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.
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Understanding ricketsRickets is a condition that has been recognised for many centuries and is due to defective mineralisation of the growth plate in growing children. This defect compromises the mechanical support and mineral reservoir functions of the skeleton which leads to the typical skeletal deformities and the disordered mineral metabolism. Either calcium and/or phosphate may be deficient in the aetiology of rickets. Considerable advances in the pathophysiology of hypophosphataemic rickets have been made in recent years. Advances in genetics have led to the identification of many forms of inherited rickets. However nutritional Vitamin D deficiency rickets remains the most prevalent cause worldwide and has made a resurgence in many developed countries in recent years. This article reviews the current knowledge about the different causes of rickets and provides guidelines on diagnosis and management.
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Extralevator abdominoperineal excision : our experience in a district general hospitalPoster abstract P217 of the 10th Scientific and Annual Meeting of the European Society of Coloproctology, 23–25 September 2015, Dublin, Ireland.
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Management of venothromboembolic disease in patients with newly diagnosed colorectal cancerPoster abstract P133 of the 10th Scientific and Annual Meeting of the European Society of Coloproctology, 23–25 September 2015, Dublin, Ireland.
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Are we under-investigating possible venothromboembolic disease in newly diagnosed colorectal cancer?Poster abstract P134 of the 10th Scientific and Annual Meeting of the European Society of Coloproctology, 23–25 September 2015, Dublin, Ireland.
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Trigonalgia : an overlooked cause of bladder painBladder pain is a cause of chronic pelvic pain, which constitutes a common presentation in urology out-patient consultation, especially among females. Some endoscopic features of the trigone observed during cystoscopy was correlated with mild to moderately bothersome bladder pain, termed trigonalgia. This is due to peculiarity of the trigonal anatomy from the rest of bladder, especially with the highest concentration of afferent nerves. Research focused on the trigone is worthwhile.
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Is full body MRI (FB-MRI) a viable alternative to bone scan (BS) in detection of metastasis in GEH patients with prostate cancer?Conference abstract 0781 from the Association of Surgeons in Training ASiT Annual International Surgical Conference 2018, Edinburgh, United Kingdom, 6 - 8 April 2018.
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Transurethral resection of prostate (TURP) surgery without using a 3-way catheter : 10 years of dataConference abstract 0644 from the Association of Surgeons in Training ASiT Annual International Surgical Conference 2018, Edinburgh, United Kingdom, 6 - 8 April 2018.
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Urology simulation teaching - COMET (Clinically Observed Medical Education Training)Conference abstract 0777 from the Association of Surgeons in Training ASiT Annual International Surgical Conference 2018, Edinburgh, United Kingdom, 6 - 8 April 2018.
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Our experience with colorectal cancer rate, Three years post colonoscopyPoster abstract P475 from the 13th Scientific and Annual Meeting of the European Society of Coloproctology, Nice, France, 26-28 September 2018.
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To biopsy or not to biopsy? MDT decision making & challenges in implementation of a quality improvement programme (QIP) in a district hospital to enhance prediction of non-significant prostate cancer by use of the PI-RAD V2 scorePoster abstract MP4-6 from the 36th World Congress of Endourology, WCE 2018, Paris, France, September 21-23, 2018.
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Transurethral resection of prostate (TURP) : surgery without using a 3-way catheterTransurethral resection of the prostate (TURP) continues to be an effective intervention for certain indications; and this procedure is still one of the most commonly performed in urology. The use of a 3-way catheter with continuous bladder irrigation (CBI) post-TURP is widely practiced in a bid to prevent clot retention. We report our unique experience with the use of 2-way urethral catheters post-TURP surgery. Methodology Data was prospectively collected for 143 consecutive patients who underwent a bipolar TURP between July 2015 and October 2017. The following outcomes where measured and compared against the literature: resection time, resected weight, haemoglobin level, hospital stay, catheterization days, transfusion rate and complications. Results Two-way 18-French catheters were used in 132/143 (91.7%) patients. The remaining 11/143 (8.3%) patients had a 3-way 22-French catheter and CBI immediately post-TURP. There were no incidences of clot retention requiring a return to theatre. There were 2/132 (1.5%) patients requiring transfusion who received 2-way catheterization. The average resection time was 44.8 (10-100) minutes, with a mean resected weight of 22.8 (2.0-70.0) grams. Post-operatively, we found minimal drop in haemoglobin levels, with a fall of 0.7 g/dL on average, with a range of 0.1-3.4 g/dL. Mean length of stay following TURP was 1.45 days (1-18), and 101/132 (76.5%) of patients had a successful trial without catheter on the first post-operative day. Conclusion Our outcomes compare favorably with the published data. This study suggests it may be possible to reduce the cost and resources associated with the use of 3-way catheters and CBI post-TURP surgery by using a 2-way catheter instead. Despite this, appropriate patient selection for this novel technique needs to be adopted. Our results would suggest that patients with smaller prostates or limited resections might be suitable for a 2-way urethral catheter post-TURP.
