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

{"title":"Injection sclerotherapy for haemorrhoids using an injection needle via an endoscope.","authors":"P Batra, A Sharma, A Sharma","doi":"10.1308/rcsann.2026.0033","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0033","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757132","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":"Potential underutilisation of weight loss medications in obese patients with knee osteoarthritis.","authors":"N Badhe, C Busby, T Kurien, B A Marson","doi":"10.1308/rcsann.2026.0063","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0063","url":null,"abstract":"<p><strong>Introduction: </strong>Obesity is a major risk factor for knee osteoarthritis (OA), contributing to earlier symptomatic onset, increased pain severity and greater lifetime disability. Despite guidance that weight alone should not limit access to total knee arthroplasty (TKA), body mass index (BMI) thresholds are applied widely in clinical practice. This study investigated the glucagon-like peptide-1 (GLP-1) receptor agonist (RA) use among obese OA patients awaiting TKA and evaluated the influence of BMI on access to TKA.</p><p><strong>Methods: </strong>A 30% random sample of a single-centre TKA waiting list (<i>n</i> = 300) in August 2025 was analysed. Data extracted included age, sex, BMI, time on waiting list, surgical listing status, comorbidities and use of weight loss interventions. Patients were stratified by BMI category (<35, 35-40, >40) and sex.</p><p><strong>Results: </strong>Median BMI was 33.0 [27.9-38.0], with 120 patients (40%) classified as obese (BMI ≥35). Among obese patients, 45% were initially denied or conditionally listed for surgery, rising to 74.1% for BMI >40. Only 13 obese patients (10.8%) were taking GLP-1 RAs, despite extensive eligibility. Female patients had a higher average BMI (<i>p</i> = 0.049) and faced higher denial rates than male patients (52% vs 28%, <i>p</i> = 0.013). Most obese patients (<i>n</i> = 102) had ≥3 comorbidities, often including diabetes (<i>n</i> = 22) and obstructive sleep apnoea (<i>n</i> = 26).</p><p><strong>Conclusion: </strong>Current pathways for managing obese patients with knee OA are inadequate. GLP-1 RAs may offer a promising solution to help reduce barriers to surgery. Further research is needed to determine whether GLP-1 RAs could help reduce the progression of OA and need for TKA.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676540","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 simple, rapid technique for preparing and applying a Zimmer finger splint.","authors":"J Roberts, L Boyce, R Manton","doi":"10.1308/rcsann.2026.0083","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0083","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676523","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 service evaluation of surgical interventions for external rectal prolapse in Wales.","authors":"E Farrow, L Silva, L Evans, O Sogaolu, M Nalmpanti, A Meggy, J Hilton, D Harris, G Williams, M Thornton, N Reeves, J Cornish","doi":"10.1308/rcsann.2026.0082","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0082","url":null,"abstract":"<p><strong>Introduction: </strong>This service evaluation aims to characterise variation in practice over time and outcomes of external rectal prolapse (ERP) surgery across Wales.</p><p><strong>Methods: </strong>Patients undergoing ERP surgery between 1 January 2016 and 31 December 2020 were identified retrospectively across Welsh Health Boards. Demographic details, surgical procedure and recurrence data were obtained by the direct care team and input into a central database for analysis. The primary outcome was ERP recurrence on clinical examination. Supplementary population-level data were requested from the Patient Episode Database for Wales (PEDW) through Digital Health and Care Wales for the period 1 January 1 2016 to 31 December 2024.</p><p><strong>Results: </strong>A total of 105 patients were identified; 91.4% (96 of 105) were female. The majority (93.3%, 98 of 105) underwent elective ERP surgery. Overall recurrence rate was 33.3% (35 of 105). Aggregated local trust data demonstrated a decline in national surgical volume from 37 cases in 2016 to 8 cases in 2019, with the reduction most pronounced in laparoscopic approach. The median number of cases per surgeon over 3.2 years was 2.5 (range 1-25), corresponding to a median annual caseload of fewer than one procedure per surgeon. Analysis of PEDW data indicated a sustained postpandemic decline in ERP surgery across Wales, with 2023/2024 procedure rates approximately half of those recorded in 2016/2017.</p><p><strong>Conclusions: </strong>These data suggest a significant reduction in the volume of ERP surgery performed in Wales with geographical variation. Reconfiguration of pelvic floor services in Wales may be required to ensure safe, sustainable and equitable delivery of ERP surgical care.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676525","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 retrospective cohort study of surgery for adrenocortical carcinoma in a tertiary endocrine surgery unit.","authors":"N Kamalakkannan, F Tahir, S O'Toole, A Al-Mukhtar, J Newell-Price, S P Balasubramanian","doi":"10.1308/rcsann.2026.0079","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0079","url":null,"abstract":"<p><strong>Introduction: </strong>Adrenocortical cancer (ACC) is a rare endocrine malignancy with a variable prognosis. This study examines clinical outcomes of patients with ACC who underwent surgery in an endocrine surgery unit over 14 years.</p><p><strong>Methods: </strong>Demographic, clinical, pathological and follow-up data on consecutive patients who underwent surgery for ACC or cortical tumours of uncertain malignant potential (UMP) and patients who had a clinical diagnosis of ACC were collected and descriptive analyses were conducted.