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

{"title":"The 'hashtag' K-wires configuration for the management of severe comminuted patellar fracture: the combination of tension band technique and cerclage wiring.","authors":"N E Koukoulias, A V Vasiliadis, S Savvidou, T Dimitriadis","doi":"10.1308/rcsann.2024.0044","DOIUrl":"10.1308/rcsann.2024.0044","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"526-527"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141854597","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":"Enhancing vascular surgery outcomes through geriatric co-management: a study on the impact of the POPS team.","authors":"Mea Bakheet, M Hughes, N Darwish, S Chen, A Egun, M Banihani","doi":"10.1308/rcsann.2024.0084","DOIUrl":"10.1308/rcsann.2024.0084","url":null,"abstract":"<p><strong>Introduction: </strong>Peripheral arterial disease (PAD) involves atherosclerotic stenosis and occlusion of lower leg arteries, leading to significant disability, high cardiovascular and cerebrovascular morbidity and mortality. Critical limb ischemia (CLI) is the most severe form of PAD. With the UK's aging population set to increase, the prevalence of PAD and the burden on vascular teams are expected to rise. This study evaluates the impact of regular input from the Proactive Care of Older People Undergoing Surgery (POPS) team on vascular surgery outcomes.</p><p><strong>Methods: </strong>This prospective cohort study examined the impact of Care of the Elderly (CoE) input on predefined parameters, focussing primarily on the length of stay (LoS) over 12 months. Data included baseline demographics, comorbidities, frailty scores (assessed using the Rockwood frailty score), LoS and referrals to medical specialties. A retrospective pilot study of 50 consecutive patients indicated a need for CoE input, showing higher local LoS compared with the national average.</p><p><strong>Results: </strong>Patients in both pilot and project groups were matched for comorbidities, frailty scores and interventions. Despite higher mean age and a greater proportion of patients aged 75+ years in the project group, the study aimed to reduce LoS. Post-quality improvement project implementation, LoS beyond fit-for-discharge decreased from 11.7 days to 9 days in 6 months and to 6 days after 12 months. Referrals to medical specialties decreased from 77% to 40%, and new diagnoses on discharge increased from 28% to 37%.</p><p><strong>Conclusions: </strong>CoE team input in vascular surgery patient care significantly improved outcomes, reducing LoS and medical specialty referrals, demonstrating cost-effectiveness and suggesting a feasible multidisciplinary approach for other regions.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"490-494"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613756","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 simple technique for checking nipple height in breast reduction and mastopexy.","authors":"Y R Chin, D Oliver","doi":"10.1308/rcsann.2024.0042","DOIUrl":"10.1308/rcsann.2024.0042","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"525-526"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141854589","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":"Medium-term restenosis after carotid endarterectomy by patch type: a single-centre retrospective study comparing biological with synthetic patch materials.","authors":"M Power Foley, N Doolan, T Connelly, M P McMonagle","doi":"10.1308/rcsann.2024.0097","DOIUrl":"10.1308/rcsann.2024.0097","url":null,"abstract":"<p><strong>Introduction: </strong>Carotid endarterectomy (CEA) with patch angioplasty is associated with lower restenosis rates compared with primary closure alone. However, evidence regarding patch-material superiority in the mitigation against neointimal hyperplasia and restenosis is limited. This retrospective observational study investigated medium-term restenosis rates between commercially available biological and synthetic carotid patches.</p><p><strong>Methods: </strong>All primary CEA with patch angioplasty performed between 2007 and 2019 at a single university hospital were identified from theatre records. Restenosis was defined using the European Society for Vascular Surgery duplex criteria, either moderate (50-69%, PSV >213cm/s) or critical (70-99%, PSV >274cm/s). Chi-square tests and Kaplan-Meier curves were used to compare restenosis rates between biological (bovine pericardium) and synthetic patches (Dacron, PFTE and polyester-urethane).