General Surgery

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Does declared surgeon specialist interest influence the outcome of emergency laparotomy?
(Royal College of Surgeons of England, 2020-05-06) Hallam, S; Bickley, M; Phelan, L; Dilworth, M; Bowley, D M; Surgery; Medical and Dental; Hallam, Sally; Phelan, Liam; Dilworth, Mark; Bowley, Doug
Introduction: In the UK, general surgeons must demonstrate competency in emergency general surgery before obtaining a certificate of completion of training. Subsequently, many consultants develop focused elective specialist interests which may not mirror the breadth of procedures encountered during emergency practice. Recent National Emergency Laparotomy Audit analysis found that declared surgeon special interest impacted emergency laparotomy outcomes, which has implications for emergency general surgery service configuration. We sought to establish whether local declared surgeon special interest impacts emergency laparotomy outcomes. Methods: Adult patients having emergency laparotomy were identified from our prospective National Emergency Laparotomy Audit database from May 2016 to May 2019 and categorised as colorectal or oesophagogastric according to operative procedure. Outcomes included 30-day mortality, return to theatre and length of stay. Binomial logistic regression was used to identify any association between declared consultant specialist interest and outcomes. Results: Of 600 laparotomies, 358 (58.6%) were classifiable as specialist procedures: 287 (80%) colorectal and 71 (20%) oesophagogastric. Discordance between declared specialty and operation undertaken occurred in 25% of procedures. For colorectal emergency laparotomy, there was an increased risk of 30-day mortality when performed by a non-colorectal consultant (unadjusted odds ratio 2.34; 95% confidence interval 1.10-5.00; p = 0.003); however, when adjusted for confounders within multivariate analysis declared surgeon specialty had no impact on mortality, return to theatre or length of stay. Conclusion: Surgeon-declared specialty does not impact emergency laparotomy outcomes in this cohort of undifferentiated emergency laparotomies. This may reflect the on-call structure at Birmingham Heartlands Hospital, where a colorectal and oesophagogastric consultant are paired on call and provide cross-cover when needed.
Extended venous thromboembolism prophylaxis: why is it not standard care?
(Oxford University Press, 2020-08-18) Naumann, D N; Karandikar, S; GI/General surgery; Surgery; Medical and Dental; Naumann, David; Karandikar, Sharad
No abstract available
Direct Skeletal Fixation in bilateral above knee amputees following blast: 2 year follow up results from the initial cohort of UK service personnel.
(Elsevier, 2020-01-07) McMenemy, Louise; Ramasamy, Arul; Sherman, Kate; Mistlin, Alan; Phillip, Rhodri; Evriviades, Demetrius; Kendrew, Jon
Aims: The aim of the study is to evaluate the clinical outcome and complications from the initial cohort of blast injured bilateral lower limb, above knee amputees who underwent Direct Skeletal Fixation (DSF). Patients and methods: We undertook a retrospective analysis of a prospective data base identifying patients who had undergone implantation with the Australian Osseointegration Group of Australia-Osseointegration Prosthetic Limb (OGAP-OPL) prosthesis, with minimum 24 months follow up. Patient demographics, injury profile, and polymicrobial colonisation status were recorded. Physical functional performance measures recorded were the 6 minute Walk Test (6-MWT) and patient reported outcome measures were the Short Form Health Survey-36 (SF-36). Post operatively, complications including infection, re-operation, and fracture were recorded. Results: 7 patients (14 femora) were identified (mean age 29.8yrs), all injured by dismounted blast. Mean follow up was 46 months. All were polytrauma patients and all had previous polymicrobial colonisation. Following surgery, all patients mobilised with significant improvement in 6-minute walk time, with a mean improvement of 154 m (248 m vs 402 m, p = 0.018). The physical component score for the SF-36 demonstrated a statistically significant improvement from 34.65 to 54.5 (p = 0.018) and the mental component score demonstrated a similar improvement (41.55-58.19 p = 0.018). At follow up, no patient required explantation of the implant. Each had been prescribed a minimum of 1 course of antibiotics with no evidence of deep infection. Conclusion: DSF is an option for amputees who, due to the nature of their injuries, may not be able to tolerate traditional suspension socket prostheses and have exhausted all other treatment options. At a minimum of 2 year follow up, the absence of significant infective complications suggests DSF may be utilised in the blast injured despite chronic polymicrobial colonisation. Longer term surveillance of these patients is required to assess the long-term suitability of this technique in this cohort of patients.
