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Ann R Coll Surg Engl 2019 Feb 18:e1-e3. Epub 2019 Feb 18.

General Surgery, Homerton University Hospital NHS Foundation Trust , London , UK.

Lumbar hernias can be superior (Grynfelt) and inferior (Petit). Inferior lumbar hernias are extremely rare and, therefore, are associated with diagnostic difficulty. 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. Read More

Ann R Coll Surg Engl 2019 Feb 18:1-4. Epub 2019 Feb 18.

Portsmouth Hospitals NHS Trust , UK.

Introduction: Healthcare professionals increasingly recognise how human factors (HF) can contribute to medical error. An understanding of HF is also important during other high stakes activities such as summative assessments or examinations. National organisations hosting such events need to be aware of potential fatigue, boredom and stress that can occur in interviewers during these often repetitive activities. Read More

Ann R Coll Surg Engl 2019 Feb 18:1-5. Epub 2019 Feb 18.

Zen Hospital , Mumbai , India.

Introduction: Epiphrenic diverticulum (ED) is an uncommon disease that is invariably associated with an underlying oesophageal motility disorder such as achalasia. Management of ED should always be accompanied by treatment of the underlying motility disorder to prevent recurrence of symptoms. Traditionally, ED were approached via a left thoracotomy but as laparoscopy offers better access to the distal oesophagus, its use is becoming more widespread. Read More

Ann R Coll Surg Engl 2019 Feb 15:1-9. Epub 2019 Feb 15.

Regional Vascular Centre, Royal Preston Hospital , Preston , UK.

Introduction: We reviewed the literature for preoperative computed tomography carotid angiography and/or carotid duplex to determine their respective sensitivity and specificity in assessing the degree of carotid stenosis. We aimed to identify whether one imaging modality can accurately identify critical stenosis in patients presenting with transient ischaemic attack or symptoms of a cerebrovascular accident requiring carotid endarterectomy.

Methods: Systematic search of MEDLINE, Embase, Cochrane database of systematic reviews, all Evidence-Based Medicine Reviews (Cochrane Database of Systematic Reviews, ACP Journal club, Database of Abstracts of Reviews of Effects, Cochrane Clinical Answers, Cochrane Controlled Trials Register, Cochrane Methodology Register, Health Technology Assessment and NHS Economic Evaluation Database) for primary studies relating to computed tomography carotid angiography (CTA) and/or carotid duplex ultrasound (CDU). Read More

Ann R Coll Surg Engl 2019 Feb 4:e1-e2. Epub 2019 Feb 4.

University Hospitals of Leicester NHS Trust , UK.

Pancreatic adenocarcinoma is a highly aggressive malignancy that usually presents at a late stage. Common sites of metastasis include the liver, lung and adjacent lymph nodes. Cervical lymph node involvement has been reported previously but there are no documented cases of submandibular lymph node metastasis in the available literature. Read More

Ann R Coll Surg Engl 2019 Jan 30:1-5. Epub 2019 Jan 30.

Royal Surrey County Hospital NHS Foundation Trust, Guildford , Surrey , UK.

Introduction: Isolated ulnar shortening osteotomies can be used to treat ulnocarpal abutment secondary to radial shortening following distal radius fractures. Given the increase of fragility distal radius fractures awareness of treating the sequelae of distal radius fractures is important. We present the largest reported case series in the UK of ulnar shortening osteotomies for this indication. Read More

Ann R Coll Surg Engl 2019 Jan 30:1-7. Epub 2019 Jan 30.

University Hospitals Plymouth NHS Trust , UK.

Introduction: Fractures are a common reason for admission to hospital around the world. Varying incidences have been reported but these are mainly based on small studies from individual centres. The aim of our study was to analyse fracture admissions in England over a ten-year period. Read More

Ann R Coll Surg Engl 2019 Jan 30:1-7. Epub 2019 Jan 30.

King's College NHS Foundation Trust , UK.

