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

{"title":"Are pelvic binders an effective measure to lower mortality and decrease blood loss after high energy pelvic ring injuries? A systematic review","authors":"Andreas Papaleontiou ,&nbsp;Andréa M. Poupard ,&nbsp;Paul Parker","doi":"10.1016/j.surge.2025.08.002","DOIUrl":"10.1016/j.surge.2025.08.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Pelvic binders are routinely used in the pre-hospital management of high energy pelvic ring injuries with a low threshold for utilisation. Current literature is inconclusive regarding the effectiveness of pelvic binders in controlling haemorrhage and decreasing mortality. The aim of this study is to investigate whether using such devices decrease mortality, blood loss, pain and complications.</div></div><div><h3>Method</h3><div>A systematic review was carried out using modern era articles published between January 2016 and May 2024 on two databases, investigating the effectiveness of pelvic binders in trauma patients in decreasing mortality, blood product requirement, pain level and complication rate.</div></div><div><h3>Results</h3><div>Five retrospective cohort studies, one interventional study with retrospective control and one RCT compared early binder application to late/no application and were included for analysis. were included. No clear superiority of pelvic binder application, regarding blood product requirements, mortality, pain and complications was demonstrated. Overall mortality in binder groups was 17.4 % and 15.7 % in the no/late binder groups. Only one study found a statistically significant superiority of pelvic binders regarding mortality when adjusted for confounding variables. Overall patients transfused were 35.6 % in the binder group and 25 % in the no/late binder group. Three out of seven studies reported a significantly lower blood product requirement in pelvic binder groups.</div></div><div><h3>Conclusion</h3><div>There is no clear superiority of early pelvic binder application over no/late binder use. The evidence is limited and lacks larger RCTs. Current widespread use of pelvic binders should be reevaluated, and alternative/adjunct devices should be further investigated for their effectiveness.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 6","pages":"Pages 371-380"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Venous thromboembolism (VTE) prevention in the trauma patient: A national survey of practice","authors":"Bibi Ayesha Bassa ,&nbsp;Michele Fernandes ,&nbsp;Elizabeth Little ,&nbsp;Kaitlin Alexander ,&nbsp;Frank Lyons ,&nbsp;Valeria Lima Passos ,&nbsp;Fionnuala Ni Ainle ,&nbsp;Etimbuk Umana","doi":"10.1016/j.surge.2025.06.001","DOIUrl":"10.1016/j.surge.2025.06.001","url":null,"abstract":"<div><h3>Aim</h3><div>Due to complex injury patterns, the safe timing of venous thromboembolism (VTE) prophylaxis in trauma patients is challenging. The purpose of this study was to characterize current thromboprophylaxis practice in trauma patients amongst trauma providers in Ireland.</div></div><div><h3>Methods</h3><div>We conducted a national, cross-sectional survey of trauma providers. The survey was sponsored by the Irish Network for VTE Research (INViTE) and disseminated through the national trauma and VTE office. The survey was a 35-item questionnaire and collected information regarding non-pharmacologic prophylaxis practice, preferred pharmacologic agent and dose, timing to initiation of prophylaxis in high-risk patients and selection of patients for extended thromboprophylaxis post discharge.</div></div><div><h3>Results</h3><div>A total of 116 trauma providers responded (estimated response rate among surgical specialities 11 %). Majority of respondents (72/116; 65 %) were consultant doctors or fellows. Thirty-seven percent of respondents (43/116) reported having a VTE guideline for trauma patients at their institution. Majority of respondents (115/116; 99 %) reported using some form of mechanical prophylaxis. The most common pharmacologic dosing regimen reported was enoxaparin 40 mg 24-hourly (44/116; 38 %). Forty-four percent of respondents (51/116) indicated adjusting doses in patients with obesity. A high degree of variability in initial timing of prophylaxis following traumatic brain injury, solid organ injury, and spinal column injuries was observed.</div></div><div><h3>Conclusion</h3><div>There is variable VTE prevention practice among trauma providers in Ireland. A standardized, national approach to VTE prevention in trauma care is needed.