</p><p><strong>Results: </strong>Of 48 patients, 32 had ACC confirmed on histology, 10 had a clinical diagnosis and 6 had UMPs. Of those with a histological diagnosis, there were 12 men and 20 women with a median (range) age at first operation of 53 (16-77) years. The histologic type was oncocytic in eight (25%) patients and metastatic disease was present in six (19%) patients at time of operation. ENSAT staging was stage I in 2 (6%), stage II in 18 (56%), stage III in 5 (16%), stage IV in 6 (19%) and unknown in 1 (3%) patient. Complete resection was achieved in 16 (50%) patients. Adjuvant treatments included mitotane and external beam radiotherapy in 18 (56%) and 2 (6%) patients, respectively. Four patients (with initial surgery outside this centre) had multiple operations. The median (range) overall survival and median (range) time to persistent or recurrent disease was 33 (7-172) months and 8 (0-71) months in histology-proven ACC.</p><p><strong>Conclusions: </strong>This study provides a contemporary perspective on epidemiology and practice in the management of ACC in the UK.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676535","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":"Fit to fly? Evaluating airline guidance for passengers with orthopaedic immobilisation.","authors":"R Travis, E Burwell, T P Davis, S Tsotsolis, K Cheema","doi":"10.1308/rcsann.2026.0041","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0041","url":null,"abstract":"<p><strong>Introduction: </strong>Air travel with cast immobilisation increases the risk of compartment syndrome and venous thromboembolism due to cabin pressure-related tissue swelling and venous stasis. Despite these concerns, guidance on flying with casts is often vague and inconsistent. This study aimed to evaluate the accessibility and consistency of airline travel policies for passengers with casts and to review existing literature regarding cast immobilisation and air travel.</p><p><strong>Methods: </strong>The travel policies of the 30 largest commercial airlines worldwide by available seat miles were reviewed, focusing on restrictions or recommendations related to orthopaedic casts. Airline websites were searched systematically and, where guidance was not readily available, customer service was contacted by telephone. Relevant literature on cast immobilisation, air travel and associated physiological risks was identified through PubMed.</p><p><strong>Results: </strong>Guidance was not easily accessible for 11 airlines (37%), requiring telephone contact. A 48-hour threshold following cast application was the most common restriction, with 22 airlines (73%) recommending cast splitting for travel within this period. Twelve airlines (40%) required a signed fit-to-fly certificate. Six airlines (20%) imposed additional restrictions for passengers with full-length leg casts, including additional seat purchase or travel in business class, and one airline prohibited travel entirely.</p><p><strong>Conclusion: </strong>Airline guidance for passengers with casts is inconsistent, difficult to access and poorly standardised. Given that air travel increases soft tissue swelling and intracompartmental pressure, clearer, evidence-based guidance is required. Although limited recommendations exist in the UK, major international aviation authorities provide no explicit guidance, highlighting a significant regulatory gap.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148672915","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":"Beyond the chest wall: anterior rib malformation causing hepatic compression in an adolescent.","authors":"S Frediani, G Romano, V Pardi, A Accinni, A Bertocchini, S Madafferi, I P Aloi","doi":"10.1308/rcsann.2026.0062","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0062","url":null,"abstract":"<p><p>Anterior chest wall deformities are rare in paediatric patients and may occasionally present with atypical clinical and radiological findings. We report the case of an adolescent presenting with intermittent chest pain, in whom imaging revealed an unusual anterior costal malformation associated with focal compression of the hepatic dome, initially raising suspicion of a hepatic lesion. Comprehensive cardiological and radiological evaluation excluded primary cardiac or hepatic disease. Cross-sectional imaging demonstrated a deformity of the anterior costal arch causing a well-defined indentation of the liver surface, consistent with extrinsic compression rather than true parenchymal pathology. Because of persistent symptoms and the anatomical abnormality, the patient underwent surgical correction. Intraoperative findings confirmed a costal deformity with direct mechanical compression of the liver. Surgical remodelling of the chest wall was successfully performed, with an uneventful postoperative course. This case emphasises the importance of considering chest wall anomalies in the differential diagnosis of apparent hepatic lesions and unexplained chest pain in children. Careful imaging interpretation is essential to avoid misdiagnosis, while a tailored surgical approach can provide effective symptom relief in selected patients.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148672935","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":"The changing patterns of injury mechanisms and mortality at a major trauma centre in the UK, 2012-2022: the increase in falls from less than two metres requires effective multidisciplinary collaboration and prevention.","authors":"M Hearn, R Lunevicius, N Misra","doi":"10.1308/rcsann.2026.0038","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0038","url":null,"abstract":"<p><strong>Introduction: </strong>As the major trauma demographic has changed in recent years, with low-energy mechanisms becoming increasingly prevalent, it is important to continue to evaluate the mechanisms of injury and their outcomes.</p><p><strong>Methods: </strong>A retrospective study was conducted in a major tertiary-level UK trauma centre between 2012 and 2022. Data were collected by the Trauma Audit and Research Network (TARN) representatives at Aintree Hospital. Analysis of 8,894 major trauma admissions was conducted, evaluating injury mechanisms, their mortality and case fatality rates.