Introduction: Surgical site infections (SSIs) are of profound significance in neurosurgical departments, resulting in high morbidity and mortality. There are limited public data regarding the incidence of SSIs in neurosurgery. The aim of this study was to determine the rate of SSIs (particularly those requiring reoperation) over a seven-year period and identify factors leading to an increased risk. Read More

Ann R Coll Surg Engl 2019 Jan 30:1-7. Epub 2019 Jan 30.

Indonesian Clinical Training and Education Centre, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia , Jakarta , Indonesia.

Introduction: This study reports the use of a dorsal pentagonal island flap for post-burn webbing contracture, in which the islanded flap is harvested from the burn scar tissue.

Methods: Fourteen dorsal pentagonal island flaps were harvested in seven patients with post-burn webbing. Each flap was selected by examining the scar tissue donor using a modified Vancouver scar scale. Read More

Ann R Coll Surg Engl 2019 Jan 30. Epub 2019 Jan 30.

Great Ormond Street Hospital for Children NHS Foundation Trust , UK.

Ann R Coll Surg Engl 2019 Feb;101(2):79-85

Department of Orthopaedics, Indraprastha Apollo Hospitals , New Delhi , India.

Introduction: Extended intralesional curettage, together with bone grafting/cementing, is considered as a surgical treatment option for giant cell tumour of the bone. This study aimed to discover the efficacy and recurrence rate with the use of bone cement in giant cell tumour and to compare it with that of bone grafting.

Material And Methods: The present systemic review is derived from the publications in the past 10 years (2009-2018). Read More

Ann R Coll Surg Engl 2019 Jan 15:1-8. Epub 2019 Jan 15.

Department of Surgery, Royal Alexandra Hospital , Paisley , UK.

Aim: Enhanced recovery after surgery (ERAS) programmes aim to standardise perioperative care leading to optimal patient outcomes. Despite these programmes, variation in outcomes still persists. This study aimed to assess the influence of lifestyle factors on short-term outcomes after colorectal surgery within this optimal recovery programme. Read More

Ann R Coll Surg Engl 2019 Jan 15:1-6. Epub 2019 Jan 15.

East and North Hertfordshire NHS Trust, Stevenage , Hertfordshire , UK.

Introduction: The aim of this single centre retrospective observational record-based audit was to assess the incidence of post-thyroidectomy hypocalcaemia. The setting was a district general hospital in Hertfordshire covering a population of 500,000 people. A total of 196 patients who had had total or completion thyroidectomy during a five-year period were included in the study. Read More

Ann R Coll Surg Engl 2019 Jan 3:e1-e3. Epub 2019 Jan 3.

Minimally Invasive Surgery Research Center, Iran University of Medical Sciences , Tehran , Iran.

A 39-year-old woman was admitted with colicky left upper-quadrant pain, dyspnoea, low-grade fever, tachycardia and a subtle left upper-quadrant tenderness without leucocytosis. Computed tomography revealed a distended gastric remnant due to small-bowel loop herniation at the trocar site. The patient underwent a diagnostic laparoscopy as her general condition worsened. Read More

Ann R Coll Surg Engl 2019 Jan 3:1-5. Epub 2019 Jan 3.

Trauma and Orthopaedics, Brighton and Sussex University Hospitals NHS Trust , Brighton , UK.

Introduction: The aim of the study was to establish whether a dedicated hip fracture unit, geographically separate from the local major trauma centre, could improve clinical outcomes for patients sustaining proximal femoral fragility fractures.

Materials And Methods: This study was a retrospective case series, using data collected from Brighton and Sussex University Hospitals NHS Trust's submissions to the National Hip Fracture Database between 1 April 2011 and 16 September 2016. The outcomes measured were mortality, length of hospital stay, time from admission to surgical intervention and return to premorbid residence. Read More

Ann R Coll Surg Engl 2019 Jan 3:1-5. Epub 2019 Jan 3.

