Revascularisation through the obturator foramen of lower limbs with a compromised ipsilateral groin due to infection.
CONCLUSION: The transobturator approach could be considered as a chance for lower limb revascularisation in case of ipsilateral groin infection. Moreover, avoiding the infected site allowed us to focus separately and safely on the treatment of the inguinal wound. PMID: 31155915 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - June 3, 2019 Category: Surgery Authors: Zenunaj G, Traina L, Acciarri P, Spataro C, Gasbarro V Tags: Ann R Coll Surg Engl Source Type: research

The anatomical relationship between the axillary arch of Langer and sentinel lymph node in breast cancer surgery.
PMID: 31155917 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - June 3, 2019 Category: Surgery Authors: Abudhaise H, Merh R, Devalia H Tags: Ann R Coll Surg Engl Source Type: research

Use of an automated knot fastener shortens operative times in minimally invasive mitral valve repair.
Abstract INTRODUCTION: Longer durations of cardiopulmonary bypass and aortic cross clamp are associated with increased morbidity and mortality. Little is known about the effect of automated knot fasteners (Cor-Knot®) in minimally invasive mitral valve repair on operative times and outcomes. The aim of this study was to evaluate whether these devices shortened cardiopulmonary bypass and aortic cross clamp times and whether this impacted on postoperative outcomes. MATERIALS AND METHODS: All patients undergoing isolated minimally invasive mitral valve repair by a single surgeon between March 2011 and March 2...
Source: Annals of the Royal College of Surgeons of England - June 3, 2019 Category: Surgery Authors: Perin G, Shaw M, Pingle V, Palmer K, Al-Rawi O, Ridgway T, Pousios D, Modi P Tags: Ann R Coll Surg Engl Source Type: research

Getting It Right First Time: the national survey of surgical site infection rates in NHS trusts in England.
CONCLUSION: The Getting It Right First Time surgical site infection programme has introduced a different approach to infection surveillance in England. Results of the survey has demonstrated variation in surgical site infection rates among surgical units, raised the importance in addressing these issues for better patient outcomes and to reduce the financial burden on the NHS. Much work remains to be done to improve surgical site infection surveillance across surgical units and trusts in England. PMID: 31155919 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - June 3, 2019 Category: Surgery Authors: Wong J, Ho C, Scott G, Machin JT, Briggs T Tags: Ann R Coll Surg Engl Source Type: research

Conservative management of diffuse cavernous haemangioma of the sigmoid and rectum.
Abstract Diffuse cavernous haemangioma is a rare disease of the rectum. It usually presents with a history of rectal bleeding in children and young adults. When conservative methods fail to control bleeding, traditionally resection is recommended. A 50-year-old man presented with per rectal bleeding and was diagnosed with diffuse cavernous haemangioma of the sigmoid and rectum extending up to 40 cm in the left colon through endoscopy, magnetic resonance imaging and computed tomography. The diagnosis was confirmed by biopsy. This patient was successful managed conservatively with tranexamic acid as needed, avoiding...
Source: Annals of the Royal College of Surgeons of England - June 3, 2019 Category: Surgery Authors: Cotzias E, Rehman SF, Arsalani Zadeh R, Smith D Tags: Ann R Coll Surg Engl Source Type: research

Perforated diverticulitis in the North of England: trends in patient outcomes, management approach and the influence of subspecialisation.
Abstract INTRODUCTION: In recent years, several management options have been used in the management of perforated diverticulitis, ranging from conservative treatment to laparotomy. General surgery has also become increasingly specialised over time. This retrospective cohort study investigated changes in patient outcomes following perforated diverticulitis, management approach and the influence of consultant subspecialisation over time. MATERIALS AND METHODS: Data was collected on patients admitted with perforated diverticulitis in the North of England between 2002 and 2016. Subspecialisation was categorised a...
Source: Annals of the Royal College of Surgeons of England - June 3, 2019 Category: Surgery Authors: Baldock TE, Brown LR, McLean RC Tags: Ann R Coll Surg Engl Source Type: research

