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Background: A prospective IDEAL stage 2a pilot study was carried out at a tertiary care center to evaluate the reliability of a homemade laparoscopic endotrainer, following the MISTEL and IDEAL framework guidelines. Methods: The validated modified (MISTELS) score was used to test the reliability of a low‐cost laparoscopic trainer with commonly found components built by surgeons. Basic household materials including a cellular phone (camera source), wifi (linking source) and freely available webcam apps were used for construction. Five basic laparoscopic skills were performed by general surgery resident volunteers with minimal (1–6 months') laparoscopic surgery experience and tested and retested based on efficiency and precision. To determine interrater reliability, two trained observers scored all subjects. The Cronbach alpha test was used to test for internal consistency between tasks. The Interclass correlation coefficient is used for test and retest reliability. Results: 15 (80% male, mean age 28 ± 5 years) residents were included. The interrater and test–retest reliabilities for the total scores of the basic laparoscopic skills tests were 0.952 (95% CI, 0.895–0.981) and 0.64 (95% CI, 0.35–0.77), respectively. The Cronbach Alpha for the first assessment test and retest was 0.83. The MISTELS metrics had excellent reliability, exceeding the threshold level of 0.8. Conclusion: It is possible to assemble a low‐cost, reliable trainer at home to enhance laparoscopic skills during residency. [ABSTRACT FROM AUTHOR]

Aim: Diverting loop ileostomy reversal (DLI‐R) is routinely performed from 2–6 months following ileal pouch‐anal anastomosis (IPAA). The safety of delayed reversal after IPAA is not well‐defined. The aim of this study was to determine if prolonged diversion is associated with adverse outcomes compared to routine closure. Methods: Adult patients undergoing primary IPAA with DLI from 2000 to 2021 were included in this retrospective cohort study from our institutional database. Patients were stratified into tertiles based on timing of reversal: Routine (56–116 days), Delayed (117–180 days), or Prolonged (>6 months). Univariate analysis compared categorical variables between groups. Patients reversed at <8 weeks were excluded. Results: In total, 2615 patients underwent DLI‐R following IPAA (3‐stage 61%, 2‐stage 39%; mean age 39.9 years). DLI‐R was performed as Routine, Delayed and Prolonged in 1908 (72.9%), 426 (16.4%) and 281 (10.8%), respectively. Overall, DLI‐R related complications occurred in 12.4% (n = 324). The complication rate in the Routine group was 11% (n = 210), in the Delayed group was 12.2% (n = 52) and in the Prolonged group was 22.1% (n = 62). Reasons for prolonged diversion in the Prolonged group were complications at the time of IPAA in 207 (73.9%) or patient preference/scheduling in 73 (26.1%). DLI‐R >6 months after IPAA due to complications had higher rates of overall complications following ileostomy reversal (OR 2.6, 95% CI 1.85–3.72, p < 0.001) whereas when DLI‐R was delayed due to preference/scheduling outcomes were not different than the Routine group (p = 0.28). Conclusion: Prolonged time to ileostomy reversal after IPAA is probably safe without increased risk of complications when due to patient preference. [ABSTRACT FROM AUTHOR]

Background: Patients undergoing colorectal surgery for inflammatory bowel disease (IBD) are recognized to have an increased risk of venous thromboembolism (VTE). The aim of this study was to determine the perioperative risk factors for VTE and to create a predictive scoring system for VTE in the IBD cohort. Methods: The NSQIP‐IBD Collaboration Registry from 2017 to 2020 was used to identify patients. Demographics, operative and outcomes data of IBD patients undergoing surgeries for IBD were analysed. A logistic multivariate regression model was performed using all significant variables to develop a predictive scoring system of VTE. Results: Five‐thousand and three patients (51.9% male, mean age: 42.7, 42.7% ulcerative colitis) were included in the study. 125 (2.49%) developed VTE. On multivariate analysis ASA grade, ulcerative colitis, sepsis, serum sodium <139 mmol/L, an open abdomen and preoperative inter hospital transfer were associated with greater risk of VTE. Using these 6 significant factors, a risk model was constructed. The risk of VTE with one risk factor was 0.7% and 1.8% with two risk factors. The risk of VTE increased to 3.6% and 4.5% with three and four risk factors respectively. With five and six risk factors, the risk of VTE increased exponentially to 10.9% and 25% respectively. Conclusion: This study shows that there are cumulative risk factors which increase the risk of VTE after surgery for IBD. The risk increases exponentially with more than five risk factors, and extended chemoprophylaxis may not be enough in reducing this risk. [ABSTRACT FROM AUTHOR]

