RSS 1.0Surgery
The Surgery Directorate represents a range of surgical departments as well as a number of additional services (including Cancer Support and Special Care Dental) and wards (Alex and Nason, Captain Tom Moore Unit, Florence Nightingale, and Mary Seacole). This sub-community represents the research outputs of those working within this area.
Collections in this community
Recent Submissions
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The management and outcomes of patients with fractured neck of femur during the COVID-19 pandemic; a district general hospital experienceAbstract 739 from the ASiT x MedAll Virtual Surgical Summit 2020.
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Life and times of Sushruta: fact and fictionA Letter to the Editor on the ancient Indian surgeon, Sushruta.
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Intra-operative Pectoral Nerve Block under direct vision – does it save theatre time for breast surgery?From the European Society of Surgical Oncology (ESSO) 40 Virtual Congress 2020.
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Percutaneous retroperitoneoscopic drainage of complex extraperitoneal abscesses using flexible endoscopy: description of technique and perioperative careThe treatment of primary psoas abscesses usually is performed by a combination of prolongued antiobiotic therapy and drainage with interventional radiology techniques. However, although this combination is usually adequate for the treatment of solitary extraperitoneal collections, the presence of multi-loculated complex abscesses requires usually multiple procedures and feruently mandates open surgery. Herein, we describe an alternative tehnique of percutaneous retroperitoneoscopic drainage of multiple extensive primary psoas abscesses using flexible endoscopy, which can enable treatment these cases as one-stop proedure in a minimally invasive manner.
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Benjamin Franklin: created a stronger constitution from improved catheter designEposter abstract P7-8 from the British Association of Urological Surgeons BAUS 2021 virtual meeting.
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Acute appendicitis in the context of undescended cecum: laparoscopic management with restoration of the orthotopic anatomyUndescended cecum is a rare congenital abnormality; upon development of acute appendicitis though, the high position of the cecum results in atypical clinical symptomatology. We present a rare case of appendicitis in a patient with undescended cecum, which we managed laparoscopically, combining the appendicectomy with orthotopic repositioning of the cecum. Key words: laparoscopy, malrotation, undescended cecum, emergency, surgery
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Laparoscopic management of acutely symptomatic chylous mesenteric cystAcutely symptomatic chylous mesenteric cyst is a very rare cause of acute abdomen. We report a case of acutely inflamed chyle-containing benign mesenteric cyst, highlighting the role of laparoscopy as a safe diagnostic and therapeutic modality.
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Is group and saving before the modern bipolar transurethral resection of the prostate still necessary?Introduction: Group and save (G&S) sampling is commonplace for patients undergoing transurethral resection of the prostate (TURP) due to the historically high risk of bleeding. However, modern adjustments to the procedure, including the advent of bipolar TURP in saline, have significantly reduced this risk. This study assessed whether routinely performing G&Ss before the modern TURP is still appropriate. Materials and Methods: This study was a retrospective review of all patients who underwent a TURP from January 2009 until December 2019 in one centre. A total of 687 patients were identified during this period. In addition, data was collected on G&S samples, blood products, and postoperative complications such as clot retention or if patients required a blood transfusion. Results: All patients had G&S samples taken before their operation. Only six (0.87%) patients required a blood transfusion. Half were transfused intra-operatively and half post-operatively. Remarkably, none of the transfused patients were below the National Institute for Health and Care Excellence (NICE) threshold to transfuse of <70g/L(8). Six patients were also noted to develop clot retention following the catheter removal. Discussion and Conclusion: This study has determined that patients undergoing a TURP rarely require blood transfusions. We propose that the practice of routinely taking G&S samples before this procedure should be reviewed. This would give a financial benefit and relieve patients of the unnecessary test. We would recommend thorough optimisation of patients before surgery, including review of anticoagulation and correction of any preoperative anaemia.
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Should hospital readmissions be a key performance indicator in assessing a colorectal unit?Abstract P561 of the European Society of Colproctology 17th Scientific & Annual Meeting, 21 - 23 September 2022, Dublin, Ireland.