Protection of trunnion during revision total hip arthroplasty.
PMID: 31155925 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - June 3, 2019 Category: Surgery Authors: Agarwala S, Vijayvargiya M, Mehmood M Tags: Ann R Coll Surg Engl Source Type: research

Continuing acromioclavicular joint pain after excision arthroplasty: is further surgery effective?
CONCLUSION: Functional outcomes after revision surgery showed improvement from scores taken before primary surgery; however, long-term satisfaction rates were relatively low. PMID: 31042427 [PubMed - in process] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - May 1, 2019 Category: Surgery Authors: Dekker AP, Borton Z, Espag M, Cresswell T, Tambe AA, Clark DI Tags: Ann R Coll Surg Engl Source Type: research

Bilateral penile cavernosal abscess secondary to Escherichia coli: a case report of a rare diagnosis.
We describe a 75-year-old man who presented with sepsis and was found to have Escherichia coli positive blood and urinary cultures. Following initial treatment for sepsis of unknown origin, computed tomography demonstrated a bilateral cavernosal abscess. The patient was successfully treated with incision and drainage, multiple re-looks and a delayed closure, alongside a course of appropriate antibiotics. A defect in the bulbar urethra was identified and repaired with bladder drainage via both suprapubic and urethral catheters. Following discharge, a urethrogram showed no urethral leak or stricture and the patient is now ca...
Source: Annals of the Royal College of Surgeons of England - May 1, 2019 Category: Surgery Authors: Capella S, Mahesan T, Taylor J, Chetwood A Tags: Ann R Coll Surg Engl Source Type: research

Mortality for emergency laparotomy is not affected by the weekend effect: a multicentre study.
This study examines whether a weekend effect exists for patients who undergo emergency laparotomy. MATERIALS AND METHODS: Data entered into the National Emergency Laparotomy Audit between 2014 and 2017 at four NHS trusts in England and Wales were analysed. Patients were grouped into those admitted on weekdays and those on weekends (Friday 5pm to Monday 8am). Patient factors, markers of quality of care and patient outcomes were compared. Secondary analysis was performed according to the day of surgery. RESULTS: After exclusion of patients who underwent laparotomy more than one week after admission to hospital, a t...
Source: Annals of the Royal College of Surgeons of England - May 1, 2019 Category: Surgery Authors: Nageswaran H, Rajalingam V, Sharma A, Joseph AO, Davies M, Jones H, Evans M Tags: Ann R Coll Surg Engl Source Type: research

Carpal tunnel decompression in primary care: what is the infection risk and is it safe and effective?
DISCUSSION: We believe that carpal tunnel decompressions performed in a treatment room is both safe, in terms of infection risk, and effective. Surgeons should consider this location as an alternative setting to the main operating theatre. PMID: 31042430 [PubMed - in process] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - May 1, 2019 Category: Surgery Authors: Palial V, Kheiran A, Siddiqui S Tags: Ann R Coll Surg Engl Source Type: research

Straight-to-test for the two-week-wait colorectal cancer pathway under the updated NICE guidelines reduces time to cancer diagnosis and treatment.
ar MP Abstract INTRODUCTION: The 2015 National Institute for Health and Care Excellence guidelines widened the referral criteria for the two-week-wait pathway for suspected lower gastrointestinal cancer. We implemented a straight-to-test protocol to accommodate the anticipated increase in referrals. We evaluated the impact of these changes for relevant pathway metrics and clinical outcomes using a retrospective cohort study with historic controls. MATERIALS AND METHODS: We analysed data from all patients referred to a teaching hospital via the two-week-wait pathway for suspected lower gastrointestinal cancer ...
Source: Annals of the Royal College of Surgeons of England - May 1, 2019 Category: Surgery Authors: Christopher J, Flint TR, Ahmed H, Dhir N, Li R, Macfarland K, Ng D, Ng J, O'Neill C, Te Water Naudé A, Sloan K, Hall NR, Powar MP Tags: Ann R Coll Surg Engl Source Type: research