Defence healthcare engagement: a UK military perspective to improve healthcare leadership and quality of care overseas.
(Dove Medical Press, 2021-01-29) Tallowin, Simon; Naumann, David N; Bowley, Douglas M; GI/General surgery; Surgery; Medical and Dental; Naumann, David; Bowley, Doug
Defence Healthcare Engagement (DHE) describes the use of military medical capabilities to achieve health effects overseas through enduring partnerships. It forms a key part of a wider strategy of Defence Engagement that utilises defence assets and activities, short of combat operations, to achieve influence. UK Defence Medical Services have significant recent DHE experience from conflict and stabilisation operations (e.g. Iraq and Afghanistan), health crises (e.g. Ebola epidemic in Sierra Leone), and as part of a long-term partnership with the Pakistan Armed Forces. Taking a historical perspective, this article describes the evolution of DHE from ad hoc rural health camps in the 1950s, to a modern integrated, multi-sector approach based on partnerships with local actors and close civil-military cooperation. It explores the evidence from recent UK experiences, highlighting the decisive contributions that military forces can make to healthcare leadership and quality of care overseas, particularly when conflict and health crisis outstrips the capacity of local healthcare providers to respond. Lessons identified include the need for long-term engagement with partners and the requirement for DHE activities to be closely coordinated with humanitarian agencies and local providers to prevent adverse effects on the local health economy and ensure a sustainable transition to civilian oversight.
ASO author reflections: endoscopic resection or gastrectomy for early clinical stage T1a or T1b gastric adenocarcinoma.
(Springer, 2021-01-21) Kamarajah, Sivesh K; Markar, Sheraz R; Phillips, Alexander W
No abstract available
Arthroscopic ligament-specific repair for triangular fibrocartilage complex foveal avulsions: a minimum 2-year follow-up study.
(SAGE Publications, 2020-09-23) Liu, Bo; Arianni, Margareta; Wu, Feiran; Surgery; Medical and Dental; Wu, Feiran
This study reports the arthroscopic ligament-specific repair of the triangular fibrocartilage complex (TFCC) that anatomically restores both the volar and dorsal radioulnar ligaments into their individual foveal footprints. Twenty-five patients underwent arthroscopic ligament-specific repair with clinical and radiological diagnoses of TFCC foveal avulsions. The mean age was 28 years (range 14-47) and the mean follow-up was 31 months (range 24-47). Following arthroscopic assessment, 20 patients underwent double limb radioulnar ligament repairs and five had single limb repairs. At final follow-up, there were significant improvements in wrist flexion-extension, forearm pronation-supination and grip strength. There were also significant improvements in pain and patient-reported outcomes as assessed by the patient-rated wrist evaluation, Disabilities of the Arm, Shoulder and Hand score and modified Mayo wrist scores. Arthroscopic ligament-specific repair of the TFCC does not require specialist dedicated equipment or consumables and offers a viable method of treating these injuries.Level of evidence: IV.
A real-time electronic symptom monitoring system for patients after discharge following surgery: a pilot study in cancer-related surgery.
