{"title":"Robotic mastectomy: the possibility of a scarless future.","authors":"Gordon R Daly,Jennifer L McGarry,Arnold D K Hill","doi":"10.1093/bjs/znag002","DOIUrl":"https://doi.org/10.1093/bjs/znag002","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"32 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Saving the surgeon-scientist: need to build enduring support for surgical science.","authors":"Noémie Villemure-Poliquin,Stephanie Wong,Julie Hallet","doi":"10.1093/bjs/znag003","DOIUrl":"https://doi.org/10.1093/bjs/znag003","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"64 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146033618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Julien Hedou,Gwendoline Mendes,Grégoire Bellan,Daniel El Khoury,Franck Verdonk
{"title":"Impact of postoperative complications on cost and length of stay: multicentre prospective clinical study.","authors":"Julien Hedou,Gwendoline Mendes,Grégoire Bellan,Daniel El Khoury,Franck Verdonk","doi":"10.1093/bjs/znaf290","DOIUrl":"https://doi.org/10.1093/bjs/znaf290","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"37 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fiorenzo V Angehrn,Julian Süsstrunk,Romano Schneider,Kaspar Baltzer,Beat P Müller,Johannes Baur,Daniel C Steinemann
BACKGROUNDSuperiority of robotic inguinal hernia repair compared with a laparoscopic minimally invasive approach remains unproven. The aim of this study was to evaluate postoperative pain after laparoscopic totally extraperitoneal repair (TEP) compared with robotic transabdominal preperitoneal repair (rTAPP).METHODSThis was a prospective, patient- and investigator-blinded, two-group, single-centre RCT conducted at a tertiary Swiss healthcare institution including 182 patients undergoing elective primary inguinal hernia repair. Patients were randomized 1 : 1 and stratified according to BMI and unilateral or bilateral hernia to either TEP or rTAPP. Surgery took place between March 2022 and November 2024. The primary endpoint was postoperative pain while coughing 24 h after surgery. Surgical workload (assessed using the National Aeronautics and Space Administration (NASA) Task Load Index (TLX)) was also recorded.RESULTSIn total, 91 patients (93% male, mean(s.d.) age of 56.8(15.2) years, mean(s.d.) BMI of 24.8(3) kg/m2, and 22% with bilateral hernias) were randomized to TEP and 91 patients (95% male, mean(s.d.) age of 55.1(14.5) years, mean(s.d.) BMI of 24.6(2.9) kg/m2, and 21% with bilateral hernias) were randomized to rTAPP. Primary outcome data were available for 90 TEP patients and 88 rTAPP patients. The median postoperative pain while coughing on a numeric rating scale 24 h after surgery was 5 (interquartile range (i.q.r.) 2-7) after TEP and 4 (i.q.r. 2-7) after rTAPP (P = 0.431, Cohen's d = 0.12). The mean(s.d.) operating time for unilateral hernias was 64.2(19.2) min for TEP and 80.3(20.9) min for rTAPP (P < 0.001). Ten (11%) postoperative complications occured after TEP and nine (10%) after rTAPP (P > 0.999). The mean(s.d.) NASA raw TLX score was 34.0(17.2) after TEP and 18.4(10.7) after rTAPP (P < 0.001).CONCLUSIONrTAPP demonstrated no superiority over TEP regarding postoperative pain and complication rates. rTAPP was associated with a reduced surgeon workload at the expense of a longer operating time.REGISTRATION NUMBERNCT05216276 (http://www.clinicaltrials.gov).