Laparohernioscopic right colectomy for bowel ischaemia within a strangulated inguinal hernia.
We present a case where hernioscopy t(i.e. laparoscopy through the hernia sac) has been used to confirm the ischaemia of the strangulated bowel and perform a hybrid laparohernioscopic right colectomy with intracorporeal anastomosis without the need for a formal laparotomy. Hernioscopy is an easy and reliable method to assess the viability of the content of the hernia sac in strangulated hernias that have spontaneously reduced before it could be visually inspected. It can also be associated with a laparoscopic access in a hybrid laparohernioscopic technique to perform complex procedures. PMID: 31042432 [PubMed - in pro...
Source: Annals of the Royal College of Surgeons of England - May 1, 2019 Category: Surgery Authors: Tebala GD, Yee J, Kola-Adejumo A Tags: Ann R Coll Surg Engl Source Type: research

The management of soft tissue injuries in open tibial fractures: the 'soft tissue tug test'.
PMID: 31042433 [PubMed - in process] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - May 1, 2019 Category: Surgery Authors: Gandham S, Refolo M, Fischer B, Kerin C Tags: Ann R Coll Surg Engl Source Type: research

Testicular pain as an atypical presentation of sarcoidosis.
We describe the case of a 25-year-old man who was referred with testicular pain. Scrotal ultrasonography demonstrated multiple bilateral hypoechoic testicular lesions that were of similar size and distributed unusually throughout the testicular parenchyma. Computed tomography detected a nodule in the middle lobe of the right lung, multiple small volume nodes in the retrocaval and left para-aortic regions, and enlarged bilateral external iliac and inguinal nodes, similar to those found in metastatic testicular cancer. Following ultrasound guided excision of one of the lesions, histopathological examination confirmed granulo...
Source: Annals of the Royal College of Surgeons of England - March 25, 2019 Category: Surgery Authors: Chierigo F, Alnajjar HM, Haider A, Walkden M, Shaikh T, Muneer A Tags: Ann R Coll Surg Engl Source Type: research

The effect of time to surgery on outcomes and complication rates following total hip arthroplasty for fractured neck of femur.
CONCLUSIONS: Delaying surgery for patients eligible for total hip arthroplasty as per the National Institute for Health and Care Excellence guidelines is justified and should not incur loss of the best practice tariff. PMID: 30854861 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 11, 2019 Category: Surgery Authors: Craik J, Geleit R, Hiddema J, Bray E, Hampton R, Railton G, Ward D, Windley J Tags: Ann R Coll Surg Engl Source Type: research

Papillary thyroid carcinoma in cervical lymph nodes with vanished thyroid gland after ablation of Graves' disease by radioactive iodine.
We present a very rare condition of lateral apparent papillary thyroid carcinoma eight years after receiving radioactive iodine for thyrotoxicosis, which led to complete anatomical and functional involution of the thyroid gland. PMID: 30854863 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 11, 2019 Category: Surgery Authors: Hamdy O, Raafat S, Saleh GA, Atallah K, Shebl AM, Hegazy MA Tags: Ann R Coll Surg Engl Source Type: research

Appendicitis due to incarceration within a laparoscopic umbilical port-site hernia secondary to a degree of intestinal malrotation.
Abstract A 37-year-old woman presented with an incarcerated hernia at a previous umbilical laparoscopic port site. This was found to contain an ischaemic appendix, which was managed successfully with open appendicectomy and a mesh repair. Previous imaging from a year prior to these events demonstrated a degree of intestinal malrotation with the caecal pole lying just under the umbilicus. Finding the appendix within an incisional port site is very rare, for this to occur at the umbilicus is unique. PMID: 30854864 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 11, 2019 Category: Surgery Authors: Lam A, Black J, Parnell B, West CT Tags: Ann R Coll Surg Engl Source Type: research

