Background: Innovation has always been central to the evolution of general surgery, driving safer techniques, better outcomes, and more efficient patient care. From antisepsis and anaesthesia to robotics and artificial intelligence, the specialty has consistently adapted to [....] » Read More
Objectives: Generative AI and Large Language Models (LLMs) have lowered the technical barrier for software creation, yet a gap remains between potential and practical application for surgeons. We aim to bridge this gap by defining a structured "Prompt Engineering Framework&q [....] » Read More
Introduction: Frailty, characterised by reduced physiological reserve and increased vulnerability, is common in end-stage heart failure. Continuous-flow left ventricular assist devices (LVADs) improve outcomes, but the impact of frailty on clinical outcomes remains unclear. [....] » Read More
Aim: Haematuria pathways primarily target urothelial malignancy, as reflected in current NICE guidance. However, this approach risks missing glomerular disease in younger adults, where early identification of conditions such as IgA nephropathy and inherited haematuric disorders m [....] » Read More
Introduction: Managing complex renal tumours in a solitary functioning kidney represents a major surgical challenge, where oncological control must be balanced against avoidance of dialysis. In highly vascular or centrally located tumours, conventional nephron-sparing surger [....] » Read More
Background: Rectal biopsy is the gold?standard investigation for Hirschsprung’s disease (HSCR), with suction rectal biopsy (SRB) preferred in infants and open/strip biopsy (O/S) more commonly used in older children or following inadequate SRB. Optimising biopsy yield, minim [....] » Read More
Introduction: The use of electronic cigarettes has increased several folds worldwide in the last decade. While studies have documented the systemic harms of vaping, its specific impact on patients undergoing general anaesthesia remains unclear. This scoping review aims to as [....] » Read More
Aim: Social media plays an increasingly prominent role in plastic surgery, influencing patient expectations, marketing strategies, and professional engagement. Yet, no bibliometric analysis has examined the most influential literature in this field. This study characterizes [....] » Read More
Background: Endoscopic Retrograde Cholangiopancreatography (ERCP) is a key therapeutic procedure in gallstone disease. Outpatient ERCP may reduce inpatient pressures and costs, but patient selection is challenging due to post-procedure complications. No validated criteria current [....] » Read More
Background: Day-case proctological surgery is commonly performed under general anaesthesia, which can be cumbersome and inefficient for often short-duration procedures, with prolonged recovery and excessive resource use. The inferior rectal nerve block provides anatomically targe [....] » Read More
Perioperative management of pain is crucial in optimising patient outcomes after laparotomy. This review focuses on the rectus sheath block (RSB) and its use in midline laparotomies. This article will examine the current evidence on the clinical efficacy of this method, [....] » Read More
Introduction: Using 3D models to help with surgical skill acquisition has been shown to improve both confidence and technical skills 1. However, surgical education has historically utilised animal tissues or human cadaveric specimens, both of which are associated with high fina [....] » Read More
Objective: With an ageing population, focus has turned to surgical outcomes in the very elderly population. This meta-analysis aims to quantify the prevalence of complication and death rates amongst the very elderly population (over 90 years old) following colorectal surgery. [....] » Read More
Background: Postoperative pain is an acute response to surgical trauma. An objective understanding of pain measurement is essential for adequate postoperative pain management. Infants and the pediatric population often have limited language skills to express their discomfort clea [....] » Read More
Popliteal artery aneurysm is defined as an abnormal dilation of the popliteal artery with a diameter greater than 15 mm. It accounts for approximately 70% of all peripheral arterial aneurysms and occurs more frequently in men. The most common etiology is atherosclerotic disease; [....] » Read More
Arteriovenous fistulas (AVFs) are the preferred vascular access for patients with chronic kidney disease undergoing hemodialysis due to their superior long-term patency and lower infection rates compared with temporary catheters. However, over time, AVFs may develop aneurysmal [....] » Read More
