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

{"title":"Not all small bowel pneumatosis is ischaemia: a case-based systematic review of non-ischaemic causes.","authors":"S Olusola, M Choudhry, V Panem, J Wilson, S Rana, C Parmar, M Kathirvel","doi":"10.1308/rcsann.2026.0011","DOIUrl":"10.1308/rcsann.2026.0011","url":null,"abstract":"<p><strong>Background: </strong>Pneumatosis intestinalis (PI) involving the small bowel is often interpreted as a radiological surrogate for ischaemia, prompting urgent surgical intervention. However, non-ischaemic causes-particularly in the postoperative setting-are under-recognised. This case-based systematic review aims to explore and synthesise reported non-ischaemic aetiologies of small bowel PI.</p><p><strong>Methods: </strong>We present the case of a 74-year-old man who developed small bowel PI following ileostomy reversal, with computed tomography findings initially suggestive of bowel ischaemia. In the absence of clinical or biochemical evidence of sepsis, he was managed conservatively and made a full recovery. A systematic review was conducted using PRISMA methodology across PubMed, Embase and Medline databases. Inclusion criteria focused on reports of small bowel PI in the English language. Data were extracted on clinical context, diagnostic modality, treatment and outcomes.</p><p><strong>Results: </strong>A total of 24 articles were included, comprising one retrospective cohort and 23 case reports, yielding 37 patients. The most frequent aetiology was small bowel obstruction (59.4%). Rarer causes included a rapidly progressive scleroderma-like disease, congenital lymphangioma and mechanical ventilation. Although 72.9% underwent surgical intervention, 27% were successfully managed conservatively. Only 10.8% had a suspected ischaemic component, and six patients died. Radiological overlap with ischaemic PI was common, yet several patients improved without surgery and only two (5.4%) had confirmed transmural small bowel necrosis.</p><p><strong>Conclusions: </strong>Not all small bowel pneumatosis indicates ischaemia. Conservative management can be effective in carefully selected patients, guided by clinical status and serial imaging. Early recognition of non-ischaemic PI is crucial to avoid unnecessary laparotomy.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"500-509"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147353553","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":"Partial nephrectomy for solid renal masses in polycystic kidneys: open surgical technique.","authors":"C O'Connell, M R Clarkson, F O'Brien, P Russo","doi":"10.1308/rcsann.2025.0052","DOIUrl":"10.1308/rcsann.2025.0052","url":null,"abstract":"<p><p>Partial nephrectomy for small renal masses is well established as the preferred means of surgical treatment for kidney cancer, to preserve renal function. Although minimally invasive techniques are now standard in many countries, open surgery remains an important technique for difficult cases. Partial nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPKD) is challenging and not widely reported. We describe the open surgical technique for partial nephrectomy in patients with multicystic kidneys who are not on renal replacement therapy (RRT). We illustrate the technique using three cases of patients with multicystic kidneys and solid renal masses. All had early chronic kidney disease, making partial nephrectomy for suspected kidney cancer the preferred strategy. The patients had stable creatinine and were recurrence-free at last follow-up. Open partial nephrectomy remains an important surgical technique for resection of challenging kidney tumours, such as those in multicystic kidneys. Patients with ADPKD and solid renal masses who are not on RRT should be managed in the same manner as the background population, with nephron-sparing surgery wherever possible.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"570-573"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145197996","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":"Outcomes for congenitally corrected transposition of great arteries using various surgical techniques: a systematic review and network meta-analysis.","authors":"S U Hasan, Sur Usmani, S H Ahmed, A Pervez, M A Kamalia, A D Shah, M M Zubair","doi":"10.1308/rcsann.2026.0019","DOIUrl":"10.1308/rcsann.2026.0019","url":null,"abstract":"<p><strong>Introduction: </strong>Congenitally corrected transposition of the great arteries (ccTGA) is a rare disorder. Here, we evaluated the effectiveness of physiological, anatomical and Fontan repair techniques for ccTGA.