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

{"title":"Laparoscopic-assisted ERCP is a safe procedure with good outcomes: experience from a single high-volume upper GI unit.","authors":"L Kenny, C Strong, S Bonnington, E J Nevins","doi":"10.1308/rcsann.2026.0052","DOIUrl":"10.1308/rcsann.2026.0052","url":null,"abstract":"<p><strong>Introduction: </strong>Patients who have undergone Roux-en-Y gastric bypass (RYGB) no longer have anatomy that is amenable to trans-oral endoscopic retrograde cholangio-pancreatogram (ERCP). Laparoscopic-assisted ERCP (LA-ERCP), which combines laparoscopic and endoscopic techniques to access the patient's biliary tree, is a possible solution. Historically, there have been concerns about the safety and feasibility of this procedure. The aim of this case series is to explore the outcomes of LA-ERCP at a single high-volume centre.</p><p><strong>Methods: </strong>This is a retrospective case series of all patients undergoing LA-ERCP at a single high-volume UK centre between 2015 and 2024.</p><p><strong>Results: </strong>A total of 17 patients underwent 19 LA-ERCPs during the above time period. Of the 19 LA-ERCPs, 16 were completed successfully with no complications and the majority of patients were discharged home within four days post-procedure. This is the largest reported UK cohort of patients who have undergone LA-ERCP.</p><p><strong>Conclusion: </strong>LA-ERCP is an effective, safe and viable option for patients who are unable to undergo trans-oral ERCP.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366688","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":"Can a generic fracture fixation assessment tool be used to assess quality of distal radius fracture fixation, and predict fixation failure?","authors":"S Beattie, A Newton, M Alsumadi, Z Akbar, G Cheung, D Brown","doi":"10.1308/rcsann.2026.0057","DOIUrl":"10.1308/rcsann.2026.0057","url":null,"abstract":"<p><strong>Introduction: </strong>Failure following volar locking plate fixation of distal radial fractures (DRFs) is a common cause of revision surgery. The Fracture Fixation Assessment Tool score (FFAT) is a validated evaluation tool for appraising long bone fracture fixations. It comprises of four domains: reduction, stability, implant choice and overall impression. This study evaluates FFAT as an educational tool for assessing DRF fixation quality. A secondary aim is to analyse its ability to predict fixation failure.</p><p><strong>Methods: </strong>A pool of 63 DRF fixations, including 22 failures, were scored by 27 orthopaedic surgeons using FFAT, with each participant assigned a set of 10 DRF fixations. The overall score and individual domain scores for failed and non-failed fixations were compared using unpaired Student's t-tests. The ability of FFAT to identify fracture fixation failure was analysed using binomial logistic regression and a receiver operating characteristic curve.</p><p><strong>Results: </strong>Lower FFAT scores correlated with poor quality fracture fixations that subsequently failed, with statistical significance demonstrated in reduction and overall impression domains. Reduction was the strongest predictor of poor fixation with subsequent failure. Regression analysis demonstrated FFAT scores to exhibit good specificity but limited sensitivity in predicting failure.</p><p><strong>Conclusion: </strong>FFAT provides a structured, reproducible framework for the formative educational assessment of distal radius fracture fixation. Although lower scores were associated with fixation failure, limited sensitivity restricts its reliability as a standalone clinical predictive tool. Refinement of FFAT domains to better reflect distal radius-specific fixation principles may enhance failure detection while preserving its primary educational role.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366736","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 prospective randomised controlled trial comparing open and laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis in a low-middle-income country setting.","authors":"S Ahmad, N Talat, M Rehan, M S Saleem, U Mahmood","doi":"10.1308/rcsann.2026.0066","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0066","url":null,"abstract":"<p><strong>Introduction: </strong>Infantile hypertrophic pyloric stenosis (IHPS) is a common cause of non-bilious projectile vomiting in early infancy. Although open pyloromyotomy (OPM) remains the standard in many low-middle-income countries (LMICs), laparoscopic pyloromyotomy (LPM) is increasingly favoured in high-income settings for its faster recovery and improved cosmesis. This study compares the feasibility, safety and outcomes of OPM and LPM at Pakistan's largest public paediatric hospital.</p><p><strong>Methods: </strong>This randomised trial enrolled 60 infants with IHPS allocated to open (OPM, <i>n</i> = 30) or laparoscopic pyloromyotomy (LPM, <i>n</i> = 30). Operative time was measured skin-to-skin, with secondary analysis of pyloromyotomy time. Primary outcomes were operative duration, time to full feeding and postoperative stay.</p><p><strong>Results: </strong>Total operative time was shorter for OPM (39.3 ± 9.5 vs 56.9 ± 31.2min, <i>p</i> < 0.05). Pyloromyotomy time was also shorter in OPM (29.1 ± 8.2 vs 49.3 ± 32.7min, <i>p</i> < 0.05). However, LPM patients achieved full feeding faster (7.1 ± 1.5 vs 11.2 ± 9.8h, <i>p</i> < 0.05) and had shorter hospital stays (1.4 ± 0.7 vs 2.5 ± 1.9 days, <i>p</i> < 0.05). Complication rates were comparable.