Volume 7, Issue 5, October 2023

There is a wide variation in approaches to identify malnutrition risk in emergency general surgery patients, using a range of tools and nutrition markers, with significant heterogeneity. Work is needed to standardize the approach to determining a patient’s nutritional status in the emergency setting.

Typical clinical presentations, radiological features and treatment options with respective success rates in patients with groove pancreatitis are summarized in the current review. Compared to patients with pancreatic ductal adenocarcinoma (PDAC), patients with groove pancreatitis present at a younger age and the disease is associated with pain and heavy alcohol consumption. The presence of cystic lesions in the pancreatic duct or duodenal wall, inflammatory thickening of the duodenum and calcifications of the pancreatic head can exclude PDAC in >90 per cent of cases.

A novel technique for localization of non-palpable breast tumours is the use of indocyanine green fluorescence; indocyanine green is a fluorescent dye increasingly used in oncological surgery. The aim was to perform a systematic review of the literature describing the efficacy of indocyanine green fluorescence for non-palpable breast tumour localization.

The authors reconcile conflicting evidence regarding the optimal waiting time for stable analgesic and vasoconstrictive effects after local infiltration of lidocaine with epinephrine. Around 2 min are required for most patients to achieve complete analgesia in all sites and anaesthesia concentrations. Waiting around 7 min in eyelids at least 25 min in other regions results in optimal hypoperfusion. Strategies are discussed to inform the decisions of when and how best to wait.

Surgical coaching programmes have become a feasible means of improving surgeon performance. Embedding audiovisual technology into such programmes has the potential to further enhance participant benefit. This systematic review evaluates how audiovisual technology has been utilized within coaching programmes for healthcare professionals in acute-care hospital settings.

Undergraduate medical students must be proficient in certain surgical skills as set out by General Medical Council and Royal College regulations. There appears a deficit in such teaching which we have discussed and attempted to address in terms of alternative methodology reported in the literature that can be used to teach these basic surgical skills.

Early postoperative mobilization is considered a key element of enhanced recovery after surgery protocols. This review describes that early postoperative mobilization after gastrointestinal surgery enhances gastrointestinal recovery, but does not significantly reduce the morbidity rate or hospital stay in randomized trials. The included studies are heterogeneous and further randomized trials on this topic are urgently required.

Crohn’s disease (CD) is an inflammatory bowel disease that often requires surgical intervention, making patient-reported outcome measures (PROMs) an important tool for monitoring and assessing patient health-related quality of life (HRQoL). This systematic review evaluates the use of PROMs within surgical CD patients and is able to identify eight studies which collectively utilize eight measures of HRQoL and two measures of function. This review highlights the need for a consensus on how these tools are used and to monitor patients, support treatment pathways and enable future quantitative reviews and meta-analyses.

Innovations in pancreatic surgery are introduced with the aim of increasing the quality of care. However, their successful implementation is deeply dependent on dissemination and standardization of surgical training, adapted to fit in the changing landscape of modern pancreatic surgery.

The open abdomen is an innovation that greatly improved surgical understanding of temporary abdominal closure indications, techniques, and outcomes. We provide an evidence-informed, expert, comprehensive narrative review of the open abdomen. Subsequent stages of the innovation of the open abdomen will likely involve the design and conduct of prospective studies to evaluate appropriate indications for its use and effectiveness and safety of the above components of open abdomen management.

This was an emergency service protocol designed to improve access to colonoscopy using faecal immunochemical testing for risk-stratified triage during the height of the COVID-19 pandemic for people with Lynch syndrome when endoscopy services were extremely limited. Requests for faecal immunochemical testing for eligible Lynch syndrome patients were made by participating National Health Service Trusts, which triggered the sending of a faecal immunochemical testing kit, faecal immunochemical testing instructions, a paper-based survey, and pre-paid return envelope from the National Health Service Bowel Cancer Screening South of England Hub in Surrey to said patients, and risk stratification for colonoscopy was as follows: faecal haemoglobin less than 10 µg/g—schedule colonoscopy within 6–12 weeks; and faecal haemoglobin greater than or equal to 10 µg/g—triage via an urgent suspected cancer clinical pathway. For 339 participants analysed, 279 (82.3 per cent) had faecal haemoglobin less than 10 µg/g and 60 (177.0 per cent) met criteria for urgent triage (faecal haemoglobin greater than or equal to 10 µg/g), with escalation to colonoscopy facilitated in the latter group of patients, with a median wait of 49 days (versus 122 days for f-Hb less than 10), demonstrating the clinical value of faecal immunochemical testing for patients with Lynch syndrome requiring colorectal cancer surveillance during the pandemic.