{"title":"Robotic versus laparoscopic minimally invasive inguinal hernia repair: randomized clinical trial (the ROGER trial).","authors":"Fiorenzo V Angehrn,Julian Süsstrunk,Romano Schneider,Kaspar Baltzer,Beat P Müller,Johannes Baur,Daniel C Steinemann","doi":"10.1093/bjs/znaf283","DOIUrl":"https://doi.org/10.1093/bjs/znaf283","url":null,"abstract":"BACKGROUNDSuperiority of robotic inguinal hernia repair compared with a laparoscopic minimally invasive approach remains unproven. The aim of this study was to evaluate postoperative pain after laparoscopic totally extraperitoneal repair (TEP) compared with robotic transabdominal preperitoneal repair (rTAPP).METHODSThis was a prospective, patient- and investigator-blinded, two-group, single-centre RCT conducted at a tertiary Swiss healthcare institution including 182 patients undergoing elective primary inguinal hernia repair. Patients were randomized 1 : 1 and stratified according to BMI and unilateral or bilateral hernia to either TEP or rTAPP. Surgery took place between March 2022 and November 2024. The primary endpoint was postoperative pain while coughing 24 h after surgery. Surgical workload (assessed using the National Aeronautics and Space Administration (NASA) Task Load Index (TLX)) was also recorded.RESULTSIn total, 91 patients (93% male, mean(s.d.) age of 56.8(15.2) years, mean(s.d.) BMI of 24.8(3) kg/m2, and 22% with bilateral hernias) were randomized to TEP and 91 patients (95% male, mean(s.d.) age of 55.1(14.5) years, mean(s.d.) BMI of 24.6(2.9) kg/m2, and 21% with bilateral hernias) were randomized to rTAPP. Primary outcome data were available for 90 TEP patients and 88 rTAPP patients. The median postoperative pain while coughing on a numeric rating scale 24 h after surgery was 5 (interquartile range (i.q.r.) 2-7) after TEP and 4 (i.q.r. 2-7) after rTAPP (P = 0.431, Cohen's d = 0.12). The mean(s.d.) operating time for unilateral hernias was 64.2(19.2) min for TEP and 80.3(20.9) min for rTAPP (P < 0.001). Ten (11%) postoperative complications occured after TEP and nine (10%) after rTAPP (P > 0.999). The mean(s.d.) NASA raw TLX score was 34.0(17.2) after TEP and 18.4(10.7) after rTAPP (P < 0.001).CONCLUSIONrTAPP demonstrated no superiority over TEP regarding postoperative pain and complication rates. rTAPP was associated with a reduced surgeon workload at the expense of a longer operating time.REGISTRATION NUMBERNCT05216276 (http://www.clinicaltrials.gov).","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"28 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145937839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Perioperative management of people with diabetes undergoing surgery.","authors":"Ketan K Dhatariya","doi":"10.1093/bjs/znaf291","DOIUrl":"https://doi.org/10.1093/bjs/znaf291","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"54 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joachim S Skovbo,Lasse M Obel,Lytfi Krasniqi,Mads Liisberg,Jes S Lindholt
INTRODUCTIONSupervised Exercise Therapy (SET) is recommended as first-line treatment for intermittent claudication. We hypothesized that oxidative stress from long-term intermittent leg ischaemia is harmful and that revascularization mitigates this risk. The aim of this hypothesis-driven systematic review and meta-analysis was to evaluate the long-term mortality rate and clinical outcomes comparing SET with early revascularization in patients with intermittent claudication.METHODSRCTs comparing SET and early revascularization with >12 months follow-up and reporting mortality rates were included. Medline, Embase, Cochrane Central, ClinicalTrials.gov, and WHO ICTRP were searched using a modified PICO (PICS) framework. Risk-of-bias was assessed using the Cochrane Risk-of-Bias Tool. Meta-analyses applied hazard ratios, incidence rate ratios (IRR), or odds ratios as appropriate. PROSPERO registration: CRD42024536634.RESULTSSome nine cohorts from seven RCTs (1113 patients) were included. Meta-analysis of HR (two cohorts) displayed higher mortality rates with SET compared to early revascularization (HR: 1.83; 95% c.i.: 1.10 to 3.04; P = 0.02). Intention-to-treat IRR analysis (eight cohorts) displayed an IRR of 1.28; 95% c.i.: 0.91 to 1.79; P = 0.16. A worst-case post-hoc sensitivity analysis assuming all losses to follow-up as deaths presented higher mortality rate with SET (IRR: 1.29; 95% c.i.: 1.04 to 1.61; P = 0.02). SET reduced initial revascularizations by 60.3%, but 34.8% crossed over, resulting in over twice the need for subsequent revascularization (OR: 2.30; 95% c.i.: 1.71 to 3.11; P < 0.001). No differences were found for amputation, myocardial infarction, or stroke. Risk-of-bias was deemed high, and certainty of evidence ranged from low to very low.CONCLUSIONEarly revascularization may improve long-term survival compared to SET, although interpretation is limited by risk-of-bias and incomplete data in published studies.