</p><p><strong>Results: </strong>Overall, 127 CEAs were included in the restenosis analysis. Bovine pericardium was the patch material used most frequently (60%, <i>n</i>=75). Median follow-up with duplex was 40.0 months (range 0-144). Moderate restenosis was detected in 14 CEAs (11%) and critical restenosis in 10 (7.8%). Compared with synthetic material, bovine was significantly associated with >50% restenosis but not >70% (<i>p</i>=0.042 and <i>p</i>=0.197, respectively). However, Kaplan-Meier curves demonstrated similar rates of >50% and >70% restenosis between patch types at five years (<i>p</i>=0.081 and <i>p</i>=0.080, respectively). There was no significant difference in peri-operative complication rates between patch types.</p><p><strong>Conclusions: </strong>These results indicate medium-term restenosis rates after CEA are similar between biological and synthetic patches. However, well-designed randomised control trials are required to definitively answer the question of which patch material is superior for carotid reconstruction.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"495-502"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143770840","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":"Intra-abdominal rhabdomyosarcoma in a paediatric patient presenting as acute appendicitis.","authors":"M C Moolamannil, H Khan, S Karim","doi":"10.1308/rcsann.2024.0065","DOIUrl":"10.1308/rcsann.2024.0065","url":null,"abstract":"<p><p>Rhabdomyosarcoma (RMS) is a form of soft tissue sarcoma that can arise from muscle or fibrous tissue almost anywhere in the body. The two major subtypes of RMS are alveolar and embryonal, whereas the two rarer subtypes are pleomorphic, which typically occurs in adults, and the spindle cell/sclerosing variant, typically seen in children. RMS usually involves the extremities, the head and neck or the genitourinary system. Although it can arise from anywhere in the body, other sites of involvement are rare and usually present only at an advanced stage owing to a mass effect on surrounding tissues and organs. We present a rare case of a child who presented with the signs and symptoms of an acute abdomen, but intraoperatively was found to have a bleeding necrotic mass arising from the anterior abdominal wall. This was histologically confirmed to be a RMS of the embryonal type.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"531-532"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141854590","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":"Nineteen-year forgotten ureteral stent removed under local anaesthetic from a transplanted kidney.","authors":"S S Gosein, J A Forster, J F Bolton","doi":"10.1308/rcsann.2024.0066","DOIUrl":"10.1308/rcsann.2024.0066","url":null,"abstract":"<p><p>Following renal transplant, ureteral stents aim to minimise ureteroneocystostomy anastomotic complications. Although there is no specified timing for stent removal after transplantation, these are ideally removed at between 2 and 4 weeks. However, forgotten stents can adversely affect renal allograft function and contribute to obstructive uropathy. We present a 59-year-old man with a retained ureteral stent for more than 19 years with an absence of encrustations, fragmentation, migration and stone formation. To our knowledge, this is the longest retained ureteral stent in a renal transplant patient and the first forgotten stent removed via flexible cystoscopy under local anaesthetic.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"528-530"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307004","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":"Operative experience in paediatric orthopaedics in UK trainees achieving a Certificate of Completion of Training in trauma and orthopaedic surgery: A descriptive analysis of national eLogbook data.","authors":"T Barrow, B D Chatterton, S N Maripuri, T Crompton, N Kiely, K James","doi":"10.1308/rcsann.2025.0057","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0057","url":null,"abstract":"<p><strong>Introduction: </strong>The Trauma and Orthopaedic curriculum set by the Joint Committee on Surgical Training (JCST) requires that consultant orthopaedic surgeons must have sufficient experience managing children's orthopaedic conditions. In this study, our objective was to describe the paediatric operative exposure of United Kingdom (UK)-trained orthopaedic registrars who obtain a Certificate of Completion of Training (CCT).</p><p><strong>Methods: </strong>This was a national retrospective cohort study of UK trainees obtaining a CCT between 1 January 2018 and 1 January 2024. ELogbook data for 884 trainees were obtained from the JCST, with 1,994,235 recorded operations. Descriptive analysis was performed on the operative data.