Bariatric surgery
Obesity presents a growing public health crisis which has significant impact for individuals and healthcare provision worldwide. Mounting evidence from randomized controlled trials would suggest that bariatric surgery, irrespective of the procedure performed, is the most effective treatment currently available for obesity and related comorbidity. Given the increasing prevalence of obesity within all populations, clinicians in all specialties will treat patients with obesity and likely those who have had bariatric surgery. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - September 21, 2020 Category: Surgery Authors: Alexis Sudlow, Dimitri J. Pournaras, Alan Osborne Tags: Oesophagus and stomach Source Type: research

Anatomy of the oesophagus
The oesophagus is a conduit between the pharynx and stomach. It may be described as consisting of cervical, thoracic and abdominal parts. The oesophagus is lined throughout by stratified squamous epithelium. The blood supply of the oesophagus is derived from multiple sources, including the inferior thyroid artery, the descending thoracic aorta and the left gastric artery. At the lower end of the oesophagus, within the mucosa and submucosa, is an important porta-systemic venous anastomosis between oesophageal tributaries of the left gastric vein and oesophageal tributaries of the azygos vein. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - September 19, 2020 Category: Surgery Authors: Vishy Mahadevan Tags: Basic science Source Type: research

Upper gastrointestinal haemorrhage
Upper gastrointestinal (UGI) haemorrhage is bleeding from any point of the GI tract proximal to the ligament of Treitz. There are multiple causes and various presentations, some of which can be quite subtle. With dramatic bleeding, aggressive resuscitation is required in the first instance. The gold standard investigation for diagnosis is endoscopy and this in turn can facilitate certain therapeutic interventions. Other forms of management include radiological and surgical interventions. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - September 19, 2020 Category: Surgery Authors: Mohamed Abdelrahman, Steve Hornby Tags: Oesophagus and stomach Source Type: research

Anatomy of the stomach
The stomach is the widest part of the alimentary canal. Continuous proximally with the abdominal oesophagus and distally with the duodenum, the stomach is ensleeved in peritoneum. The principal functions of the stomach are: (i) to act as a receptacle and reservoir for ingested food and to release the food into the duodenum in small and physiologically appropriate amounts; (ii) to secrete hydrochloric acid and proteolytic enzymes that initiate protein digestion and neutralize harmful bacteria in the ingested food; and (iii) to churn the ingested food and soften it with the help of gastric juice to produce a liquefied mixtur...
Source: Surgery (Medicine Publishing) - September 18, 2020 Category: Surgery Authors: Vishy Mahadevan Tags: Basic science Source Type: research

Oesophageal injury
Oesophageal injuries are rare, the majority being iatrogenic, spontaneous (Boerhaave's syndrome) or caustic. Partial thickness injuries are usually not serious, and heal. Due to its location, full thickness injuries of the oesophagus can have catastrophic consequences, leading to significant morbidity and sometimes death. Effective early treatment in experienced centres can lead to successful outcomes, although this relies on a low index of suspicion and rapid clinical recognition of this uncommon problem. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - September 17, 2020 Category: Surgery Authors: Stefan Antonowicz, Nick Maynard Tags: Oesophagus and stomach Source Type: research

Oesophageal cancer
is a lethal condition where 5-year survival remains at about 15%. There are two main subtypes of oesophageal cancer, squamous cell carcinoma (OSCC) and adenocarcinoma (OAC). OSCC usually affects the middle third of the oesophagus and is associated with smoking, alcohol and low socio-economic status. OAC affects the lower third of the oesophagus and is associated with gastro-oesophageal reflux disease. The UK has the highest incidence of OAC in the world and it is rising. Treatment may be palliative or curative. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - September 16, 2020 Category: Surgery Authors: Robert C. Walker, Timothy J. Underwood Tags: Oesophagus and stomach Source Type: research

Pathology of the oesophagus and stomach
The oesophagus is subject to a number of disorders affecting motility (swallowing) including gastro-oesophageal reflux disease, malignancy and disorders of neuromuscular function, such as achalasia. Most neoplasms of the oesophagus and stomach are epithelial in nature. Benign epithelial neoplasms usually take the form of polypoid lesions, such as oesophageal squamous papillomas, gastric adenomas, hyperplastic and fundic gland polyps. Malignant epithelial neoplasms of the oesophagus are divided into squamous cell carcinoma and adenocarcinoma, whereas malignant gastric neoplasms are predominantly adenocarcinomas. (Source: Su...
Source: Surgery (Medicine Publishing) - September 16, 2020 Category: Surgery Authors: Yvonne L. Woods, Frank A. Carey Tags: Basic science Source Type: research

