Annals of the Royal College of Surgeons of England最新文献

{"title":"A comparison of outcomes following laparoscopic cholecystectomies before and after COVID using objective scoring systems.","authors":"F Nicholas, N Viswanathan","doi":"10.1308/rcsann.2025.0070","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0070","url":null,"abstract":"<p><strong>Introduction: </strong>There is an almost universal perception that following the COVID-19 disruption laparoscopic cholecystectomies (LCs) have become more technically demanding, resulting in poorer outcomes. This study quantifies the differences in outcomes before and after the pandemic.</p><p><strong>Methods: </strong>Elective LCs performed by two upper gastrointestinal surgeons in the same hospital between January and December 2019 (pre-COVID group) and between September 2021 and August 2022 (post-COVID group) were included. LCs on the emergency list and those that included common bile duct exploration were excluded. Demographics, American Society of Anesthesiologists' grade, indications, waiting times, operative times, Nassar score, Parkland grade and outcome measures were collected. An online calculator for social science statistics was used to analyse the data.</p><p><strong>Results: </strong>In the pre-COVID group, a lower proportion of patients underwent cholecystectomy for previous cholecystitis (pre-COVID 13.04% vs post-COVID 35.7%; <i>p</i> < 0.001), and LCs were shorter (pre-COVID 74min vs post-COVID 85min; <i>p</i> = 0.018). The mean Nassar score and Parkland grade in the pre-COVID group (Nassar = 4.03, Parkland = 1.8) were less than in the post-COVID group (Nassar =5.41, Parkland = 2.5; <i>p</i> < 0.001 and <i>p</i> = 0.006). Other than a higher rate of subtotal cholecystectomies (5.4% pre-COVID vs 12.2% post-COVID; <i>p</i> = 0.04), there were no significant differences in outcomes.</p><p><strong>Conclusion: </strong>This study demonstrates that a larger proportion of LCs were performed for patients with a history of cholecystitis, and LCs were indeed challenging. There were no significant differences in outcome, apart from the rates of subtotal cholecystectomy. These data should inform the debate about early LCs following index admission.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145197926","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":"Variation in costs to complete surgical training: a cross-sectional observation analysis.","authors":"C L Eley, O P James, N Warren, C Carpenter, D Hanratty, R J Egan, J D Barry, W G Lewis","doi":"10.1308/rcsann.2024.0088","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0088","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical training is expensive. The aim of this study was to quantify the costs surgical trainees are expected to pay related to the ten surgical specialties in a single Statutory Education Body (SEB).</p><p><strong>Methods: </strong>Intercollegiate Surgical Curriculum Programme (ISCP) and Joint Committee on Surgical Training (JCST) certification requirements including mandatory and highly recommended courses, related to specialty, along with professional registration and examination fees were estimated.</p><p><strong>Results: </strong>Assuming an uninterrupted eight-year training pathway from Core (CST) through Higher Specialty Training (HST) to Certification of Completion of Training, median cost of mandatory courses was £1,498 (interquartile range (IQR) £1,498-£1,998). Highly recommended courses increased median cost to £5,998 (£4,880-£6,840); £749.75 per year (py) (£610-£855). Annual individual study budget (£600) was exceeded in 30.7% of the total trainee cohort (<i>n</i>=309) by mandatory and recommended curriculum course cost (<i>n</i>=95). Examination fees and professional subscriptions further increased costs to a median £17,669.50 (£16,552-£18,512); £2,148.75 per person py (£2,069-£2,251.38). Cost varied related to specialty, with General Surgery associated with the most cost (>£21,000; £2,626 py) compared with Otolaryngology the least (£15,613; <i>p</i><0.001).</p><p><strong>Conclusion: </strong>Surgical training expense varied by more than 33%. Mandatory and highly recommended courses exceeded SEB study budgets for almost one-third of trainees, with a theoretical fivefold study budget overspend. Trainees, trainers and schools of surgery alike should be aware of these costs when designing curricula and teaching programmes.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145013707","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 systematic review and meta-analysis comparing the safety and efficacy of open oesophagectomy and hybrid minimally invasive oesophagectomy.","authors":"N Naim, Mds Reza","doi":"10.1308/rcsann.2025.0066","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0066","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical resection, with or without neoadjuvant therapy, remains the primary treatment for oesophageal cancer. The two main surgical approaches are open oesophagectomy (OE) and hybrid minimally invasive oesophagectomy (HMIE). However, their relative safety and efficacy remain controversial. This review aims to compare perioperative and postoperative complications between OE and HMIE in the management of oesophageal cancer.</p><p><strong>Methods: </strong>Web of Science, EMBASE, PubMed, Scopus and the Cochrane Library were searched for relevant studies. Odds ratios (OR), standard mean differences (SMD) and 95% confidence intervals (CI) were used for statistical analysis.