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
Acute appendicitis is the leading cause of emergency abdominal surgery worldwide, affecting approximately 7% of the population at some stage of life, with perforation rates reaching up to 20% underscoring the importance of accurate and timely diagnosis. Traditionally, clinici [....] » 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
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
Background: Enhanced Recovery After Surgery (ERAS) is an evidence-based, multidisciplinary perioperative care pathway that optimises recovery following colorectal surgery by reducing surgical stress, postoperative complications, and length of hospital stay. Adherence to ERAS reco [....] » Read More
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
Background: Enhanced Recovery After Surgery (ERAS) pathways emphasise early feeding and mobilisation to improve postoperative recovery; however, perioperative protein optimisation remains inconsistently implemented despite its potential impact on outcomes. Objective: To evalua [....] » Read More
Background: Alpha-fetoprotein (AFP) remains the most widely used biomarker in hepatocellular carcinoma (HCC) for diagnosis, disease monitoring, and prognostic assessment. However, AFP expression varies across tumour burden and underlying disease aetiology, which may influence i [....] » Read More
Background: A popliteal artery aneurysm is the most common type of peripheral artery aneurysm, that can lead to limb threatening ischaemia. Early recognition is essential; however, diagnosis may be delayed when presentations mimic more common conditions. Case Presen [....] » Read More
Background: Bochdalek hernias are congenital posterolateral diaphragmatic defects that usually present in infancy. Adult presentations are rare and may first manifest with bowel obstruction, strangulation, or ischaemia. Early diagnosis is essential to reduce morbidity and mo [....] » 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
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
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
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
Background: Intraoperative macroscopic assessment of the appendix influences surgical decisionmaking and provides an immediate estimate of disease severity; however, visual assessment may not reliably correspond with definitive histopathology. Misclassification may result in remo [....] » Read More
Background: Negative appendicectomy remains an important quality marker in emergency general surgery. Senior surgical review may improve diagnostic decision-making, although patients with greater diagnostic uncertainty may also be preferentially escalated. We evaluated whether co [....] » Read More
Background: Enhanced Recovery After Surgery (ERAS) is an evidence-based, multimodal perioperative care pathway proven to reduce complications, shorten hospital stays, and improve patient experience following colorectal surgery. Despite the strength of the evidence, compliance wit [....] » Read More
Background: Pilonidal sinus disease recurs in roughly 15 to 40 percent of patients after incision and drainage, with recurrence rates varying by surgical technique. Each emergency admission costs the NHS approximately £1,081 per episode, with the wider socio-economic burden [....] » Read More
Introduction: BiZact (Medtronic) is an electrothermal device used in a small number of UK centres. This study presents the first large-series UK comparative analysis of BiZact, bipolar diathermy and intracapsular coblation across adult and paediatric cohorts. Methods:&nbs [....] » Read More
Introduction: Despite initiatives such as the Green Theatre Checklist and Green Surgery Report, adoption of sustainable practices in surgery is limited, due to low stakeholder engagement. Existing literature has focused primarily on consultant perspectives. As future key sta [....] » Read More
Regional anesthesia (RA) is increasingly used in anesthesia practice. Ultrasound has been used to facilitate the performance of the regional blocks. The use of ultrasound for nerve localization increases success and reduces complication rate. Ultrasound technology has increasi [....] » Read More
Artificial intelligence is increasingly influencing colorectal surgery by supporting more accurate diagnosis, individualized operative planning, real-time decision-making, and postoperative risk prediction. This keynote address will examine how AI is being integrated across the s [....] » Read More
Background: Type 1 diabetes mellitus (T1DM) is a chronic autoimmune disorder characterized by destruction of pancreatic β-cells, resulting in lifelong dependence on exogenous insulin. Although insulin therapy and islet cell transplantation remain the standard treatment optio [....] » 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
Introduction: The British Society for Surgery of the Hand’s (BSSH) Getting It Right First Time (GIRFT) guidelines recommend that surgery for traumatic amputations of the digits is ideally performed during normal working hours even if this results in a delay of up to 24 hour [....] » Read More
Background: Lumbar artery pseudoaneurysm is a rare vascular pathology, with infective (“mycotic”) cases exceptionally uncommon. Only three cases of infective lumbar artery pseudoaneurysm have previously been reported. We describe a unique case of multilobed mycotic lu [....] » Read More