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Sports, ankle osteoarthritis, and total ankle arthroplastyAnkle osteoarthritis (OA) is common among young and active people. The majority of the affected population are physiologically young and used to be sports active, which make their expectations of the treatment higher than hip and knee OA population. Non-surgical interventions sometimes can be a short-term solution, but surgical procedures such as Total Ankle Arthroplasty (TAA) are considered in end-stage OA. Until recently, sports and exercise restriction has been widely recommended by surgeons for patients with ankle OA, to avoid increasing pain or further joint damage. The published studies showed that sports activities can be used as a treatment or at least as an adjunct in the management plan. Patients with TAA are classically advised to avoid sports participation for fear of implant failure. However, surprisingly some articles reported a good influence of sports activity on the functional TAA outcome. Up to date, guidelines and recommendations for intensity and types of sports to be practiced by TAA patients are scanty. In this article, sports activities in relation to Ankle OA and TAA will be comprehensively discussed.
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Acute complicated diverticulitis—opportunity for conservative treatmentPoster abstract P102 from the 14th Scientific and Annual Meeting of the European Society of Coloproctology, Austria Centre, 25-27 September 2019.
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Risk of colorectal cancer and advanced adenomas in complicated diverticulitis – is there a concern?Poster abstract P110 from the 14th Scientific and Annual Meeting of the European Society of Coloproctology, Austria Centre, 25-27 September 2019.
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Re-audit of accuracy of axillary ultrasound scan in detecting metastatic lymph node involvement in breast cancer patientsPoster abstract P022 from the Association of Breast Surgery ABS Conference 2019, 13-14 May 2019, SEC Glasgow, United Kingdom.
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Colonoscopy requests and follow-up appointments – evolving practicePoster abstract P087 from the 14th Scientific and Annual Meeting of the European Society of Coloproctology, Vienna, Austria, 25–27 September 2019.
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The burden on a urologist of percutaneous nephrostomies and antegrade ureteric stents : should trainee urologists learn to perform these procedures?Background and Objective Renal obstruction is a common urological emergency potentially requiring urgent decompression by percutaneous nephrostomy (PCN) or antegrade ureteric stent (AUrS), procedures performed by interventional radiologists, or retrograde stenting in theatre by a urologist. The study aimed to assess the burden of PCN / AUrS on the overall workload of a urology department and evaluate impact of procedural delays in terms of bed-occupancy and cost. The findings serve to explore whether formal PCN / AUrS training would be desirable for UK trainees in urology. Material and Methods Prospective study of all patients admitted under urology at Queen Elizabeth Hospital Birmingham (QEHB) between 20thOctober - 18thNovember 2018. Electronic records to retrieve data pertaining to admission, treatment provided, length of in-patient stay and delay awaiting PCN / AUrS. Results n=148 patients identified. n=22 (14.8% of total) primary admission reason and/or main treatment provided related to PCN / AUrS. 601 urology in-patient days occupied for all causes, 166 (27.6%) related to PCN / AUrS and 66 (10.9%) awaiting PCN / AUrS (delays cost �11,361 / month). Conclusion PCN / AUrS constituted a noteworthy proportion of all admissions and in-patient bed days in QEHB urology. Clinically non-urgent patients experienced notable cumulative delays whilst awaiting PCN / AUrS which adversely impacted bed occupancy. A suitably trained urologist competent at PCN / AUrS may positively address these issues. The findings merit consideration of a call for UK urology trainees to be trained in PCN / AUrS as part of CCT requirements.
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Deliberate corrosive substance attacks – a systematic reviewPoster abstract from the 20th Trauma Care International Conference, 3-6 March 2019, Yarnfield Park, Stone, UK.
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Deliberate corrosive substance attacks – a systematic reviewIntroduction Deliberate corrosive substance attacks (DCSA) have traditionally been associated with low- and middle-income countries (LMIC). However, the incidence of DCSA in certain geographical locations of the UK has increased in recent years. These attacks have a relatively low mortality rate but cause extensive life-changing injuries and the management from point of wounding to definitive care is challenging for all involved. Methods A systematic review was used to identify literature about DCSA and establish how much evidence about these attacks has been published over the last decade. Victim and perpetrator characteristics, substances used, injury patterns, mortality, pre-hospital and hospital-based management and complications associated with management were areas of interest. The review included any medical literature (case reports, letters, reviews) published within the last 10 years that described DCSA against human victims. Non-English language articles were excluded. Results Eighteen articles containing 762 victims of DCSA were included; seven victims had incomplete data. Articles were mostly from LMIC (Bangladesh, Columbia, Cambodia, India, Iran, Sri Lanka and Pakistan) but there were five articles were from the UK (three ‘Letters to Editors’, one survivor letter and one retrospective review of 21 victims). UK victim and perpetrator characteristics varied from those in LMIC. Seven papers described pre-hospital management and nine described hospital/surgical management. Conclusions The evidence base surrounding DCSA is limited especially in the UK setting. More research into the epidemiology and management of DCSA in the UK is warranted.
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Restrospective review of post colonoscopy colorectal cancer rates at the George Eliot Hospital Endoscopy UnitPoster presentation abstract 429 from the Association of Surgeons in Training (ASiT) Annual Conference 6th-8th March 2020, Birmingham International Convention Centre.