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1. Laparoscopic and open inguinal hernia repair: Patient reported outcomes in the elderly from a single centre - A prospective cohort study

Author

S. Leong, Jaideep Rait, G. Srinivas, E. Massri, K. Bowling, J. Atkinson, Sarah El-Badawy, and A. Stuart

Subjects
medicine.medical_specialty, Nausea, media_common.quotation_subject, medicine.medical_treatment, Population, 03 medical and health sciences, 0302 clinical medicine, Patient satisfaction, medicine, 030212 general & internal medicine, education, Prospective cohort study, Original Research, media_common, education.field_of_study, business.industry, General surgery, General Medicine, medicine.disease, Hernia repair, Surgery, Inguinal hernia, Feeling, 030220 oncology & carcinogenesis, Vomiting, medicine.symptom, business
Abstract

Background With those over 65 making up over 16% of the UK's population, surgeons are counselling increasing numbers of elderly patients for hernia repair. Data is currently lacking comparing different repair methods of inguinal hernias in the elderly population with regards to patient reported outcomes. Aim To compare open and laparoscopic hernia repair in patients >65 years old and those 65 TEP group this was significantly lower (10.2% open IHR 65). Patient satisfaction with the surgery was satisfied or very satisfied in all patients in all groups. Conclusion Time off work is not an absolute appropriate measure of return to premorbid status with respect to the elderly as a substantial number of >65 year olds have retired. We therefore present this interesting insight into patient perceptions following hernia repair by age group. Overall patients over 65 can expect the same high levels of satisfaction and low levels of pain following either technique for inguinal hernia repair as younger patients., Highlights • Time off work is not an appropriate measure of laparoscopic hernia repair in the over 65 year old population as the majority of this cohort is retired. • Dizziness and drowsiness appeared to be no more prevalent in the over 65 year age group. • Patient satisfaction with the surgery was satisfied or very satisfied in all patients in all groups. • Overall a patient of any age can expect the same high levels of satisfaction and low levels of pain with either technique.

Published
2017
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2. A Single Centre Experience of Day Case Laparoscopic Cholecystectomy Outcomes by Body Mass Index Group

Author

G. Srinivas, Samantha Leong, Kirk Bowling, Erfan Massri, Stuart Andrews, Jaideep Rait, Sarah El-Badawy, and Jay Atkinson

Subjects
medicine.medical_specialty, Retrospective review, Article Subject, business.industry, lcsh:Surgery, nutritional and metabolic diseases, lcsh:RD1-811, medicine.disease, Surgery, Single centre, Cholecystitis, Medicine, Radiology, Nuclear Medicine and imaging, Complication rate, General hospital, business, Complication, Laparoscopic cholecystectomy, Body mass index, Research Article
Abstract

Aim. The purpose of this study was to evaluate whether patients with a high BMI can undergo safe day case LC for cholecystitis compared to groups of patients with a lower BMI. Setting. NHS District General Hospital, UK. Methods. A retrospective review of 2391 patients who underwent an attempted day case LC between 1 January 2009 and 15 August 2015 was performed. Patients were divided into five groups depending on their BMI. Inclusion criteria were patients undergoing elective day case laparoscopic cholecystectomy with cholecystitis on histology. The endpoints were complication requiring readmission and postoperative length of stay (LOS). Results. There were 2391 LCs performed in the time period of which 1646 were eligible for inclusion. These LCs were classified as 273 (16.9%), 608 (37.8%), 428 (26.6%), 208 (12.9%), and 91 (5.66%) patients in the groups with BMI values of 18.5–24.9, 25–29.9, 30–34.9, 35–39.9, and >40, respectively. Average BMI was 30.0 (±5.53, 19–51) with an average postoperative LOS of 0.86, and there was no difference between the BMI groups. Overall complication rate was 4.3%; there was no significance between BMI groups. Conclusions. Increased BMI was not associated with worse outcomes after day case LC.