Popliteal vascular trauma is an uncommon but highly complex condition associated with significant morbidity, risk of permanent disability, and potential limb loss, substantially impacting patients’ quality of life. One of the most serious complications is traumatic pseudoan [....] » Read More
Iatrogenic femoral artery thrombosis during pediatric orthopedic procedures is an uncommon but clinically significant complication due to the high risk of acute limb ischemia, limb loss, and permanent functional impairment. Surgical procedures such as open reduction for the treat [....] » Read More
Introduction: Enhanced recovery after cesarean section (ERAC) is an evidence-based, standardized peri-operative care program aimed at improving quality of surgical care, decrease surgical related complications, and increase patient satisfaction. The ERAC care bundles include b [....] » Read More
Objective: A tracheostomy is a surgically created airway in which a stoma is formed, and a tracheostomy tube is inserted to establish a secure airway1 . Common indications include upper airway obstruction, prolonged mechanical ventilation, and airway protection2 . The National Co [....] » Read More
Introduction: Prevalence of common hand conditions is increasing. Hand injuries account for ~20% of attendances to the UK emergency department. We aimed to analyse temporal trends in hand surgery over a 40-year period at the Pulvertaft Hand Centre. Methods: We conducted a [....] » Read More
Introduction: Scaphoid height-to-length (H/L) ratio is an established quantitative measurement of scaphoid deformity. There is no consensus for normal computed tomography (CT)-based H/L ratio for healthy scaphoids, including for age and gender. Our study aimed to establish normat [....] » Read More
Background: Anaemia prior to surgery for colorectal cancer is associated with increased morbidity and mortality. A significant proportion of patients will have anaemia secondary to iron deficiency, a symptom of colorectal cancer. National Institute of Health and Care Excellence ( [....] » Read More
Background: Meta-analyses and large-scale studies have stated that minimally invasive surgery reduces surgical stress compared with open procedures; however, they also indicated that the physiologic effects of pneumoperitoneum may exacerbate neuroendocrine and inflammatory r [....] » Read More
Background: The World Health Organisation (WHO) indicates that the goals for quality health care for mothers and neonates have not been achieved. The decision to delivery interval (DDI) time refers to the timeline from the decision for the caesarean section (CS) to the deliver [....] » Read More
Background/Aims: The umbilicus is a central feature of abdominal aesthetics and an important consideration in procedures such as abdominoplasty and umbilicoplasty. Despite its clinical relevance, there is no universally accepted definition of the ideal umbilicus. This review aims [....] » Read More
Aim: To present a rare case of a fractured peripheral intravenous cannula retained within the cephalic vein, and to describe the successful surgical retrieval technique used to prevent potential complications associated with intravascular foreign body migration. Methods:& [....] » Read More
Foreign-body ingestion is a common problem in the pediatric age group, as infants and young children naturally explore their surroundings by placing objects in their mouths. Among the hazardous items they may encounter are decorative crystal gel balls, which have the ability to a [....] » Read More
Background: • Epigastric hernias typically contain fat/omentum • Rarely migrate into pre-sternal region • Bowel involvement is rare, large bowl strangulation extremely uncommon • Emergency laparotomy = higher morbidity / mortality rates, especially in elde [....] » Read More
An audit was conducted within the Ambulatory General Surgery service to evaluate the appropriateness and efficiency of ultrasound scan requests. Initial review identified significant variation in requesting practices, including inconsistent clinical information, inappropriate ind [....] » Read More
The complexity and deficiencies in current perioperative pathways for people with anaemia are well-described, optimising these patients pre-operatively before major trauma and orthopaedic surgeries reduced chances of readmission, mortality and poor wound healing. The CPOC guideli [....] » Read More
Complex limb injuries present a major challenge in trauma and orthopaedic practice due to the extent of damage involving bone, soft tissue, nerves, and vascular structures. These injuries create a critical decision point between limb salvage and primary amputation, both of which [....] » Read More
Background: Selective neck dissection aims to reduce surgical complications and morbidity while maintaining oncological control of nodal disease in head and neck squamous cell carcinoma (HNSCC). However, its success depends on accurate prediction of level-specific nodal dis [....] » Read More