Variation between hospitals in outcomes following cardiac surgery in the UK.
CONCLUSIONS: Variations among hospital level factors exists in both delivery of, and outcomes, following cardiac surgery in the UK. However, there was no clear association between these factors and patient outcomes. This negative finding could be explained by differences in outcome definition, differences in risk factors between centres that are not captured by standard risk stratification scores or individual surgeon/team performance. PMID: 30854865 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 11, 2019 Category: Surgery Authors: Soppa G, Theodoropoulos P, Bilkhu R, Harrison DA, Alam R, Beattie R, Bleetman D, Hussain A, Jones S, Kenny L, Khorsandi M, Lea A, Mensah K, Hici TN, Pinho-Gomes AC, Rogers L, Sepehripour A, Singh S, Steele D, Weaver H, Klein A, Fletcher N, Jahangiri M Tags: Ann R Coll Surg Engl Source Type: research

Unilateral visual loss resulting from orbital encroachment of an ethmoidal juvenile trabecular ossifying fibroma.
We present a case of an otherwise healthy 20-year-old man with gradual onset of right visual disturbance signified by right relative afferent pupillary defect due to a large unilateral ossifying fibroma arising from the ethmoid sinus compressing the medial half of the right orbit. We emphasise the multidisciplinary combined endoscopic endonasal and external approach to ensure a successful debulking of the fibroma. PMID: 30854866 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 11, 2019 Category: Surgery Authors: Ta NH, Addison A, Beigi B, Philpott C Tags: Ann R Coll Surg Engl Source Type: research

A rare solitary fibrous tumour of the ascending mesocolon: a case report.
u O Abstract Solitary fibrous tumours are rare mesenchymal tumours which mostly arise from pleura. Such tumours occurring in the mesocolon are exceptionally rare. A 35-year-old man was referred to the general surgery department with a painless and nonpalpable mass in the right quadrant of the abdomen, which was detected incidentally on magnetic resonance imaging. The patient had no symptoms and the physical examination revealed no findings. The patient underwent surgical resection and excisional biopsy results revealed an intra-abdominal solitary fibrous tumour originating from the ascending mesocolon. He was disc...
Source: Annals of the Royal College of Surgeons of England - March 11, 2019 Category: Surgery Authors: Keser BN, Kırman ÜN, Aktemur G, Alimoĝlu O Tags: Ann R Coll Surg Engl Source Type: research

A novel technique to remove a broken tibiotalocalcaneal intramedullary nail using Moreland hip revision instrumentation.
We describe a novel technique using a curved thin hook from the Moreland hip revision set to remove the distal part of a broken tibiotalocalcaneal intramedullary nail. PMID: 30854872 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 11, 2019 Category: Surgery Authors: Papachristos IV, Dalal RB Tags: Ann R Coll Surg Engl Source Type: research

Mechanical thrombectomy for the treatment of acute ischaemic stroke following pulmonary lobectomy.
We report the case of a patient developing an acute ischaemic stroke following pulmonary lobectomy, who was transferred to the regional neurosciences unit, despite the absence of an established referral pathway, to undergo mechanical thrombectomy, with significant prognostic neurological benefit. We would advocate all cardiothoracic centres identify their regional neurosciences unit and initiate discussion to establish a referral pathway. PMID: 30855160 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 11, 2019 Category: Surgery Authors: Ali JM, Wolff I, Falconieri F, Aresu G, Coonar AS, Joshi Y, Peryt A Tags: Ann R Coll Surg Engl Source Type: research

Ex vivo model for a new bilateral antimesenteric V-modified side-to-side isoperistaltic anastomosis to prevent recurrence in ileocolic Crohn's disease.
CONCLUSIONS: We have developed an experimental animal model for a new anastomotic technique which could be applied in surgery for Crohn's disease following small-bowel or ileocolic resection. PMID: 30855162 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 11, 2019 Category: Surgery Authors: Celentano V, Luvisetto F, Toh S Tags: Ann R Coll Surg Engl Source Type: research

Systematic review and meta-analysis on outcomes of salvage therapy in patients with tumour recurrence during 'watch and wait' in rectal cancer.
CONCLUSION: Our findings demonstrated that there was no significant difference in overall and disease specific mortality in patients who had salvage treatment following recurrence of disease in the watch and wait group compared with the standard treatment group. However, future research into the oncological safety of salvage treatment is needed. PMID: 30855163 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 11, 2019 Category: Surgery Authors: On J, Shim J, Aly EH Tags: Ann R Coll Surg Engl Source Type: research