Published
2017
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3. Early years postgraduate surgical training programmes in the UK are failing to meet national quality standards: An analysis from the ASiT/BOTA Lost Tribe prospective cohort study of 2,569 surgical trainees

Author

James C. Glasbey, Rhiannon L. Harries, Andrew J. Beamish, Vimal J. Gokani, Helen Mohan, Adam P. Williams, Simon Fleming, Aaron Chai, Abhinav Singh, Adam C.S. Stoneham, Adam J. Lunt, Adeeb H. Rehman, Adeel A. Dhahri, Adrien R.A. Yvon, Agneish Dutta, Ahmad K. Abou-Foul, Ahmed Abdelrahman, Ahmed Daoub, Ahmed Sanalla, Aitor de Gea Rico, Alastair Konarski, Alex E. Ward, Alex J. Wilkin, Alexandra K. Winter, Ali Arnaout, Ali Bakhsh, Alireza Esfandiari, Alistair W. Hardy, Amad N. Khan, Amitabh Thacoor, Ana D. Gavrila, Anca-Mihaela Nedea, Andreas Fontalis, Andrew J. Hall, Andrew J. Williamson, Angeliki Kosti, Anna Harlinska, Anthony Adimonye, Anthony Egglestone, Anthony J. Thaventhiran, Antonia Myatt, Anuhya Vusirikala, Arab S. Rawashdeh, Arjun C. Paramasivan, Arthur E. Cotton, Ashley B. Scrimshire, Ashwanth C. Ramesh, Ashwin K. Krishnamoorthy, Asif Ahmed, Ayeshah Abdul-Hamid, Ayushah Khan, Babatunde Oremule, Beatrice Ho, Ben Barkham, Ben Collard, Ben F. Edgar, Benjamin Drake, Bethan E. John, Catherine R. Gordon, Catherine Rossborough, Chang Y. Park, Charalampos Seretis, Charles H.N. Johnson, Charn Gill, Chiara Serino, Chinomso I. Ogbuokiri, Chloe Swords, Chong Y. Kang, Chris McKinnon, Christopher E. Brown, Christopher J. Manning, Christopher J. Marusza, Christopher P. Jones, Cillian T. Forde, Claire L. Wilson, Claudia Koh, Conal Horgan, Daniel J. Lin, Daniel L. Ashmore, Daniel Ness, Daniel O. Akhtar, Daniel T. Doherty, Daniel W. Scholfield, David C. Ensor, David G. Bratt, David J.R. Spence, David R. Thomson, David W. Ferguson, Denish Apparau, Devaraj M. Navaratnam, Dinh Mai, Duncan G. Rutherford, Edward Karam, Eiling Wu, Eleanor F. Zimmermann, Eleftheria Douka, Elinor Flatt, Elizabeth G. Kane, Elizabeth L. Thornhill, Emanuele Gammeri, Emma G. Littlehales, Epaminondas M. Valsamis, Erin J. Hankin, Erin R.M. Meenan, Etienne N. Botha, Farhan Khalid, Fatema Patel, Fiachra R. Power, Fiona M. Rutherford, Fozia Saeed, Francesca L. Guest, Francisco J. Barbosa, Fraser G. Cameron, Furqan R. Raja, Gajendiran Thiruchandran, Gavish Munbauhal, Gemma E. Dovey, Gemma E. Hogg, George E. Dovell, George Matheron, George T. Hill, Georgia R. Layton, Georgiana G.S. Jong, Georgina Hicks, Graham J. Millward, Grahame A. Shaw, Gregory F.W. Stamp, Hammad Parwaiz, Han Hong Chong, Hannah C. Copley, Hannah C. Lennox-Warburton, Hannah M. Emerson, Harry F. Dean, Hazim Eltyeb, Howard O. Chu, Iannish Sadien, Imran M. Mohamed, Iram Parwaiz, Isabella M.H. Drummond, Jack C.H. Pearce, Jacob J. Ahmed, Jacob Koris, Jaideep S. Rait, James A. Bailey, James A. Cohen, James A. Kennedy, James B. Olivier, James Bailey, James E. Archer, James J. Stewart, James N.J.Monteiro de Barros, James R. Allen, James W. O'Brien, null James, T. McGhee, Jared N. Quarcoopome, Jasmine C. Winyard, Jason L. Roberts, Jennifer S. Barwell, Jeremy Rodrigues, Jessica A.R. Chapman, Jessica Y. Fairbanks, Jessika Voll, Jie Q. Lim, Jin H. Chang, Joanna L. Bovis, John Ferns, Johnson Pok Him Tam, Jonathan B.T. Herron, Jonathan D.R. Macdonald, Jonathan