(BioMed Central, 2020-06-10) Richards, H S; Blazeby, J M; Portal, A; Harding, R; Reed, T; Lander, T; Chalmers, K A; Carter, R; Singhal, R; Absolom, K; Velikova, G; Avery, K N L; Surgery; Medical and Dental; Singhal, Rishi
Background: Advances in peri-operative care of surgical oncology patients result in shorter hospital stays. Earlier discharge may bring benefits, but complications can occur while patients are recovering at home. Electronic patient-reported outcome (ePRO) systems may enhance remote, real-time symptom monitoring and detection of complications after hospital discharge, thereby improving patient safety and outcomes. Evidence of the effectiveness of ePRO systems in surgical oncology is lacking. This pilot study evaluated the feasibility of a real-time electronic symptom monitoring system for patients after discharge following cancer-related upper gastrointestinal surgery. Methods: A pilot study in two UK hospitals included patients who had undergone cancer-related upper gastrointestinal surgery. Participants completed the ePRO symptom-report at discharge, twice in the first week and weekly post-discharge. Symptom-report completeness, system actions, barriers to using the ePRO system and technical performance were examined. The ePRO surgery system is an online symptom-report that allows clinicians to view patient symptom-reports within hospital electronic health records and was developed as part of the eRAPID project. Clinically derived algorithms provide patients with tailored self-management advice, prompts to contact a clinician or automated clinician alerts depending on symptom severity. Interviews with participants and clinicians determined the acceptability of the ePRO system to support patients and their clinical management during recovery. Results: Ninety-one patients were approached, of which 40 consented to participate (27 male, mean age 64 years). Symptom-report response rates were high (range 63-100%). Of 197 ePRO completions analysed, 76 (39%) triggered self-management advice, 72 (36%) trigged advice to contact a clinician, 9 (5%) triggered a clinician alert and 40 (20%) did not require advice. Participants found the ePRO system reassuring, providing timely information and advice relevant to supporting their recovery. Clinicians regarded the system as a useful adjunct to usual care, by signposting patients to seek appropriate help and enhancing their understanding of patients' experiences during recovery. Conclusion: Use of the ePRO system for the real-time, remote monitoring of symptoms in patients recovering from cancer-related upper gastrointestinal surgery is feasible and acceptable. A definitive randomised controlled trial is needed to evaluate the impact of the system on patients' wellbeing after hospital discharge.
A multi-centre insight into general surgical care during the coronavirus outbreak in the United Kingdom.
(Oxford University Press, 2020-08-05) Joseph, Anokha Oomman; Joseph, Janso Padickakudi; Nageswaran, Haritharan; Rajalingam, Viswa Retnasingam; Sharma, Amit; Pereira, Bernadette; Gahir, Jasdeep
No abstract available
A 16-year longitudinal cohort study of incidence and bacteriology of necrotising fasciitis in England.
(Wiley, 2020-08) Bodansky, David M S; Begaj, Irena; Evison, Felicity; Webber, Mark; Woodman, Ciaran B; Tucker, Olga N; Surgery; Medical and Dental; Tucker, Olga
Background: Necrotising fasciitis (NF) is a rapidly progressive, destructive soft tissue infection with high mortality. The primary aim of this study was to evaluate the incidence and mortality of NF amongst patients admitted to English National Health Service (NHS) hospitals. The secondary aims included the identification of risk factors for mortality and causative pathogens. Methods: The Hospital Episodes Statistics database identified patients with NF admitted to English NHS Trusts from 1/1/2002 to 31/12/2017. Information on patient demographics, co-morbid conditions, microbiology specimens, surgical intervention and in-hospital mortality was collected. Uni- and multivariable analyses were performed to investigate factors related to in-hospital mortality. Results: A total of 11,042 patients were diagnosed with NF. Age-standardised incidence rose from 9 per million in 2002 to 21 per million in 2017 (annual percentage change = 6.9%). Incidence increased with age and was higher in men. Age-standardised mortality rate remained at 16% over the study period, while in-hospital mortality declined. On multivariable analysis, the following factors were associated with increased risk of in-hospital mortality: emergency admission, female sex, history of congestive heart failure, peripheral vascular disease, chronic kidney disease and cancer. Admission year and diabetes, which was significantly prevalent at 27%, were not associated with increased risk of mortality. Gram-positive pathogens, particularly Staphylococci, decreased over the study period with a corresponding increase in Gram-negative pathogens, predominantly E. coli. Conclusion: The incidence of NF increased markedly from 2002 to 2017 although in-hospital mortality did not change. There was a gradual shift in the causative organisms from Gram-positive to Gram-negative.