Management of pancreaticoduodenal artery aneurysm associated with coeliac artery stenosis.
Abstract Pancreaticoduodenal and gastroduodenal artery aneurysms are rare but require early radiological or surgical intervention due to a high risk (61%) of rupture. A 71-year-old woman presented with an incidental 30-mm aneurysm arising from the inferior pancreaticoduodenal artery associated with coeliac axis stenosis. She underwent embolisation of the pancreaticoduodenal aneurysm, but the coeliac axis stenosis was not amenable to radiological intervention. She remained well at six months of follow-up and a repeat computed tomography angiogram six months later reported stable appearances. The management of pancr...
Source: Annals of the Royal College of Surgeons of England - March 11, 2019 Category: Surgery Authors: Kamarajah SK, Kharkhanis S, Duddy M, Isaac J, Sutcliffe RP, Mehrzad H, Dasari B Tags: Ann R Coll Surg Engl Source Type: research

Chronic osteomyelitis with proliferative periostitis of the mandibular body: report of a case and review of the literature.
Abstract Chronic osteomyelitis with proliferative periostitis is a rare form of osteomyelitis that is characterised by new bone formation with periosteal reaction. It is also traditionally known as Garre's osteomyelitis. The common sources of infection of the jaw include dental caries associated with periapical periodontitis, periodontitis, fractures and nonodontogenic infections. Chronic osteomyelitis with proliferative periostitis mainly presents in younger patients. Here, we present a case of a 12-year-old patient with chronic osteomyelitis with proliferative periostitis with no definitive infection source such...
Source: Annals of the Royal College of Surgeons of England - March 11, 2019 Category: Surgery Authors: Liu D, Zhang J, Li T, Li C, Liu X, Zheng J, Su Z, Wang X Tags: Ann R Coll Surg Engl Source Type: research

Management of 'low-risk' ankle fractures in children: a systematic review.
CONCLUSION: There is a need for a definitive trial to establish the best treatment for ankle fractures and a core outcome set to ensure study findings are consistent and can be analysed in future meta-analyses. PMID: 30855167 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 11, 2019 Category: Surgery Authors: Marson BA, Ng J, Myint Y, Jc Grindlay D, Ollivere BJ Tags: Ann R Coll Surg Engl Source Type: research

Malakoplakia of the parotid gland: a case report and review of localised malakoplakia of the head and neck.
CONCLUSION: A possibility of malakoplakia should be considered as a differential diagnosis in patients with enlarged head and neck masses. Histology is essential to diagnose this benign inflammatory disorder and to differentiate from a malignant process. PMID: 30855168 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 11, 2019 Category: Surgery Authors: Samian C, Ghaffar S, Nandapalan V, Santosh S Tags: Ann R Coll Surg Engl Source Type: research

The role of cross-sectional imaging in suspected nasopharyngeal carcinoma.
CONCLUSION: The study supports magnetic resonance imaging as the primary investigation in patients with suspected nasopharyngeal carcinoma followed by endoscopic examination under anaesthesia and biopsy in cases with suspicious findings on imaging only. PMID: 30855169 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 11, 2019 Category: Surgery Authors: Shayah A, Wickstone L, Kershaw E, Agada F Tags: Ann R Coll Surg Engl Source Type: research

Trends in paediatric distal radius fractures: an eight-year review from a large UK trauma unit.
Abstract INTRODUCTION: This observational study investigated the incidence of distal radius fractures in children, to determine whether the rate is rising, the effect of seasonal variation on incidence and whether fracture type and rate of surgical intervention has changed, to help in determining costs for secondary care and to aid resource allocation. MATERIALS AND METHODS: All paediatric patients(n = 6529) who sustained a distal radius fracture over an eight-year period (2007-2014) were identified. Poisson regression modelling was used to identify change in trends. RESULTS: There was no change in dista...
Source: Annals of the Royal College of Surgeons of England - March 11, 2019 Category: Surgery Authors: Mamoowala N, Johnson NA, Dias JJ Tags: Ann R Coll Surg Engl Source Type: research