R. Ducey, Joseph W. DIxon, Joshua T. Luck, Kalon Hewage, Kamal M. Yakoub, Kamran F. Bhopal, Karen A. Vejsbjerg, Karim Aboelmagd, Katarzyna D. Bera, Katharine E. Hamlett, Katherine E. Fok, Katherine V. Hurst, Kathryn L. Gillams, Katie L. Siggens, Katie Young, Kenneth M. Burns, Kerry A. Burke, Kevin Seebah, Khalid A. Shah, Kieran R. Bentick, Kiran Majid, Kirsty L. Davies, Krystal Tan, Kwaku W. Baryeh, Laura A.F. Phillips, Laura N. Ellerton, Leeying J. Giet, Liam Monaghan, Lok Ka Cheung, Louise L. Shen, Louise Paramore, Lucy J. Arrowsmith, Lukas A. Attwell, Luke Thornton, Luting Xu, Madeline L. Leadon, Madhavi Natarajan, Maria C.R. Houlihan, Marisa Cheah, Markus L. Sagmeister, Maryam Abubakar, Matthew F. Flynn, Matthew Harris, Matthew J. Stone, Matthew J. Young, Matthew P. Gray, Matthew P. Horner, Matthew Schembri, Matthew Trail, Melvin Joy, Michael J. Rice, Michael P. Thomas, Michael T.C. Poon, Michael T. Stoddart, Michelle L. Fong, Mitchell T. Foster, Mohamed F. Mohamud, Mohammed N. Hoque, Mohammedabbas Remtulla, Mohsin Javed Karim, Monika Rezacova, Muhammad B. Siddiqui, Muhammad R. Iqbal, Mussa Mensa, Nadine McCauley, Natasha J. Bauer, Nathan Walker, Navid A. Hakim, Ngonidzashe Knight, Niall O'Hara, Nicholas A. Fawcett, Nicholas Wong, Nicola F.D. Allen, Nilofer Husnoo, Nimisha Vallabh, Nisaharan Srikandarajah, Nnaemeka Chidumije, Obaiy Elamin, Odunayo O. Akinlaja, Olga Griffiths, Oliver D. Brown, Oliver Shastri, Olivia J. Cameron, Olivia Kenyon, Omar A. Javed, Opeyemi O. Sogaolu, Panagiota Birmpili, Patricia Haylock-Vize, Patrick A. Green, Patrick J. Carroll, Peiming Yang, Philip Beak, Pia Persson, Pok Him Johnson Tam, Rabia Waqar, Rachael L. Morley, Rachel Clare Bowden, Rachel L. Eyre, Rahul M. Pankhania, Rajpreet S. Sahemey, Rakan Kabariti, M. Rawashdeh, Rawashdeh S. Arab, Rebecca A. Rollett, Rebecca S. Nicholas, Rebecca V. Morgan, Richard Limb, Richard Mark Robinson, Richard S. Hayes, Ridwan Daureeawoo, Robert A. Cooke, Robert A.J. Espey, Robert Chessman, Robert D.J. Whitham, Robert E. Payne, Robert Staruch, Roberto J.R. Alho, Robin Gordon, Rory Cuthbert, Roseanna B. Harrison, Rupert A. Scott, Ruth M. Parks, Ryan C.T. Cheong, Ryan L. Hillier-Smith, Ryan Moffatt, Saad Rehman, Sabah Ambren, Sabria Abdulal, Sagar Kulkarni, Sam Hopwood, Samantha H. Greenfield, Samir K. Mehta, Samuel Haines, Sarah A. AlSaati, Sarah A. Williams, Sarah El-Badawy, Sarah L. Barlow, Sarah Pywell, Sarah-jayne Pollock, Savvas Lampridis, Scarlet Nazarian, Sean Rezvani, Sean Scattergood, Sebastian M. Toescu, Sesi Hotonu, Shafaque Shaikh, Shamil Rupani, Shumaila Hasan, Shwetha Pradeep, Simon J. Cole, Siona A. Growcott, Sofia E. Bedoya, Sonia I. Ike, Stefan V. Bodnarescu, Stella C. Seppings, Stephanie A. Poyntz, Stevan J. Jordan, Sundas Iqbal, Suparna Das, Suravi Chatterjee-Woolman, Syed Shumon, Tamsin E.M. Morrison, Tara Sibartie, Tariq Aboelmagd, Thomas B. Russell, Thomas C. Seddon, Thomas D. Stringfellow, Thomas Goldsmith, Thomas H.F. Banks, Thomas Tolley, Tobenna J. Oputa, Todd T. Kanzara, Tom Challoner, Tomas Urbonas, Tomos B. Richards, Victoria J. Morrison-Jones, Vivek Garikapati, Waheeb A.K. Al-Azzani, Wajiha Zahra, Weiguang Ho, Wesam Al-Dhahir, William G.W. Gibson, Yasmin Grant, Yasser Hijazi, Yayganeh Chiang, Zobia K. Gundkalli, Zoe M. Seymour, and Zoe Panayi