Department of Vascular Surgery, Oxford University Hospitals , Oxford , UK.

Introduction: This prospective study of foam sclerotherapy for varicose veins aimed to determine the outcomes of treatment including ulcer healing and complication rates in our unit. Data were collected prospectively over a 10-year period and maintained on a database by our vascular sciences unit, which performed the planning and post-treatment venous duplex scans. Patients undergoing treatment due to venous ulceration were identified from this database. Read More

Ann R Coll Surg Engl 2019 Jan 3:e1-e4. Epub 2019 Jan 3.

Department of General Surgery, King Fahd Central Hospital , Jazan , Saudi Arabia.

Cystic hygroma is a benign congenital malformation of the lymphatic system that occurs in children younger than two years of age. Hygroma commonly presents in head and neck but can be present anywhere. It is rarely seen in adults. Read More

Ann R Coll Surg Engl 2019 Jan 3:1-7. Epub 2019 Jan 3.

Department of Surgical Oncology, First Affiliated Hospital of China Medical University , Shenyang , China.

Background: For patients with gastric cancer intraoperative macroscopic serosal change is not always consistent with pathological T stage. We investigated whether macroscopic serosal change is associated with unfavourable prognosis of patients with gastric cancer.

Methods: We reviewed 856 patients with stage T3 gastric cancer who underwent curative gastrectomy in our institution. Read More

Ann R Coll Surg Engl 2019 Jan 3:1-4. Epub 2019 Jan 3.

Northumbria Healthcare NHS Foundation Trust , UK.

Introduction: The aim of this study was to review the experience of general surgeons performing splenectomy in a district general hospital. The outcomes are discussed together with potential reasons for the increasing rarity of the procedure.

Methods: A retrospective cohort study was carried out of all patients undergoing splenectomy (as identified by a single trust pathology department on receipt of splenic samples) between 1 January 2000 and 1 May 2017. Read More

Ann R Coll Surg Engl 2019 Jan 3:e1-e3. Epub 2019 Jan 3.

General Surgery Department, Mansoura University Hospitals Mansoura University , Mansoura City , Egypt.

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. Read More

Ann R Coll Surg Engl 2019 Jan 3:e1-e5. Epub 2019 Jan 3.

Aneurin Bevan University Health Board , UK.

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. Read More

Ann R Coll Surg Engl 2019 Jan;101(1)

Ann R Coll Surg Engl 2018 Dec 11:1-6. Epub 2018 Dec 11.

School of Surgery, North West Deanery , Manchester , UK.

Introduction: In recent years there has been a rise in the number of trauma and orthopaedics trainees working on full shift patterns. Historically, most trauma and orthopaedics trainees worked 24 hours non-resident on-call shifts. The effect of this change in shift patterns has not previously been measured. Read More

Ann R Coll Surg Engl 2019 Jan 28;101(1):14-16. Epub 2018 Nov 28.

Northwick Park Hospital , London , UK.

Introduction: Percutaneous access and closure is commonly performed for patients undergoing endovascular aneurysm repair (EVAR). It has proven to be a safe and successful method of closure associated with fewer complications when compared with the traditional open technique. Fascial closure is an alternative technique that can be used for closure reducing the risks associated with the open technique. Read More

Ann R Coll Surg Engl 2018 Nov 28:1-4. Epub 2018 Nov 28.

Department of Oral and Maxillofacial Surgery, King's College Hospital , London , UK.

Introduction: King's College Hospital has proudly provided a one-stop neck lump clinic since 2012. These multidisciplinary clinics allow for rapid diagnoses due to in-clinic investigations. In April 2013, ultrasound-guided core needle biopsies were introduced as an alternative/adjunct to fine-needle aspiration cytology and open biopsies for obtaining histological diagnoses. Read More

Ann R Coll Surg Engl 2018 Nov 28. Epub 2018 Nov 28.