The approach to an isolated close anterior margin in breast conserving surgery.
CONCLUSION: The low yield of residual disease in re-excised anterior margins specimens supports the concept that routine re-excision of close anterior margins is not necessary. Further research is required to definitively assess its influence on the risk of local recurrence. PMID: 30855173 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 11, 2019 Category: Surgery Authors: O'Connell L, Walsh S, Evoy D, O'Doherty A, Quinn C, Rothwell J, Geraghty J, McDermott EW, Prichard R Tags: Ann R Coll Surg Engl Source Type: research

Phalangeal fracture leading to digital amputation, sustained during manipulation for Dupuytren's disease as part of clostridial collagenase treatment.
Abstract Collagenase injection was approved in Europe for use in the treatment of Dupuytren's disease in 2011. Reported adverse effects include skin tears, swelling, pain and complex regional pain syndrome. Here, we present a case of a rare complication of phalangeal fracture following treatment with collagenase clostridium and the resultant digital amputation. An 81-year-old man was treated for a 25-year history of progressively disabling Dupuytren's disease of his left middle and ring fingers. Nine days post-manipulation he presented with persistent pain and swelling and was diagnosed with a displaced fracture o...
Source: Annals of the Royal College of Surgeons of England - March 11, 2019 Category: Surgery Authors: Richards K, Sethu C, Tiernan E Tags: Ann R Coll Surg Engl Source Type: research

Necrotising fasciitis in the North East of Scotland: a 10-year retrospective review.
CONCLUSIONS: Necrotising fasciitis presents subtly and carries significant morbidity and mortality. A high index of suspicion allows early diagnosis and intervention. We believe that a pan-specialty approach is the cornerstone for good outcomes. PMID: 30855976 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 11, 2019 Category: Surgery Authors: Neilly DW, Smith M, Woo A, Bateman V, Stevenson I Tags: Ann R Coll Surg Engl Source Type: research

A novel technique for supramalleolar osteotomy of the tibia using a circular frame.
PMID: 30855977 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 11, 2019 Category: Surgery Authors: Chatterton BD, Bing A Tags: Ann R Coll Surg Engl Source Type: research

Is the laparoscopic approach a safe choice for the management of acute appendicitis in pregnant women? A meta-analysis of observational studies.
CONCLUSION: Laparoscopic appendectomy seems to be a relatively safe therapeutic option in pregnancy when it is indicated. Thus, it should be implemented in clinical practice, always considering the experience of the surgeon in such procedures. Nevertheless, the need of new studies to enhance this statement remains crucial. PMID: 30855978 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 11, 2019 Category: Surgery Authors: Frountzas M, Nikolaou C, Stergios K, Kontzoglou K, Toutouzas K, Pergialiotis V Tags: Ann R Coll Surg Engl Source Type: research

Safe investigation of isolated change in bowel habit with a flexible sigmoidoscopy? A systematic review and meta-analysis.
CONCLUSIONS: There is a higher than expected risk that if a cancer is diagnosed in a patient presenting with either an isolated change in bowel habit or a combination of change in bowel habit with rectal bleeding, the cancer may be right sided. PMID: 30855983 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - March 11, 2019 Category: Surgery Authors: Herrod P, Boyd-Carson H, Doleman B, Blackwell J, Hardy E, Harper F, Lund JN Tags: Ann R Coll Surg Engl Source Type: research

The laparoscopic approach for epiphrenic diverticula with achalasia.
CONCLUSIONS: Along with diverticulectomy, treating the underlying motility disorder with an adequate Heller myotomy and partial fundoplication is of prime importance for a good surgical outcome without symptom recurrence. Laparoscopy offers better access to the distal oesophagus than the conventional thoracic approach for ED. PMID: 30773891 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - February 18, 2019 Category: Surgery Authors: Mandovra P, Kalikar V, Patel A, Patankar RV Tags: Ann R Coll Surg Engl Source Type: research