{"title":"Long-term mortality rate after supervised exercise therapy versus early revascularization for intermittent claudication: a systematic review and meta-analysis.","authors":"Joachim S Skovbo,Lasse M Obel,Lytfi Krasniqi,Mads Liisberg,Jes S Lindholt","doi":"10.1093/bjs/znaf294","DOIUrl":"https://doi.org/10.1093/bjs/znaf294","url":null,"abstract":"INTRODUCTIONSupervised Exercise Therapy (SET) is recommended as first-line treatment for intermittent claudication. We hypothesized that oxidative stress from long-term intermittent leg ischaemia is harmful and that revascularization mitigates this risk. The aim of this hypothesis-driven systematic review and meta-analysis was to evaluate the long-term mortality rate and clinical outcomes comparing SET with early revascularization in patients with intermittent claudication.METHODSRCTs comparing SET and early revascularization with >12 months follow-up and reporting mortality rates were included. Medline, Embase, Cochrane Central, ClinicalTrials.gov, and WHO ICTRP were searched using a modified PICO (PICS) framework. Risk-of-bias was assessed using the Cochrane Risk-of-Bias Tool. Meta-analyses applied hazard ratios, incidence rate ratios (IRR), or odds ratios as appropriate. PROSPERO registration: CRD42024536634.RESULTSSome nine cohorts from seven RCTs (1113 patients) were included. Meta-analysis of HR (two cohorts) displayed higher mortality rates with SET compared to early revascularization (HR: 1.83; 95% c.i.: 1.10 to 3.04; P = 0.02). Intention-to-treat IRR analysis (eight cohorts) displayed an IRR of 1.28; 95% c.i.: 0.91 to 1.79; P = 0.16. A worst-case post-hoc sensitivity analysis assuming all losses to follow-up as deaths presented higher mortality rate with SET (IRR: 1.29; 95% c.i.: 1.04 to 1.61; P = 0.02). SET reduced initial revascularizations by 60.3%, but 34.8% crossed over, resulting in over twice the need for subsequent revascularization (OR: 2.30; 95% c.i.: 1.71 to 3.11; P < 0.001). No differences were found for amputation, myocardial infarction, or stroke. Risk-of-bias was deemed high, and certainty of evidence ranged from low to very low.CONCLUSIONEarly revascularization may improve long-term survival compared to SET, although interpretation is limited by risk-of-bias and incomplete data in published studies.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"23 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joel Norton,Allison M Janda,Emma Howie,Nicole Pohl,Egide Abahuje,Steven D Harrington,Vitaliy Popov,Tyler M Bauer,Paulo Borges,Gabriela Querejeta Roca,Michael R Mathis,Raymond J Strobel,Austin Airhart,Nicole Pham,Ryan Harari,Jake A Awtry,Francis D Pagani,Roger D Dias,Donald S Likosky,Steven Yule,
BACKGROUNDDeficiencies in non-technical skills (NTS) such as leadership and communication can lead to intraoperative inefficiency and error. However, the relationship between these skills and patient-level outcomes has yet to be synthesized. The aim of this study was to systematically review the evidence examining the relationship between intraoperative NTS and clinical outcomes.METHODSThe PubMed, Embase, CENTRAL, CINAHL, and PsycINFO databases were searched for relevant studies published between inception and 1 November 2024. Eligible studies assessed NTS of operating room personnel, were conducted in non-simulated environments, and reported clinical outcomes. NTS were categorized into five core domains including leadership and communication. Patient-level outcomes comprised eight clinical measures including mortality and postoperative complications.RESULTSOf 6313 screened studies, 21 met the inclusion criteria. Included studies represented 8536 participants performing 251 180 procedures across 13 specialties. Eleven observational studies assessed NTS of surgical personnel via study participants or observers. Ten interventional studies introduced NTS team training initiatives. Twelve of 21 studies (57%) incorporating 247 036 of all procedures (98.4%) reported significant improvements in clinical outcomes. Nine of 11 observational studies (82%) reported significant improvement in clinical outcomes compared with 3 of 10 interventional studies (30%). No studies demonstrated a significant deterioration in clinical outcomes associated with improved NTS.CONCLUSIONPublished evidence shows a significant link between intraoperative NTS and patient-level outcomes. These findings reinforce the value of behavioural assessment in surgery, support evidence-based team training, and underscore the need to embed NTS into regulatory frameworks to improve surgical quality and safety worldwide.
