Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland最新文献

Background: Rectal division during minimally invasive surgery including robotic assisted surgery remains challenging, with current techniques often requiring multiple stapler firings to achieve effective transection.

Aims: We propose a novel technique which allows the use of a Contour® Curved Cutter Stapler to achieve rectal division during robotic assisted surgery.

Methods: The stapler is inserted through the routinely made pfannenstiel incision and a glove, over an Alexis® port used to create an airtight seal.

Conclusion: This simple technique enables reliable perpendicular single stapler firing to achieve rectal transection during colorectal robotic assisted surgery without the requirement for any further incisions.

Introduction: Gallstone disease is prevalent and carries substantial implications for morbidity and healthcare resource utilization. While early laparoscopic cholecystectomy (LC) is often preferred, its feasibility may be limited in some cases. As a result, many patients undergo conservative management.

Aims: To conduct a systematic review of the current literature to identify studies reporting on clinical predictors of recurrence in patients who undergo non-operative management of acute cholecystitis.

Methods: A systematic review was performed as per PRISMA and MOOSE guidelines. Studies comparing variables in patients who had acute cholecystitis recurrence (ACR) were included.

Results: Three studies were included in the review. There were 678 patients in total with a 28.5 % recurrence rate. Age, history of biliary disease, and severity of cholecystitis were identified as potential predictors of ACR. Biochemical results, such as inflammatory markers, white cells, and albumin levels, may also play a role. Radiological findings, including gallbladder wall thickness and stone characteristics, showed potential as predictors.

Conclusion: Identifying patients at risk of recurrent cholecystitis is important in guiding clinical decision-making. While certain findings show promise as predictors, the available evidence is limited and inconclusive. Larger studies are needed to develop risk stratification tools for better management of gallstone disease.

Purpose: The objective of this research was to explore the role of surgeon relationships with their colleagues on career satisfaction.

Methods: This qualitative study employed a thematic analysis based on the core elements of The Grounded Theory Method. Forty-two pediatric neurosurgeons, cardio-thoracic surgeons and ophthalmologists were recruited from 9 countries around the globe and interviewed in-depth about the role of their collegial relationships on their career satisfaction. Data was coded line-by-line to extract themes and to identify patterns across the interviews.

Results: Career satisfaction was greatly enhanced by having a cohesive and healthy team. 'Healthy' teams were described as those that were emotionally supportive of each other, where colleagues could be trusted to back each other up, where communication was open and transparent, and where collaboration was the departmental norm. Career satisfaction was greatly diminished when there were interpersonal conflicts and personality clashes between surgeons, where there was poor departmental leadership creating a culture of fear and insecurity, when colleagues were perceived as egotistical, in competitive departments, where there was perceived to be an unequal distribution of work, and when surgeons felt alone and unsupported.

Conclusions: Our study found that healthy teams had very specific qualities that could be cultivated and enhanced on surgical teams by making a conscious effort to improve the workplace culture and psychological safety among the team. In the conclusions, a number of recommendations are made on how to go about achieving this goal.

Background: Synovial sarcoma (SS) is typically diagnoses in young adults and usually appears in the extremities and soft tissues. However, it can sometimes arise in visceral organs. This study examines the differences in patient demographics, clinical features, and survival rates between soft tissue and visceral synovial sarcoma.

Methods: We analyzed data from the Surveillance, Epidemiology, and End Results (SEER) database spanning 2000-2018. ANOVA (analysis of variance) was used to identify significant factors for multivariate analysis. Cox regression modeling was used to determine independent risk factors for survival.

Results: Of the 2,776 SS patients included, the median age was 39.0 years, predominating male (53.0 %) and white (81.3 %). Bone and soft tissue sarcomas were more common, accounting for 86.4 % of cases (p-value<0.001), while the rest were diagnosed as visceral sarcomas. Visceral SS patients were typically older (p-value<0.001), male (56.8 %), and white (84.8 %). They also presented more frequently with distant metastasis (HR 3.8, 95 % CI, 2.4-6.1), had larger tumors on average (HR for tumors >10 cm: 2.9, 95 % CI, 2.0-4.1), and were less likely to undergo surgery (HR 0.4, 95 % CI, 0.3-0.6). Despite receiving multimodal treatments, including surgery, radiation, and/or chemotherapy, visceral SS patients exhibited poorer overall survival compared to their bone and soft tissue SS counterparts (p-value<0.001).

Conclusion: Visceral SS often presents in older patients with advanced-stage and larger tumor size as compared to bone and soft tissue SS, which likely contributes to poorer survival. Advanced age, regional spread, and larger tumor size were all found to worsen outcomes, while surgery and radiation were found to be protective factors.

Introduction: Hernias following iliac bone grafting are a rare but significant complication, with the earliest case reported in 1945. Repairing these hernias is challenging. Appropriate repair techniques are needed to minimise morbidity and recurrence. We present our experience with three cases of post-iliac graft hernia repair with mesh anchored to titanium mini-plates and a systematic review of current literature.

Method: We conducted a systematic review of the literature in February 2024 on two online databases, PubMed®/MEDLINE and EMBASE, in accordance with PRISMA guidelines. Keywords used were "Hernia," "Iliac," and "Graft." Data on demographics, initial pathology, time to presentation, type of hernia repair, and outcome were collected. Studies not in English and related to other types of hernia were excluded.