Autotransplantation of the liver for ex vivo resection of intrahepatic caval leiomyosarcoma: a case report.
(Bas̜kent University, 2019-03-14) Buchholz, Bettina M; Pinter Carvalheiro da Silva Boteon, Amanda; Taniere, Phillipe; Isaac, John R; Gourevitch, David; Muiesan, Paolo; Histopathology; Anaesthetics; General Surgery; Medical and Dental; Taniere, Phillipe; Isaac, John R; Gourevitch, David
Intrahepatic caval leiomyosarcomas are rare tumors with limited therapeutic options as patients with the disease are not eligible for liver transplantation from the deceased-donor pool. Advances in surgical techniques gained in split and domino liver transplant procedures can be applied to resection of advanced tumors involving the hepatocaval confluence. Here, we describe the case of a 58-year-old white female who presented with visible abdominal wall collaterals and a palpable right subcostal tumor. Imaging revealed a 5.7 × 5.7 × 11-cm intrahepatic caval soft tissue mass extending into the hepatic veins, right renal vein, and infrarenal caval vein. The entire inferior caval vein was resected en bloc with the liver and right kidney and replaced with a blood group-identical fresh caval vein graft from a deceased donor. The splanchnic circulation was decompressed with a temporary portocaval shunt to the caval vein graft, and caudal inflow into the caval vein graft was established with a left iliac anastomosis. Ex vivo resection of the native inferior caval vein containing the intravascular tumor together with a sleeve of liver was performed under hypothermic conditions, and hepatic outflow was reconstructed with vein from the deceased donor. The liver was autotransplanted via the classical piggyback technique with uneventful portal reperfusion following a cold ischemic time of 2 hours. Histology confirmed a grade 3 leiomyosarcoma with clear resection margins. Liver function was stable, and the patient is currently alive at 2 years after resection. Follow-up imaging at 12 months was unremarkable, but local recurrence was detected on the most recent computed tomography scan. In conclusion, ex vivo resection of an intrahepatic caval leiomyosarcoma with inferior caval vein replacement by a deceased-donor caval graft and subsequent liver autotransplantation are technically demanding but provide a chance on prolonged survival.
The UK perioperative pain study : a national snapshot of pain management in patients undergoing abdominal surgery across the United Kingdom
(SAGE Publications, 2017-10-27) Small, C.; Marriott, P.; Tucker, O.; Yeung, J.; University Hospitals Birmingham NHS Foundation Trust; South Warwickshire University NHS Foundation Trust; General Surgery; Surgery; Medical and Dental; Marriott, P.; Tucker, Olga; Yeung, Joyce
Winning paper abstract 1.1 of the National Acute Pain Symposium 2017, UK.