Subjects
medicine.medical_specialty, media_common.quotation_subject, education, Specialties, Surgical, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Nursing, medicine, Tribe, Humans, Quality (business), 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Societies, Medical, media_common, Quality Indicators, Health Care, Descriptive statistics, business.industry, General Medicine, Surgical training, United Kingdom, Education, Medical, Graduate, 030220 oncology & carcinogenesis, Family medicine, Workforce, Cohort, Surgery, Observational study, Clinical Competence, Guideline Adherence, business
Abstract

Introduction This study aimed to assess training of Senior House Officer-grade equivalent doctors in postgraduate surgical training or service (SHO-DIPST) in surgical specialties across the United Kingdom (UK), against nationally agreed Joint Committee on Surgical Training Quality Indicators (JCST QIs). Specific recommendations are made, with a view to improving quality of training, workforce retention and recruitment to Higher Surgical Training. Method Prospective, observational, multicentre study conducted by the Association of Surgeons in Training, using the UK National Research Collaborative model. Any centres in the UK providing acute surgical services were eligible. SHO-DIPST with a permanent contract, on out-of-hours ‘on-call rota' were included across four, one-week data capture periods (September to October 2016, February to March 2017). Adherence to five quality indicators was reported using descriptive statistics. P-values were calculated using Student's t-test for continuous data, with a 5% level of significance. Results 2569 SHO-DIPST were included from all ten surgical specialties in 141 NHS trusts across all 16 Local Education and Training Boards in the UK. 960 SHO-DIPST were in registered ‘training' posts (37.3%). The median number of SHO-DIPST per rota was 7.0 (IQR 5.0–9.0). Adherence to the five included JCST QIs ranged from 6.0 to 53.1%. Only four SHO-DIPST posts across the study population met all five JCST QIs (0.3%). The total number of training sessions was higher for those in registered training posts (p Conclusions Only four early years postgraduate surgical training posts in the UK meet nationally approved minimum quality standards. Specific recommendations are made to improve training in this cohort and to bolster recruitment and retention into Higher Surgical Training.

Published
2017

4. A case of spontaneous haematoma from vertebral artery arterio-venous fistula in a patient with neurofibromatosis type 1

Author

William Mukonoweshuro, Peter C. Whitfield, Sarah El-Badawy, and Harsha Narayanamurthy

Subjects
Adult, Male, Left vertebral artery, congenital, hereditary, and neonatal diseases and abnormalities, medicine.medical_specialty, Neurofibromatosis 1, Vertebral artery, Fistula, Arteriovenous fistula, Neurosurgical Procedures, 03 medical and health sciences, Fatal Outcome, 0302 clinical medicine, medicine.artery, medicine, Humans, Neurofibromatosis, neoplasms, Vertebral Artery, Hematoma, business.industry, Angiography, Digital Subtraction, 030208 emergency & critical care medicine, General Medicine, Bleed, medicine.disease, Arterio-venous fistula, nervous system diseases, Surgery, Arteriovenous Fistula, Neurology (clinical), Radiology, business, 030217 neurology & neurosurgery
Abstract

Neurofibromatosis type 1 (NF1) is an autosomal dominant condition caused by a mutation on chromosome 17. Vascular abnormalities are recognised complications of NF1. These include aneurysms, stenoses, arteriovenous malformations, fistulae, etc. We report the case of a young gentleman with NF1 with a spontaneous cervical bleed from an arteriovenous fistula arising from the left vertebral artery, and illustrate the various management options and difficulties arising from rapid fistula formation.

Published
2016
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