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

{"title":"Critical values for body mass index related to morbidity in high-volume low-complexity general surgery: a systematic review and meta-analysis.","authors":"S Hajibandeh, S Hajibandeh, K Harries, W G Lewis, R J Egan","doi":"10.1308/rcsann.2024.0057","DOIUrl":"10.1308/rcsann.2024.0057","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to investigate the effect of body mass index (BMI, kg/m²) on outcomes of high-volume low-complexity (HVLC) general surgery procedures and to determine critical values for BMI when selecting patients into HVLC programmes.</p><p><strong>Methods: </strong>A systematic review was conducted of studies looking at patients in different BMI categories undergoing HVLC general surgery procedures (laparoscopic cholecystectomy, inguinal hernia repair and umbilical or paraumbilical hernia repair), in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. A comparison meta-analysis model was constructed to compare the outcomes using random-effects modelling. The QUIPS (Quality In Prognosis Studies) tool and GRADE (Grading of Recommendations Assessment, Development and Evaluation) system were used to assess bias.</p><p><strong>Results: </strong>A total of 26 studies including 486,392 patients were examined. In laparoscopic cholecystectomy, BMI ≥40 was associated with higher conversion to open surgery (odds ratio [OR]: 1.33, <i>p</i>=0.040) but did not affect complications (OR: 0.69, <i>p</i>=0.400) or length of hospital stay (mean difference [MD]: -0.01 days, <i>p</i>=0.900). In inguinal hernia repair, BMI ≥35 was associated with longer operative time (MD: 18.00 minutes, <i>p</i><0.00001), and higher risk of wound complications (OR: 3.01, <i>p</i><0.00001) and hospital readmission (OR: 1.46, <i>p</i>=0.0008). In umbilical or paraumbilical hernia repair, BMI ≥30 was associated with higher risk of wound complications (OR: 6.45, <i>p</i><0.0001) and hospital readmission (OR: 5.56, <i>p</i><0.00001), and longer operative time (MD: 4.01 minutes, <i>p</i>=0.030).</p><p><strong>Conclusions: </strong>Obesity was associated with longer operative time (up to 23 minutes) and higher risk of postoperative morbidity (up to 4-fold) in HVLC procedures. BMI <40 (moderate GRADE certainty - laparoscopic cholecystectomy) and BMI <35 (moderate GRADE certainty - inguinal hernia) appear to represent optimal critical values for perioperative safety metrics.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"242-252"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141974947","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":"Reverse boot technique for applying traction in below knee amputees.","authors":"R McAllister, M Franklin, N Hyder","doi":"10.1308/rcsann.2024.0046","DOIUrl":"10.1308/rcsann.2024.0046","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"309"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141316627","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 diagnosis of syphilis following a radical circumcision for suspected penile cancer.","authors":"K H Pang, A Haider, A Freeman, P Hadway, C Bunker, A Muneer, H M Alnajjar","doi":"10.1308/rcsann.2022.0143","DOIUrl":"10.1308/rcsann.2022.0143","url":null,"abstract":"<p><p>We present a case of a 70-year-old gentleman who was referred to our tertiary 2-week-wait penile cancer clinic with a penile mass that was ulcerated, painful and discharging. This was suspicious for penile cancer and a radical circumcision was performed to remove the diseased foreskin en bloc with the lesion that was arising from the inner foreskin. Histopathology did not reveal cancer; however, we identified spirochaetes in keeping with syphilis. This was confirmed on serology. The patient was referred to the genitourinary medicine team and treated with antibiotics. This case demonstrates a rare presentation of genital syphilis in an elderly gentleman initially referred with concerns of penile cancer. Although, rare, especially in this age group, syphilis should be considered as a differential diagnosis in a patient presenting with an ulcerated, discharging, firm penile mass, especially given that the incidence of syphilis has been rising in recent years.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"310-312"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140334520","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":"Technique for traversing both plate and nail-locking screw holes in nail-plate composite fixation.","authors":"C Uzoigwe, T Symes","doi":"10.1308/rcsann.2022.0064","DOIUrl":"10.1308/rcsann.2022.0064","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"307-308"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140118567","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":"Frailty and body composition predict adverse outcomes after emergency general surgery admission: a multicentre observational cohort study.","authors":"P May-Miller, Map Ligthart, A R Darbyshire, S Rahman, P H Pucher, N J Curtis, M A West","doi":"10.1308/rcsann.2024.0091","DOIUrl":"10.1308/rcsann.2024.0091","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency surgical admissions represent the most unwell patients admitted to any hospital. Frailty and body composition independently identify risk of adverse outcomes but are seldom combined to predict outcomes in emergency patients. We aim to determine the relationships between frailty, body composition analyses (BCA) and mortality in an undifferentiated emergency general surgical patient population.</p><p><strong>Method: </strong>A prospective, multicentre observational cohort study of patients admitted with emergency surgical pathology was conducted in eight hospitals. BCA were performed at L3 vertebrae using computed tomography images to quantify sarcopenia and myosteatosis. Sex-specific BCA cut-off values were determined by our previous study. Reported Edmonton Frail Scale (REFS) values ≥8 identified frailty. The primary outcomes were all-cause 30-day and 1-year mortality. Multivariable logistic regression was utilised to explore predictive relationships between frailty, BCA, mortality and independent discharge.