Surgical trainee feedback-seeking behavior in the context of workplace-based assessment in clinical settings
(Lippincott, Williams & Wilkins, 2017-06) Gaunt, Anne; Patel, Abhilasha; Fallis, Simon; Rusius, Victoria; Mylvaganam, Seni; Royle, T. James; Almond, Max; Markham, Deborah H.; Pawlikowska, Teresa; University of Warwick; Good Hope Hospital, Birmingham; Russells Hall Hospital, Dudley; Royal Wolverhampton Hospital; Sunderland Royal Hospital; Heartlands Hospital, Birmingham; South Warwickshire University NHS Foundation Trust; Royal College of Surgeons in Ireland; General Surgery; Medical and Dental; Markham, Deborah H.; Fallis, Simon; Almond, Max
Purpose: To investigate surgical trainee feedback-seeking behaviors-directly asking for feedback (inquiry) and observing and responding to situational clues (monitoring)-in the context of workplace-based assessment (WBA). Method: A hypothetical model of trainee feedback-seeking behavior was developed using existing literature. A questionnaire, incorporating previously validated instruments from organizational psychology, was distributed to general surgical trainees at 23 U.K. hospitals in 2012-2013. Statistical modeling techniques compared the data with 12 predetermined hypothetical relationships between feedback-seeking behaviors and predictive variables (goal orientation, supervisory style) through mediating variables (perceptions of personal benefits and costs of feedback) to develop a final model. Results: Of 235 trainees invited, 178 (76%) responded. Trainees completed 48 WBAs/year on average, and 73% reported receiving feedback via WBA. The final model was of good fit (chi-square/degree of freedom ratio = 1.620, comparative fit index = 0.953, root mean square error of approximation = 0.059). Modeled data showed trainees who perceive personal benefits to feedback use both feedback inquiry and monitoring to engage in feedback interactions. Trainees who seek feedback engage in using WBA. Trainees' goal orientations and perceptions of trainers' supervisory styles as supportive and instrumental are associated with perceived benefits and costs to feedback. Conclusions: Trainees actively engage in seeking feedback and using WBA. Their perceptions of feedback benefits and costs and supervisory style play a role in their feedback-seeking behavior. Encouraging trainees to actively seek feedback by providing specific training and creating a supportive environment for feedback interactions could positively affect their ability to seek feedback.
Accuracy of intraoperative diagnosis of appendicitis in laparoscopy. Should this affect decision for appendicectomy
(Oxford University Press, 2020-06-24) Gronroos, J.; Konstantinou, C.; George Eliot Hospital, Nuneaton; Good Hope Hospital, Birmingham; Warwick Hospital; Medical and Dental; Gronroos, J.
Poster presentation abstract 942 from the Association of Surgeons in Training (ASiT) Annual Conference 6th-8th March 2020, Birmingham International Convention Centre.
Comparative effectiveness of different cystic duct ligation techniques in laparoscopic cholecystectomy: a systematic review and network meta-analysis.
(Mary Ann Liebert, Inc., 2024-11-28) Athanasiou, Christos; Radwan, Ahmed; Qureshi, Saeed; Kanwar, Aditya; Kosmoliaptsis, Vasilis; Aroori, Somaiah; Renal Surgery; Medical and Dental; Radwan, Ahmed
Background: Laparoscopic cholecystectomy is one of the most common surgical procedures. Several techniques of ligating the cystic duct have been compared in randomized trials, but data on comparative effectiveness are missing. Our aim was to systematically review the literature and, if appropriate, synthesize the available evidence. Methods: A systematic search of PubMed, Scopus, Ovid, and Cochrane Library was conducted to identify randomized studies comparing different ligation techniques of the cystic duct in laparoscopic cholecystectomy. Network meta-analysis synthesized evidence from all available techniques. Techniques compared were metal (MC), absorbable (AC), or polymer clips (PC), suture ligation (SL), and ultrasonic shears (US). Results: Twenty-three randomized studies with 2851 patients were included in our study. A well-connected network was formed for bile leak and a star-shaped network for operative time, with MC as the common comparator. No difference was found when SL, AC, US, or PC were compared for bile leak. Operative time was statistically significantly reduced when US were compared to MC (mean difference [MD] = -14.32 [-19.37, -9.28]), SL MD = -20.16 (-10.84, -29.47), and AC MD = -18.32 (-1.25, -35.39). The remaining techniques had similar operative times. PC had the highest probability of being the best technique P = 41.8, and SL had the highest probability P = 46.1 of being the second best for bile leak. US had a 98.1% chance of being the best technique for operative time. Conclusions: Given that all techniques demonstrate similar efficacy, the decision should be based on cost, familiarity with the technique, and environmental factors.