Benign surgical diseases of the gastro-oesophageal junction
This article discusses both elective and emergency benign disorders of the OGJ, including their investigation and management. Elective conditions include gastro-oesophageal reflux disease (GORD), giant para-oesophageal hiatal herniae (GPHH), achalasia and other motility disorders. These conditions are now usually all managed laparoscopically when operative intervention is required. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - September 16, 2020 Category: Surgery Authors: Richard J. McGregor, Andrew GN. Robertson Tags: Oesophagus and stomach Source Type: research

Surgical malpractice: staying out of trouble
This article discusses why surgeons get into trouble more than most specialties and reviews data from the National Clinical Assessment Authority and the General Medical Council National Training Survey. It explores some of the areas that are known to be associated with the highest risk of suspension and malpractice claims, including working in the private and independent sectors, the introduction of new procedures and use of novel devices, consent and documentation, peri-procedural precautions, lack of resources and support, and medicolegal work. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - September 5, 2020 Category: Surgery Authors: Jonathan D. Beard Tags: Professional development Source Type: research

Burnout in surgeons: a ticking time bomb?
Burnout refers to a syndrome of depersonalization, emotional exhaustion and feelings of reduced achievement. It is believed to affect at least 40% of surgeons and is associated with both direct adverse clinical outcomes and increased attrition from training programmes. Despite falling recruitment and a growing awareness of its significance, the surgical profession is arguably engaging less than other specialties in schemes to address and modify the consequences of burnout. We examine the reasons why surgeons may be particularly vulnerable to this syndrome, both as individuals and from the environment in which they practise...
Source: Surgery (Medicine Publishing) - September 5, 2020 Category: Surgery Authors: Claire Dawkins, Anne Burdess Tags: Professional development Source Type: research

Leadership and working in teams
are core aspects of surgical training and practice. They are highlighted in the General Medical Council's ‘General Professional Capabilities’ framework, are included in the Good Surgical Practice guidance published by the Royal College of Surgeons of England and are incorporated in the ‘Non-Technical Skills for Surgeons’ (NOTSS) programme run by the Royal College of Surgeons of Edinburgh. Persis tent failings, as detailed in a number of public inquiries, including the Bristol cardiac surgery inquiry and the more recent Paterson inquiry, highlight the importance of prioritizing leadership and teamwo...
Source: Surgery (Medicine Publishing) - September 2, 2020 Category: Surgery Authors: Reena Ravikumar, Rowan W. Parks Tags: Professional development Source Type: research

Getting It Right First Time: what have we learnt?
Getting It Right First Time (GIRFT) is a national programme of improvement to identify and reduce unwarranted variation and non-evidence-based practice in healthcare. It aims to improve patient care, increase productivity and reduce costs. Professor Tim Briggs, an orthopaedic surgeon, began the programme with a pilot review visiting every orthopaedic surgery department in England. He used publicly available data to illuminate variation, and worked with the clinicians and management to develop improvements. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - September 2, 2020 Category: Surgery Authors: Andrew N. Duncan, Rob Sayers Tags: Professional development Source Type: research

Contents
(Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - September 1, 2020 Category: Surgery Source Type: research

Editorial Board
(Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - September 1, 2020 Category: Surgery Source Type: research

The new General Surgical Curriculum and ISCP
After wide consultation with trainees, trainers, employers and other stakeholders, the new General Surgical Curriculum was approved earlier this year and will be implemented from 4 August 2021. It will be outcome based and will be the biggest change in surgical training since 2007. Trainees can progress at their own rate and complete when they have acquired the capabilities of a Day-1 consultant in general surgery with a special interest. The Multiple Consultant Report (MCR) is new and has been developed as the main assessment tool for this outcomes-based curriculum. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - August 31, 2020 Category: Surgery Authors: Jon Lund Tags: Professional development Source Type: research

Research methods for the clinical surgeon
This article outlines the different research methods commonly used in clinical research, highlighting the basic features, appropriateness, benefits and limitations of each method. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - August 31, 2020 Category: Surgery Authors: Louise Hitchman, Ian Chetter Tags: Professional development Source Type: research