Bristol Royal Infirmary , Bristol , UK.

A technique to reduce mess and odour in abscess drainage is presented. Read More

Ann R Coll Surg Engl 2018 Nov 28:1-8. Epub 2018 Nov 28.

Department of General Surgery, James Cook University Hospital , Middlesbrough , UK.

Introduction: The definitive treatment of anal cancer with chemoradiotherapy spares abdominoperineal resection for salvage treatment but carries a high burden of toxicity. Intensity-modulated radiation therapy has been implemented to reduce toxicity, reduce treatment breaks and improve survival. However, large and long-term studies are lacking. Read More

Ann R Coll Surg Engl 2018 Nov 28:e1-e3. Epub 2018 Nov 28.

General and Digestive Surgery Department, Rio-Hortega University Hospital , Valladolid , Spain.

Splenic cysts are a rare pathology, which can be classified as true (25%) or pseudocysts (75%). Total splenectomy has been the treatment of choice, particularly in recent times with the advent of the laparoscopic approach. However, as the spleen is an organ with multiple immunological functions, the laparoscopic partial splenectomy is an alternative, which is technically difficult but effective. Read More

Ann R Coll Surg Engl 2018 Nov 28. Epub 2018 Nov 28.

Leighton Hospital , Crewe , UK.

Ann R Coll Surg Engl 2018 Nov 28:e1-e2. Epub 2018 Nov 28.

Department of Surgery, Tallaght University Hospital , Dublin , Ireland.

Cysts in the liver have a wide variety of aetiologies. Important features of malignancy based on various imaging techniques must be considered prior to any intervention. Perioperative decision making in complex or difficult cysts is key to appropriate patient management. Read More

Ann R Coll Surg Engl 2018 Nov 28:e1-e2. Epub 2018 Nov 28.

Institute of Liver Disease & Transplantation, Gleneagles Global Health City , Chennai , India.

Introduction: Auxiliary partial orthotopic liver transplantation (APOLT) in acute liver failure acts as a bridge to native liver regeneration with potential for immunosuppression free survival. While technical concerns limit its universal acceptance, the indications in acute liver failure also need to be examined for this procedure to ultimately succeed.

Case History: We present the case of an eight-month-old girl with cryptogenic acute liver failure who underwent APOLT. Read More

Ann R Coll Surg Engl 2019 Jan 13;101(1):7-13. Epub 2018 Nov 13.

NHS Lothian , UK.

Introduction: Guidelines for peripheral vascular disease state that supervised exercise therapy (SET) programmes improve walking distance and quality of life in patients with intermittent claudication. This paper outlines the steps needed to implement a successful SET programme and discusses some of the challenges.

Methods: Edinburgh Leisure was approached to coordinate an exercise programme aimed at rehabilitation, run by level 4 members of the Register of Exercise Professionals. Read More

Ann R Coll Surg Engl 2018 Nov 13:1-7. Epub 2018 Nov 13.

Department of Surgery, Hospital Universitario La Pa , Madrid , Spain.

Introduction: Recent prospective studies support the feasibility of performing sentinel lymph node biopsy following neoadjuvant chemotherapy in initially fine-needle aspiration cytology or ultrasound-guided biopsy-proven node-positive breast cancer. The main aid is to identify preoperative features that help us predict a complete axillary response to neoadjuvant chemotherapy in these patients and thus select the candidates for sentinel lymph node biopsy post-neoadjuvant chemotherapy to avoid unnecessary axillary lymphadenectomy.

Materials And Methods: A retrospective observational study with a total of 150 patients, biopsy-proven node-positive breast cancer who underwent neoadjuvant chemotherapy followed by breast surgery and axillary lymphadenectomy were included and retrospectively analysed. Read More

Ann R Coll Surg Engl 2019 Feb 13;101(2):e66-e70. Epub 2018 Nov 13.

Department of Urology, Ibn Sina Military Hospital , Marrakech , Morocco.