Bile duct injury during cholecystectomy: necessity to learn how to do and interpret intraoperative cholangiography
(Frontiers Media, 2021-02-17) Christou, Niki; Roux-David, Alexia; Naumann, David N; Bouvier, Stephane; Rivaille, Thibaud; Derbal, Sophiane; Taibi, Abdelkader; Fabre, Anne; Fredon, Fabien; Durand-Fontanier, Sylvaine; Valleix, Denis; Mathonnet, Muriel; University Hospital of Limoges; Geneva University Hospitals; Geneva Medical School; University Hospitals Birmingham NHS Foundation Trust; General Surgery; Medical and Dental; Naumann, David
Introduction: Biliary duct injury (BDI) is a serious complication during cholecystectomy. Perioperative cholangiography (POC) has recently been generating interest in order to prevent BDI. However, the current literature (including randomized controlled trials) cannot conclude whether POC is protective or not against the risk of BDI. The aim of our study was to investigate whether POC could demonstrate earlier BDI and which criteria are required to make that diagnosis. Methods: We performed a retrospective study between 2005 and 2018 in our French tertiary referral center, which included all patients who had presented following BDI during cholecystectomy. Results: Twenty-two patients were included. Nine patients had POC, whereas 13 did not. When executed, POC was interpreted as normal for three patients and abnormal for six. In this latter group, only two cases had a BDI diagnosed intraoperatively. In other cases, the interpretation was not adequate. Conclusion: BDIs are rare but may reduce patients' quality of life. Our study highlights the surgeon's responsibility to learn how to perform and interpret POC in order to diagnose and manage BDIs and potentially avoid catastrophic consequences.
Robotic and laparoscopic minimally invasive surgery for colorectal cancer in Africa: an outcome comparison endorsed by the Nigerian society for colorectal disorders
(Springer, 2024-12-10) Falola, Adebayo Feranmi; Adeyeye, Ademola; Shekoni, Oluwatobi; Oluwagbemi, Ayotemi; Effiong-John, Blessing; Ogbodu, Emmanuella; Dada, Oluwasina Samuel; Ndong, Abdourahmane
Background: Minimally invasive surgery for colorectal cancer (CRC) offer superior outcomes compared to open surgery. This study aimed to review the robotic and laparoscopic procedures for CRC performed in Africa, and compare the mean surgery duration, blood loss, hospital stay, rate of conversion, and prevalence of morbidity and mortality. This is the first study to compare the outcomes of robotic and laparoscopic surgeries for CRC in Africa. Methods: A systematic review following the PRISMA guidelines was conducted. PubMed, Google Scholar, Web of Science, AJOL, EMBASE, and CENTRAL were searched, identifying 2,259 publications, 33 of which were deemed eligible. Statistical analysis of outcomes was performed using "R". Methodological quality of the included studies was assessed using the Cochrane ROBINS-I tool. Results: The minimally invasive approach has been applied for CRC treatment in seven African countries: Algeria, Cameroon, Egypt, Morocco, Nigeria, Senegal, and South Africa. Laparoscopic surgeries accounted for 1,485 (95%) of cases, while 71 (5%) were robotic. Robotic procedures were associated with a longer surgery duration (256.41 min vs. 190.45 min, p < 0.0001), higher blood loss (226.48 mL vs. 141.55 mL, p < 0.0001), and a shorter hospital stay (4.52 days vs. 6.06 days, p = 0.85). Robotic procedures had a lower rate of conversion (3% vs. 8%, p = 0.29) and a lower prevalence of morbidity (19% vs. 26%, p = 0.26). Wound infection (24.49%) and ileus (57.14%) were the most common complications following laparoscopic and robotic procedures, respectively. There was no mortality from robotic surgeries; however, a prevalence of 0.39% (95% CI: 0;1.19) was recorded from laparoscopy. Conclusions: This study establishes and compares the outcomes of advances in the treatment of CRC in the African setting, providing insights for policymakers, healthcare providers, and international organizations to make decisions regarding optimizing care for CRC patients in Africa.