Enhancing junior doctors' working lives
Junior doctor wellbeing has been a topic of increasing interest in recent years. There is increasing evidence of poor workplace satisfaction, rising levels of burnout and increasing diaspora of UK-trained junior doctors. There is therefore a pressing need to address the wellbeing of our trainees and recent concerted efforts at local, national and international levels are working towards this, with the ultimate goal of also improving patient care. The tension between the personal and the professional may never be so keenly felt as during the unique challenges we are facing this year, in 2020, as we tackle the biggest global...
Source: Surgery (Medicine Publishing) - August 30, 2020 Category: Surgery Authors: Rachael O. Forsythe, Stuart A. Suttie Tags: Professional development Source Type: research

Adapting for the future: flexibility of UK postgraduate training
Postgraduate surgical training has undergone repeated reforms alongside changes in terms of employment. The broad structure of progression from Foundation years through core and specialist training to the award of a Certificate of Completion of Training is likely to continue for the foreseeable future. Technological developments including robotics, genomics and artificial intelligence together with an extension of the surgical team are likely to alter dramatically the nature of surgery in the future. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - August 30, 2020 Category: Surgery Authors: Tim Mitchell Tags: Professional development Source Type: research

Non-technical skills for surgeons (NOTSS)
Modern patient safety is approached in a systematic manner with a view to both minimizing harm and maximizing good practice. Small performance adjustments are used to make incremental gains. Non-technical skills are a key set of skills necessary for safe, effective patient management. The NOTSS (non-technical skills for surgeons) taxonomy defines the skills required of surgeons in the operating room, namely situation awareness, decision making, communication and teamwork, and leadership. Each of these skill categories pertains to a distinct skill set that needs to be practised and refined. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - August 30, 2020 Category: Surgery Authors: Alistair Geraghty, Simon Paterson-Brown Tags: Professional development Source Type: research

Evaluating quality in clinical care
This article will define quality in healthcare and discuss assessment models with reference to pertinent surgical literature. National initiatives are discussed with a critical appraisal of their role and effectiveness. We discuss the aim of quality improvement initiatives and comment on reporting of outcomes. The difficult question of how to maintain quality during a crisis, such as an infectious disease pandemic, is addressed. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - August 30, 2020 Category: Surgery Authors: Aminder A. Singh, Jonathan R. Boyle Tags: Professional development Source Type: research

Bullying in the workplace
Bullying is an under-recognized and often inadequately managed problem in the workplace. As well as bullying, individuals may be subjected to other problematic behaviours such as discrimination and harassment. Within the healthcare setting these can not only affect the victim, but can also have a potentially catastrophic impact on patient outcomes. Inadequately managed bullying can propagate within teams and disseminate, affecting organizational culture. Bullying impacts on training, with a Royal College of Surgeons survey indicating 60% of trainees had experienced bullying in the previous year and 94% of trainees had witn...
Source: Surgery (Medicine Publishing) - August 30, 2020 Category: Surgery Authors: Clara E. Munro, Alexander W. Phillips Tags: Professional development Source Type: research

How to pass the national selection interview
This article outlines the author's recommendations on how to navigate the current national selection process in order to achieve a higher surgical training post. The article breaks the daunting task of selection down into manageable sections covering pre-application portfolio boosting activity, an explanation of the online application process, and hints and tips to prepare for the interview itself. We hope to provide an overview of this process and allay some fears that surround this challenging time for applicants. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - August 30, 2020 Category: Surgery Authors: Emma E.F. Scott, Craig Nesbitt Tags: Professional development Source Type: research

How surgeons should behave on social media
This article documents the rise in popularity of social media use by surgeons for personal and professional use. It considers some of the important issues around privacy, patient confidentiality and professionalism and discusses some of the common pitfalls of using social media as a surgeon. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - August 30, 2020 Category: Surgery Authors: Janet WC. Kung, Stephen J. Wigmore Tags: Professional development Source Type: research

Improving Surgical Training
is a programme piloting an innovative, evidence-based  approach to training. It was developed in response to the Shape of Training report which reviewed postgraduate training and recommended changes in medical education to meet the demands of the modern NHS. A series of initiatives have been developed to enhance the experience for surgical trainees no t only to encourage a more focussed and supported method, but also to improve their job satisfaction. The initiatives have combined a greater emphasis on time for training provided by trainers with allocated time for training with multidisciplinary teamworking and the u...
Source: Surgery (Medicine Publishing) - August 30, 2020 Category: Surgery Authors: William Allum Tags: Professional development Source Type: research