</p><p><strong>Results: </strong>The total annual admissions almost tripled, from 404 to 1,135 (95% CI: 55.6-107.9, <i>p</i><0.0001, <i>R</i>²=0.866), as did annual deaths, from 28 to 72 (95% CI: 3.5-8.0, <i>p</i>=0.0003, <i>R</i>²=0.816). The most common cause of major trauma admissions and mortality was a fall of less than 2m, with the proportion of these admissions increasing from 39.6% to 47.8% (95% CI: 0.2-2.0%, <i>p</i>=0.0220, <i>R</i>²=0.459) in this period. This was followed by falls of more than 2m and vehicle collisions. Total and injury-specific case fatality rates were unchanged over the period. All admissions' total case fatality rate was 6.7%; for falls less than 2m, it was 7.0%. The annual case fatality rate for falls more than 2m was 3.2% higher than vehicle collisions (<i>p</i>=0.0021, 95% CI: 1.2-5.9%).</p><p><strong>Conclusions: </strong>Despite being an under-focused injury mechanism, the clinical burden from falls less than 2m continues to increase in major trauma centres. This should be considered in local, regional and national trauma prevention strategies.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590143","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":"Laparoscopic anti-reflux surgery in connective tissue disorders: a review of clinical outcomes.","authors":"J Siby, J Hendry, H Nageswaran","doi":"10.1308/rcsann.2026.0064","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0064","url":null,"abstract":"<p><strong>Introduction: </strong>Connective tissue disorders (CTDs) frequently cause severe oesophageal dysmotility and medically refractory gastro-oesophageal reflux disease (GERD). Laparoscopic anti-reflux surgery may offer symptom relief, but concerns remain regarding postoperative dysphagia in patients with ineffective or absent peristalsis. This review assesses outcomes of anti-reflux surgery in patients with CTD, focusing on reflux control, dysphagia and the impact of fundoplication type.</p><p><strong>Methods: </strong>A PubMed search identified English-language studies reporting outcomes of laparoscopic anti-reflux surgery in patients with CTD. Extracted variables included demographics, preoperative investigations, operative approach, complications and symptom outcomes.</p><p><strong>Findings: </strong>Nine studies reporting 129 laparoscopic procedures were included, 109 of which were fundoplications. Scleroderma represented 78% of CTD diagnoses. Partial fundoplication comprised 68% of operations. Reflux symptoms resolved in 87% of patients, and regurgitation improved in 74%. Among the 62 patients with reported data, postoperative dysphagia occurred in 24%, with higher rates in cohorts predominantly undergoing Nissen fundoplication. Studies favouring partial wraps generally demonstrated lower dysphagia rates and sustained symptomatic improvement. Overall complication rates were 12%, with no reported mortality. Limited data on robotic procedures suggested comparable safety.</p><p><strong>Conclusions: </strong>Laparoscopic fundoplication is a safe and effective treatment for GERD in patients with CTD, achieving 74%-87% resolution of presenting symptoms balanced against 24% postoperative dysphagia in the early postoperative period. Overall, 93% of patients were satisfied at 5 years post-surgery. Despite a lack of conclusive data, partial wraps appear to provide the lowest rates of postoperative dysphagia while maintaining effective resolution of reflux. Insufficient data currently exists to compare anterior and posterior partial wraps.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148560357","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":"Perspectives on digital recovery platforms in perioperative care: insights from patients and clinicians.","authors":"A Abeles, R M Kwasnicki, C Goyal, A Darzi","doi":"10.1308/rcsann.2026.0067","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0067","url":null,"abstract":"<p><strong>Introduction: </strong>Digital health technologies, including wearable activity monitors (WAMs), have the potential to transform perioperative care by improving patient engagement and enhancing clinical decision making. However, there is limited qualitative research exploring how patients and healthcare professionals perceive such tools within the perioperative setting.</p><p><strong>Methods: </strong>A qualitative study was conducted using semi-structured interviews with six postoperative patients and five healthcare professionals at an Imperial College Healthcare NHS Trust. Participants interacted with physical activity data generated from WAMs and viewed on smart devices. Transcripts were analysed using inductive thematic analysis, following the Framework Methodology.</p><p><strong>Results: </strong>Four key themes emerged from patient interviews: practicality, value, functionality and the WAM as a data collection/display tool. Patients valued the feedback for motivation and recovery tracking, but varied in preferred data presentation. Three themes emerged from healthcare professionals: value, multidisciplinary relationships and functionality. Clinicians viewed physical activity data as a useful adjunct to enhance recovery, discharge planning and patient empowerment; however, concerns about resource burden and data management were also noted.</p><p><strong>Conclusions: </strong>Both patients and clinicians recognise the potential of digital recovery platforms to support individualised care and enhance postoperative recovery. Real-time feedback, user-friendly interfaces and integration with existing care pathways are critical for adoption. Future research should explore real-time deployment, broader surgical populations, and cost-effectiveness to inform wider implementation.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148560476","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}