{"title":"Impact of surgical non-technical skills on clinical outcomes: systematic review.","authors":"Joel Norton,Allison M Janda,Emma Howie,Nicole Pohl,Egide Abahuje,Steven D Harrington,Vitaliy Popov,Tyler M Bauer,Paulo Borges,Gabriela Querejeta Roca,Michael R Mathis,Raymond J Strobel,Austin Airhart,Nicole Pham,Ryan Harari,Jake A Awtry,Francis D Pagani,Roger D Dias,Donald S Likosky,Steven Yule, ","doi":"10.1093/bjs/znaf271","DOIUrl":"https://doi.org/10.1093/bjs/znaf271","url":null,"abstract":"BACKGROUNDDeficiencies in non-technical skills (NTS) such as leadership and communication can lead to intraoperative inefficiency and error. However, the relationship between these skills and patient-level outcomes has yet to be synthesized. The aim of this study was to systematically review the evidence examining the relationship between intraoperative NTS and clinical outcomes.METHODSThe PubMed, Embase, CENTRAL, CINAHL, and PsycINFO databases were searched for relevant studies published between inception and 1 November 2024. Eligible studies assessed NTS of operating room personnel, were conducted in non-simulated environments, and reported clinical outcomes. NTS were categorized into five core domains including leadership and communication. Patient-level outcomes comprised eight clinical measures including mortality and postoperative complications.RESULTSOf 6313 screened studies, 21 met the inclusion criteria. Included studies represented 8536 participants performing 251 180 procedures across 13 specialties. Eleven observational studies assessed NTS of surgical personnel via study participants or observers. Ten interventional studies introduced NTS team training initiatives. Twelve of 21 studies (57%) incorporating 247 036 of all procedures (98.4%) reported significant improvements in clinical outcomes. Nine of 11 observational studies (82%) reported significant improvement in clinical outcomes compared with 3 of 10 interventional studies (30%). No studies demonstrated a significant deterioration in clinical outcomes associated with improved NTS.CONCLUSIONPublished evidence shows a significant link between intraoperative NTS and patient-level outcomes. These findings reinforce the value of behavioural assessment in surgery, support evidence-based team training, and underscore the need to embed NTS into regulatory frameworks to improve surgical quality and safety worldwide.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"9 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145847253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gordon R Daly,Gavin P Dowling,Sandra Hembrecht,Sorcha O'Grady,Aisling Hegarty,Trudi Roche,Gabriel Orsi,Arielle Pierre,Gavin G Calpin,Colm Neary,Cian M Hehir,Gerard J Hill,Abigail O'Brien,William P Duggan,Matthew G Davey,Ian J B Stephens,Niall D Kennedy,Oisín Brennan,Cathal Hayes,Mohammed Al Azzawi,Ishwarya Balasubramanian,Andrew McGuire,Alexandra M Zaborowski,Ian S Reynolds,Paula Loughlin,Michael Allen,Colm Power,Abeeda Butt,Michael R Boland,Niamh McCawley,John P Burke,William B Robb,Achille Mastrosimone,Mayilone Arumugasamy,Hugo Prins,David Beddy,Michael J Kerin,Deborah A McNamara,David Kearney,Jan Sorensen,Gerard F Curley,Sami Abd El Wahab,Arnold D K Hill