Duty of candour and keeping patients safe
Over the decades we have witnessed legal cases influencing the government to develop the statutory duty of candour (DoC) in the medical profession. A duty that for a long time existed only in tort (civil) law. The purpose of the statutory DoC is understandingly important. For the public it simply reinforces an ethical duty already enforced by most professional regulators. For the medical profession, it is rather complex in ways that the courts can interpret and use it leaving uncertain legal ramifications for doctors. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - August 30, 2020 Category: Surgery Authors: Vinita Shekar, Peter A. Brennan Tags: Professional development Source Type: research

Choosing the new normal for surgical education using alternative platforms
The traditional methods for surgical education and professional development are changing, from a variety of external factors. The COVID-19 pandemic accelerated the pace innovative alternative tools are introduced into clinical practice, creating a new normal for teaching and training. In this new normal is the challenge to create durable changes for the future of surgical education. Social media (SoMe), a tool that uses electronic communications and applications to allow users create and share information in dynamic ways, can meet this challenge. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - August 30, 2020 Category: Surgery Authors: Deborah S. Keller, Rebecca C. Grossman, Des C. Winter Tags: Professional development Source Type: research

Slipped upper femoral epiphysis
(SUFE) is a common hip disorder of adolescence, with unknown aetiology. The typical patient presenting with SUFE is an overweight adolescent boy, who reports pain in the groin, thigh or knee, with an associated limp. SUFE is defined as stable when the patient can walk, with or without support. The current treatment of choice for stable SUFE is by fixation in situ with a single screw. This method has a high probability of success, with minimal risk of osteonecrosis or chondrolysis. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - August 8, 2020 Category: Surgery Authors: Ritesh A. Rathi, Tahir Khan Tags: ORTHOPAEDICS -- V: PAEDIATRICS Source Type: research

Polytrauma in children
is rare; however, trauma is a leading cause of death in children. Clinicians with responsibility for management of the child suffering major trauma must recognize the conflict between these facts. Simulation and preparation can help to improve the quality of care at both individual and institutional levels. Children are not small adults, and their anatomical and physiological differences manifest themselves in different responses to major trauma than those seen in adults. This reality should be met with a tailored approach to assessment, investigation and management that accommodates the changes occurring from infancy, th...
Source: Surgery (Medicine Publishing) - August 7, 2020 Category: Surgery Authors: Nicholas Peterson, Leroy James Tags: Orthopaedics – V: Paediatrics Source Type: research

Developmental dysplasia of the hip (DDH): diagnosis and treatment
This article describes the definition, investigation, imaging and treatment of developmental dysplasia of the hip (DDH). There is controversy in what constitutes physiological or pathological DDH. The results of hip screening programmes are disappointing. DDH may be diagnosed by clinical, sonographic or radiological means. The clinical diagnosis is confirmed by sonographic imaging (in the first months of life). Late presenting pathological DDH (>6 months of age) is usually diagnosed by an X-ray(s) of the pelvis. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - August 7, 2020 Category: Surgery Authors: Robin W. Paton, Qaisar Choudry Tags: Orthopaedics – V: Paediatrics Source Type: research

Legg –Calvé–Perthes Disease of the Hip
Legg –Calvé–Perthes’ disease is a condition of unknown aetiology affecting the developing hip. Various theories as to the underlying cause have been explored, but much remains unexplained. The clinical course of the condition is highly variable. For most young patients age 6 years or under, the di sease has been shown to be relatively benign, with few long-term implications. Conversely, in older children with more aggressive disease, the future prognosis can be very bleak, with premature degenerative joint disease an all too common outcome. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - August 7, 2020 Category: Surgery Authors: Manoj Ramachandran, Daniel W. Reed Tags: Orthopaedics – V: Paediatrics Source Type: research

Paediatric humeral supracondylar fractures
The supracondylar humeral fracture is the most common elbow fracture in children, accounting for just under one-fifth of all paediatric fractures and 60% of paediatric elbow fractures. Modifications of the Gartland classification have been made over the years. The mainstay treatment option is that of closed reduction and percutaneous wiring. However, there remains no gold standard in the management of this injury. Outcomes from other treatment options, including traction and external fixator application have been described and report good results. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - August 7, 2020 Category: Surgery Authors: Christopher Talbot, Sanjeev Madan Tags: Orthopaedics – V: Paediatrics Source Type: research