Sleep and general anaesthesia are poorly understood physical states, this presentation explores the connections between sleep, anaesthesia, and thermoregulation. There are overlapping neural mechanisms and physiological functions. What are the fundamental purposes of sleep? En [....] » Read More
Introduction: Lower back pain affects approximately 30% of pregnancies. Disc herniation during pregnancy is rare (incidence of 1:10,000)1 and poses significant management challenges and risks progression to cauda equina syndrome (CES). We present a case of severe L4/5 radicu [....] » Read More
Aim: To evaluate whether mechanical ventilation during cardiopulmonary bypass (CPB) reduces postoperative pulmonary complications (PPCs) in adult cardiac surgery patients. Methods: We searched PubMed, Cochrane and Google Scholar for randomized controlled trials (RCTs) comparin [....] » Read More
Aim: Three-dimensional (3D) printing has transformed surgical planning and education around congenital heart disease (CHD) by using patient-specific anatomical visualisation. However, manual image segmentation is a major bottleneck and limits scalability. This review explores the [....] » Read More
This study aimed to evaluate the impact of artificial intelligence (AI)–based decision support systems on the personalized selection of general anesthetic agents in patients with predicted difficult airway, focusing on optimization of airway management and peri-induction [....] » Read More
Background: Breast reconstruction following mastectomy plays a key role in restoring body image and improving quality of life in breast cancer survivors. Implant-based reconstruction (IBR) is widely used due to shorter operative times and the absence of donor-site morbidity, wh [....] » Read More
Introduction: Urology is a challenging specialty for Foundation Year 1 (FY1) doctors, as it is often under-represented in undergraduate curricula and has limited overlap with other disciplines. At our tertiary centre, many FY1s reported difficulty adapting to the pace and demands [....] » Read More
Introduction: Rheumatoid Arthritis (RA) comes with significant morbidity for patients. They have an increased risk of post-operative complications in orthopaedic surgery because of the effect of the disease on bone as well as the immunomodulatory medications that can interfe [....] » Read More
Endogenous fungal endophthalmitis can occur secondary to fungaemia with haematogenous seeding of the choroid, most commonly due to Candida species. Recognised risk factors include hospitalisation, indwelling intravenous lines, immunosuppression, malignancy, and broad-sp [....] » Read More
Background: Pancreaticoduodenectomy is associated with substantial postoperative morbidity and delays in recovery that can hinder timely initiation of adjuvant therapy. Enhanced Recovery After Surgery (ERAS) pathways aim to attenuate surgical stress and accelerate functional reco [....] » Read More
Background: Advances in artificial intelligence (AI) have enabled the identification of subtle acoustic signatures in human voice. The concept of “voice biomarkers” refers to quantifiable vocal characteristics that can distinguish between normal and pathological condi [....] » Read More
Aim: To achieve ≥90% compliance with timely pharmacological DVT prophylaxis (within 14 hours of admission) in surgical inpatients by introducing an automated electronic alert system. Methods: This quality improvement project analysed all new adult admissions into Ward 4 (Ge [....] » Read More
Penetrating injuries to the gluteal and perineal regions are uncommon in pediatric patients, and involvement of the presacral (retrorectal) space is particularly rare. Due to its anatomically concealed nature and capacity to accommodate injury with minimal early symptoms, diagn [....] » Read More
Background: Blunt chest wall trauma is a common presentation to an acute surgical take, accounting for up to 10–15% of emergency department attendances globally, with rib fractures present in the majority of cases. These injuries are associated with significant morbidi [....] » Read More
Introduction: Perioperative antibiotic prophylaxis is essential in reducing surgical site infections (SSI) and postoperative morbidity following bowel surgery. Institutional and national guidelines emphasise appropriate antibiotic selection, timing, dosing, and intraoperative red [....] » Read More
Relevance and Aim of the Study: Lung transplantation is the only treatment for the terminal stage of lung diseases. In the early postoperative period, an important task is monitoring the condition of the lung graft. Ultrasound imaging has several advantages over other instru [....] » Read More