Background: Lung-protective ventilation (LPV) reduces ventilator-induced lung injury through limitation of tidal volume and airway pressures. Although LPV is well established in acute respiratory distress syndrome (ARDS), its principles are increasingly applied to mechanically ve [....] » Read More
Introduction: Transurethral resection of the prostate (TURP) has been the gold standard surgical treatment for benign prostatic hyperplasia (BPH). However, minimally invasive surgical therapies (MIST) and laser-based approaches are increasingly adopted. We evaluated the evolution [....] » Read More
Aim: To evaluate the rationale and effectiveness of colonoscopy in patients aged over 80 years during a one-year period at Southport Hospital, which serves a predominantly geriatric population. Current protocol-driven diagnostic pathways frequently result in direct triaging to en [....] » Read More
Aim: Anal Squamous cell carcinoma (ASCC) is uncommon but has an increasing incidence. The 2024 International Anal Neoplasia Society (IANS) consensus guidelines for ASCC screening prioritise high-risk groups, primarily individuals with HIV, men who have sex with men (MSM) and tran [....] » 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
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
Background: Emergency laparotomy is associated with significant morbidity and mortality (1). Emergency laparotomy is a common procedure, with 30,000–50,000 performed annually in the UK. The 30-day postoperative mortality rate is 8.1% (2). Assessing mortality risk [....] » Read More
Objectives: Total knee arthroplasty (TKA) remains the gold-standard surgical treatment for end-stage knee osteoarthritis (OA). With TKA numbers rising, this review summarises its development, implant options, perioperative care and the technologies likely to shape its future. [....] » 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: Isolated greater trochanter fractures (GTFs) are an uncommon presentation of hip fracture, representing approximately 2% of all hip fractures. Historically managed non-operatively, recent evidence using cross-sectional imaging has challenged this approach by showing a [....] » Read More
Introduction: Blood pressure (BP) management during endovascular thrombectomy (EVT) remains one of the most debated aspects of acute ischemic stroke care. While the 2026 American Heart Association/American Stroke Association (AHA/ASA) guideline advises against routine intens [....] » 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
Castleman’s disease is a rare, benign, lymphoproliferative disorder effecting 1 in 100,000. It is characterised into multicentric or unicentric disease. Unicentric disease is typified by compressive symptoms with a midline mass often misdiagnosed as malignancy. Gold-standar [....] » Read More
Introduction: The Liverpool Head Injury Tomography (HIT) score is a validated tool that stratifies patients with CT-confirmed traumatic brain injury by their need for neurosurgical intervention, supporting the decision to refer to neurosurgery (HIT >2) or manage locally with n [....] » Read More
Introduction: Incision and drainage is the definitive treatment for most cutaneous abscesses, and the majority of patients are discharged without antibiotics. No NICE guideline specifically addresses swabbing of primary cutaneous abscesses. We therefore applied the antimicrobial- [....] » 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/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
Background: Renal infarction is a rare and frequently overlooked clinical entity, often presenting with non-specific abdominal symptoms that mimic more common intra-abdominal pathology, resulting in delayed recognition. The condition is typically associated with cardioembolic dis [....] » Read More
Introduction: Xanthogranulomatous pyelonephritis (XGP) is an uncommon inflammatory renal condition associated with urinary obstruction, infection and calculi. Focal XGP may resemble renal cell carcinoma (RCC), particularly when typical radiological features are absent. We report [....] » Read More
Dermatofibrosarcoma protuberans was first described by Darier and Ferrand in 1924, and was termed by Hoffmann in 1925. In this clinical series of patients with dermatofibrosarcoma protuberans data was retrieved ,collected and analysed for the study from JSS Hospital ( [....] » Read More
Background: Fluoroquinolone antibiotics are associated with serious musculoskeletal adverse effects, most commonly Achilles tendinopathy. Following the 2019 MHRA and European Medicines Agency safety review, and strengthened restrictions issued in January 2024, systemic fluor [....] » 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
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
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: Splenectomy is performed for a broad range of emergency and elective conditions, each presenting distinct perioperative challenges. Anaesthetic management must be individualized according to the underlying pathology, physiological derangements, and associated comorbid [....] » 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 : 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 : 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 : The rhinologist as developer: A practical framework for prompt engineering and app creation in clinical practice