</p><p><strong>Methods: </strong>A systematic database search in PubMed, Embase and Cochrane Central Register of Controlled Trials was conducted from inception to 5 June 2023. Random-effects network meta-analysis was performed, comparing mortality, postoperative arrhythmias, reintervention after definitive surgery and transplant-free survival in patients undergoing physiological, anatomical and Fontan repair.</p><p><strong>Findings: </strong>A total of 1,209 patients were included from nine studies. Fontan repair was associated with a higher rate of transplant-free survival (absolute risk [AR] 0.999 (±0.0101), 95% confidence interval [CI]) and reintervention after definitive surgery (AR 0.098 (±0.067), 95% CI), whereas the difference for mortality and postoperative arrhythmias did not reach statistical significance.</p><p><strong>Conclusions: </strong>Fontan repair is significantly better than anatomical or physiological repair in terms of transplant-free survival and also had a better rank probability for overall survival and reintervention after definitive surgery.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"510-517"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147353543","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":"Undergraduate medical student exposure to OMFS, a future workforce concern-a narrative review of the literature.","authors":"I Perwaiz, A Mackenzie, U Rehman, M S Sarwar, P A Brennan","doi":"10.1308/rcsann.2025.0038","DOIUrl":"10.1308/rcsann.2025.0038","url":null,"abstract":"<p><strong>Introduction: </strong>Oral and maxillofacial surgery (OMFS) is a surgical specialty dealing with a broad spectrum of pathology affecting the head and neck. Despite a rising burden of head and neck conditions, exposure to OMFS in the undergraduate medical curriculum remains limited. This has consequences for medical undergraduates' competence and confidence in managing related conditions and their recruitment into this specialty.</p><p><strong>Methods: </strong>A literature search was conducted in September 2024 on Pubmed, Dynamed, DARE, EMBASE, Cochrane and BMJ electronic databases for articles published between 1970 and 2024. The review was registered with PROSPERO (CRD42024556491).</p><p><strong>Results: </strong>Ten studies involving 2,499 participants were included. Only 33.1% of students had experience in OMFS, with variations in exposure type ranging from formal teaching sessions to clinical placements. Most exposures were brief, typically less than a week, and often did not extend beyond basic lectures or shadowing. A notable proportion of students expressed a desire for more comprehensive training in OMFS. Only 12.8-37% of participants were considering a career in OMFS. Low interest rates were attributed to dual qualification requirements, cost and duration of training.</p><p><strong>Conclusions: </strong>The findings highlight a major gap in OMFS education delivered by medical schools. This is concerning given that OMFS in the UK is struggling to fill higher surgical training posts. If interest in the profession remains low, we may encounter a recruitment and workforce crisis. Future strategies must focus on meaningful opportunities to increase OMFS experience in the medical curriculum while addressing other barriers to recruitment and retention.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"545-554"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145306738","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":"The impact and utilisation of patient-initiated follow-ups (PIFU) in the elective upper-limb clinic at secondary care.","authors":"R Naskar, V Garg, E Middleton, R Moverley","doi":"10.1308/rcsann.2025.0073","DOIUrl":"10.1308/rcsann.2025.0073","url":null,"abstract":"<p><strong>Background: </strong>Musculoskeletal (MSK) conditions affect over 20 million people in the UK. Follow-up appointments account for nearly two-thirds of all outpatient activity. Patient-initiated follow-up (PIFU) allows patients to request follow-up appointments based on clinical need, aiming to reduce unnecessary reviews and optimise service use. This study evaluated the impact and utilisation of PIFU in a secondary care Elective Upper Limb (Shoulder and Elbow) Clinic, focusing on patient engagement, re-presentation rates, and suitability across common upper limb conditions.</p><p><strong>Methods: </strong>A retrospective service evaluation was conducted over 18 months. Patients discharged under the PIFU pathway were included if they had at least six months' follow-up opportunity. Data collected included diagnosis, treatments received, re-presentation rates and outcomes. Descriptive analysis was used to assess patterns and clinical implications.