</p><p><strong>Conclusions: </strong>Despite longer operative times, LPM demonstrated significantly better postoperative recovery. With appropriate training and investment, LPM is a feasible and beneficial alternative to OPM in LMIC settings.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366713","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":"Trends and causes of litigation in paediatric surgery within the National Health Service (NHS) England: a 19-year analysis.","authors":"P Nikolinakos, M M Antonaraki, I Donkov, N Zavras, K H Pang","doi":"10.1308/rcsann.2026.0061","DOIUrl":"https://doi.org/10.1308/rcsann.2026.0061","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to assess litigation patterns within paediatric surgery in the National Health Service (NHS) England by analysing long-term trends, financial costs and causes of successful claims over the past 19 years.</p><p><strong>Methods: </strong>Litigation data were obtained from NHS Resolution via a Freedom of Information (FOI) Act 2000 request covering financial years 2006/2007 to 2024/2025. For paediatric surgery cases (patients <18 years), extracted variables included total claims, successful claims, damages paid and associated legal costs. Successful claims were categorised by primary cause and primary injury incurred.</p><p><strong>Results: </strong>Over the study period, 591 litigation claims were submitted in paediatric surgery, of which 332 (56.2%) were successful. Damages paid amounted to £48.05 million. Annual claims rose 5.1-fold, from 10 in 2006/2007 to 51 in 2024/2025. Damages increased 1.98-fold, from £1.47 million in 2006/2007 to £2.91 million in 2024/2025. The most frequent causes of successful claims were failure or delay in diagnosis (15.1%, 50/332), failure or delay in treatment (13.9%, 46/332), and intraoperative problems (10.8%, 36/332). Operative-related factors accounted for 27.4% (91/332), whereas non-operative causes comprised 57.2% (190/332). The most reported primary injuries were: additional or unnecessary procedures (15.7%, 52/332), unnecessary pain (15.1%, 50/332) and fatality (14.2%, 47/332).</p><p><strong>Conclusion: </strong>Paediatric surgery litigation in NHS England has increased over 19 years, driven predominantly by diagnostic and treatment delays rather than operative error. Improvement of time-critical diagnostic pathways, enhanced follow-up systems and targeted claims resolution strategies represent the most impactful approaches to reducing litigation burden in this specialty.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366716","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":"Renal hyperparathyroidism: comparative outcomes of parathyroidectomy in two regional centres over 14 years.","authors":"S Michael, N Matias, O Alwani, W Matkin, E Solomon, A Lively, D Ricardo, M Ahmed, Z Moinuddin, T Augustine, R Chinnadurai, H Doran","doi":"10.1308/rcsann.2025.0112","DOIUrl":"10.1308/rcsann.2025.0112","url":null,"abstract":"<p><strong>Introduction: </strong>Renal hyperparathyroidism is a common complication of chronic kidney disease, often requiring parathyroidectomy (PTX) when medical therapy fails. Following surgical intervention, recurrence and postoperative complications, in particular hypocalcaemia, are variable. This study compares post-PTX outcomes between two UK centres, focusing on recurrence rates, length of stay (LOS) and factors influencing postoperative intravenous (IV) calcium administration.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted across two centres from 2008-2022. Demographic, biochemical, and clinical factors were analysed, with primary outcomes being disease recurrence and postoperative IV calcium requirement.</p><p><strong>Results: </strong>In total, 114 patients were included: 66 from centre A and 48 from centre B. Some 65.2% underwent total parathyroidectomy in centre A vs 60.4% in centre B. The remainder were subtotal parathyroidectomies. Total recurrence was higher in centre A (34.8%) than centre B (20.8%) and a longer LOS was seen in centre A (median 5.5 days vs 3 days, <i>p</i> = 0.007). IV calcium use was higher in centre B (35.4% vs 24.2%, <i>p</i> = 0.194), although not statistically significant. Predictors of recurrence were limited, with preloading with alfacalcidol being protective in a univariate model (hazard ratio [HR] 0.33, <i>p</i> = 0.005). Higher postoperative phosphate, parathyroid hormone and alkaline phosphate levels were significant predictors of postoperative IV calcium in multivariate analysis (<i>p</i> < 0.05).</p><p><strong>Conclusions: </strong>Significant differences in recurrence and LOS suggest that preoperative disease burden and perioperative management strategies influence outcomes. The higher recurrence at centre A may be linked to disease severity, while the shorter LOS and higher IV calcium use at centre B may reflect different pre- and postoperative care approaches. These findings highlight the need for careful management and identification of factors which may impact outcomes.