Ayan Ibrat, Gloucestershire Hospitals NHS Trust, United Kingdom
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
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 : Large unclassified hepatocellular adenoma with spontaneous haemorrhage and necrosis in a young woman: Surgical management and post-operative surveillance challenges
Sukanya Lakshmi Mahendran, Medway Maritime Hospital, United Kingdom
Hepatocellular adenomas (HCA) are rare benign liver tumours predominantly affecting young women of reproductive age, strongly associated with oral contraceptive pill (OCP) use. Spontaneous haemorrhage and necrosis are recognised but uncommon complications, occurring in larger les [....] » Read More
Title : Guiding selective neck dissection: Pattern of nodal spread and imaging accuracy in head and neck SCC
Sheung Hang Mak, Hywel Dda University Health Board, United Kingdom
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
Title : Outcomes of rectal biopsy in the investigation of Hirschsprung’s disease: A six-year two-cycle departmental audit
Arian Rahim, Royal Alexandra Children’s Hospital, United Kingdom
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
Title : Impact of frailty in patients undergoing continuous-flow left ventricular assist device therapy: A systematic review and meta-analysis
Christos Costa, Oxford University Hospitals NHS Foundation Trust, United Kingdom
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
Title : Renal autotransplantation for a hypervascular renal tumour in a solitary kidney: Ex vivo bench surgery to preserve renal function
Christos Costa, Oxford University Hospitals NHS Foundation Trust, United Kingdom
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
Title : Benchmarking paediatric appendicitis care against GIRFT standards: A single-centre audit
Ishan Singh, Norfolk and Norwich University Hospital, United Kingdom
Aim: To assess compliance with Getting It Right First Time (GIRFT) best-practice standards for paediatric appendicitis at Norfolk and Norwich University Hospital and compare local negative appendicectomy and readmission rates with national benchmarks. Methods: A six-month retr [....] » Read More
Title : Inpatient vs outpatient endoscopic retrograde cholangiopancreatography: Patient characteristics and outcomes in a cohort study
Annika Parmar, Lewisham and Greenwich NHS Trust, United Kingdom
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
Title : An avoidable delay: Audit of the neurosurgical referral pathway for head injury in Galway University Hospital
Afiq Rafidzy Bin Anwar Samhari, Galway University Hospital, Ireland
Introduction: Head injuries are a common Emergency Department (ED) presentation and may require urgent CT brain imaging and timely specialist neurosurgical input. At Galway University Hospital (GUH), the current adult head injury pathway involves ED assessment, referral to the Ge [....] » Read More
Title : Negative appendectomy rates in the department of general surgery, Galway University Hospital, Republic of Ireland, 2025: A retrospective chart review
Afiq Rafidzy Bin Anwar Samhari, Galway University Hospital, Ireland
Introduction: Acute appendicitis is one of the most common surgical emergencies, but diagnostic uncertainty can lead to removal of a histologically non-inflamed appendix. The negative appendicectomy rate (NAR) is therefore used as a surgical quality indicator. This study aimed to [....] » 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 : 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 : Enhancing foundation doctor confidence in acute surgical management through a structured simulation programme
Caitlin Mclaughlin, Medway NHS Foundation Trust, United Kingdom
Background: UK Foundation doctors rotating through surgical specialities have reported low confidence in assessing and managing acute surgical presentations[1]. High-fidelity simulation provides a safe and supportive environment in which trainees can practise the recognitio [....] » Read More
Title : Optimising NELA risk stratification through enhanced accuracy in ASA grading
Caitlin Mclaughlin, Medway NHS Foundation Trust, United Kingdom
Background: Accurate ASA (American Society of Anaesthesiologists) grading is essential for perioperative risk assessment, anaesthetic planning, and surgical risk communication. It is also a key input in audit tools such as the National Emergency Laparotomy Audit (NELA) calculator [....] » Read More
Title : Isolated gallbladder injury following blunt abdominal trauma: A rare surgical presentation
Afua Timah Agyei, Medway Maritime Hospital, United Kingdom
Background: Isolated gallbladder injury following blunt abdominal trauma is an uncommon and diagnostically challenging condition. Its clinical presentation is frequently nonspecific, mimicking other intra-abdominal pathologies, and necessitates a high ind [....] » Read More
Title : Utilizing a 3D printed laparoscopic nissen fundoplication model to shorten a resident's learning curve
Muhammad Osama Wali Zada, Hangzhou Medical College, China
Laparoscopic Nissen fundoplication (LNF) requires extensive training for surgical proficiency, with significant early learning curve complications. A structured trainingprotocol utilizing a 3D-printed anatomical model is described and designed to accelerate the acquisition of adv [....] » Read More