Martin Michel, Richard Newton, Joseph Ayathamattam, Saleem Ahmed
{"title":"Endoscopic management of bariatric complications","authors":"Martin Michel, Richard Newton, Joseph Ayathamattam, Saleem Ahmed","doi":"10.1016/j.mpsur.2025.07.010","DOIUrl":"10.1016/j.mpsur.2025.07.010","url":null,"abstract":"<div><div>Bariatric metabolic surgery is a frequently performed elective procedure within general surgery. Over the last decade the sleeve gastrectomy has become the most common bariatric procedure globally, followed by the Roux-en-Y gastric bypass, making up the two most common operations. These procedures are considered safe and have low rates of morbidity and mortality. Postoperative complications include staple line/anastomotic leaks, bleeds, strictures and ulceration. Revisional laparoscopic or open surgery can be challenging. Endoscopy can play an important role in both the diagnosis and therapeutic management of these complications. Recent advancements in endoscopic techniques have expanded the range of available treatment options. It is imperative for healthcare professionals working in non-specialized bariatric settings to collaborate with specialized units for guidance and management when faced with these complications.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 9","pages":"Pages 614-619"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050531","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":"Complications of blood transfusion","authors":"Hussain Janan, Sara Boyce","doi":"10.1016/j.mpsur.2025.07.003","DOIUrl":"10.1016/j.mpsur.2025.07.003","url":null,"abstract":"<div><div>Blood transfusions are an essential medical intervention, often lifesaving in both elective and emergency settings. However, they carry the risk of acute and long-term complications. Acute transfusion reactions (ATRs), can broadly be divided into immunological and non-immunological reactions and can range from mild, self-limiting events to severe, life-threatening complications. This article provides an overview of the recognition, investigation, and management of transfusion complications. The article also highlights the importance of rapid management of ATRs and preventative strategies to optimize the outcomes for affected recipients of blood components.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 9","pages":"Pages 556-561"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050607","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}
Jonathan Powell, William Maclean, Bruce Levy, Timothy Rockall
{"title":"Trauma laparotomy and damage control surgery","authors":"Jonathan Powell, William Maclean, Bruce Levy, Timothy Rockall","doi":"10.1016/j.mpsur.2025.07.004","DOIUrl":"10.1016/j.mpsur.2025.07.004","url":null,"abstract":"<div><div>Abdominal trauma can result in multiple different injuries affecting a number of organs. Early recognition and management of these injuries will improve patient survival and morbidity. Appropriate intervention involves the use of either definitive or damage control surgery for both haemorrhage and peritonitis. This article discusses the different mechanisms of injury, early assessment and investigations. It goes on to highlight the features of a trauma laparotomy, its preparation, management and the systematic approach for damage control surgery. The main abdominal organs are outlined in more detail to describe the individual approach to them in trauma.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 9","pages":"Pages 562-570"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050608","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":"Management of upper gastrointestinal perforations","authors":"Emily Moore, Nima Abbassi-Ghadi","doi":"10.1016/j.mpsur.2025.07.011","DOIUrl":"10.1016/j.mpsur.2025.07.011","url":null,"abstract":"<div><div>Perforation of the upper gastrointestinal (UGI) tract is a surgical emergency. Causes of oesophageal perforation include spontaneous (Boerhaave’s), iatrogenic or foreign body ingestion. Perforation of the stomach and duodenum is most often caused by peptic ulcer disease. Management involves obtaining an accurate clinical diagnosis, through a combination of patient assessment, imaging and endoscopy. It is important to differentiate intramural from full thickness oesophageal perforations as this will guide the definitive surgical or endoscopic management. Perioperative care of these patients is as important as the definitive management step. This article will summarize an approach to managing perforation of the UGI tract; from initial assessment to postoperative care.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 9","pages":"Pages 620-625"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050529","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":"Laparoscopic management of acute abdominal emergencies","authors":"Vikash Talib, Nicholas Farkas, Andrea Scala","doi":"10.1016/j.mpsur.2025.07.005","DOIUrl":"10.1016/j.mpsur.2025.07.005","url":null,"abstract":"<div><div>Laparoscopic management is increasingly recognized as a valuable approach in treating acute abdominal emergencies due to its diagnostic accuracy, minimally invasive approach and therapeutic advantages. It serves as an effective diagnostic tool in unclear abdominal cases, reducing the need for exploratory laparotomies. Key insights from recent literature include the following: Laparoscopic appendicectomy (LA) has been shown to lower wound infection rates and hospital stays compared to open appendicectomy, though the incidence of intra-abdominal abscesses may be slightly higher with LA. Laparoscopy is a safe method for managing acute abdominal pain during pregnancy, especially in cases of appendicitis or cholecystitis, as it minimizes fetal risks and avoids the use of ionizing radiation. Early laparoscopic cholecystectomy, preferably within 72 hours of onset of cholecystitis symptoms, is recommended for quicker recovery and fewer complications. Laparoscopy can be applied in certain trauma cases, although its use is contingent on the surgeon's skill and the patient's stability. It is particularly beneficial in diagnosing gynaecological emergencies such as ectopic pregnancy or ovarian torsion, where rapid diagnosis and treatment can improve outcomes. The success of laparoscopic surgery is highly dependent on the surgeon's expertise. In conditions such as adhesional bowel obstruction or mesenteric ischemia, the evidence is less conclusive, and further clinical trials are needed. In resource-limited settings, the availability of equipment and costs may limit the widespread use of laparoscopic techniques.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 9","pages":"Pages 571-579"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050524","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}
