The British journal of surgery最新文献

{"title":"Gallbladder cancer.","authors":"Anita Balakrishnan, Javier Lendoire, Itaru Endo","doi":"10.1093/bjs/znaf275","DOIUrl":"https://doi.org/10.1093/bjs/znaf275","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 2","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147287078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antimicrobial dressings for the prevention of surgical-site infection: systematic review and meta-analysis.","authors":"Suraya M Yusuf, Jonathan James, Bryant Chong, Esmee Dohle, Luka Jovanovic, Soma Farag, Ryckie G Wade, Justin C R Wormald","doi":"10.1093/bjs/znaf277","DOIUrl":"10.1093/bjs/znaf277","url":null,"abstract":"<p><strong>Background: </strong>Surgical-site infections (SSIs) are a leading cause of postoperative morbidity, prolonged hospitalization, and significant healthcare costs. Antimicrobial dressings may mitigate SSI risk by minimizing local microbial burden, but their effectiveness remains uncertain.</p><p><strong>Methods: </strong>MEDLINE, Embase, CINAHL, and Cochrane CENTRAL were searched from inception up to 5 July 2024, supplemented by searches of the grey literature and citation chasing. RCTs comparing antimicrobial dressings with any other inert dressing for closed incisional wounds after elective or emergency surgery were included. Data were extracted in duplicate, risk of bias (RoB) was assessed using the Cochrane RoB 2 tool, and certainty of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Pairwise random-effects meta-analyses were performed. The primary outcome was SSI within 30 days (90 days if prosthesis used); secondary outcomes included adverse events and costs.</p><p><strong>Results: </strong>A total of 35 RCTs involving 8718 participants were included. Meta-analyses were conducted for silver (21 studies, 5504 participants), dialkylcarbamoyl chloride (DACC) (3 studies, 892 participants), and mupirocin (3 studies, 1320 participants). Compared with standard dressings, silver dressings reduced the risk of SSI by 22% (risk ratio (RR) 0.78 (95% c.i. 0.62 to 0.97); I2 = 43%; moderate-certainty evidence). DACC dressings halved the risk of SSI (RR 0.49 (95% c.i. 0.29 to 0.83); I2 = 0%; moderate-certainty evidence) compared with standard dressings. Mupirocin dressings were not associated with SSI prevention (RR 0.62 (95% c.i. 0.15 to 2.63); I2 = 67%; very low-certainty evidence). Evidence for other agents was insufficient.</p><p><strong>Conclusion: </strong>Silver and DACC dressings probably reduce the risk of SSI in closed surgical wounds. There is residual uncertainty over the clinical effectiveness of other antimicrobial dressings.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 2","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146169316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency hospital admissions while on an elective waiting list in England: an observational study using administrative data.","authors":"Anthony P James, William K Gray, Mark J Cheetham, Ian Eardley, Mark Lansdown","doi":"10.1093/bjs/znaf292","DOIUrl":"10.1093/bjs/znaf292","url":null,"abstract":"<p><strong>Introduction: </strong>Patients awaiting elective procedures often have conditions that carry a risk of medical emergencies. This study quantifies the extent and variation of emergency hospital admissions during the waiting period across selected specialties and procedures.</p><p><strong>Methods: </strong>Data from the NHS England Waiting List Minimum Dataset linked to the Secondary Uses Service hospital admissions data set from 1 January 2022 to 31 December 2023 was analysed. Emergency admissions occurring while patients awaited treatment were identified and categorized from 'very likely' related to the index condition or its recognized co-morbid risks-and potentially avoidable through definitive treatment-through to 'unrelated'.</p><p><strong>Results: </strong>In 2023 some 2 093 789 waits (both incomplete and complete) were recorded across 41 selected procedures spanning 11 specialties. Over a combined waiting time of 33 832 790 days, 69 322 emergency admissions occurred, accounting for 535 806 bed days. The highest emergency admission rates per 52 weeks waiting were observed for urinary stent procedures (0.71), endoscopic retrograde cholangiopancreatography (0.63), and urinary catheter care (0.55). Nine procedures had more emergency bed days during the wait than elective bed days post-treatment, with the highest emergency/elective bed day ratios for ureteric stones (4.59), colonoscopy (2.80), and ablation/cardioversion (2.05).</p><p><strong>Conclusion: </strong>A substantial number of patients on elective waiting lists are being admitted as emergencies during their wait, placing a burden on emergency care that would be avoided through more timely treatment. The variation in risk between specialties and pathways requires further prioritization strategies that mitigate patients' risk of associated harm, acting both within and across waiting lists, specialties, and organizations.