Surgery and theatres
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Research outputs from the Theatres department at the RD&E.
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Item Management of bleeding varicose veins(Atypon, 2023-12-01) Tan, M.; Campbell, B.; Parsi, K.; Davies, A. H.Item EAES, SAGES, and ESCP rapid guideline: bowel preparation for minimally invasive colorectal resection(Springer, 2023-10-30) Antoniou, S. A.; Huo, B.; Tzanis, A. A.; Koutsiouroumpa, O.; Mavridis, D.; Balla, A.; Dore, S.; Kaiser, A. M.; Koraki, E.; Massey, L.; Pellino, G.; Psichogiou, M.; Sayers, A. E.; Smart, N. J.; Sylla, P.; Tschudin-Sutter, S.; Woodfield, J. C.; Carrano, F. M.; Ortenzi, M.; Morales-Conde, S.BACKGROUND: Variation exists in practice pertaining to bowel preparation before minimally invasive colorectal surgery. A survey of EAES members prioritized this topic to be addressed by a clinical practice guideline. OBJECTIVE: The aim of the study was to develop evidence-informed clinical practice recommendations on the use of bowel preparation before minimally invasive colorectal surgery, through evidence synthesis and a structured evidence-to-decision framework by an interdisciplinary panel of stakeholders. METHODS: This is a collaborative project of EAES, SAGES, and ESCP. We updated a previous systematic review and performed a network meta-analysis of interventions. We appraised the certainty of the evidence for each comparison, using the GRADE and CINeMA methods. A panel of general and colorectal surgeons, infectious diseases specialists, an anesthetist, and a patient representative discussed the evidence in the context of benefits and harms, the certainty of the evidence, acceptability, feasibility, equity, cost, and use of resources, moderated by a GIN-certified master guideline developer and chair. We developed the recommendations in a consensus meeting, followed by a modified Delphi survey. RESULTS: The panel suggests either oral antibiotics alone prior to minimally invasive right colon resection or mechanical bowel preparation (MBP) plus oral antibiotics; MBP plus oral antibiotics prior to minimally invasive left colon and sigmoid resection, and prior to minimally invasive right colon resection when there is an intention to perform intracorporeal anastomosis; and MBP plus oral antibiotics plus enema prior to minimally invasive rectal surgery (conditional recommendations); and recommends MBP plus oral antibiotics prior to minimally invasive colorectal surgery, when there is an intention to localize the lesion intraoperatively (strong recommendation). The full guideline with user-friendly decision aids is available in https://app.magicapp.org/#/guideline/LwvKej . CONCLUSION: This guideline provides recommendations on bowel preparation prior to minimally invasive colorectal surgery for different procedures, using highest methodological standards, through a structured framework informed by key stakeholders. Guideline registration number PREPARE-2023CN045.Item Arthroscopic knots: Suture and knot characterisation of modern polyblend suture materials(Elsevier, 2023-08-25) Savage, E.; Hurren, C. J.; Rajmohan, G. D.; Thomas, W.; Page, R. S.OBJECTIVE: The primary aim of this study was to explore the relationship between the biophysical structure and function of modern suture materials. Particularly the suture's ability to withstand the stressors of surgery and how the material properties affect knot stability. The secondary aim was to investigate the effect that different knots have on the suture material itself. This study builds on previous research assessing suture and knot characteristics but in modern Ultra High Molecular Weight Polyethylene (UHMWPE) materials currently in widespread clinical use in arthroscopic surgery. METHODS: Three common UHMWPE sutures and one polyester suture were tested in both a dry and wet state using the Geelong, Nicky's, Surgeon's and Tautline knots. Tensile strength of knots was tested vertically at a 60 mm/min strain rate and 45 mm gauge length. Sutures were tied through a cannula around two 8 mm diameter circular bollards. Testing was conducted in a controlled environment temperature and humidity environment (20 ± 2 °C, 65 ± 2%). RESULTS: No one knot type was optimal over all suture types. Mean tensile strength in both a dry and wet state and a low coefficient of variation (CV) in tensile strength in a wet state were considered as an indication of suitability. With Ethibond sutures this was the Geelong knot (CV:4.2%). With Orthocord sutures both the Geelong and Tautline knots (CV:4.2% and CV:11.9% respectively). With FiberWire sutures the Nickys and Tautline knots (CV:22.6% and CV:22.5% respectively). With ForceFiber sutures all four knots exhibited similar wet tensile strength with high variability showing that all should perform in a similar way invivo. CONCLUSIONS: This study demonstrates a statistically significant three-way interaction between polyblend suture materials, the knot and the environment. This has implications for knot security using the tested sutures in different environments, as one knot may not behave the same under all conditions.Item Does correction of carpal malalignment influence the union rate of scaphoid nonunion surgery?(Sage, 2023-11-21) McLaughlin, K.; Jabbar, F. A. A.; Kelly, L. J.; Jovanovic, I.; Gray, M. P.; Charalambous, C. P.; Harrison, J. W. K.The aim of this retrospective study was to assess the relation between carpal malalignment correction and radiological union rates in surgery for scaphoid nonunions. A total of 59 scaphoid waist fracture nonunions treated with open reduction and palmar tricortical autograft were divided according to their pre- and postoperative scapholunate (SL) and radiolunate (RL) angles. We found that carpal malalignment failed to correct in 32 of 59 (54.2%) patients despite meticulous surgical technique and placement of an appropriately sized wedge-shaped graft. In total, 43 (72.9%) fractures united at a mean of 4.47 months (range 3-11). Of the 27 fractures with postoperative SL and RL angles within the normal range, 21 united, whereas 22 of the 32 remaining fractures that failed to achieve postoperative angles within the normal range went on to union. The postoperative SL and RL angles were not related to union. Our findings suggest that in scaphoid fracture nonunion surgery, carpal malalignment may not be corrected in a substantial proportion of patients, but such correction may not be essential for bony union. Our findings also show that there is no marked collapse of the scaphoid graft in the early postoperative period. LEVEL OF EVIDENCE: IV.Item Midline incisional hernia guidelines: the European Hernia Society(Wiley, 2023-11-09) Sanders, D. L.; Pawlak, M. M.; Simons, M. P.; Aufenacker, T.; Balla, A.; Berger, C.; Berrevoet, F.; de Beaux, A. C.; East, B.; Henriksen, N. A.; Klugar, M.; Langaufová, A.; Miserez, M.; Morales-Conde, S.; Montgomery, A.; Pettersson, P. K.; Reinpold, W.; Renard, Y.; Slezáková, S.; Whitehead-Clarke, T.; Stabilini, C.