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"449-456"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13318455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951392","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":"Using a bladder syringe for retrograde urethrogram.","authors":"R Karanjia, A Chetwood","doi":"10.1308/rcsann.2025.0092","DOIUrl":"10.1308/rcsann.2025.0092","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"484"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13318462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145755057","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":"This story shall the good [surgeon] teach.","authors":"B Rogers","doi":"10.1308/rcsann.2026.0074","DOIUrl":"10.1308/rcsann.2026.0074","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":"108 6","pages":"409"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13318468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359169","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":"Decision making and outcomes in colorectal cancer and frailty: the DeCaF study.","authors":"A Kler, J Tay, C Slawinski, C Welch, S Moug, S Blackwell, R Arnott, P Mitchell, N Heywood","doi":"10.1308/rcsann.2025.0050","DOIUrl":"10.1308/rcsann.2025.0050","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical resection is the main treatment for non-metastatic colorectal cancer (CRC). However, 6% of patients do not undergo surgery owing to frailty, according to the National Bowel Cancer Audit (NBOCA). The impact of preoperative evaluation and decision making on outcomes in frail patients is underexplored. This study examines variation in decision making for frail, older patients and the availability/use of resources by colorectal multidisciplinary teams (MDTs) across United Kingdom (UK) hospitals.</p><p><strong>Methods: </strong>A UK-wide questionnaire was distributed to colorectal MDTs via the NBOCA newsletter and social media (18 May to 30 June 2021). Part A assessed MDT structure and resource use; Part B explored MDT decisions for two simulated 75-year-old patients with colonic and rectal cancer.</p><p><strong>Results: </strong>Twenty MDTs responded. Decisions were MDT-driven in 55% (<i>n</i> = 11) and surgeon-driven in 45% (<i>n</i> = 9). Clinical examination (85%) and performance status (90%) were most used. Resource utilisation during MDT meetings varied across sites; for example, echocardiogram results were available and considered in MDT decision making in only 15% of centres. Cardiopulmonary exercise testing was used in 75%, anaesthetic assessment in 80%, frailty scoring in 25%, and preoperative geriatric assessment in 5%. Management of right-sided cancer was more consistent; rectal cancer decisions were more variable.</p><p><strong>Conclusions: </strong>Variation exists across MDTs in the availability and use of resources when managing frail CRC patients. There is less consensus for rectal than caecal cancer. These findings highlight the need for standardised MDT protocols to support equitable, patient-centred care in complex cases.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"430-437"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13318465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636017","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":"Evaluating the ability of AI chatbots to provide informed consent information for common oncological surgeries.","authors":"R S Sidhu, A Selvamogan, M Abdellatif, R Franscois, A Boddy","doi":"10.1308/rcsann.2025.0089","DOIUrl":"10.1308/rcsann.2025.0089","url":null,"abstract":"<p><strong>Introduction: </strong>Informed consent is fundamental to oncological surgery, but communication is often hindered by medical terminology, inconsistent explanations and variation in patient understanding. Large language models may improve accessibility by generating simplified consent information. This study assessed whether four leading artificial intelligence (AI) chatbots, ChatGPT (GPT-4), Gemini (2.5 Flash), DeepSeek (R1) and Grok (3) could generate information understandable to patients and comprehensive enough to support informed consent for six common oncological operations.</p><p><strong>Methods: </strong>Standardised patient-style prompts were applied, and chatbot outputs were evaluated for readability using the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL) and Gunning Fog Index (GF). Quality and completeness, including coverage of procedure details, risks, benefits, alternatives and consequences of no treatment, were assessed by three consultant surgeons using a modified DISCERN instrument.</p><p><strong>Results: </strong>Gemini produced the highest quality information (mean DISCERN 72.3 ± 3.0), followed by Grok (63.0 ± 1.8), whereas ChatGPT (48.0 ± 4.7) and DeepSeek (47.1 ± 1.8) performed less well. DeepSeek generated the most readable content (FKGL 9.7; GF 10.8), although no model achieved the recommended sixth-grade level. Common limitations included the lack of systematic referencing (except Gemini), occasional factual inaccuracies, reliance on predominantly US-based resources, and failure to assess patient understanding.</p><p><strong>Conclusion: </strong>Overall, AI chatbots can provide structured, accessible information to support surgical consent, but current limitations restrict their use as standalone tools. Gemini demonstrated the strongest balance of readability and quality, yet all models require refinement to improve reliability, equity, and patient safety. At present, AI should complement, rather than replace, clinician-led consent discussions.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"469-475"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13321173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145755031","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":"Response to letters from Ms Deepa Bose (SAC) & Mr Alexander Thomas Schade (BOTA).","authors":"T Barrow, B D Chatterton, T Crompton, N T Kiely, S N Maripuri, K James","doi":"10.1308/rcsann.2025.0109","DOIUrl":"10.1308/rcsann.2025.0109","url":null,"abstract":"","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"494"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13318464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951403","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}