectomy outcomes: A systematic review and meta-analysis.","authors":"Qing Zhou, Yong-Fa Zhi, Jin-Ke Kang, Ming-Jie Ma, Xiao-de Ren, Jie Niu, Xing-Yuan Yang, Ting Xiang","doi":"10.1016/j.surge.2025.10.002","DOIUrl":"https://doi.org/10.1016/j.surge.2025.10.002","url":null,"abstract":"<p><strong>Background & aims: </strong>Sleeve gastrectomy is a widely performed bariatric surgery, yet its outcomes can vary significantly depending on environmental factors such as high altitude. High altitude, characterized by hypobaric hypoxia, may affect oxygen delivery, recovery, and metabolic processes post-surgery. This study aims to evaluate high altitude as a prognostic factor in sleeve gastrectomy outcomes, focusing on complication rates, weight loss, and recovery duration.</p><p><strong>Results: </strong>The meta-analysis revealed a significantly higher postoperative complication rate for the high-altitude group, with a relative risk (RR) of 1.45 (95 % CI: 1.35-1.55, p < 0.05) [9, 14]. To address heterogeneity in altitude definitions [6, 9], we performed a sensitivity analysis excluding the study with the highest altitude cutoff (≥2500 m). The results remained consistent (RR: 1.42, 95 % CI: 1.32-1.53) [14, 19], confirming the robustness of our primary finding.</p><p><strong>Conclusions: </strong>High altitude is a critical factor influencing sleeve gastrectomy outcomes, leading to increased complications and prolonged recovery. Preoperative assessments and postoperative care must address altitude-specific challenges, including enhanced oxygenation strategies, to optimize patient recovery and surgical success. These findings emphasize the need for tailored clinical approaches to improve outcomes for bariatric surgery patients in high-altitude environments.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145356660","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":"The survival of patients with invasive ductal and invasive lobular breast cancer and its epidemiological and biological differences","authors":"Dr Ansu Joseph ,&nbsp;Dr Kapilraj Ravendran","doi":"10.1016/j.surge.2025.04.017","DOIUrl":"10.1016/j.surge.2025.04.017","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 5","pages":"Page 328"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044243","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":"Small bowel obstruction secondary to peritoneal tuberculosis: A case report","authors":"Marcus James Renshaw,&nbsp;Pete John Webster","doi":"10.1016/j.surge.2025.04.027","DOIUrl":"10.1016/j.surge.2025.04.027","url":null,"abstract":"<div><div>Extrapulmonary Tuberculosis<span><span> (EPTB) can affect many organ systems, including the gastrointestinal (GI) tract. Here, it may manifest as intestinal, peritoneal, hepato-pancreato-biliary TB, or as TB lymphadenitis<span>. We report a case of small bowel obstruction secondary to </span></span>peritoneal TB<span> deposits in a patient who had previous received BCG<span> vaccination<span>. The patient was managed with emergency laparotomy<span> and received TB treatment<span><span> post-operatively. This article highlights the innocuous presentation of peritoneal TB and difficulties obtaining a diagnosis. Furthermore, we review the efficacy of the </span>BCG vaccine<span> and remind the reader of the importance of a travel history in the acute abdomen setting.</span></span></span></span></span></span></span></div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 5","pages":"Pages 313-315"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144230","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":"Comparative Study of Metal vs. Ceramic Implants in Joint Arthroplasty: Longevity and Complication Rates","authors":"Mr. Taufiq Qurrohman ,&nbsp;Dr. Chairul Wahjudi","doi":"10.1016/j.surge.2025.04.026","DOIUrl":"10.1016/j.surge.2025.04.026","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 5","pages":"Page 331"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044134","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":"VTE Prophylaxis in Trauma Unit","authors":"Dr Vincent Dundas-Smith","doi":"10.1016/j.surge.2025.04.020","DOIUrl":"10.1016/j.surge.2025.04.020","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 5","pages":"Page 329"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044246","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":"Intern involvement in emergency general surgical handover and implications for patient care","authors":"Niall Murnaghan ,&nbsp;Jessica M. Ryan ,&nbsp;William P. Duggan ,&nbsp;Deborah A. McNamara","doi":"10.1016/j.surge.2025.05.004","DOIUrl":"10.1016/j.surge.2025.05.004","url":null,"abstract":"<div><h3>Background</h3><div>Surgical handover is a key risk area in patient care, yet the impact of junior team member involvement in the process is not well understood. This study aims to assess the level of intern involvement in emergency general surgery (EGS) handover and its impact on daily tasks.