</p><p><strong>Results: </strong>Out of 353 consultations, 81 patients (23%) were discharged to PIFU. Among these, 62% were first-time referrals discharged at their initial appointment. Conditions most suitable were rotator cuff-related pain (33%), early glenohumeral arthritis (19%) and adhesive capsulitis (10%). Within six months, only 18% of PIFU patients re-accessed care - just 4.2% of the total cohort. One-third of returning patients required surgery, while the remainder were managed nonoperatively and re-entered the PIFU pathway. PIFU freed approximately 20% of follow-up slots.</p><p><strong>Conclusions: </strong>PIFU is a safe and effective follow-up model for stable or early-stage shoulder and elbow conditions, reducing outpatient burden, supporting patient autonomy and preserving clinic capacity without compromising care quality. Broader implementation, supported by patient education and structured feedback, may enhance sustainable delivery of orthopaedic services.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"540-544"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336254","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":"Ischial tuberosity avulsion fractures: limited evidence supporting displacement cut-offs for surgery.","authors":"H D Veldman, R M Jeuken, Tag van Vugt, L Verlaan","doi":"10.1308/rcsann.2025.0098","DOIUrl":"10.1308/rcsann.2025.0098","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"575-576"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145601678","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":"Intraoperative parathyroid hormone assay benefits surgery for primary hyperparathyroidism when preoperative localisation is negative or not performed.","authors":"D Scott-Coombes, M Stechman, N Patel, R Egan","doi":"10.1308/rcsann.2024.0051","DOIUrl":"10.1308/rcsann.2024.0051","url":null,"abstract":"<p><strong>Introduction: </strong>Parathyroid localisation is now routine before first-time surgery for patients with primary hyperparathyroidism (PHPT). The aim of this study was to investigate the contribution of intraoperative parathyroid hormone (PTH) (ioPTH) in patients in whom localisation was either not undertaken or negative for a tumour.</p><p><strong>Methods: </strong>This was a retrospective study of patients undergoing first-time parathyroidectomy for PHPT in a regional endocrine centre. Data were collected prospectively (Microsoft Excel) and the all-Wales electronic patient record portal was used to retrieve missing data. Statistical analysis appropriate for nonparametric data was undertaken, with statistical significance reached when <i>p</i><0.05.</p><p><strong>Results: </strong>Between 1 July 2002 and 31 December 2022, 1,490 patients underwent a first-time parathyroidectomy for PHPT. Of this cohort, 1,133 patients had at least one positive imaging modality; the study group consisted of 343 patients that had negative imaging, and 13 that had no preoperative localisation. Patients with MEN-1 (<i>n</i>=26), an incorrect diagnosis (<i>n</i>=4), or less than six months follow-up (<i>n</i>=6) were excluded. Of the remaining 321, 106 patients underwent surgery without ioPTH (Group A), 215 cases with ioPTH (Group B). In Group B there were more women (170 female/45 male; 79% vs 67 female/37 male; 63% <i>p</i>=0.002, chi-squared), lower calcium (median [range] 2.77 [2.63-3.24] mmol/l; vs 2.85 [2.60-4.52] <i>p</i>=0.001) and lower PTH (12.0pmol/l [3.4-39.5] vs 14.4 [3.9-97.0] <i>p</i>=0.001) and smaller weights of resected tissue (320mg [50-9,000] vs 454 [46-8,280] <i>p</i>=0.02) (Student's <i>t</i>-test). The rate of multiple gland disease was similar (Group A 29%; Group B 27%). The rate of normocalcaemia at 6 months was significantly higher when ioPTH was used (Group B 202/215; 94% vs Group A 90/106; 85%) (<i>p</i>=0.014, chi-square test). The sensitivity and specificity of ioPTH was 98.5% [confidence interval (CI) 96.2-99.6] and 91.2% [80.7-97.0] (positive predictive value 99.9%, CI 93.6-100.0).</p><p><strong>Conclusion: </strong>Despite milder hyperparathyroidism and smaller tumour weight, the outcome in patients in whom ioPTH was used was superior, with failure rates 2.5-fold higher in the cohort where ioPTH was not utilised. The results of this study demonstrate that ioPTH is a valuable adjunct for the surgeon in cases where localisation has failed or not been undertaken.