</p><p><strong>Results: </strong>Eight studies involving 6,053 patients were included. HMIE was associated significantly with lower rates of conduit necrosis (risk ratio (RR)=3.54, 95% CI [1.07, 11.73]; <i>p</i>=0.04), postoperative pneumonia (RR=1.29, 95% CI [1.05, 1.57]; <i>p</i>=0.01) and recurrent laryngeal nerve paralysis (RR=2.51, 95% CI [1.13, 5.55]; <i>p</i>=0.02). No significant differences were observed in Clavien-Dindo complication grades IIIa-IVb (RR=1.13, 95% CI [0.92, 1.38]; <i>p</i>=0.24), grade V complications (RR=1.03, 95% CI [0.30, 3.51]; <i>p</i>=0.96), bleeding, inhospital mortality, 90-day mortality, duration of surgery, hospital stay or intensive care unit stay. Although not statistically significant, OE was associated with fewer cases of anastomotic and chyle leaks.</p><p><strong>Conclusions: </strong>Both OE and HMIE have distinct advantages and drawbacks. HMIE appears superior in reducing conduit necrosis, postoperative pneumonia and nerve paralysis, whereas OE has slightly lower rates of anastomotic and chyle leaks. Surgical approach should be tailored to individual patient profiles. Further studies are needed to assess long-term oncologic outcomes.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991425","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":"Could resistance training prevent or improve work-related musculoskeletal disorders among surgeons?","authors":"A Vijay, P A Brennan, M Fagbohun, R S Oeppen, D Parry","doi":"10.1308/rcsann.2024.0089","DOIUrl":"10.1308/rcsann.2024.0089","url":null,"abstract":"<p><p>Studies have demonstrated the negative impact that work-related musculoskeletal disorders (WMSDs) have on surgeons. These are also likely to affect some allied healthcare professionals such as interventional radiologists. Problems from WMSDs include pain, diminished technical and cognitive performance, and work absence. These could contribute to burnout, to which surgeons are already vulnerable owing to other working practices such as shift patterns and long hours. WMSDs could negatively affect working performance, and lead to poorer surgical outcomes and patient care. Surgeons are at risk of WMSDs of the neck and back that result from fixed and damaging postures while operating. Some have reduced their operation numbers and working days as result of WMSDs. Theatre ergonomics (e.g. table positioning, operating stools and monitors), intraoperative breaks and stretching may improve WMSDs for some. Strength/resistance training (RT) may be used to prevent or mitigate WMSDs. RT can also enhance general health and concentration, and combat intraoperative fatigue. Low engagement times of moderate-intensity RT of 20 minutes, twice a week, improve neck and back pain from WMSDs. Moreover, RT has been shown to reduce all-cause mortality by up to 15%, increase bone density, improve proprioception and reduce the fear of movement due to pain. Alongside ergonomic improvement and stretching, we recommend RT as an activity to improve general health and WMSDs.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"453-456"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456671","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":"Hurdles to boys with acute scrotal pain being evaluated and treated in district general hospitals: we are not Getting It Right the First Time yet.","authors":"M Gopal, U Ibrahim, I Salphale, M Mostafizur, S Walker, M Clement, D Macafee, A Patel, R Balu, K S Eswaravaka Sudha Radha","doi":"10.1308/rcsann.2024.0078","DOIUrl":"10.1308/rcsann.2024.0078","url":null,"abstract":"<p><strong>Introduction: </strong>Testicular torsion is a time-critical emergency, though its incidence in the paediatric age group is relatively rare. Changes in training pathways have led to a decreasing number of adult general surgical and urological trainees being comfortable in performing an emergency scrotal exploration in children, resulting in children being transferred to regional units with the requisite expertise. This delay has been shown to increase the risk of orchidectomy. There is, therefore, an increased emphasis on the diagnostic evaluation of these children by emergency department staff.</p><p><strong>Methods: </strong>We explore how lack of experience and availability of appropriate investigations led to transfer of children presenting to a district general hospital in the North East of England.</p><p><strong>Results: </strong>Children with true testicular torsion in this cohort had an unacceptably high rate of needing an orchidectomy (∼67%) compared with the reported incidence of orchidectomy with testicular torsion (∼20%).</p><p><strong>Conclusions: </strong>We offer potential solutions to the hurdles that have to be overcome to improve this service. This will align the service to the recently published Get It Right First Time report on the management of testicular torsion in children and young adults and is within the remit of Operational Delivery Networks.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"473-478"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143770850","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":"Meatal stenosis and lichen sclerosus in children: is it a real risk? A single-centre retrospective observational study.","authors":"R Angotti, F Nascimben, M Messina, A Roggero, N Calomino, V Bagnara, F Raffaelli, F Ferrara, A Benigna, F Molinaro","doi":"10.1308/rcsann.2024.0096","DOIUrl":"10.1308/rcsann.2024.0096","url":null,"abstract":"<p><strong>Background: </strong>Early diagnosis, early treatment and long-term follow-up in paediatric patients with Lichen Sclerosus (LS) are mandatory to avoid complications such as urethral meatal stenosis.