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 6","pages":"Pages 412-419"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lumbar decompression surgery for cauda equina syndrome: A meta-analysis and systematic review of the safety of operating out of hours","authors":"Henry A. Crouch-Smith,&nbsp;Iain Feeley,&nbsp;Margaret K. Lee,&nbsp;Nicholas Carleton-Bland,&nbsp;Simon Clark,&nbsp;Matthew Wilby","doi":"10.1016/j.surge.2025.08.003","DOIUrl":"10.1016/j.surge.2025.08.003","url":null,"abstract":"<div><h3>Objectives</h3><div>We conduct a systematic review and meta-analysis of the published literature regarding the impact of performing lumbar decompression for cauda equina syndrome (CES) out of hours compared to regular operating hours.</div></div><div><h3>Methods</h3><div>A search of databases including Medline, EMBASE and Cochrane Library was performed with two independent reviewers per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A senior author arbitrated in event of disagreement. MeSH terms [((cauda equina) OR (CES)) AND ((hours) OR OOH)] were used. Filters including date range (from January 01, 1990 to November 01, 2022) and the English language were applied. Inclusion criteria consisted of retrospective or prospective cohort studies, English or full translation available, surgical complication as primary or secondary outcome and out of hours surgery as an independent variable. Case reports and studies without complication frequency were excluded. There were no additional studies identified through a snowballing secondary search through references of identified articles. Operative metrics were compiled into ad-hoc tables. Statistical analysis was performed using RevMan 5.4. A difference in complication rates with a P value of &lt; .05 was deemed statistically significant. Heterogeneity was reported using I². Study quality was assessed using the Newcastle Ottawa Score (NOS).</div></div><div><h3>Results</h3><div>The search strategy yielded 363 articles. After duplicate removal and application of inclusion/exclusion criteria, 15 studies were sought for retrieval and full text review. Of these, 5 studies were included for qualitative synthesis. Of these, 4 studies underwent quantitative analysis with 581 datasets. Meta-analysis was undertaken on 3 studies comprising 495 datasets. A dichotomous outcome was modelled using the Mantel-Haenszel statistical method with fixed effect which demonstrated an odds ratio (OR) of 2.38 (95 % CI 1.39–4.07) for sustaining an adverse event from out of hours surgery compared to routine operative hours. I² = 12 %, suggesting homogeneity between studies analysed.</div></div><div><h3>Conclusions</h3><div>This study provides clinical evidence that out of hours surgery for lumbar decompression for CES is associated with a higher rate of surgical complications. The spinal surgeon should appropriately counsel the patient with CES that while it is important to do the surgery as soon as possible, operating out of hours carries a higher risk of surgical complications.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 6","pages":"Pages 352-358"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided versus laparoscopic-guided transversus abdominus plane block for laparoscopic cholecystectomy – A systematic review and meta-analysis of randomised clinical trials","authors":"Matthew G. Davey ,&nbsp;Gordon R. Daly ,&nbsp;Noel E. Donlon ,&nbsp;Nuala A. Healy ,&nbsp;Arnold D.K. Hill","doi":"10.1016/j.surge.2025.05.003","DOIUrl":"10.1016/j.surge.2025.05.003","url":null,"abstract":"<div><h3>Background</h3><div>The use of transversus abdominus plane (TAP) blocks have come into vogue in recent times, with the ambition to reduce post-operative pain following laparoscopic cholecystectomy. TAP block is commonly performed using an ultrasound-guided approach (US-TAP), with emerging data indicating that laparoscopic-guided (L-TAP) approach may also be useful.</div></div><div><h3>Aim</h3><div>To perform a systematic review and meta-analysis of randomised clinical trials (RCTs) comparing outcomes following US-TAP and L-TAP block in patients undergoing laparoscopic cholecystectomy.</div></div><div><h3>Methods</h3><div>A systematic review was performed in accordance with PRISMA guidelines. Meta-analysis was performed using Review Manager version 5.4.</div></div><div><h3>Results</h3><div>6 RCTs including 428 patients were included. Overall, 212 patients were randomised to US-TAP (49.5 %) and 216 to L-TAP (50.5 %) respectively. A non-significant difference was observed between groups for mean age, gender, mean body mass indices, and American Society of Anesthesiologists grades (all <em>P</em> &gt; 0.050). At meta-analyses, a non-significant difference was observed for US-TAP and L-TAP with respect to 2-, 6-, 12-, 24-, and 48-h post-operative visual analogue scores. A non-significant difference was also observed in relation to intraoperative duration, breakthrough opioid consumption, and post-operative vomiting, at meta-analysis. Patients who underwent US-TAP had longer anesthetic administration times (mean difference: 6.38, 95 % confidence interval: 2.77–10.00, <em>P</em> &lt; 0.001) compared to those randomised to undergo L-TAP.