Fibroepithelial polyps of the ureter are rare non-epithelial benign tumours with a slight female predominance. They are primarily located in the upper left ureter, incidentally diagnosed in patients who are evaluated for gross haematuria or renal colic. Fibroepithelial polyps are traditionally managed by open surgery with resection of the polyp and its stalk or partial resection of the ureter. Read More

Ann R Coll Surg Engl 2019 Jan 13;101(1):70-71. Epub 2018 Nov 13.

Bradford Teaching Hospitals NHS Foundation Trust , UK.

Ann R Coll Surg Engl 2019 Jan 1;101(1):72-73. Epub 2018 Nov 1.

Cambridge University Hospitals NHS Foundation Trust , UK.

Ann R Coll Surg Engl 2019 Feb 1;101(2):123-125. Epub 2018 Nov 1.

Department of Orthopaedic Surgery, King Hamad University Hospital , Bahrain.

Introduction: Anterior cruciate ligament tears are a common ligamentous knee injury and are usually managed with arthroscopic reconstruction surgery using a tourniquet. The employment of a tourniquet in the management of an anterior cruciate ligament tear has been a debatable topic for some time. Here, we discuss our technique in the reconstruction of anterior cruciate ligament tears without the use of a tourniquet. Read More

Ann R Coll Surg Engl 2019 Jan 1;101(1):71-72. Epub 2018 Nov 1.

Cambridge University Hospitals NHS Foundation Trust , UK.

Ann R Coll Surg Engl 2019 Feb 29;101(2):103-106. Epub 2018 Oct 29.

Department of Otolaryngology, Head and Neck Surgery, Queen Elizabeth University Hospital , Glasgow , UK.

Introduction: Primary care patients with a suspected head and neck cancer are referred through the urgent suspicion of cancer referral pathway. Rates of cancer detection through this pathway are low. Evidence surrounding the pathway of these patients is lacking. Read More

Ann R Coll Surg Engl 2019 Feb 29;101(2):e52-e54. Epub 2018 Oct 29.

Maxillofacial Surgery Operative Unit, Department of Life, Health and Environmental Sciences, 'San Salvatore' City Hospital , L'Aquila , Italy.

Lemierre's syndrome is also known as the forgotten disease, and is a rare but life-threatening complication that can arise after surgical extractions of infected mandibular third molars. Owing to its rarity, oral and maxillofacial surgeons might not immediately recognise or can underestimate the pathological signs, and consequently do not apply the appropriate therapy to treat the syndrome. Here, we report on the occurrence and management of a case of Lemierre's syndrome, where the complications affected the right sigmoid sinus. Read More

Ann R Coll Surg Engl 2019 Feb 29;101(2):e48-e51. Epub 2018 Oct 29.

Department of General Surgery, Queen Elizabeth University Hospital , Glasgow , UK.

Bariatric surgery is an established intervention providing significant health benefits to patients with obesity. As a result, the National Institute for Health and Care Excellence now recommends bariatric surgery for those that fulfil the eligibility criteria, while emphasising the need for multidisciplinary care before and after surgery. The UK National Bariatric Surgery Registry shows gastric band procedures to be the second most common bariatric procedure performed in the UK. Read More

Ann R Coll Surg Engl 2019 Feb 29;101(2):e62-e65. Epub 2018 Oct 29.

Post Graduate Institute of Medical Education and Research, Advanced Urology Centre Nehru Hospital, Pgimer , Chandigarh , India.

Retroperitoneal paragangliomas are rare tumours arising from neural crest cells located near or in the autonomic nervous system; right from the skull bass to the pelvic floor. Often called the great masqueraders, their diagnosis and treatment is often difficult and fraught with danger, considering the close proximity of these tumours to important retroperitoneal organs. A 29-year-old woman presented to the outpatient department with complaints of paroxysms of headache, sweating and palpitations for one year. Read More

Ann R Coll Surg Engl 2019 Feb 29;101(2):e55-e58. Epub 2018 Oct 29.