The effects of human factor related issues on assessors during the recruitment process for general and vascular surgery in the UK.
CONCLUSIONS: Organisations need to plan carefully and recognise the human element to ensure that their interviewers are cared for during any high stakes assessment such as national selection. Our work suggests that a positive assessor experience will further help contribute to a reliable and fair recruitment process. PMID: 30773892 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - February 18, 2019 Category: Surgery Authors: Scrimgeour D, Patel R, Patel N, Cleland J, Lee AJ, McKinley AJ, Smith F, Griffiths G, Brennan PA Tags: Ann R Coll Surg Engl Source Type: research

A primary inferior lumbar hernia misdiagnosed as a lipoma.
We present a case of a primary spontaneous inferior lumbar hernia in a 79-year-old woman that was initially diagnosed as a large lipoma on ultrasound. The first operation was abandoned and an open mesh repair was conducted. Lumbar hernias can be primary acquired (55%), secondary acquired (25%) or congenital (20%). Cross-sectional imaging by CT or MRI appears to be the gold standard in diagnosis as ultrasound may lead to misdiagnosis. Strangulation, incarceration and obstruction are recognised complications, requiring prompt surgical intervention. There are currently no guidelines for surgical managements, although laparosc...
Source: Annals of the Royal College of Surgeons of England - February 18, 2019 Category: Surgery Authors: Kadler B, Shetye A, Patten DK, Al-Nowfal A Tags: Ann R Coll Surg Engl Source Type: research

Systematic review of preoperative carotid duplex ultrasound compared with computed tomography carotid angiography for carotid endarterectomy.
CONCLUSIONS: The sensitivity and specificity of CTA (90.6% and 93%, respectively) and CDU (92.3% and 89%, respectively) are comparable. Both are dependent on criteria used in vascular laboratories. CDU sensitivity and specificity was improved to 98.7% and 94.1%, respectively, where peak systolic velocity and end diastolic velocity were assessed. Either modality can be used to determine greater than 70% stenosis, although a secondary imaging modality may be required for cases of greater than 50% stenosis. PMID: 30767557 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - February 15, 2019 Category: Surgery Authors: Forjoe T, Asad Rahi M Tags: Ann R Coll Surg Engl Source Type: research

Isolated submandibular lymph node metastasis in pancreatic adenocarcinoma.
We describe a case of pancreatic adenocarcinoma metastasis to the left submandibular lymph node with no confirmed concurrent sites of metastasis. PMID: 30715906 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - February 4, 2019 Category: Surgery Authors: Oyebola T, Mavilakandy A, Conboy P, Bhardwaj N Tags: Ann R Coll Surg Engl Source Type: research

Current status of bone cementing and bone grafting for giant cell tumour of bone: a systemic review.
CONCLUSION: The use of bone cement was associated with a statistically significantly lower recurrence rate than bone grafting in giant cell tumour of bones. We therefore recommend the use of bone cement with extensive intralesional curettage. Adjuvant therapy like electrocautery, phenol irrigation and the use of intravenous denosumab or bisphosphonates may help in decreasing the incidence of recurrence in giant cell tumour of bone. PMID: 30688529 [PubMed - in process] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - January 30, 2019 Category: Surgery Authors: Vaishya R, Pokhrel A, Agarwal AK, Vijay V Tags: Ann R Coll Surg Engl Source Type: research

The incidence of post-thyroidectomy hypocalcaemia: a retrospective single-centre audit.
CONCLUSIONS: Our audit shows that the rate of PTHC within our population was below the national average with higher risk in benign thyroid disease. PMID: 30644321 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - January 15, 2019 Category: Surgery Authors: Arman S, Vijendren A, Mochloulis G Tags: Ann R Coll Surg Engl Source Type: research