At a median follow-up of 50.9 months, the 1-year, 2-year, 3-year and 5-year overall survival rates were 86.4 per cent, 67.5 per cent, 52.6 per cent and 33.8 per cent respectively; the corresponding recurrence-free survival rates were 48.7 per cent, 26.6 per cent, 19.2 per cent and 10.5 per cent; the study demonstrates survival advantage of adjuvant chemotherapy in patients with margin-positive resection.

We have conducted a retrospective multi-centre study of 430 patients with resected phaeochromocytoma with the aim to identify risk factors associated with development of post-operative complications and length of hospital stay. Complication rate was 25.3% and Charlson comorbidity index, laparoscopic converted to open, and open surgery were independently associated with postoperative complications and prolonged length of stay ≥ 5 days together with tumor size.

Using this large dataset, we have demonstrated that adrenalectomy for phaeochromocytoma is associated with very low mortality, whilst postoperative complications are relatively common and lead to prolonged hospital stay. We believe that our findings should be considered when counselling patients and are important for surgical planning.

This study aims to assess the impact of timing of ileocecal resection (ICR) on postoperative prognosis of Crohn’s disease (CD) in a multivariable model. After correction for possible confounders, patients with early and late ICR have an equally beneficial short- and long-term postoperative prognosis. Therefore, timing of ICR in CD patients is not associated with a change of disease course.

Accurately predicting clinically relevant postoperative pancreatic fistula before surgery may assist surgeons in better counselling patients. The radiomics preoperative-Fistula Risk Score was generated using computed tomography features and shown to accurately predict postoperative pancreatic fistula. After further validation it has the potential to be integrated in hospital CT report systems.

Most patients with adhesional small bowel obstruction are treated non-operatively. However, recent registry studies suggest that operative management may be of benefit, reducing the risk of recurrent small bowel obstruction. In this prospective multicentre study, we found that operative treatment of adhesional small bowel obstruction was associated with reduced risk of recurrence but increased risk of all-cause mortality rate.

In order to develop efficient interventions preventing anastomotic leakage and to better predict if a patient will develop anastomotic leakage, it is crucial to understand the underlying mechanisms of normal and disturbed anastomotic healing. In this animal model, the healing process over time was investigated and it was observed that the sequential phases of intestinal healing resemble the sequential phases of skin healing. Furthermore, 6 hours after anastomosis creation, transcriptional differences are present in the anastomotic tissue between healing and disturbed healing. These findings could be used as the first step to truly understand the disrupted healing processes underlying anastomotic leakage, which in turn might be used as potential early-onset biomarkers of anastomotic leakage.

This population-based nationwide cohort study included 2196 patients who underwent surgery for gastric adenocarcinoma and describes the incidence of complications after gastrectomy. The incidence of 30-day complications after gastrectomy was 41.3 per cent and the incidence of 90-day complications was 43.1 per cent. The most common 90‐day complications were gastrointestinal (19.9 per cent), infectious (17.2 per cent) and pulmonary (15.3 per cent).

The proportion of non-pancreatic periampullary cancer is substantially higher in patients with a histopathological diagnosis than in those with a clinical diagnosis. Histopathological standardization correlated with an increased frequency of pancreatic ductal adenocarcinoma diagnosis, R1 resection and N1 stage. The misdiagnosis of periampullary cancer origin occurs in a clinically relevant proportion of patients and needs to be considered in patients with a neoadjuvant oncological treatment plan.

Acute groin hernia presentations are a common feature of the emergency general surgery workload. This high-volume, retrospective, observational study shows that patients presenting with groin hernias are often elderly and are becoming increasingly co-morbid. Changing patient demographics are influencing investigation and management techniques as demonstrated in this study.

Minimum operation numbers for open anterior inguinal hernia mesh repair are set arbitrarily and vary between different curricula. Hernia recurrence rates, surgical complications and operation times were compared with the operation volumes of surgical trainees in the Swedish Hernia Register to investigate the learning curve for the procedure.