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 2","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146215360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-operative management of mismatch repair-deficient (dMMR) / micro satellite instability-high (MSI-H) colorectal cancer treated with immunotherapy: systematic review and meta-analysis.","authors":"Jih Huei Tan, Ian Wee Jun Yan, Jasmine Hui Er Chang, Michelle Shi Qing Khoo, Thomas Jun Yao Tan, Emile John Kwong Wei Tan","doi":"10.1093/bjs/znaf284","DOIUrl":"https://doi.org/10.1093/bjs/znaf284","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 2","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146215332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative management of respiratory conditions and complications.","authors":"Khadija Ranjha, Michael Gilbert","doi":"10.1093/bjs/znaf296","DOIUrl":"https://doi.org/10.1093/bjs/znaf296","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 2","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open surgery versus branched endovascular repair of the aortic arch in residual dissections after type A surgical repair.","authors":"Giovanni Tinelli, Simona Sica, Nikolaos Tsilimparis, Maximilian Pichlmaier, Eugenio Neri, Aurélien Hostalrich, Tilo Kölbel, Jonathan Sobocinski, Marco Di Eusanio, Emanuele Gatta, Andres Schanzer, Guillaume Guimbretière, Diana Giannarelli, Ming Hao Guo, Yamume Tshomba, Massimo Massetti, Stéphan Haulon","doi":"10.1093/bjs/znaf300","DOIUrl":"10.1093/bjs/znaf300","url":null,"abstract":"<p><strong>Background: </strong>Redo open arch repair is challenging; arch branched endovascular aortic repair (a-BEVAR) offers a less invasive alternative. However, direct comparisons are lacking. The aim of this study was to compare the outcomes of open arch repair versus a-BEVAR in patients with residual aortic dissection after ascending aorta replacement for acute Stanford type A aortic dissection.</p><p><strong>Methods: </strong>This multicentre retrospective study included patients treated for residual dissection after type A aortic dissection in ten high-volume centres from January 2018 to May 2024. Propensity score matching (1 : 1) was used to adjust for baseline differences. Primary endpoints included 30-day mortality and stroke rates, and secondary endpoints included acute kidney injury, spinal cord ischaemia, reintervention, aortic-related mortality, and hospital length of stay.</p><p><strong>Results: </strong>A total of 183 patients were included: 89 (48.6%) underwent open arch repair and 94 (51.4%) underwent a-BEVAR. After propensity score matching, there were 57 patients in each group. The 30-day mortality rate was 3.5% for open arch repair and 5.3% for a-BEVAR (P = 0.220). The stroke rate was 5.3% for open arch repair and 3.5% for a-BEVAR (P = 0.650). Open arch repair was associated with significantly higher rates of prolonged (>48 h) intubation (28.1% versus 3.5%; P < 0.001), acute kidney injury (31.6% versus 8.8%; P = 0.002), and temporary dialysis (22.8% versus 7.0%; P = 0.002). The median hospital length of stay was 21 days for open arch repair and 10 days for a-BEVAR (P < 0.001). During a median follow-up of 30 months (i.q.r. 7-49), no difference in mortality was observed (10.5% for open arch repair versus 12.3% for a-BEVAR; P = 0.770).</p><p><strong>Conclusion: </strong>a-BEVAR provides a less invasive alternative to open arch repair with reduced complications. Long-term studies are needed.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 2","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146215530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Day case and inpatient elective thyroid lobectomy across England: observational study of variation in practice and safety.","authors":"Michael Monaghan, William K Gray, Mark Cheetham, Paul Dent, Tim W R Briggs, Mark Lansdown","doi":"10.1093/bjs/znaf299","DOIUrl":"10.1093/bjs/znaf299","url":null,"abstract":"<p><strong>Background: </strong>Day case elective surgery is becoming increasingly common across a range of procedures. The aim of this study was to investigate the safety of day case thyroid lobectomy, a procedure with low uptake in the UK.</p><p><strong>Methods: </strong>This study analysed the Hospital Episode Statistics administrative data set for all first-time elective thyroid lobectomies performed on adults in England from 1 April 2017 to 31 March 2024. The primary outcome was 30-day emergency readmission and secondary outcomes were 30-day emergency readmission for complications and specifically for haemorrhage. The primary exposure variable was whether patients were day case patients or inpatients. Models were adjusted for the demographic and frailty characteristics of the patients.