Limited preoperative physical capacity continues to be associated with poor postoperative outcomes within a colorectal ERAS programme.
CONCLUSIONS: Limited physical capacity was the only patient and lifestyle factor associated with poorer postoperative complications and prolonged hospital stay after elective colorectal surgery within an ERAS programme. Consideration should be given to individualised prehabilitation that aims to increase physical capacity pre-operatively to improve patient outcomes. PMID: 30644323 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - January 15, 2019 Category: Surgery Authors: McLennan E, Oliphant R, Moug SJ Tags: Ann R Coll Surg Engl Source Type: research

Three intrasubstance failures of a LARS ™ ligament used for ligament reconstruction.
We report three cases of intrasubstance failure of a LARS™ (Ligament Augmentation and Reconstruction System) artificial ligament used for acromioclavicular joint reconstruction. The LARS™ ligament failed within four months of the index procedure. All patients underwent a revision procedure following an unsuccessful trial of conservative management. A modified second loop technique was employed during the revision procedure for all cases using the LARS™ ligament. All three patients achieved full recovery to pre-injury level function. PMID: 30602284 [PubMed - as supplied by publisher] (Source: Annals o...
Source: Annals of the Royal College of Surgeons of England - January 3, 2019 Category: Surgery Authors: Ramsingh V, Yewlett AD, Pullen HC Tags: Ann R Coll Surg Engl Source Type: research

Giant angiolipoma of the back complicated with ulceration and sepsis: unusual presentation of a rare benign tumour.
Abstract A 63-year-old woman presented to the emergency unit with a huge (40 × 35 × 10 cm) oval-shaped pedunculated growth in the back with superficial ulceration in its lower aspect, associated with signs of sepsis. After adequate resuscitation, the patient was transferred to the operation theatre where the tumour was completely excised and the resultant wound was closed in primary manner using polypropylene sutures with suction drains inserted in the wound bed. The patient was discharged home after two days and was followed-up for two months. No wound complications were recorded on follow-up. Angioli...
Source: Annals of the Royal College of Surgeons of England - January 3, 2019 Category: Surgery Authors: Elfallal AH, Laimon YN, Emile SH Tags: Ann R Coll Surg Engl Source Type: research

The elusive spleen.
CONCLUSIONS: Splenectomy is required ever more rarely and experience as a district general hospital consultant is limited. Possible reasons for this include improvements in medical management of haematological diseases, the increasing use of conservative and radiological management for traumatic splenic injury, and a reduction in trauma cases and diversion of such cases to major trauma centres. Trainees and consultants must seek experience during specialty training or via cadaveric training in order to demonstrate competence. PMID: 30602286 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - January 3, 2019 Category: Surgery Authors: Dixon S, Horgan LF Tags: Ann R Coll Surg Engl Source Type: research

The prognostic significance of macroscopic serosal change in subserosal invasion (stage T3) gastric cancer.
CONCLUSION: Although the depth of tumour invasion mainly depends on pathological evaluation after surgery, the prognostic significance of intraoperative macroscopic serosal change should not be ignored for those patients with subserosal invasion. PMID: 30602290 [PubMed - as supplied by publisher] (Source: Annals of the Royal College of Surgeons of England)
Source: Annals of the Royal College of Surgeons of England - January 3, 2019 Category: Surgery Authors: Zhao B, Mei D, Zhang J, Zou S, Lu H, Xu H, Huang B Tags: Ann R Coll Surg Engl Source Type: research

Adult-onset giant cervical cystic hygroma with pressure manifestations on aerodigestive tract, managed surgically: reporting of a rare case.
We report the case of a 28-year-old woman who presented with a huge painless right-sided cystic neck swelling of 11 months duration, associated with progressive dysphagia and difficulty in breathing when lying supine or on her left side. Clinically, the swelling occupied both right anterior and posterior triangles of her neck with impalpable right carotid pulsations. Computed tomography revealed a cystic mass lesion. The mass was excised totally through right supraclavicular incision, after identification of the great auricular, spinal accessory and phrenic nerves. Paraffin section confirmed the diagnosis of cystic hygroma...
Source: Annals of the Royal College of Surgeons of England - January 3, 2019 Category: Surgery Authors: Elshaar K, AbuAleid L Tags: Ann R Coll Surg Engl Source Type: research