Non-accidental injury, femoral shaft and neck fractures in children
Fractures of the femur present some unique challenges to the treating orthopaedic surgeon. Non-accidental injury must always be considered. There are various modalities that can be used in the management of shaft fractures and these should be treated with careful consideration of not just the fracture pattern but also the patient ’s age, weight, bone maturity and social circumstances. Treatment options include: Pavlik harness, traction, spica casting, elastic nailing, sub-muscular plating, external fixation and intramedullary nailing. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - August 7, 2020 Category: Surgery Authors: Edward A.O. Lindisfarne, Oluwarantimi Ayodele Tags: ORTHOPAEDICS – V: PAEDIATRICS Source Type: research

Test yourself: MCQ and single best answer
For questions 1 –4, select the statements which are true and which are false. The correct answers are given below. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - August 7, 2020 Category: Surgery Authors: Adrian Ben Cresswell Tags: Test Yourself Source Type: research

Injuries to the distal femur and patella
Injuries around the knee are often high-energy injuries. The anatomy of the distal femoral physis contributes to its stability and hence high energy is required for disruption of this physis. As the distal femur contributes to the majority of the growth of the lower limb, injury to this growth plate has a high incidence of growth disturbance. Supracondylar femoral fractures can be difficult to reduce and fix due to the short metaphyseal segment. Patellar dislocations are commonly seen in adolescents. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - August 6, 2020 Category: Surgery Authors: Ishani P. Shah, James A. Fernandes Tags: Orthopaedics – V: Paediatrics Source Type: research

A review of paediatric cervical spinal trauma
This article looks at the initial assessment and management of injuries. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - August 6, 2020 Category: Surgery Authors: Philip Brown, Sudarshan Munigangaiah, Neil Davidson, Colin Bruce, Jayesh Trivedi Tags: Orthopaedics – v: paediatrics Source Type: research

Assessment and management of childhood skeletal malignancies
Primary bone cancers are a rare but life changing diagnosis. Early diagnosis and onward referral to a multidisciplinary team within a dedicated sarcoma centre is associated with the best outcomes. The most common lesions, osteosarcoma and Ewing ’s sarcoma, are aggressive tumours with a tendency to metastasize to the lungs. Treatment for localized and some metastatic cases generally consists of multi-agent neoadjuvant chemotherapy followed by surgical resection and reconstruction prior to further chemotherapy. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - August 6, 2020 Category: Surgery Authors: R.S. Craig, A. Wainwright Tags: Orthopaedics – v: paediatrics Source Type: research

Back pain in children
This article focuses on the assessment, differential diagnosis and overview of management of frequently encountered causes of back pain in children. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - August 6, 2020 Category: Surgery Authors: Prasad Karpe, Maire-Claire Killen, David Fender Tags: Orthopaedics – V: Paediatrics Source Type: research

Scoliosis in childhood
Scoliosis is the most frequently encountered spinal deformity of childhood. It is a three-dimensional deformity with lateral curvature in the coronal plane and associated rotation. Scoliosis is classified according to its a etiopathogenesis; it can be idiopathic (80%), congenital, neuromuscular or syndromic. Treatment depends on the etiology, age and maturity at presentation and magnitude of the deformity. The mainstay of treatment for significant scoliosis is surgery by way of spinal instrumentation, correction and bone grafting to achieve a selective fusion of the spine. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - August 6, 2020 Category: Surgery Authors: Prasad Karpe, Maire-Claire Killen, David Fender Tags: Orthopaedics - v: Paediatrics Source Type: research

Contents
(Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - August 1, 2020 Category: Surgery Source Type: research

Editorial Board
(Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - August 1, 2020 Category: Surgery Source Type: research

Malignant liver tumours
The liver is commonly affected by malignant tumours, both primary and secondary. The majority of liver tumours are diagnosed radiologically, and MRI and CT are accurate at detecting even small tumours. Hepatocellular carcinoma (HCC) is the most common primary tumour and often presents on a background of liver cirrhosis. The curative options for HCC are liver resection and transplantation. However, non-curative management such as radiofrequency ablation and transarterial chemoembolisation (TACE) can prolong survival in patients not suited to curative management. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - July 25, 2020 Category: Surgery Authors: Chris JC. Johnston, Andrew J. Healey Tags: Hepatobiliary surgery Source Type: research