BACKGROUNDTransversus abdominis plane (TAP) block has been shown to be an effective technique in providing postoperative analgesia across a range of intra-abdominal surgeries. Laparoscopic-assisted transversus abdominis plane (LTAP) block is a recent advancement of this technique. The aim of this trial was to evaluate the effectiveness of LTAP block compared with port-site infiltration (PSI) of local anaesthetic in patients undergoing laparoscopic appendicectomy.METHODSA single-blinded RCT was performed across three academic hospitals. Patients were randomized 1 : 1 to receive LTAP block or PSI. The primary outcome was postoperative pain, assessed using a visual analogue scale (VAS). Secondary outcomes were postoperative opioid requirements, length of hospital stay (LOS), time to mobilization, and quality of life (QoL) after hospital discharge.RESULTSIn total, 85 of 87 patients (97.7%) in the LTAP group and 82 of 84 patients (97.6%) in the control (PSI) group were eligible for analysis. The VAS pain scores were statistically significantly lower overall in the LTAP group compared with the control (PSI) group on time-weighted analysis after laparoscopic appendicectomy (-1.7 (95% c.i. -2.06 to -1.34); P < 0.001). The difference-in-difference analysis showed that the mean VAS score for the LTAP group statistically significantly improved at 6 h (-1.63 (95% c.i. -2.55 to -0.70); P = 0.001) and 12 h (-2.06 (95% c.i. -2.92 to -1.20); P < 0.001) with no difference at 24 h (-0.68 (95% c.i. -1.55 to 0.19); P = 0.125). This is in comparison with the PSI group at 6 h (3.72 (95% c.i. 3.27 to 4.17); P < 0.001), 12 h (3.37 (95% c.i. 2.89 to 3.87); P < 0.011), and 24 h (1.57 (95% c.i. 1.13 to 2.01); P < 0.001). There was a significant reduction in oxycodone requirements in the LTAP group (1.2 versus 0.8; P = 0.032).CONCLUSIONLTAP block significantly improved early postoperative analgesia outcomes in patients undergoing laparoscopic appendicectomy and holds promise as part of an effective postoperative analgesic regimen.REGISTRATION NUMBERNCT05427266 (http://www.clinicaltrials.gov).
背景：腹横面阻滞（TAP）已被证明是一种有效的技术，可在一系列腹内手术中提供术后镇痛。腹腔镜辅助腹横面阻滞（LTAP）是该技术的最新进展。本试验的目的是评估LTAP阻滞与端口部位浸润（PSI）局部麻醉在腹腔镜阑尾切除术患者中的有效性。方法采用单盲随机对照试验（RCT）对3所专科医院进行分析。患者以1:1的比例随机接受LTAP阻滞或PSI治疗。主要终点是术后疼痛，使用视觉模拟评分（VAS）进行评估。次要结局是术后阿片类药物需求、住院时间（LOS）、活动时间和出院后生活质量（QoL）。结果LTAP组87例患者中有85例（97.7%）符合分析标准，对照组（PSI） 84例患者中有82例（97.6%）符合分析标准。腹腔镜阑尾切除术后，LTAP组VAS疼痛评分总体上低于对照组（PSI）组(-1.7 (95% ci . -2.06 ~ -1.34)；P < 0.001)。两组间差异分析显示，LTAP组VAS平均评分在6 h时显著改善(-1.63 (95% ci . -2.55 ~ -0.70)；P = 0.001)和12 h (-2.06 (95% c.i。-2.92 - -1.20);P < 0.001)， 24小时无差异(-0.68 (95% ci: -1.55 ~ 0.19)；P = 0.125)。这与PSI组在6小时(3.72 (95% c.i. 3.27至4.17)；P < 0.001)， 12小时（3.37）（95% ci: 2.89 ~ 3.87）；P < 0.011), 24 h (1.57) (95% ci = 1.13 ~ 2.01)；P < 0.001)。LTAP组羟考酮需要量显著降低（1.2 vs 0.8; P = 0.032）。结论ltap阻滞可显著改善腹腔镜阑尾切除术患者术后早期镇痛效果，有望成为有效的术后镇痛方案的一部分。注册号05427266 （http://www.clinicaltrials.gov）。