Accurate comprehensive operative documentation is essential for patient safety, continuity of care, and medico-legal practice. The Royal College of Surgeons of England (RCSEng) outlines clear guidelines for operative notes. This ensures continuity of care by another doctor and ex [....] » Read More
Background: The Foley catheter remains one of the most commonly used devices in urological and surgical practice. Despite its widespread use, patient understanding of catheter purpose, care, and complications is often suboptimal, leading to preventable morbidity. In private pract [....] » Read More
Background: In low-resource centres, advanced nodal staging techniques such as dynamic sentinel lymph node biopsy are often unavailable, leading to under-staging or overtreatment in penile cancer. Palpation-guided inguinal node sampling with intraoperative frozen section offers a [....] » Read More
Title : When things go wrong! From victim to liability and the case of AI
Ricky Rasschaert, AZ Rivierenland, Belgium
As surgeons we all have to deal with complications and sometimes errors. In neurosurgery this can be devastating for the patients with a lifelong deficit or even resulting in the decease of the patient. These unforeseen events cause a lot of (emotional) stress and should be handl [....] » Read More
Title : Improving scrotal examination in male patients presenting with acute abdominal pain: An audit and quality improvement intervention
Maab Elsaddig, University Hospital Lewisham, United Kingdom
Background: NICE guidance states that all male patients presenting with abdominal pain should undergo a scrotal examination. This is based on evidence that testicular torsion may present atypically and that abdominal pain alone can be the only symptom in a significant propor [....] » Read More
Title : Analysis of morbidityof salvage esophagectomy in advanced esophageal cancer
Jose Luis Braga De Aquino, Pontifical Catholic University, Brazil
Even through the esophageal cancer has innumerable treatment options, its prognosis is still unsettled. Because esophagectomy is rarely curative, others therapies, such as chemorradiation emerging in advanced disease followed or not surgery. The salvage esophagectomy is an altern [....] » Read More
Title : Critical analysis of surgical treatment of relapse advanced esophageal achalasia
Jose Luis Braga De Aquino, Pontifical Catholic University, Brazil
Endoscopic and/or laparoscopic myotomy has shown positive results in non-advanced esophageal achalasia due to the development of this surgical technique currently. For the most advanced stages of the disease, esophagectomy seems to be the most indicated procedure due to the invol [....] » Read More
Title : Intrapericardial incarceration of preperitoneal fat after subxiphoid pericardial window
Abraham Garcia Reyes, Universidad Autonoma del Estado de Mexico, Mexico
Intrapericardial incarceration of preperitoneal fat is an exceptionally rare complication of subxiphoid pericardial window creation. We report a 70yearold Hispanic Mexican woman with morbid obesity (BMI 45 kg/m²), hypertension, type 2 diabetes, and hypothyroidism who develop [....] » Read More
Title : Comparison of eras pathway compliance and outcomes in robotic vs laparoscopic cholecystectomy
Pooja Dutta, Max Hospital, India
Introduction: Enhanced Recovery After Surgery (ERAS) protocols are increasingly incorporated into minimally invasive biliary surgery, aiming to reduce postoperative morbidity and enhance functional recovery. While robotic cholecystectomy (RC) offers improved ergonomics and precis [....] » Read More
Title : Bloodless trans abdominal resection of a large pre sacral tumour in a jehovahs witness patient: A case report
Ngwang Prosper, Pan African Academy of Christian Surgeons, Cameroon
Background: Presacral tumours are rare and surgically challenging lesions due to their deep pelvic location, proximity to major vessels, and risk of significant intraoperative haemorrhage. Surgical resection remains the mainstay of treatment. Jehovah’s Witness patients do n [....] » Read More
Title : Spontaneous splenic rupture: A rare complication of concurrent malaria and dengue infections - A case report
Hassan Elmi Moumin, Amoud University, Somalia
Introduction: Spontaneous splenic rupture (SSR) is a rare, life-threatening complication, sometimes associated with infections like malaria and dengue fever. This case report details a unique presentation of SSR. Case presentation: A 28-year-old male in Somalia presented with fev [....] » Read More
Title : Glycaemic variability and all-cause mortality in adult patients with sepsis: A systematic review and critical appraisal
Sanjali Anil Chu Ahuja, Queen Mary University of London, United Kingdom
Background: Sepsis accounts for an estimated 49 million cases and 11 million deaths globally each year, representing approximately one in five of all global fatalities. Identifying modifiable risk factors associated with mortality in septic patients is therefore a clinical and pu [....] » Read More