Department of Endocrine Surgery, National University Hospital , Singapore.

The occurrence of nonrecurrent laryngeal nerve and delayed nerve palsy of the contralateral nerve occurring simultaneously has never been described. A 67-year-old woman underwent reoperative completion thyroidectomy for enlarging thyroid nodules with recurrent hyperthyroidism and obstructive symptoms. Preoperative computed tomography of the neck showed a large compressive goitre with an aberrant right subclavian artery. Read More

Ann R Coll Surg Engl 2019 Feb 24;101(2):136-137. Epub 2018 Oct 24.

Newcastle University , Brazil.

Ann R Coll Surg Engl 2019 Feb 24;101(2):e59-e61. Epub 2018 Oct 24.

Department of General Surgery, Queen Elizabeth University Hospital , Glasgow , UK.

An 84-year-old woman presented with acute worsening of diarrhoea for a few weeks, with a background of chronic diarrhoea over the past 12 months accompanied by weight loss. Computed tomography during this admission revealed air in the biliary tree and resolution of gallstones in keeping with a cholecystocolonic fistula. Owing to her comorbidities, surgical management was deemed not to be the best option. Read More

Ann R Coll Surg Engl 2019 Feb 24;101(2):126-132. Epub 2018 Oct 24.

Department of Colorectal Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Fulwood , Preston , UK.

Introduction: Although the mainstay of colorectal cancer treatment remains operative, a significant proportion of patients end up without surgery. This is because they are either deemed to have no oncological benefit from the resection (too much disease) or to be unfit for major surgery (too frail). The aim of this study was to assess the proportion and survival of these two groups among the totality of practice in a tertiary unit and to discuss the implications on the conceptual understanding of outcome measures. Read More

Ann R Coll Surg Engl 2019 Feb 24;101(2):e45-e47. Epub 2018 Oct 24.

Clinica Chirurgica Generale, Università di Parma , Parma , Italy.

The incidence of biliary lithiasis after gastric surgery seems to be higher than in the general population. Endoscopic retrograde cholangiopancreatography (ERCP) allows several biliary and pancreatic pathologies to be dealt with; however, in patients with an altered anatomy of the upper and mid gastrointestinal tract, this endoscopic manoeuvre can be extremely challenging. We report a case of a 79-year-old woman with previous subtotal gastrectomy and Roux-en-Y reconstruction, admitted with a diagnosis of cholecystitis and choledocolithiasis. Read More

Ann R Coll Surg Engl 2018 Oct 24:1-6. Epub 2018 Oct 24.

Department of Neurosurgery, Addenbrooke's Hospital , Cambridge , UK.

Introduction: Surgical site infection is associated with significant morbidity and mortality. Effective preoperative skin decolonisation is an important preventative strategy. The National Institute for Health and Care Excellence clinical guidelines recommend decolonisation using chlorhexidine gluconate (CHG) or povidone iodine (PVI). Read More

Ann R Coll Surg Engl 2019 Jan 17;101(1):60-68. Epub 2018 Oct 17.

Cork Institute of Technology , Cork , Ireland.

Introduction: The importance of postoperative drain fixation cannot be overemphasised. There are numerous described techniques for drain fixation. However, to our knowledge, there is no evidence-based comparison between the various techniques of drain fixation used in postoperative management. Read More

Ann R Coll Surg Engl 2019 Feb 16;101(2):e38-e42. Epub 2018 Oct 16.

Royal Orthopaedic Hospital NHS Foundation Trust , UK.

We present the case of a 75-year-old man with a rapidly progressive cervical myelopathy on a background of a 3-year history of neck pain and a severely degenerative cervical spine. The patient developed progressive myelopathy over a six-month period and suffered from worsening kyphosis. Suspicion of an underlying oncological process prompted transfer to our tertiary referral unit. Read More