{"title":"Laparoscopic-assisted transversus abdominis plane block versus port-site infiltration in appendicectomy: multicentre randomized clinical trial.","authors":"Gordon R Daly,Gavin P Dowling,Sandra Hembrecht,Sorcha O'Grady,Aisling Hegarty,Trudi Roche,Gabriel Orsi,Arielle Pierre,Gavin G Calpin,Colm Neary,Cian M Hehir,Gerard J Hill,Abigail O'Brien,William P Duggan,Matthew G Davey,Ian J B Stephens,Niall D Kennedy,Oisín Brennan,Cathal Hayes,Mohammed Al Azzawi,Ishwarya Balasubramanian,Andrew McGuire,Alexandra M Zaborowski,Ian S Reynolds,Paula Loughlin,Michael Allen,Colm Power,Abeeda Butt,Michael R Boland,Niamh McCawley,John P Burke,William B Robb,Achille Mastrosimone,Mayilone Arumugasamy,Hugo Prins,David Beddy,Michael J Kerin,Deborah A McNamara,David Kearney,Jan Sorensen,Gerard F Curley,Sami Abd El Wahab,Arnold D K Hill","doi":"10.1093/bjs/znaf257","DOIUrl":"https://doi.org/10.1093/bjs/znaf257","url":null,"abstract":"BACKGROUNDTransversus abdominis plane (TAP) block has been shown to be an effective technique in providing postoperative analgesia across a range of intra-abdominal surgeries. Laparoscopic-assisted transversus abdominis plane (LTAP) block is a recent advancement of this technique. The aim of this trial was to evaluate the effectiveness of LTAP block compared with port-site infiltration (PSI) of local anaesthetic in patients undergoing laparoscopic appendicectomy.METHODSA single-blinded RCT was performed across three academic hospitals. Patients were randomized 1 : 1 to receive LTAP block or PSI. The primary outcome was postoperative pain, assessed using a visual analogue scale (VAS). Secondary outcomes were postoperative opioid requirements, length of hospital stay (LOS), time to mobilization, and quality of life (QoL) after hospital discharge.RESULTSIn total, 85 of 87 patients (97.7%) in the LTAP group and 82 of 84 patients (97.6%) in the control (PSI) group were eligible for analysis. The VAS pain scores were statistically significantly lower overall in the LTAP group compared with the control (PSI) group on time-weighted analysis after laparoscopic appendicectomy (-1.7 (95% c.i. -2.06 to -1.34); P < 0.001). The difference-in-difference analysis showed that the mean VAS score for the LTAP group statistically significantly improved at 6 h (-1.63 (95% c.i. -2.55 to -0.70); P = 0.001) and 12 h (-2.06 (95% c.i. -2.92 to -1.20); P < 0.001) with no difference at 24 h (-0.68 (95% c.i. -1.55 to 0.19); P = 0.125). This is in comparison with the PSI group at 6 h (3.72 (95% c.i. 3.27 to 4.17); P < 0.001), 12 h (3.37 (95% c.i. 2.89 to 3.87); P < 0.011), and 24 h (1.57 (95% c.i. 1.13 to 2.01); P < 0.001). There was a significant reduction in oxycodone requirements in the LTAP group (1.2 versus 0.8; P = 0.032).CONCLUSIONLTAP block significantly improved early postoperative analgesia outcomes in patients undergoing laparoscopic appendicectomy and holds promise as part of an effective postoperative analgesic regimen.REGISTRATION NUMBERNCT05427266 (http://www.clinicaltrials.gov).","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"5 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145937838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A novel retromuscular Sugarbaker technique for parastomal hernia prevention in end colostomy: combination of laparoscopic posterior component separation and extraperitoneal bowel pull-through.","authors":"Jianlin Xiao,Wenjian Meng,Ziqiang Wang","doi":"10.1093/bjs/znaf252","DOIUrl":"https://doi.org/10.1093/bjs/znaf252","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"41 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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