Aim: In low rectal cancers without sphincter involvement a permanent stoma can be avoided without compromising oncological safety. Functional outcomes following coloanal anastomosis (CAA) compared to abdominoperineal excision (APR) may be significantly different. This study examines all available comparative quality of life (QoL) data for patients undergoing CAA versus APR for low rectal cancer. Methods: Published studies with comparative data on QoL outcomes following CAA versus APR for low rectal cancer were extracted from electronic databases. The study was registered with PROSPERO and adhered to PRISMA (Preferred Reporting Items in Systematic Reviews and Meta‐analyses) guidelines. Data was combined using random‐effects models. Results: Seven comparative series examined QoL in 527 patients. There was no difference in the numbers receiving neoadjuvant radiotherapy in the APR and CAA groups (OR: 1.19, 95% CI: 0.78–1.81, p = 0.43). CAA was associated with higher mean scores for physical functioning(std mean diff −7.08, 95% CI: −11.92 to −2.25, p = 0.004) and body image (std. mean diff 11.11, 95% CI: 6.04–16.18, p < 0.0001). Male sexual problems were significantly increased in patients who had undergone APR compared to CAA (std. mean diff −16.20, 95% CI: −25.76 to −6.64, p = 0.0009). Patients who had an APR reported more fatigue, dyspnoea and appetite loss. Those who had a CAA reported higher scores for both constipation and diarrhoea. Discussion: It is reasonable to offer a CAA to motivated patients where oncological outcomes will not be threatened. QoL outcomes appear to be superior when intestinal continuity is maintained, and permanent stoma avoided. [ABSTRACT FROM AUTHOR]

Background: Right iliac fossa (RIF) pain is a common indication for laparoscopy to diagnose and treat appendicitis. When a macroscopically normal appendix is found, there is no standard consensus regarding excision. Some surgeons remove the appendix due to the risk of microscopic inflammation and to avoid a future, repeat laparoscopy for possible appendicitis. Alternatively, others leave the appendix in situ to avoid morbidity from a potentially unnecessary procedure. We aimed to evaluate the outcomes of patients with macroscopically normal appendices left in situ. Methods: All emergency laparoscopies without appendicectomy between January 1st 2010- December 31st 2020 were identified from theatre records. All operative notes were individually evaluated and comments on the macroscopic appearance of the appendix and any intra-operative pathology were recorded. Only patients undergoing laparoscopy for suspected appendicitis with macroscopically normal appendices were included. Results: A total of 120 patients [median age 21.68 (range 9–90.8) years] were included. The cohort was predominantly female (n=105, 87.5%). Forty-eight patients (40.0%) had a positive finding during index laparoscopy. During a median duration of 94.5 (range 8–131) months' follow-up, 16 patients (13.33%) underwent a repeat laparoscopy for recurrent RIF pain. Thirteen (10.8% of total cohort) subsequently underwent an appendicectomy. Histology confirmed acute appendicitis in six cases (4.17% of entire cohort). On subanalysis of smaller cohort, index laparoscopies with no positive findings (n=72), nine patients (12.5%) underwent appendicectomy with two (2.7%) appendices demonstrating appendicitis on histological examination. Conclusion: 87% of the total cohort with a normal appendix at laparoscopy for RIF pain did not undergo further laparoscopy. Less than 5% of the total cohort and 2.7% of subanalysis cohort had an appendicectomy for histologically-proven appendicitis within the follow-up period. From the evidence in this study, we conclude that leaving the appendix in situ unless macroscopically inflamed is a viable alternative to excision. [ABSTRACT FROM AUTHOR]