Results: We included 30 studies out of 751 results, spanning from 1975 to 2023. There were 40 reported cases of hernias post iliac bone grafting. The age distribution ranged from 37 to 88 years, with a median age of 60. The majority of patients (40 %) presented within one year. Fracture management, accounting for 19 cases (47.5 %), was the main indication for bone grafting. Mesh repair was performed in 31 cases (77.5 %). Seven cases (17.5 %) of recurrence were reported.

Conclusion: Recurrence is a common complication in patients with post-iliac graft hernias. Open mesh repair is the most frequently performed surgery and involves various techniques. While titanium mini-plates as anchors enable a pre-peritoneal plane mesh repair, long-term follow-up and comparative studies are needed to evaluate its efficacy compared to simple mesh.

Background: Multi-ligament knee injury (MLKI) is a complex orthopaedic knee problem, usually following traumatic knee dislocation. Surgical management is preferred and has resulted in better clinical outcomes. However, the optimal surgical treatment protocol is continuously evolving. This study aimed to compare the outcomes of one-stage versus two-stage reconstruction of MLKI.

Materials and methods: This retrospective comparative study was conducted between July 2020 and December 2023 at a government orthopaedic hospital in Nigeria. The inclusion criteria include males and females between 18 and 45 years of age who had one- or two staged knee reconstructions for MLKI and were followed up for a minimum of 12 months. The exclusion criteria were patients below 18 and above 45 years of age, those with previous knee surgery, those associated with femoral or tibia fractures, those with radiological evidence of osteoarthritis, and those with follow-ups less than 12 months. Clinical outcomes using the Lysholm scoring system and complication rate were recorded. The statistical analysis was performed using SPSS version 23.

Results: Fifty-one patients (26 in the OS group and 25 in the TS group) were studied. There was a significant difference between the preoperative and postoperative Lysholm scores in the two groups (p = 0.86 and 0.57 for OS and TS, respectively). However, there was no significant difference between the postoperative Lysholm scores in the two groups (p = 0.918).

Conclusion: One-stage and two-stage reconstruction of chronic MLKI give similar excellent clinical outcomes.

Background: Endovascular aneurysm repair (EVAR) has become the predominant treatment for Abdominal aortic aneurysm (AAA). Racial disparity has been observed in EVAR but Asian Americans have been largely excluded from previous studies. This study aimed to comprehensively evaluate 30-day outcomes of Asian Americans undergoing EVAR for intact infrarenal AAA using a multi-institutional national database.

Methods: Patients who underwent infrarenal EVAR from 2012 to 2022 were identified in the ACS-NSQIP database. Exclusion criteria included age less than 18 years, emergency presentation, and acute intraoperative conversion to open. A 1:3 propensity-score matching was applied to Asian Americans and Caucasians to match their demographics, comorbidities, aneurysm diameter, distant extent of the aneurysm, anesthesia, and concomitant procedures. Thirty-day postoperative outcomes were examined.

Results: Among 16,463 patients who underwent EVAR for non-ruptured infrarenal AAA, 302 (1.83 %) were Asian Americans and 12,373 (75.16 %) were Caucasians. Asian Americans had older age and higher burdens of medical comorbidities. After propensity-score matching, Asian American and Caucasian patients had comparable 30-day outcomes including mortality (1.99 % vs 1.34 %, p = 0.42), cardiac complications (2.32 % vs 1.56 %, p = 0.45), pulmonary complications (2.32 % vs 1.89 %, p = 0.64), and renal complications (1.99 % vs 0.89 %, p = 0.13). However, Asian American patients had a longer operative time (155.80 ± 84.59 vs 136.60 ± 69.60 min, p < 0.01) and length of stay (3.60 ± 6.16 vs 2.71 ± 4.50 days, p = 0.01). All other 30-day outcomes were comparable between Asian American and Caucasian patients.

Conclusion: Asian Americans might be underrepresented in EVAR due to limited healthcare access or a more insidious disease progression. After propensity-score matching, Asian Americans showed similar 30-day outcomes as their Caucasian counterparts. Thus, when given access, EVAR can be as effective and safe for Asian American patients. Future research should investigate the long-term prognosis for Asian Americans after EVAR.

Background & purpose: Cleft Lip and/or Palate, which affects approximately 1:650 live births in Ireland, is a complex congenital condition with lifelong implications. It can affect upper airway function, feeding, hearing, speech development, dental development as well as oral functioning, facial growth and physical appearance. Within cleft surgery, rigorous audit of speech, facial growth and nasolabial aesthetic outcomes is well-established. The importance of including patient-reported outcomes in our routine data-collection is now recognised. The purpose of the current study was to examine patient-reported outcomes (PROs) in a consecutive series of adolescents attending the Dublin Cleft Centre (DCC).

Methods: A validated patient-reported outcome measure (PROM), the CLEFT-Q, was prospectively administered to 156 patients attending the cleft clinic. Results were analysed according to cleft type and compared to those recorded in the CLEFT-Q validation study.

Results: Between (February 2020 and March 2022), the CLEFT-Q was administered to 156 patients with a mean age of 13.5 years (range 10-19 years). Males scored higher satisfaction across all subdomains irrespective of age. Satisfaction was higher in younger age groups compared to older patients in both appearance and quality of life outcomes. Patients with isolated cleft palate scored highest for satisfaction in school, social and psychological function.

Conclusions: PRO data now informs consultations with patients and families at the DCC. This information is also useful in targeting service development to the specific needs of this patient group.