Title : Improving the dietary guidance in patients with a newly-formed ileostomy in a district general hospital in the UK
Matteo Moro, University Hospitals Sussex NHS Foundation Trust, United Kingdom
Background: Ileostomy formation is a common operation in the UK amongst certain patient groups including inflammatory bowel disease, colon cancers and other colorectal diseases. In certain UK centres, there is no written dietary guidance given to patients discharged with a newly- [....] » Read More
Title : Improved prognostic stratification of the revised ninth edition american joint committee on cancer staging system for colorectal cancer
Zhigang Sun, China-Japan Friendship Hospital, China
Background: The 9th edition American Joint Committee on Cancer (AJCC) staging system has been proposed by the AJCC Cancer Expert Panel (AJCCCCEP). The prognostic discriminatory validity of the new staging system in actual patient cohorts has not been fully validated. Aim: To i [....] » Read More
Title : Intrapericardial diaphragmatric hernia with central tendon deficiency in a case of triple vessel coronary artery disease. An intraoperative revelation
Nischit Murgod, ESI RAJAJINAGAR, India
Introduction: Intrapericardial diaphragmatic hernia with central tendon deficiency is extremely rare, usually presenting in infancy. Only 28 adult cases have been reported, and one such incidental case is described here. Case- A 46-year-old male presented with intermittent che [....] » Read More
Title : Comparative study of single layer extramucosal verses double layer intestinal anastomosis
Chandrika Sah, Civil Services Hospital of Nepal, Nepal
Intestinal anastomosis is mostly performed procedure in both elective and emergency cases and therefore, it is necessary for surgeons and residents to be acquainted with the art of bowel anastomosis. This study is to determine the efficacy of single layer intestinal anastomosis i [....] » Read More
Title : Emergency vascular shunting using IV tubing for brachial artery injury: A life-saving innovation in resource-limited settings
Mohamed Farah Gabobe, Mogadishu University, Somalia
The brachial artery is the most commonly injured artery in the upper extremities because of its vulnerability. This case report presents our experience with managing brachial artery injury using an improvised vascular shunting technique. A 38-year-old man presented to the emergen [....] » Read More
Title : Mapping pediatric general surgery training in low and middle income countries: A scoping review
Habba Mahal, University of Alberta, Canada
Children in low- and middle-income countries experience a substantial disparity in access to essential pediatric surgical care. Estimates suggest that up to 85 percent of children will require at least one surgical intervention before the age of 15. However, the availability of t [....] » Read More
Title : Sentinel lymph node biopsy for breast cancer in low-resource settings: The role of superparamagnetic iron oxide tracers
Alice Honigmann, Oxford University Medical School, United Kingdom
Sentinel lymph node biopsy (SLNB) is the standard technique for axillary staging in early breast cancer, allowing accurate nodal assessment while avoiding the morbidity associated with full axillary clearance. However, the conventional SLNB approach, which relies on radioactive t [....] » Read More
Title : From panic to protocol: A QIP on developing a paediatric breast referral pathway
Neriah Mangion, University Hospital Sussex NHS Foundation Trust, United Kingdom
Background: Paediatric patients presenting with breast symptoms are uncommon, yet they often introduce diagnostic and management challenges. Current national guidelines, from the Association of Breast Surgery, outline a referral criterion, however, many hospital trusts lack a s [....] » Read More
Title : Scheduled surgery cancellations: A socioeconomic analysis
Anita Rose Babu, Royal College of Surgeons, Ireland
Background: Scheduled surgeries are essential for improving quality of life and preventing disease progression. While the clinical benefits are well established, their delivery is frequently challenged by significant operational pressures, including bed shortages, workforce [....] » Read More
Title : Undiagnosed paraganglioma complicated by intraoperative ventricular fibrillation and takotsubo-like cardiomyopathy: A case report
Vu Thi Quyen, Hanoi Medical University Hospital, Vietnam
Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumors that may secrete catecholamines, leading to diverse clinical manifestations, especially cardiovascular disorders such as hypertension, arrhythmias, and cardiomyopathy. These tumors carry significant morbi [....] » Read More