</p><p><strong>Methods: </strong>All patients older than five years who underwent circumcision from January 2015 to December 2021 at our centre with positive histology for LS were included. Demographic, preoperative, surgical and postoperative data were analysed. Patients were physically evaluated, and they were asked to fill in two quality of life questionnaires and to perform an uroflowmetry. They were stratified into clusters according to physical and histological examination. Urethral dilatations were investigated to assess the correlation between circumcision and incidence of LS-linked complications.</p><p><strong>Results: </strong>Among 99 patients included in the study, 95 were finally evaluated. Median age at diagnosis was seven years (range, five to ten years). Median age at surgery was 10.8 years (6-17). Urethral meatus was grade 0 in 47% of cases, grade 1 in 41% and grade 2 in 12%. A total of 19% of circumcised patients with LS had pathological uroflowmetry: the number of patients with pathological uroflowmetry increased as the grade of meatal stenosis increased (13% grade 0, 15% grade 1 and 33% grade 2). Four (4.7%) patients with diagnosis of meatal stenosis underwent meatal dilatations.</p><p><strong>Conclusions: </strong>By assessing histology of LS it is possible to determine who will develop LS-linked complications such as meatal stenosis. Patients with LS must be followed-up closely and should be treated with corticosteroids for at least for one month to improve their postoperative outcomes.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"503-510"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522522","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":"Ten-year outcome of a dedicated hip fracture unit embedded within a level 1 major trauma centre.","authors":"B Ahmad, F Davis, G Chan, B A Rogers","doi":"10.1308/rcsann.2024.0094","DOIUrl":"10.1308/rcsann.2024.0094","url":null,"abstract":"<p><strong>Introduction: </strong>Fragility hip fracture (FHF) care has been revolutionised by the introduction of the best practice tariff and its associated quality assessment domains. However, increasing demands on trauma services, most notably in regional major trauma centres (MTC), have resulted in competing challenges for clinical resources. This study aims to identify whether a dedicated hip fracture unit (HFU) embedded within a trust hosting the regional MTC affords sustained improvements in clinical outcomes for FHFs.</p><p><strong>Methods: </strong>A 10-year retrospective cohort study was performed using a prospectively collected database that was cross-referenced against contemporary data submitted to the National Hip Fracture Database by a single multicentre National Health Service trust. The study period encompassed a 10-year period covering 5 years before and 5 years after formation of a dedicated HFU. The outcomes evaluated include time to surgery, length of hospital stay, discharge location and mortality.</p><p><strong>Results: </strong>Some 4,998 patients sustained FHFs: 2,387 patients (2,533 injuries) treated prior to formation of the HFU formation and 2,611 patients (2,813 injuries) treated after. The mean time to surgical intervention was significantly lower in the group treated at the HFU by 3.1 days (<i>p </i>< 0.001). Length of hospital stay was also significantly reduced at the HFU (<i>p </i>< 0.001). More patients were discharged back to their premorbid residence from the HFU (47% vs 40%). The 30- and 365-day mortality rates were significantly reduced at the HFU (<i>p </i>= 0.005 and <i>p </i>= 0.024, respectively).</p><p><strong>Conclusion: </strong>When embedded within an MTC, the HFU model is a sustainable operational structure in the medium term that provides clear clinical benefits and could be replicated nationally and internationally at similar institutions.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"485-489"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762621","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":"A comparison of general surgery training programmes across 11 countries: improving understanding of the experience level of international medical graduates in the UK.","authors":"K M Spellar, A Z Chacko, C Beaton","doi":"10.1308/rcsann.2024.0086","DOIUrl":"10.1308/rcsann.2024.0086","url":null,"abstract":"<p><strong>Introduction: </strong>Within the past five years there has been a significant increase in the number of international medical graduates (IMGs) joining the United Kingdom's (UK) workforce. Having mentors and supervisors who understand the needs of IMGs and clinical and cultural differences in the workplace can benefit in the transition to working in a new country. Improving knowledge of and understanding differences between general surgical training programmes and grades across different countries could therefore aid in the support of IMGs within the UK.</p><p><strong>Methods: </strong>Data on general surgical training programmes of the top ten countries for the primary medical qualifications of IMGs in the UK were collected to provide comparison with the UK training programme.