Gallstones
This article explores the pathogenesis of gallstones, the presentation and management options; the technique of cholecystectomy and the prevention and recognition of bile duct injury. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - July 21, 2020 Category: Surgery Authors: Ian J. Beckingham Tags: HEPATOBILIARY SURGERY Source Type: research

Jaundice
is a yellow discoloration of body tissues usually observed in the skin secondary to excess bilirubin in the serum. This occurs due to imbalance between production and clearance of bilirubin. It is important to understand the pathophysiology of jaundice to understand its aetiology. Careful history and physical examination, together with appropriate urine and blood tests will guide further investigations to obtain an appropriate diagnosis. It is important to assess and address associated sepsis, dehydration, electrolyte imbalance and clotting abnormality to reduce morbidity prior to instituting any treatment plan. (Source: ...
Source: Surgery (Medicine Publishing) - July 21, 2020 Category: Surgery Authors: Ravi (Rajan) Ravindran Tags: Hepatobiliary surgery Source Type: research

Pathology of liver tumours
Histopathological assessment of liver tissue is essential for the management of patients with a whole range of liver tumours. Biopsies are often helpful in establishing the initial diagnosis of a lesion. Intraoperative frozen sections can provide the surgeon with valuable information regarding the nature of a liver lesion and/or the clearance of surgical margins. Examination of tissue from resection and transplant operations is important in confirming the preoperative diagnosis and for providing additional prognostic information. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - July 17, 2020 Category: Surgery Authors: Owen L. Cain, Rachel M. Brown Tags: Basic science Source Type: research

Benign liver lesions
are common and can pose a diagnostic challenge due to the difficulty in differentiating them from malignant hepatic lesions. They seldom present as an emergency. Most benign liver lesions are asymptomatic and are frequently detected incidentally during investigations for other conditions. Symptomatic lesions usually cause non-specific symptoms. Liver function tests are usually within the normal range, and diagnosis is established by abdominal ultrasound, computed tomography, magnetic resonance imaging or positron emission tomography. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - July 16, 2020 Category: Surgery Authors: James RH. O'Kelly, Damian J. Mole Tags: Hepatobiliary surgery Source Type: research

Test yourself: MCQ and single best answer
For questions 1 –4, select the statements which are true and which are false. The correct answers are given below. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - July 16, 2020 Category: Surgery Authors: Adrian Ben Cresswell Tags: Test yourself Source Type: research

Portal hypertension and ascites
Portal hypertension is secondary to increased resistance to blood flow and increased blood flow through the portal system. The most common cause is liver cirrhosis. The most severe and life-threatening presentation of portal hypertension is acute variceal bleeding. Pharmacotherapy with vasoactive agents (terlipressin or somatostatin), endoscopic band ligation and radiological treatment with transjugular intrahepatic portosystemic shunt (TIPSS) are the most common treatment options for variceal bleeding. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - July 15, 2020 Category: Surgery Authors: Stephen O ’Neill, Gabriel C. Oniscu Tags: Hepatobiliary surgery Source Type: research

The principles of liver resection
Liver resection offers the only potential for curative treatment for many primary and secondary hepatic malignancies. With ongoing advances in both surgical technique and postoperative management, the indications for surgery continue to expand; however, perioperative risk remains significant as increasingly complex cases are considered. The fundamental principle is to achieve complete resection of disease with preservation of an adequate functional liver remnant. Successful outcomes rely on detailed knowledge of both intra- and extrahepatic anatomy and demand meticulous attention to patient selection, surgical technique an...
Source: Surgery (Medicine Publishing) - July 15, 2020 Category: Surgery Authors: Daniel Vagg, Giles Toogood Tags: Hepatobiliary surgery Source Type: research

Test yourself: MCQ and single best answer
For questions 1 –4, select the statements which are true and which are false. The correct answers are given below. (Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - July 4, 2020 Category: Surgery Authors: Adrian Ben Cresswell Tags: Test yourself Source Type: research

Contents
(Source: Surgery (Medicine Publishing))
Source: Surgery (Medicine Publishing) - July 1, 2020 Category: Surgery Source Type: research