</div></div><div><h3>Conclusion</h3><div>L-TAP and US-TAP provided similar post-operative pain scores, intraoperative duration, breakthrough opioid consumption, and post-operative vomiting following laparoscopic cholecystectomy. However, the time taken to perform L-TAP was significantly shorter. Should expertise allow, L-TAP should be considered in patients undergoing laparoscopic cholecystectomy.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 6","pages":"Pages 399-405"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personality traits and surgical performance: A human factors perspective","authors":"Michael El Boghdady ,&nbsp;Joris J. Blok","doi":"10.1016/j.surge.2025.07.008","DOIUrl":"10.1016/j.surge.2025.07.008","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 6","pages":"Page 421"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145281480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"List of editors","authors":"","doi":"10.1016/S1479-666X(25)00163-5","DOIUrl":"10.1016/S1479-666X(25)00163-5","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 6","pages":"Page i"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145532563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"POSE-UK: Paediatric orthopaedic surgery exposure in the UK","authors":"Chloe Jane Lowe ,&nbsp;Jun Wei Lim ,&nbsp;Stephanie Buchan ,&nbsp;Anouska Ayub ,&nbsp;Felicity Pease ,&nbsp;Emily Baird","doi":"10.1016/j.surge.2025.04.003","DOIUrl":"10.1016/j.surge.2025.04.003","url":null,"abstract":"<div><h3>Aim</h3><div>This study aims to investigate the early exposure of orthopaedic<span> trainees to paediatric orthopaedics and explore their training experiences, focusing on the factors influencing their decision to either select or deselect paediatric orthopaedics as a subspecialty.</span></div></div><div><h3>Method</h3><div>A national survey was distributed electronically to members of the British Orthopaedic Trainees' Association following a pilot survey sent to British Society of Children's Orthopaedic Surgery members. The survey concentrated on trainees' experiences and interest in paediatric orthopaedics. It included open, closed, and free-text questions, with the responses thematically analysed using NVivo software.</div></div><div><h3>Results</h3><div>133 responses were received from trainees across the UK and Ireland. The findings showed significant variation in the timing of the first exposure to paediatric orthopaedics, with 25 % not encountering it until Specialty Trainee level 6 or later. Most participants had mixed placements involving both adult and paediatric orthopaedics. Limited theatre exposure and insufficient emphasis on paediatric orthopaedic surgery during training may contribute to a lack of interest. A worrying lack of confidence was noted amongst trainees in performing standard emergency paediatric orthopaedic procedures, which are expected competencies for newly appointed consultants, regardless of their intended subspecialty. Furthermore, many trainees indicated that they might not meet the required work-based assessments and indicative numbers necessary to complete training.</div></div><div><h3>Conclusion</h3><div>Earlier and more extensive exposure to paediatric orthopaedics during training could help foster greater interest in the subspecialty. Enhanced training in standard emergency paediatric orthopaedic presentations is essential to ensure trainees are confident in performing these procedures as newly appointed general orthopaedic consultants.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 6","pages":"Pages 347-351"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to editor on “Primary closure versus Graham patch omentopexy in perforated peptic ulcer: A systematic review and meta-analysis”","authors":"Timotius Ivan Hariyanto","doi":"10.1016/j.surge.2025.09.005","DOIUrl":"10.1016/j.surge.2025.09.005","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 6","pages":"Page 420"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative efficacy of lidocaine- and nifedipine-based conservative therapies in acute hemorrhoidal disease: A retrospective cohort study","authors":"Michele Schiano di Visconte","doi":"10.1016/j.surge.2025.06.002","DOIUrl":"10.1016/j.surge.2025.06.002","url":null,"abstract":"<div><h3>Background</h3><div>Acute hemorrhoidal disease (AHD) is a prevalent anorectal condition that significantly impacts patients' quality of life<span> and healthcare systems. Despite the availability of various conservative treatments, comparative efficacy data remains limited. This retrospective study evaluates two treatment regimens for AHD, focusing on symptom relief, patient-reported outcomes, and treatment tolerability.