Robotic and laparoscopic right anterior sectionectomy and central hepatectomy: multicentre propensity score-matched analysis
(Oxford University Press, 2022-02-09) Yang, Hye Yeon; Choi, Gi Hong; Chin, Ken-Min; Choi, Sung Hoon; Syn, Nicholas L; Cheung, Tan-To; Chiow, Adrian K H; Sucandy, Iswanto; Marino, Marco V; Prieto, Mikel; Chong, Charing C; Lee, Jae Hoon; Efanov, Mikhail; Kingham, T Peter; Sutcliffe, Robert P; Troisi, Roberto I; Pratschke, Johann; Wang, Xiaoying; D'Hondt, Mathieu; Tang, Chung Ngai; Liu, Rong; Park, James O; Rotellar, Fernando; Scatton, Olivier; Sugioka, Atsushi; Long, Tran Cong Duy; Chan, Chung-Yip; Fuks, David; Han, Ho-Seong; Goh, Brian K P; Severance Hospital; Yonsei University College of Medicine; Singapore General Hospital; CHA Bundang Medical Centre; CHA University School of Medicine; National University of Singapore; Queen Mary Hospital, Hong Kong; University of Hong Kong; Changi General Hospital; Digestive Health Institute, Tampa; Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello; P. Giaccone University Hospital; Cruces University Hospital; University of the Basque Country; Prince of Wales Hospital, Hong Kong; Chinese University of Hong Kong; Asan Medical Centre; University of Ulsan College of Medicine; Moscow Clinical Scientific Centre; Memorial Sloan Kettering Cancer Center; University Hospitals Birmingham NHS Foundation Trust; Federico II University Hospital Naples; Freie Universität Berlin; Berlin Institute of Health; Zhongshan Hospital; Fudan University; Groeninge Hospital; Pamela Youde Nethersole Eastern Hospital; First Medical Centre of Chinese People's Liberation Army General Hospital; University of Washington Medical Center; Clinica Universidad de Navarra; Universidad de Navarra; Institute of Health Research of Navarra (IdisNA); Assistance Publique des Hopitaux de Paris; Sorbonne Université; Fujita Health University School of Medicine; University Medical Center, Ho Chi Minh City; University of Medicine and Pharmacy, Ho Chi Minh City; Singapore General Hospital; Duke National University of Singapore Medical School; Institute Mutualiste Montsouris; Université Paris Descartes; Seoul National University Bundang Hospital; Seoul National University College of Medicine; Liver; Medical and Dental; Sutcliffe, Robert
Both robotic and laparoscopic right anterior sectionectomy and central hepatectomy can be performed safely in expert centres, with excellent outcomes. The robotic approach was associated with statistically significant less blood loss compared with laparoscopy, although the clinical relevance of this finding remains unclear.
Risk factors for surgical site infection after groin hernia repair: does the mesh or technique matter?
(Springer, 2021-10-01) Christou, N; Ris, F; Naumann, D; Robert-Yap, J; Mathonnet, M; Gillion, J-F; Centre Hospitalier Universitaire de Limoges; University Hospitals Birmingham NHS Foundation Trust; Geneva University Hospitals and Medical School; Hôpital Privé d'Antony; General Surgery; Medical and Dental; Naumann, David
Introduction: Surgical site infections (SSIs) following groin hernia repair (GHR) are getting rarer in high income countries despite a wider use of meshes. Among the risk factors for SSIs, those related to the mesh and the surgical technique have rarely been described. Methods: A registry-based multicenter study using prospectively collected data, including SSIs and their potential risk factors, was conducted in the French Hernia-Club. Results: Between 2012 and 2019, 21,976 consecutive unselected adult patients aged 64.8 ± 15.4 years old (88.9% male) underwent GHR (83.5% unilateral). Fifty four percent were laparoscopic; 97.6% used mesh. The overall incidence of SSI was 0.26%. The incidence of SSI was respectively, 0.24% and 0.19% (p = 0.420) in open vs laparoscopic repairs; 0.19% and 0.25% (p = 0.638) for polyester vs polypropylene mesh; In adjusted multivariate analysis focusing on macroporous meshes (which were the most implanted meshes: 23,148 out of 24,099), there were no differences in terms of SSIs' rates regarding the technique: open versus laparoscopy (p = 0.762) nor the type of mesh used: polypropylene versus polyester (p = 0.557). Conclusion: The rate of SSI following GHR was low in this large registry study. Mesh type and surgical technique did not affect SSIs rates. Caution is advised when interpreting these data due to this very low rate of SSI and the potential for a type II error.