</p><p><strong>Results: </strong>The following countries were included: UK, India, Pakistan, Nigeria, Egypt, Ireland, Sudan, Sri Lanka, Romania, Iraq and South Africa. Training programme lengths ranged from 3 to 10 years. Only some training programmes provide additional training and qualification in sub-specialisation in general surgery. Other differences included a requirement for internship/non specialist training prior to training, differences in lengths of time spent in other surgical specialties and a requirement for research.</p><p><strong>Conclusion: </strong>Understanding the training programmes of other countries may help UK surgeons to understand the prior experience of IMGs and enable them to provide better training and support.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"511-524"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456669","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":"Trapeziectomy and ligament reconstruction tendon interposition: an in vivo, patient-controlled, biomechanical study relating to pinch grip.","authors":"H L Morley, M Argyropoulos, P Souroullas, Jaf Read","doi":"10.1308/rcsann.2024.0109","DOIUrl":"10.1308/rcsann.2024.0109","url":null,"abstract":"<p><strong>Introduction: </strong>Trapeziectomy and ligament reconstruction tendon interposition (LRTI) is a commonly used procedure in the management of first carpometacarpal osteoarthritis. Debate persists regarding the degree of biomechanical improvement following trapeziectomy and subsequently LRTI. This preliminary, single-centre, in vivo, biomechanical study addresses the biomechanical effect of LRTI following trapeziectomy at the time of surgery, with each participant acting as their own control.</p><p><strong>Methods: </strong>Trapeziectomy and LRTI were performed under wide-awake local anaesthetic with no tourniquet (WALANT) with a flexor carpi radialis (FCR) donor graft. Key pinch grip was assessed in each participant.</p><p><strong>Results: </strong>The surgical method that resulted in biomechanically the most significant decrease in grip strength compared with preoperative grip strength was trapeziectomy alone with a mean difference of 4.27kg, which was also statistically significant (Tukey's test <i>p</i><0.001). Mean post-WALANT key pinch grip strength was 6.4kg (sd 2.61); post LRTI the mean key pinch grip strength was 6.33kg (sd 2.63). Following the surgical procedure (trapeziectomy and LRTI) the mean key pinch grip strength was -0.1kg (95% confidence interval -0.93 to 0.81) (Tukey's test <i>p</i>=1), demonstrating no statistically significant difference between the two values. This indicates that LRTI restores pinch grip strength.</p><p><strong>Conclusions: </strong>Our preliminary research presents a novel method to evaluate for biomechanical advantages following trapeziectomy and LRTI. This supports the biomechanical advantages of FCR LRTI following trapeziectomy, at the time of surgery. There is scope for this research process to be applied more widely in future.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"479-484"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143770861","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":"Systematic review of surgical techniques for medial epicondylitis: evaluating the impact of preoperative injections and concomitant ulnar neuritis on postoperative outcomes.","authors":"A Barakat, G Jha, P Raval, E Abourisha, P Divall, H P Singh, R Pandey","doi":"10.1308/rcsann.2025.0005","DOIUrl":"10.1308/rcsann.2025.0005","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical intervention for medial epicondylitis (ME) is indicated when conservative management fails. This review evaluates different surgical techniques for management of ME in terms of patient-reported outcomes (PROs) and complication rates with a focus on the prognostic implications of preoperative injections and concomitant ulnar neuritis on postoperative outcomes.</p><p><strong>Methods: </strong>Major medical databases were searched for relevant ME studies published between 2000 and September 2023. Case reports, reviews, abstract-only studies and pre-2000 studies were excluded. Two independent reviewers assessed the databases. A best evidence synthesis using Methodological Index for Non-Randomised Studies (MINORS) criteria summarised findings because of study heterogeneity.</p><p><strong>Findings: </strong>Seventeen surgical studies (442 patients) met the inclusion criteria; most were retrospective (14 studies). MINORS scores ranged from 3 to 14, indicating variable methodological quality. Weighted means showed significant postoperative PRO improvements (<i>p</i> > 0.05). The overall complication rate was 3.1%, with percutaneous techniques showing 0% complications vs 6.4% for arthroscopic release and 11.1% for ulnar nerve transposition. Median time to surgery was 6 months of failed nonoperative treatment. Two studies found minimal impact of preoperative ulnar neuritis on outcomes. One of four studies assessing preoperative injections found a significant negative correlation with outcomes.</p><p><strong>Conclusions: </strong>This review highlights a scarcity of high-quality research on surgical ME management. Nevertheless, surgical treatment for recalcitrant cases shows promising outcomes with low complication rates, particularly for percutaneous techniques. The evidence suggests that neither preoperative injections nor pre-existing ulnar neuritis significantly affects postoperative outcomes in patients undergoing surgery for ME.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"457-468"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708245","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}