</p><p><strong>Results: </strong>Over the 7-year interval, 41 518 elective thyroid lobectomies were performed by 127 different hospital trusts. The day case rate was 9.9% (4125 patients) across all hospital trusts. Rates in the 118 hospital trusts conducting >20 procedures during the 7 years varied from 0% to 74.6%. Day case surgery was associated with a lower 30-day emergency readmission rate (OR 0.73 (95% c.i. 0.56 to 0.96); P < 0.021), with no evidence of association with poorer outcomes. There was no evidence that trusts with day case rates >30% had poorer outcomes than trusts with day case rates <1%.</p><p><strong>Conclusion: </strong>In low-risk patients, day case thyroid lobectomy is safe.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 2","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147287040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing parathyroid function requires both parathyroid hormone and calcaemia assessments.","authors":"Jean-Philippe Bertocchio, Cécile Ghander","doi":"10.1093/bjs/znaf297","DOIUrl":"https://doi.org/10.1093/bjs/znaf297","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 2","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146160037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a perioperative protocol for parathyroidectomy reduces postoperative hypocalcaemia and healthcare utilization.","authors":"Pieter C R Dahmen, Jeroen C Hol, Johannes Feenstra, Anne Brecht Francken, Annette D van Dalsen","doi":"10.1093/bjs/znaf301","DOIUrl":"https://doi.org/10.1093/bjs/znaf301","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146014225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The E-AHPBA-ESSO-Innsbruck consensus recommendations on peri- and postoperative management following liver resection.","authors":"Eva Maier, Stefan Stättner, Lucia Carrion-Alvarez, Marcello Di Martino, Pim Olthof, Florian Primavesi, Dana Sochorova, Stijn van Laarhoven, Anita Balakrishnan, Robert Breitkopf, Carlijn I Buis, Federica Cipriani, Joris Erdmann, Adam Frampton, David Fuks, Stefan Gilg, Aiste Gulla, Francesco Lancellotti, Christian Margreiter, Emmanuel Melloul, Christian Oberkofler, Stefan Petritsch, Helmut Raab, Nuh N Rahbari, Daniela Rappold, Thomas Reiberger, Andrea Ruzzenente, Ville Sallinen, Benedikt Schaefer, Andreas A Schnitzbauer, Alejandro Serrablo, Kjetil Soreide, Ernesto Sparrelid, Patrick Starlinger, Gregor A Stavrou, Pascale Tinguely, Luca Aldrighetti, Bobby V M Dasari, Matteo Donadon, Cristina Dopazo, Thomas Gruenberger, Eduard Jonas, Hassan Malik, Luca Viganó, Ajith K Siriwardena, Manuel Maglione","doi":"10.1093/bjs/znaf272","DOIUrl":"10.1093/bjs/znaf272","url":null,"abstract":"<p><strong>Background: </strong>Liver surgery carries a high risk of complications due to the complex interplay of patient-related factors, disease characteristics, and liver function. Expertise is essential for healthcare professionals managing hepatobiliary patients. This European consensus provides evidence-based guidance on selected aspects of peri- and postoperative care.</p><p><strong>Methods: </strong>A modified Delphi process was used to achieve consensus, with a 70% agreement threshold. The expert panel comprised hepatobiliary surgeons, anaesthetists, hepatologists, a specialist nurse, and a physiotherapist. A systematic literature search was conducted in PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases. Six topics were addressed: thromboprophylaxis; perioperative antibiotics; prehabilitation/nutrition/mobilization; bile leak including bilioenteric anastomosis leaks; post-hepatectomy haemorrhage; and post-hepatectomy liver failure (PHLF). Evidence appraisal and statement development followed Scottish Intercollegiate Guidelines Network methodology. A patient representative reviewed the guideline.</p><p><strong>Results: </strong>Searching the literature yielded 204 included publications from an initial 6514. Thirty-two statements were formulated with a median evidence level of 2. Evidence strength varied by topic with noticeably lower evidence levels in complex surgery settings and less prevalent conditions. In some topics, study heterogeneity and specific inclusion criteria resulted in conditional recommendations, despite high-level evidence. Notably, the weakest evidence was found for perioperative thromboprophylaxis and PHLF management. Strong recommendations were formulated for prehabilitation, early postoperative mobilization, and avoidance of routine drain use. Several evidence gaps warranting multicentre studies were identified.</p><p><strong>Conclusion: </strong>Optimizing peri- and postoperative care after liver resection remains challenging. Standardizing key practices and addressing evidence gaps through collaborative research are vital to improve outcomes.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 1","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12750329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145859813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}