Risk factors for anastomotic stricture after hepaticojejunostomy for bile duct injury - A systematic review and meta-analysis
(Mosby, 2021-06-17) Halle-Smith, James M; Hall, Lewis A; Mirza, Darius F; Roberts, Keith J; University Hospitals Birmingham NHS Foundation Trust; University of Birmingham; Gastrointestinal Surgery; General Surgery; Liver; Liver Surgery; Additional Clinical Services; Medical and Dental; Halle-Smith, James; Hall, Lewis; Roberts, keith
Background: After major bile duct injury, hepaticojejunostomy can result in good long-term patency, but anastomotic stricture is a common cause of long-term morbidity. There is a need to assimilate high-level evidence to establish risk factors for development of anastomotic stricture after hepaticojejunostomy for bile duct injury. Methods: A systematic review of studies reporting the rate of anastomotic stricture after hepaticojejunostomy for bile duct injury was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Meta-analyses of proposed risk factors were then performed. Results: Meta-analysis included 5 factors (n = 2,155 patients, 17 studies). Concomitant vascular injury (odds ratio 4.96; 95% confidence interval 1.92-12.86; P = .001), postrepair bile leak (odds ratio: 8.03; 95% confidence interval 2.04-31.71; P = .003), and repair by nonspecialist surgeon (odds ratio 11.29; 95% confidence interval 5.21-24.47; P < .0001) increased the rate of anastomotic stricture of hepaticojejunostomy after bile duct injury. Level of injury according to the Strasberg Grade did not significantly affect the rate of anastomotic stricture (odds ratio: 0.97; 95% confidence interval 0.45-2.10; P = .93). Owing to heterogeneity of reporting, it was not possible to perform a meta-analysis for the impact of timing of repair on anastomotic stricture rate. Conclusion: The only modifiable risk factor, repair by a nonspecialist surgeon, demonstrates the importance of broad awareness of these data. Knowledge of these risk factors may permit risk stratification of follow-up, better informed consent, and understanding of prognosis.
Recovery of surgical training through extended laparoscopic simulation training
(Cureus, 2021-10-12) Hamid, Mohammed; Siddiqui, Zohaib; Aslam Joiya, Shaheer; University Hospitals Birmingham NHS Foundation Trust; Maidstone and Tunbridge Wells NHS Trust; Yeovil District Hospital
Introduction: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected surgical training internationally. Laparoscopic surgery has a steep learning curve necessitating repetitive procedural practice. We evaluate the efficacy of short- and long-duration simulation training on participant skill acquisition to support the recovery of surgical training. Methods: A prospective, observational study involving 18 novice medical students enrolled in a five-week course. Nodal timed assessments involved three tasks: hoop placement, stacking of sugar cubes and surgical cutting. One month post-completion, we compared the ability of six novice course participants to that of six surgical trainees who completed a smaller portion of the course curriculum. Results: Course participants (n=18) completed tasks 111% faster on their third and last course attempt. The surgical trainee group (n=6) took 46% longer to complete tasks compared to the six re-invited course participants, whose ability continued to advance on their fourth effort with a combined 154% earlier completion time compared to try one. Conclusions: This study supports the adoption of a structured, extended, regular and spaced-out simulation course or curriculum to cultivate greater skill acquisition and retention amongst surgical trainees, and improve patient care.

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