Targeted lateral pelvic node dissection in the era of total neoadjuvant therapy. Is lateral pelvic node dissection necessary after preoperative chemoradiotherapy for rectalcancer patients with initially suspected lateral pelvic node?. [Extracted from the article]

The Arctic is warming at a rate nearly twice the global average, leading to thawing permafrost, increased coastal erosion, and enhanced delivery of riverine terrestrially-derived dissolved organic matter (tDOM) to coastal waters. This humic-rich tDOM has the ability to attenuate light required for photosynthesis and stimulate heterotrophic growth by supplying a source of labile organic carbon. Due to tDOM's high carbon to nitrogen (C : N) ratio, additional nitrogen is required for microorganisms to utilize this excess carbon for growth, thus exacerbating competition between autotrophs and heterotrophs for limiting nutrients and potentially reducing primary production. The effect of Arctic tDOM additions on nitrate uptake by two microplankton size fractions in the coastal Chukchi Sea was quantified using 15N tracer methods. To assess the biogeochemical vs. spectral impacts of tDOM, the uptake incubations were amended with either tDOM or light attenuating films that mimic light absorption by the tDOM. Nitrate uptake and primary production rates in the larger, predominantly phytoplankton, size fraction generally decreased with increasing tDOM additions. The change in light attenuation alone accounted for a ∼ 50% reduction in nitrate uptake. Responses in the smaller size fraction varied seasonally with tDOM additions stimulating uptake in spring and suppressing it in summer. The largest variation in summer nitrate uptake can be explained by the shared effect of biogeochemistry and light attenuation. Therefore, large increases in tDOM delivery currently occurring and predicted to increase in the coastal Arctic, could reduce primary production, broadly impact nitrogen and carbon cycling, and affect higher trophic levels. [ABSTRACT FROM AUTHOR]

Climate change is having profound impacts on Arctic ecosystems with important implications for coastal productivity and food web dynamics. We investigated seasonal variations in resource use of 16 invertebrate taxa in lagoon ecosystems along the Alaska Beaufort Sea coast using a combination of fatty acid (FA) biomarkers, bulk stable carbon isotope measurements of whole animals, and compound-specific stable carbon isotope measurements of total lipid extracts and individual FAs. Invertebrates were collected during full-ice cover (April), ice breakup (June), and open water (August) periods. Amphipods (Onisimus glacialis) had higher proportions of 18:2n-6 and 18:3n-3 FAs in April than in the other months. These elevated markers were accompanied by relatively low bulk and 18:2n-6 δ13C values, indicating proportionally higher contributions from terrestrial/freshwater sources in April. A wider range of invertebrates examined during June and August showed increases in algae-specific markers and higher proportions of essential FAs (e.g., 22:6n-3 [docosahexaenoic acid] and 20:5n-3 [eicosapentaenoic acid]) later in the summer. There were also marked differences in FA characteristics among invertebrates that highlighted differential feeding modes. For example, proportions of bacterial FAs were generally higher in deposit-feeding invertebrates than in suspension feeders. These results highlight the current role of diverse carbon sources to Arctic coastal food webs, which may change with future warming. [ABSTRACT FROM AUTHOR]