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How well do endoscopic morphological and histopathological characteristics correlate in colonic polypectomy reporting?Abstract P384 of the ESCP 17th Scientific & Annual Meeting, 21-23 September 2022, Dublin, Ireland.
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Introduction of under 40s clinic to reduce pressures of the 2 week wait targets in a district general hospitalAbstract P074 from The Association of Breast Surgery Conference 2022.
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Ruscus extract, hesperidin methyl-chalcone and vitamin C, constituents of Cyclo 3 fort® in symptomatic chronic venous insufficiency: initial tertiary experience from southwestern GreeceLetter to the Editor regarding an initial tertiary experience from southwestern Greece of ruscus extract, hesperidin methyl-chalcone and vitamin C, constituents of Cyclo 3 fort® in symptomatic chronic venous insufficiency.
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Hyperthermic intraperitoneal chemotherapy with mitomycin C versus oxaliplatin after cytoreductive surgery for the treatment of peritoneal metastases of colorectal cancer originBackground: Mitomycin C and oxaliplatin are considered the main chemotherapeutic agents used in the context of hyperthermic intraperitoneal chemotherapy (HIPEC) after the performance of cytoreductive surgery for peritoneal metastases of colorectal cancer origin. However, there is lack of a generally accepted consensus regarding the optimal choice between them as upfront chemo-therapetic agent. Our paper aims to summarize in a comprehensive manner the available evidence, while individualised schemes with targeted therapies are under development. Methods: We conducted a comprehensive, narrative review of the literature including all previous studies until 03/2022, which reported perioperative and/ or oncological outcomes after the use of mitomycin C and/ or oxaliplatin as main hyperthermic chemotherapy agents after cytoreductive surgery for colorectal peritoneal metastatic disease. Results: Data from a total of 23 single-agent and 13 comparative studies were included in our review. Despite the demonstrated safety profile of both chemotherapeutics, the heterogeneity of the included studies, their retrospective nature and the absence of relevant randomized trials prohibits the drawing of safe conclusions regarding the superiority of one of the two agents. However, it seems that perioperative morbidity is less with oxaliplatin-based HIPEC, while mitomycin C appears as a more cost-effective option. Conclusions: Selection of the optimal intraperitoneal chemotherapy agent for peritoneal metastases of colorectal cancer origin after the completion of cytoreductive surgery is still a matter of debate, with significant institutional variation. Further randomized clinical trials between the two commonest HIPEC agents are required, assessing the differences in perioperative outcomes, oncological outcomes, healthcare-associated costs and patients' quality of life. Keywords: chemotherapy; cytoreduction; hyperthermia; mitomycin; oxaliplatin.
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Is the increase in emergency colorectal cancer presentation directly related to the after effects of the pandemic?Poster abstract from the ESCP 17th Scientific & Annual Meeting, 21 - 23 September 2022, Dublin, Ireland.
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Multiple synchronous intestinal tumorsLetter to the Editor reporting the case of an 83-year-old woman with synchronous primary cancers of terminal ileum, sigmoid and upper rectum.
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Is group and saving before the modern transurethral resection of the prostate still necessary?A group and save (G&S) sample is routinely taken preoperatively for patients undergoing a transurethral resection of the prostate (TURP). This procedure has become a key endo-urological procedure; however, it can be associated with complications such as bleeding, potentially requiring blood transfusion. The aim of our study was to assess the need for preoperative G&S sampling in all patients undergoing TURP. This study was a retrospective review of all patients who underwent a TURP from January 2009 until December 2019 in one centre. A total of 687 patients were identified during this period. Data was collected on G&S samples, blood products and post-operative complications such as clot retention or if patients required a blood transfusion. All patients had G&S samples taken prior to their operation, of these, only six (0.87%) patients required a blood transfusion. Half were transfused intra-operatively and half post-operatively. Remarkably, none of the transfused patients were below the National Institute for Health and Care Excellence (NICE) threshold to transfuse of <70g/dl(8). Six patients were also noted to develop clot retention following removal of catheter. This study has determined that patients undergoing a TURP rarely require blood transfusions. We propose that the practice of routinely taking G&S samples prior to this procedure should be reviewed. This would give a financial benefit and relieve patients of an unnecessary test. We would recommend thorough optimisation of patients prior to surgery including review of anticoagulation and correction of any pre-operative anaemia.