</span></div></div><div><h3>Methods</h3><div><span>Medical records of 123 patients with AHD treated at a tertiary care center between October 2022 and October 2024 were reviewed. Patients were divided into two groups: Group A treated with oral diosmin/hesperidin, </span>bromelain<span><span>, and topical lidocaine, and Group B treated with oral diosmin/hesperidin, bromelain, and topical </span>nifedipine<span>. Symptoms were evaluated using the Hemorrhoidal Disease Symptom Score (HDSS), Visual Analog Scale (VAS) for pain, and Short Health Scale for Hemorrhoidal Disease (SHS-HD) at baseline and on days 7, 14, and 21.</span></span></div></div><div><h3>Results</h3><div>Both groups showed significant improvements in symptoms during the study period. Group A demonstrated faster pain reduction (VAS day 7:0.17 ± 0.52 vs. 2.20 ± 1.11, <em>p</em><span> &lt; 0.001) and greater improvement in HDSS score (day 7: 0.02 ± 0.87 vs. 10.16 ± 3.38, p &lt; 0.001). Improvements in SHS-HD scores were more rapid for Group A, with scores on day 7 showing a significant difference (Group A: 7.58 ± 2.58 vs. Group B: 12.27 ± 4.21, p &lt; 0.001). Both regimens were well tolerated, with no significant adverse events.</span></div></div><div><h3>Conclusions</h3><div><span>The combination of oral diosmin/hesperidin, bromelain, and lidocaine provides superior initial symptom relief compared with nifedipine-based regimens. Lidocaine is the preferred topical agent for rapid pain management in AHD patients. Further studies are required to confirm these results</span><strong>.</strong></div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 6","pages":"Pages 406-411"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of direct consultant-to-consultant referrals on the spinal care pathway: A clinical audit","authors":"Arnav Barve ,&nbsp;Paul McCarroll ,&nbsp;Kevin Clesham ,&nbsp;Harry Marland ,&nbsp;Jake M. McDonnell ,&nbsp;Stacey Darwish ,&nbsp;Marcus Timlin ,&nbsp;Sam Lynch ,&nbsp;Seamus Morris ,&nbsp;Joseph S. Butler ,&nbsp;Keith Synnott","doi":"10.1016/j.surge.2025.05.001","DOIUrl":"10.1016/j.surge.2025.05.001","url":null,"abstract":"<div><h3>Background</h3><div>The institution in focus is a tertiary referral centre for all spinal pathology in the country. Traditionally, referrals to this centre have been reviewed by an on-call resident at the referring hospital. However, on May 10, 2023, this changed to a direct consultant-to-consultant referral protocol. This study aims to evaluate the impact of this change in protocol on the spinal care pathway.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted based on patients with spinal pathology referred to the tertiary centre from February 2023 to August 2023. Referrals made using the traditional referral system (‘Before’ from 08/02/2023–09/05/2023) were compared to referrals made through the consultant-led referral system (‘After’ from 10/05/2023–08/08/2023). Parameters such as the number of referrals, number of surgically managed patients, and patients with complete imaging at the time of referral (TOR) were statistically compared between the groups.</div></div><div><h3>Results</h3><div>There were 31.2 % fewer referrals in the ‘After’ group (223) than in the ‘Before’ group (324). The proportion of patients with complete imaging at TOR increased significantly (67.3 % vs. 81.6 %, p &lt; 0.05). Also, the number of patients who were treated surgically increased significantly (33.3 % vs. 40.4 %, p &lt; 0.05). Furthermore, the number of patients referred for follow-up to the outpatient department (OPD) decreased significantly (5.2 % vs. 0.9 %; p &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>The consultant-to-consultant referral protocol decreased the overall referral numbers, increased the number of patients with complete imaging, increased the surgical yield, and decreased the rates of OPD follow-up. This can be attributed to more efficient consultant-led local decision-making, which fortifies the benefits of this referral protocol.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 6","pages":"Pages 359-364"},"PeriodicalIF":2.3,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}