</div></div><div><h3>Methods</h3><div>Overt, structured, non-participant observations of morning EGS handover meetings were carried out to assess intern involvement. The same interns were then observed over the course of the day-shift immediately following the handover. During these observation periods, details of all patient care queries addressed to the interns were recorded.</div></div><div><h3>Results</h3><div>Five general surgery interns (42%) were observed across six EGS handover meetings. A total of 100 clinical queries were recorded during 25 h of observation. Only 2/6 handover meetings had full intern involvement. While all appeared to be actively listening during handover, questions were asked, and readbacks were provided by interns during 4/6 and 3/6 handovers, respectively. Clinical queries directed at interns who were fully involved in the morning handover were more likely to be answered immediately (96.6 %,n = 29 vs. 78.6 %,n = 55; <em>p</em> = 0.024) and using memory of the verbal handover (50 %,n = 15 vs 24.3 %,n = 17; <em>p</em> = 0.012). One incidence of negligible harm occurred, due to omission of a patient's allergy information from the handover.</div></div><div><h3>Conclusion</h3><div>Interns who are fully involved in handover show evidence of learning and are more likely to respond to queries faster and from memory. Reduced involvement in the post-call handover process has the potential to delay, and therefore negatively impact, patient care.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 5","pages":"Pages 277-280"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163456","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":"Optimising topical wound care outcomes for fungating breast wounds – A systematic review of current institutional practice","authors":"Ryan Seng Hong Wong ,&nbsp;Trishan Manav Sri Ram ,&nbsp;Zhi Min Lin ,&nbsp;Clement Luck Khng Chia","doi":"10.1016/j.surge.2024.12.003","DOIUrl":"10.1016/j.surge.2024.12.003","url":null,"abstract":"<div><h3>Background</h3><div>Fungating breast wounds<span> cause significant complications and morbidity to patients. Wound care is of paramount importance in optimising care and alleviating suffering for patients with malignant breast wounds. Currently, routinely implemented objective assessment tools for fungating breast wound treatment outcomes are non-existent, and institutional practice varies.</span></div></div><div><h3>Aims</h3><div>This review aims to evaluate current evidence regarding various wound care methodologies for fungating breast tumours on their effectiveness at targeting established fungating wound-specific complications: malodour, pain, exudates, bleeding, wound characteristics, emotional and quality-of-life outcomes.</div></div><div><h3>Data sources</h3><div>We conducted a systematic review<span><span> of four databases (PubMed, Embase, </span>Scopus, The Cochrane Library) and hand-search of bibliographies of relevant reviews, in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P) guidelines.</span></div></div><div><h3>Results</h3><div>The search strategy yielded 1319 articles, of which, 8 studies involving 188 patients were included in the review. Studies examined the effects of wound care products such as but not limited to calcium alginate<span>, hydrocellular dressing and metronidazole<span> and looked at outcomes such as bleeding (6), malodour (5), exudates (3), pain (4), wound size/length (2), emotion (3) and quality-of-life (1).</span></span></div></div><div><h3>Conclusion</h3><div>There is a wide variety of options for wound care which is able to target the various complications of fungating breast wounds. Certain wound care methods are effective in alleviating patient morbidity. However, key barriers toward establishing evidenced-based management of patients with fungating breast wounds were identified in the paucity of studies, lack of standardisation of interventions and objective outcome measures.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 5","pages":"Pages 281-287"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883529","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}