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Delayed presentation of non-traumatic bilateral leg pseudoaneurysms mimicking soft-tissue sarcoma - a case reportIntroduction: Non-traumatic pseudoaneurysms are very rare but should be considered as a differential diagnosis on patients presenting with a thigh mass. Case Report: We present an extremely unusual case of a 70-year-old patient who presented with clinical features of a soft-tissue sarcoma of the thigh that instead was proven to be a non-traumatic pseudoaneurysm. There was also incidental finding of bilateral leg non-traumatic pseudoaneurysms. Conclusion: Medical practitioners must consider the possibility of non-traumatic pseudoaneurysm in patients that present with a thigh mass. Keywords: Pseudoaneurysm, non-traumatic, thigh, sarcoma
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Grade 3 AC joint injury: a survey of current practice in the United KingdomAcromio-clavicular (AC) joint injuries are a common injury seen in athletes and represent 9% to 12% of all shoulder injuries. There is no clear consensus on treatment of grade 3 injuries. We conducted a survey among upper limb surgeons in the United Kingdom to review commonly accepted practise. We found that majority of surgeons never did stress view. Most surgeons favoured surgery only if needed but not first choice. There is no consensus on timing of surgery. There are many fixation options available for AC joint dislocation and we found that surgeon's preferences were quiet wide for choosing fixation method. That is also evident from this questionnaire as there is no consensus in orthopaedic surgeons for ideal treatment of type 3 AC joint dislocations. Authors recommend randomized controlled trial to formulate definite treatment plan.
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Auditing the routine microbiological examination of pus swabs from uncomplicated perianal abscesses: clinical necessity or old habit?Background: Obtaining pus swabs from perianal abscesses after incision and drainage for subsequent microbiological analysis is traditionally performed by general surgeons. Our aim is to assess the current practice in our institution, emphasizing on whether pus swabs were sent or not, as well as to identify any associations between the revealed microbiology and the occurrence of immediate post-operative complications and re-admission rates with fistula-in-ano up to 12 months post the emergency drainage. Finally, we aimed to identify if the any members of the surgical team reviewed at any stage post-operatively the results of the microbiological examination of the obtained pus swabs and if that resulted in changes of the patient management. Methods: We reviewed the operative findings and perioperative antimicrobial management of all patients within our institution that required surgical treatment of perianal abscesses over a 6-week period and re-assessed them after 12 months from the performed drainage, with respect to re-admission and identification of occurred fistula-in-ano. Results: A total of 24 patients met our inclusion criteria. Pus swabs were sent in 66.7% of cases and only a third of the requested microbiology reports were reviewed by a part of the surgical team. All patients were discharged prior to the release of the microbiology results with no subsequent change in the management plan. We did not find any consistent association between the microbiology results and re-admission with perianal abscess, with or without fistula-in-ano. Conclusions: We do not recommend routine use of pus swabs when draining perianal abscesses unless clinical concerns arise, including recurrent perianal sepsis, immuno-compromised status or extensive soft tissue necrosis, especially when these features are associated with systemic sepsis.
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Benign multicystic peritoneal mesothelioma presenting as appendiceal abscess: a diagnostic and therapeutic challengePrimary peritoneal tumors are rarely encountered and their management is usually challenging for the clinicians. Especially when the patients with advanced peritoneal malignancy present as surgical emergencies, usually with symptoms of obstruction, perforation or gross space-occupying lesions, the on-call surgical team has to weigh the pros and cons of urgent versus delayed treatment and plans a safe and simultaneously oncologically beneficial therapeutic approach. Herein, we present a case of a Caucasian man who was referred as suspected complicated appendicitis by his primary care physician, with the final diagnosis being benign multicystic mesothelioma. We describe the challenges of the clinical decision making for the emergency general surgeon and relevant diagnostic and therapeutic pitfalls, which can be potentially minimized by early liaison with tertiary units specializing in the treatment of disseminated peritoneal malignancy.