Madhavi UV Natarajan, James W O'Brien, Matthew Rogers, Michelle Gallagher, Timothy Rockall
{"title":"Management of massive gastrointestinal haemorrhage","authors":"Madhavi UV Natarajan, James W O'Brien, Matthew Rogers, Michelle Gallagher, Timothy Rockall","doi":"10.1016/j.mpsur.2025.07.006","DOIUrl":"10.1016/j.mpsur.2025.07.006","url":null,"abstract":"<div><div>Gastrointestinal (GI) haemorrhage is a common medical emergency, with one patient presenting every 6 minutes in the UK (70–90,000 cases per year). It is associated with a significant mortality rate that has remained relatively static at 10% for more than two decades. Haemorrhage is commonly categorized as bleeding of upper or lower GI origin, but for organization of care, both groups should be regarded as one clinical entity. Rapid assessment, resuscitation and correction of coagulopathy should be undertaken, following local major haemorrhage protocols, with investigation urgently arranged. For upper GI haemorrhage, endoscopy remains the gold standard for simultaneous investigation and treatment. For lower GI haemorrhage, a more nuanced algorithm is available, including CT angiography for actively bleeding or unstable patients, and endoscopic evaluation in select cases. Clinicians may utilize a range of endoscopic and radiological techniques to diagnose and control the source of haemorrhage, which should be tailored to the site of bleeding and pathology. When haemostasis is not achieved, either repeat intervention or a different modality should be selected. Surgery is now infrequently used as a treatment for GI haemorrhage and should be contemplated only once endoscopic and radiological treatments have failed, following discussion between senior clinicians. Postoperative GI bleeding may still be best served with return to theatre, but interventional radiology should also be considered.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 9","pages":"Pages 580-592"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050525","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":"Test yourself MCQ and Single Best Answer","authors":"Adrian Ben Cresswell","doi":"10.1016/j.mpsur.2025.07.012","DOIUrl":"10.1016/j.mpsur.2025.07.012","url":null,"abstract":"","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 9","pages":"Pages 626-627"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050528","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":"Physiology of shock and volume resuscitation","authors":"Robert Jericho, Steffan Glaze","doi":"10.1016/j.mpsur.2025.07.002","DOIUrl":"10.1016/j.mpsur.2025.07.002","url":null,"abstract":"<div><div>In shock, hypoperfusion of vital organs can lead to their failure. Recognizing shock, identifying the type and treating it promptly saves lives. Monitoring of haemodynamic and cellular end points is crucial in guiding treatment and improving outcomes. This article therefore focuses on the pathophysiology of shock, volume resuscitation, haemostasis and approaches to management. The body has a number of intrinsic homeostatic mechanisms for controlling blood pressure and organ perfusion which are pushed to their limits and beyond in disease. Replacement of circulating volume with fluids or blood is often necessary, but the best strategy depends on the clinical situation and latest evidence. Coagulopathy can accompany haemorrhage, particularly in trauma, and correction should be guided by testing. In haemorrhage, the aim is to stabilize the patient until definitive control can be achieved by intervention. Drug therapy to increase blood pressure and cardiac output may be necessary to increase the time available to treat underlying pathologies.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 9","pages":"Pages 549-555"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050523","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":"Abdominal compartment syndrome","authors":"Alicia Skervin, Khlud Asanai, Mohammad Mobasheri","doi":"10.1016/j.mpsur.2025.07.009","DOIUrl":"10.1016/j.mpsur.2025.07.009","url":null,"abstract":"<div><div>Abdominal compartment syndrome (ACS) is a devastating condition for the critically unwell patient. Initially described as solely affecting surgical patients, ACS is now also recognized in the medical intensive care setting. Without prompt and definitive treatment mortality rates approach 70% as multi-organ failure develops. Over the past decade our understanding, recognition and management of ACS has evolved. The World Society of Abdominal Compartment Syndrome published updated guidelines in 2013 to draw consensus and improve patient outcomes. ACS is the end sequela of raised intra-abdominal pressure (IAP), defined as a sustained IAP >20 mmHg with or without an abdominal perfusion pressure <60 mmHg and associated with new organ dysfunction. Intravesical measuring of IAP is the gold standard diagnostic technique. Surgical decompressive laparotomy and open abdomen with temporary abdominal closure measures is the definitive treatment. This article summarizes the updated consensus definitions, pathophysiology, diagnostic investigation and management to help the junior surgical trainee faced with ACS.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 9","pages":"Pages 607-613"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050530","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 detection and management of complications following the treatment of liver metastases","authors":"Caoimhe M. Walsh, Adrian Ben Cresswell","doi":"10.1016/j.mpsur.2025.07.007","DOIUrl":"10.1016/j.mpsur.2025.07.007","url":null,"abstract":"<div><div>Whilst once considered as incurable systemic disease, treatment options for liver metastases have increased over the last 30 years and safety has improved dramatically, such that for a selected group of patients the hope of cure can now be offered with radical treatment, and low-morbidity interventions can be offered which prolong survival, even in patients with more widely disseminated disease. Advances have been made in patient selection and surgical technique for liver resection and several adjuncts to resection now exist in the form of portal vein embolization, thermal ablation and targeted drug or radiotherapy delivery options. A natural consequence of these developments has been the delivery of services within fewer specialist units, with the result that later complications of therapy may present to local hospitals, rather than directly to the specialist centres. This article will describe the current common liver-directed therapies and outline the presentation and management of their complications.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 9","pages":"Pages 593-600"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050526","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}
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