Annals of the Royal College of Surgeons of England最新文献

Bezoars are foreign bodies formed by indigestible material that can form in the gastrointestinal tract, most often in the stomach. Gastric bezoars can be managed by endoscopic or surgical approaches. An elderly woman with a background of learning disabilities, known to be consuming non-food items, presented with abdominal pain and vomiting. Computed tomography imaging demonstrated stomach wall thickening and a large gastric bezoar was identified endoscopically. Following a multidisciplinary team meeting, she underwent a laparotomy, gastrostomy and removal of the bezoar. Intraoperatively, a gastrocolic fistula was identified and surgically repaired. Postoperatively, the patient developed a gastrocutaneous fistula requiring ultrasound-guided drainage. She subsequently developed a chest infection and passed away 24 days postoperatively. Management of gastric bezoars can be difficult, with large bezoars often requiring surgical intervention. In a patient with learning disabilities, early multidisciplinary team involvement is key to allow for timely therapeutic intervention.

Introduction: In England, around two million fractures occur annually, with 250,000 requiring hospital admission. At Wythenshawe Hospital, the Trauma and Orthopaedic service discusses 10-15 new patient cases every weekday. We aimed to design and implement a structured proforma for the trauma meeting to ensure clear documentation of trauma meeting discussions and orthopaedic plans for each new patient at Wythenshawe Hospital.

Methods: Based on a literature search, input from orthopaedic surgeons and analysis of existing documentation, we created a proforma. We collected data in four phases: pre-implementation (1-10 October 2022), post-initial proforma (11-20 October 2022), post-updated proforma (20-30 October 2022) and long-term effectiveness (20-24 November 2023).

Results: Phase 1: 90 cases reviewed; 64% had inadequate documentation. Key details were often missing. Phase 2: After proforma implementation, 98 cases reviewed; documentation increased to 94%. Significant improvements in recording consultant names (92%), imaging (59%) and diagnosis (80%). Phase 3: After feedback update, 108 cases reviewed; 88% had documentation. Improvements in documentation of imaging (85%) and weight-bearing status (57%). Phase 4: One year later, 85 cases reviewed; documentation at 84%. Key details such as consultant names and imaging reached 100% completion, diagnosis at 97%.

Conclusions: This study proposes a standardised trauma meeting proforma to enhance the efficiency and accuracy of trauma meeting documentation. Our findings highlight the need for professional bodies to establish guidelines for trauma meeting handovers. We encourage further research into effective trauma meetings and suggest our proforma as a template for other orthopaedic departments to adapt to their needs.

Despite advances in multimodality therapies and surgical technique, locally recurrent rectal cancers (LRRC) and those with peritoneal metastasis (PM) remain challenging for surgeons and oncologists. Although total pelvic exenteration (TPE) and cytoreductive surgery (CRS) for peritoneal disease may enable removal of the main tumour mass and macroscopically visible peritoneal spread, respectively, local recurrence from an R1 resection, and peritoneal recurrence from microscopic peritoneal disease, remain key concerns. Combining radical surgery with oncological adjuncts such as intraoperative electron beam radiotherapy (IOERT), and hyperthermic intraperitoneal chemotherapy (HIPEC), may improve outcomes in this field. Nevertheless the application of both together is poorly reported. Here we describe a case of LRRC with PM treated with TPE and simultaneous HIPEC and IOERT.

Background: Although bariatric surgery is highly cost effective, accessing this treatment in the UK and other western nations is often challenging. Patients are therefore increasingly engaging in bariatric health tourism despite its associated risks and warnings from health institutions. A systematic review was performed to assess the reasons why patients are travelling abroad for surgery and common practices among bariatric tourism service providers.

Methods: Medline and PubMed were searched for articles analysing the experiences of patients and service providers. Articles published in English between 2010 and 2023 were considered and seven were included for review after title, abstract and full text analysis.

Results: Four studies assessing patients' experiences and outcomes following bariatric tourism and three examining the perspectives of bariatric service providers were reviewed. Patients across the studies were mostly from western Europe, North America and the Middle East. The most common reasons for pursuing bariatric tourism were a lack of bariatric service provision in patients' home nations, high costs of surgery in the private sector and long waiting times. Examples of practice outside the scope of most internationally recognised guidelines were identified across multiple studies, especially regarding patients' pre-operative optimisation and follow-up. The studies therefore suggest that bariatric tourism may lead to significant health risks and issues that need managing once patients return home.

Conclusions: Bariatric tourism is a common practice with significant associated risks. The reasons underpinning its appeal however, reflect genuine problems with accessing bariatric services and a lack of pre-operative education and optimisation.

Introduction: Hypothyroidism following laryngectomy is a well-recognised complication. The symptoms are multisystemic and can cause significant morbidity in patients. We aim to characterise the incidence of hypothyroidism following laryngectomy, and identify risk factors and preventative measures.

Methods: A systematic search of EMBASE and PubMed was performed. We appraised relevant articles as per the predefined eligibility criteria. A quality assessment of the included studies was done. A meta-analysis was performed to evaluate the association between reported risk factors and hypothyroidism.

Results: Forty articles were included. This encompassed a total of 3,061 patients with a median age of 61 years. Overall incidence of hypothyroidism was 50% (interquartile range: 38.3-75.7). The following factors were significantly associated with hypothyroidism: hemithyroidectomy, odds ratio (OR) 4.84 (95% confidence interval [CI] 3.46-6.77); radiotherapy, OR 4.4 (95% CI 2.29-8.43); and neck dissection, OR 2.63 (95% CI 1.56-4.44). Age, sex, chemotherapy and tumour stage were not significant in the meta-analysis. Preventative measures were based on reducing the extent of thyroid dissection, attention to the preservation of blood supply, and pre- and postoperative thyroid function test monitoring.

Conclusions: A significant proportion of patients develop hypothyroidism following laryngectomy. Utilising known risk factors may direct a preventative measure. Further well-designed multicentre observational studies exploring preventative measures including reducing hemithyroidectomy, monitoring intervals of thyroid function and utility of routine thyroxine replacement are required.