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"577-581"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339952","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":"It begins with the right questions.","authors":"K Mahawar","doi":"10.1308/rcsann.2026.0091","DOIUrl":"10.1308/rcsann.2026.0091","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":"108 7","pages":"499"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148862822","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":"Comparison of laparoscopic and robotic right hemicolectomy: insights from a single centre.","authors":"M A Yusufi, U Mateen, M Uneeb, M Gupta, N Muhibullah, N N Siddiqi","doi":"10.1308/rcsann.2025.0084","DOIUrl":"10.1308/rcsann.2025.0084","url":null,"abstract":"<p><strong>Introduction: </strong>Right hemicolectomy has evolved from open to minimally invasive approaches. Laparoscopic right hemicolectomy (LRH) is widely adopted, yet challenges persist, particularly in complex dissections. Robotic right hemicolectomy (RRH) offers enhanced precision and ergonomics but remains under scrutiny for its comparative advantages. This study critically evaluates the perioperative outcomes of LRH vs RRH within a single-centre framework.</p><p><strong>Methods: </strong>A retrospective cohort analysis was carried out at a single tertiary institution, reviewing all RRH cases from January 2021 to December 2024 and comparing them with the most recent LRH cases. Inclusion criteria encompassed adults undergoing elective right hemicolectomy for confirmed malignancy; patients with recurrent disease or emergency indications were excluded. Demographics, tumour characteristics, operative details and short-term outcomes were compared using appropriate statistical tests.</p><p><strong>Results: </strong>The baseline demographics were comparable between the groups. Transverse colon tumours were more frequent in the RRH group (<i>n</i> = 15, 37.5%) than in the LRH group (<i>n</i> = 2, 5%) (<i>p</i> = 0.003). The mean operative time was comparable in both groups (219.9mi in RRH vs 206.8min in LRH; <i>p</i> = 0.277). RRH demonstrated significantly reduced blood loss (24 vs 50.1 m; <i>p</i> < 0.001), earlier return of bowel function (1.9 vs 2.6 days; <i>p</i> = 0.004), and a reduced hospital stay (3.5 vs 6.1 days; <i>p</i> = 0.001). Lymph node yield was comparable.</p><p><strong>Conclusion: </strong>RRH offers measurable benefits in recovery and haemostasis as compared with LRH. It offers equivalent short-term oncological outcomes without prolonging the operative time. Our findings suggest RRH may be preferable for anatomically complex cases. Larger, prospective studies with a long-term follow-up period are therefore indicated.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"524-530"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145487591","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":"Bone-conduction hearing implants: a potential postcode lottery.","authors":"S Akbar, T Davies, N R Walker, G Thompson, R Fameesh, A Pahade, R Aggarwal, S Agarwal, A Muddaiah, I Anderco, E Heward","doi":"10.1308/rcsann.2025.0074","DOIUrl":"10.1308/rcsann.2025.0074","url":null,"abstract":"<p><strong>Background: </strong>Bone conduction hearing implants (BCHIs) are a valuable alternative option for patients with hearing loss when conventional hearing aids are not effective or a viable option. In the UK, specialist sites offer BCHI services. We aimed to understand whether patients face geographical barriers to accessing this healthcare service.</p><p><strong>Methods: </strong>A retrospective cohort study was performed at five hospitals in the North West of England over a one-year period (January-December 2023).</p><p><strong>Results: </strong>In total, 167 primary BCHIs were implanted (median age, 57.7 years; female, <i>n</i>=52 (31.1%)). Patients travelled a median distance of 17.3km from their home to the BCHI site. Of the patients receiving a BCHI, 108 (64.7%) lived in the locality of a BCHI site. The remaining 59 (35.3%) were referred from a non-BCHI centre. The majority of BCHIs were percutaneous (<i>n</i>=154/167, 92.2%) and were performed under local anaesthetic (<i>n</i>=127/167, 76.0%). No correlation between patient age and distance travelled was identified (<i>p</i>=0.22, <i>R</i>=-0.0951).</p><p><strong>Conclusions: </strong>The findings suggest a greater percentage of all BCHIs that are conducted are seen first at a BCHI centre initially rather than seen elsewhere. This could represent a potential geographical barrier to accessing BCHI services for patients not living in the locality of a non-BCHI providing centre. Future work is required to better understand BCHI service barriers on a national level and to identify methods to ensure equitable access for all.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"536-539"},"PeriodicalIF":2.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145430281","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}