</p><p><strong>Results: </strong>A total of 194 patients were included; 24% were frail, 25% were sarcopenic and 23% myosteatotic. Some 61% of patients underwent an emergency laparotomy. Frail patients were more likely to be sarcopenic (20.4% vs 40.4%; <i>p</i> = 0.011) and myosteatotic (27.2% vs 51.1%; <i>p</i> = 0.004). Thirty-day and 1-year mortality was 5.2% and 15.5%, respectively; 30-day mortality was two times higher in the frail group (4.1% vs 8.5%; <i>p</i> = 0.414), and three times higher at 1 year (10.2% vs 31.9%; <i>p</i> = 0.001). Age (odds ratio [OR] 1.06; <i>p</i> = 0.001), sarcopenia (OR 2.88; <i>p</i> = 0.047) and frailty (OR 4.13; <i>p</i> = 0.001) were associated with 1-year mortality. Only 55.3% of frail patients were discharged home independently compared with 88.4% non-frail patients (<i>p</i> < 0.001). One-year mortality was greater in those with frailty and/or BCA abnormalities than in those without (28.8% vs 9.6%; <i>p</i> = 0.003).</p><p><strong>Conclusion: </strong>Frailty, sarcopenia and myosteatosis contribute significantly to adverse outcomes.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"285-294"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680674","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 practices in surgical disciplines.","authors":"V Sahni","doi":"10.1308/rcsann.2025.0003","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0003","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708247","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":"Retroperitoneal haemangioma masquerading as recurrence of well-differentiated neuroendocrine tumour: a cautionary note.","authors":"A M AbdelDayem, S Navalkissoor, T V Luong, M Caplin, R Mirnezami","doi":"10.1308/rcsann.2025.0009","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0009","url":null,"abstract":"<p><p>Gallium 68-DOTATATE positron emission tomography scanning is the cornerstone of nuclear medicine imaging for neuroendocrine tumours. Previous reports have demonstrated the potential for vertebral haemangiomata to mimic neuroendocrine skeletal metastases. We present the case of a 42-year-old man with a history of well-differentiated neuroendocrine tumour of the appendix, identified incidentally following emergency appendicectomy. Postoperative ⁶⁸Ga-DOTATATE positron emission tomography/computed tomography scanning revealed an intensely gallium-avid retroperitoneal lesion adjacent to the right psoas muscle. Surgical excision of this lesion was recommended following multidisciplinary team discussion. Histological evaluation of the resected lesion revealed an intravascular capillary haemangioma. Haemangiomas can mimic residual or recurrent neuroendocrine tumour based on gallium avidity, and this should be considered in atypical cases.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708244","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":"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":"https://doi.org/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":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent ascending cholangitis secondary to food reflux following transduodenal resection of an ampullary adenoma.","authors":"M Fouad, M W James, A M Zaitoun, M Hanks, D N Lobo","doi":"10.1308/rcsann.2024.0110","DOIUrl":"10.1308/rcsann.2024.0110","url":null,"abstract":"<p><p>Ampullary lesions, including adenomas and early-stage carcinomas, pose a diagnostic and therapeutic challenge because of their location and proximity to the pancreatic and bile ducts. Transduodenal ampullectomy offers a targeted approach for the resection of these lesions while preserving the integrity of the pancreaticobiliary system. Moreover, transduodenal ampullectomy is associated with favourable postoperative outcomes, including low rates of morbidity and mortality, as well as preservation of pancreatic and biliary function. However, potential complications such as ascending cholangitis pancreatic leakage, bleeding and duodenal stenosis can occur, which would impact the postoperative quality of life. Addressing these outcomes might require either endoscopic procedures or surgical interventions. We present an exceedingly uncommon case of recurrent ascending cholangitis resulting from reflux of food particles into the common bile duct that was treated successfully with a Roux-en-Y hepaticojejunostomy and gastroenterostomy.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708192","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":"Investigating the fluid and electrolyte prescribing knowledge of Foundation Year doctors.","authors":"D Johnson, J Houdmont, N Levy, D N Lobo","doi":"10.1308/rcsann.2025.0004","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0004","url":null,"abstract":"<p><strong>Introduction: </strong>Changes to the medical curriculum have been advocated to improve knowledge on fluid and electrolytes. We aimed to determine the contemporary level of knowledge of trainee doctors on different aspects of fluid and electrolyte prescribing.</p><p><strong>Methods: </strong>An online survey was distributed to Foundation Year doctors working throughout the United Kingdom. The first part determined demographic information, where participants studied and currently work, and probed their perceptions of their knowledge on fluid and electrolytes. The second part tested knowledge on a wide variety of aspects of fluid and electrolyte management using 20 multiple-choice questions.</p><p><strong>Results: </strong>In total, 190 responses were received. Trainee doctors remain responsible for much of the fluid and electrolyte management of patients, and often practise independently. Overall, the average 'score' of each respondent was suboptimal (52%), with no significant difference found between doctors in the first or second year of postgraduate medical practice. Many participants were unable to correctly identify the components of common intravenous fluid products. Understanding of daily electrolyte requirements was also demonstrated poorly, although most showed a good understanding of the daily requirements of water and glucose. The amount of time in medical school allocated to the topic remains low, as do doctors' confidences in their abilities to prescribe fluid and electrolytes.</p><p><strong>Conclusions: </strong>Knowledge surrounding fluid and electrolyte prescribing remains suboptimal, and Foundation Year doctors are frequently undertaking this responsibility independently. These findings reflect previous research performed over the past 20 years, and little improvement appears to have been made.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708160","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}