Food web relationships are traditionally defined in terms of the flow of key elements, such as carbon, nitrogen, and phosphorus, and their role in limiting production. There is growing recognition that availability of important biomolecules, such as fatty acids, may exert controls on secondary production that are not easily explained by traditional element-oriented models. Essential fatty acids (EFAs) are required by most organisms for proper physiological function but are manufactured almost entirely by primary producers. Therefore, the flow of EFAs, especially docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), and arachidonic acid (ARA), through aquatic food webs is critical for ecosystem functioning. A meta-analysis of data on the EFA content of marine organisms reveals that individual eggs of marine animals have exceptionally high concentrations of EFAs, and that superabundances of eggs released in temporally and spatially discrete patches create rich, but temporary, nutritional resources for egg predators, called ''egg boons.'' Mortality rates of fish eggs are disproportionately higher than animals of similar size, and those eggs are consumed by predators, both larger and smaller than the adults that produce the eggs. Thus, egg boons are a major trophic pathway through which EFAs are repackaged and redistributed, and they are among the few pathways that run counter to the main direction of trophic flow. Egg boons can transport EFAs across ecosystems through advection of patches of eggs and spawning migrations of adults. Recognizing the significance of egg boons to aquatic food webs reveals linkages and feedbacks between organisms and environments that have important implications for understanding how food webs vary in time and space. Examples are given of top-down, bottom-up, and lateral control mechanisms that could significantly alter food webs through their effects on eggs. Our results suggest that trophodynamic food web models should include EFAs generally, and egg production and egg EFA content in particular. [ABSTRACT FROM AUTHOR]

Biogeochemical rate processes in the Arctic are not currently well constrained, and there is very limited information on how rates may change as the region warms. Here we present data on the sensitivity of ammonium (NH4+) uptake and nitrification rates to short-term warming. Samples were collected from the Chukchi Sea off the coast of Barrow, Alaska, during winter, spring, and summer and incubated for 24 h in the dark with additions of 15NH4+ at −1.5, 6, 13, and 20°C. Rates of NH4+ uptake and nitrification were measured in conjunction with bacterial production. In all seasons, NH4+ uptake rates were highest at temperatures similar to current summertime conditions but dropped off with increased warming, indicative of psychrophilic (i.e., cold-loving) microbial communities. In contrast, nitrification rates were less sensitive to temperature and were higher in winter and spring compared to summer. These findings suggest that as the Arctic coastal ecosystem continues to warm, NH4+ assimilation may become increasingly important, relative to nitrification, although the magnitude of NH4+ assimilation would be still be lower than nitrification. [ABSTRACT FROM AUTHOR]

I Dear Editor i , We present the case of a 55-year-old woman with a rectal polyp in the site of a scar from polypectomy surgery performed 1 year previously. When performing TAMIS for anterior rectal lesions, the prone position facilitates easier closure of the defect, avoids bowel injury and maintains pneumorectum. The patient underwent transanal minimally invasive surgery (TAMIS) using the GelPOINT platform with AirSeal to maintain pneumorectum. [Extracted from the article]

University Hospital Waterford (UHW) is a regional haematological unit and has offered a consult-based service for splenectomy since June 2010. Should the patient fail to improve with first-line therapy, splenectomy offers a second-line treatment in some patients. I Dear Editor i , First-line treatment for haematological and immune disorders (e.g., autoimmune haemolytic anaemia and idiopathic thrombocytopaenic purpura) is medical therapy in the form of immunosuppression. [Extracted from the article]

Small bowel dilatation was noted up to the level of a gallstone in the mid-small bowel with collapsed bowel distal to it. Gallstone ileus accounts for up to 25% of mechanical small bowel obstruction in patients >65 years. [Extracted from the article]

Histology results demonstrated a Tang B, signet ring cell type, adenocarcinoma ex goblet cell carcinoid (GCC). Biopsies demonstrated a Tang B, signet ring cell type, adenocarcinoma ex GCC. gl Adenocarcinoma ex-goblet cell carcinoid (appendiceal-type crypt cell adenocarcinoma) is a morphologically distinct entity with highly aggressive behavior and frequent association with peritoneal/intra-abdominal dissemination: an analysis of 77 cases. [Extracted from the article]