</p><p><strong>Results: </strong>Our results demonstrated that the median number of cases per trainee throughout training decreased each year across both adult and paediatric experience. The proportion of paediatric cases (age <17 years) within the trainees' logbooks remained constant at 11%. Trainees recorded a higher number of cases of paediatric trauma than elective cases, particularly surgery for forearm, wrist and supracondylar fractures. Trainees infrequently performed surgery for lower limb trauma, emergencies such as musculoskeletal infection and paediatric elective procedures.</p><p><strong>Conclusions: </strong>Paediatric orthopaedics is an integral part of orthopaedic training. Our results suggest that paediatric orthopaedic experience at CCT may not satisfy the requirements of the JCST curriculum. Future curriculum adjustments and additional training methods may be required to ensure trainees obtain the necessary experience to meet both the JCST standards and the demands of paediatric trauma care.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940167","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 brush with danger: operative management of a through and through urethral and rectal injury following paintbrush insertion into the urethra.","authors":"R Karanjia, D Whiting, M Qureshi, H Dowson, A Chetwood","doi":"10.1308/rcsann.2025.0033","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0033","url":null,"abstract":"<p><p>Iatrogenic injury from urethral foreign body insertion is rare but a recognised urological emergency. We present a case of a 61-year-old man who presented to the emergency department having inserted a 15cm-long paintbrush into his urethra, resulting in two 'exit' wounds in his urethra with an associated rectal injury. The patient was taken to theatre and a primary perineal repair of the two 'exit' defects in his urethra was performed over a urethral catheter and covering suprapubic catheter. His rectal injury was also repaired with a covering laparoscopic defunctioning colostomy performed. The patient recovered fully, without any residual urinary symptoms. To our knowledge, there are no reported cases of concomitant urethral and rectal injury following urethral foreign body insertion.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940147","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 temporary measure for ureteral stenting.","authors":"R Doodnath, B Rampersad","doi":"10.1308/rcsann.2025.0047","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0047","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854327","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":"Utility and outcomes of routine jejunostomy placement following oesophagectomy.","authors":"H Tw Chon, A Botros, I El-Zayat, S J Mercer, J Straatman, G van Boxel, P H Pucher","doi":"10.1308/rcsann.2025.0045","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0045","url":null,"abstract":"<p><strong>Introduction: </strong>Feeding jejunostomy (FJ) is used widely as a nutritional adjunct in oesophagectomy. However, FJ placement is also associated with additional morbidity. While FJ may be invaluable in some patients, particularly in those who suffer postoperative complications, it may be an avoidable source of distress and morbidity in others. This study aimed to assess the utility and outcomes of FJ in patients with uncomplicated recovery after oesophagectomy.</p><p><strong>Methods: </strong>Outcomes for 100 consecutive patients who underwent oesophagectomy with uncomplicated recovery (Clavien-Dindo ≤2) were included from a prospectively maintained database. All had routine FJ placement. Demographic, disease, operative and clinical outcomes were analysed. Necessity of FJ usage (as assessed by specialist dietician) and complications were recorded. Differences between patients requiring postdischarge FJ use, and those who did not, were assessed.</p><p><strong>Results: </strong>Complete data for a total of 97 patients were included. Overall, only 9/97(9.3%) patients required ongoing FJ usage on discharge. No significant differences in demographics between two groups were observed. Postoperative complications were seen in 42/97(43.3%) patients, most commonly respiratory complications. FJ-related complications were recorded in 18/97(18.5%) patients, most commonly jejunostomy tube displacement.</p><p><strong>Conclusions: </strong>The low rate of postoperative FJ usage and relatively high risk of associated complications suggests that a selective FJ placement strategy may have positive implications for patients over a routine placement strategy. No significant predictive factors for requiring postoperative FJ use were identified; work to define optimal feeding adjunct strategies in the postoperative context is needed.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854328","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}