General Surgery

 

Recent Submissions

  • Extrahepatic gallstones and abscess formation post-cholecystostomy: a rare complication in high-risk acute cholecystitis management
    MacDonald-Nethercott, Meiling; Ahmed, Naeem; Tanner, Nicola; Finch, Guy (2024)
    This intriguing case report explores an interesting complication following percutaneous cholecystostomy for the management of acute cholecystitis in an elderly female with multiple comorbidities. Despite initial improvement, she later presented with recurrent symptoms, due to a collection of gallstones, that had migrated through the cholecystostomy tract, requiring exploration, stone retrieval and abscess drainage. While percutaneous cholecystostomy remains an effective treatment for managing acute cholecystitis in high-risk surgical candidates, this case highlights the rare yet critical risk of extrahepatic gallstones and abscess formation. It emphasises the necessity for vigilance in detecting and managing complications associated with percutaneous transhepatic cholecystostomy, ensuring timely diagnosis and effective treatment.

  • Post-ERCP clearance of bile duct stones: should the gallbladder be left in-situ?
    Wong, Cindy Siaw Lin; Krishnan, Arya; Kumaran, Naren; Tanner, Nicola (2025)
    BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) has become the gold standard management for patients who present with common bile duct stone (CBDS). Although laparoscopic cholecystectomy is generally recommended for patients who have CBDS clearance, there is still a significant proportion of patients who are managed expectantly. Our study aimed to evaluate the outcomes of expectant management (EM) versus prophylactic cholecystectomy after initial endoscopic removal of CBDS., METHOD: We performed a retrospective review of all patients who underwent ERCP for choledocholithiasis from 1st January 2017 to 31st December 2019. Patients were further classified into young or elderly group using age 60 years as the cut-off. Primary outcomes measured biliary-related complications in each interventional group whereas secondary outcomes measured all-cause mortality., RESULTS: 136 patients (51.3%) had EM whereas 129 patients (48.7%) were initially planned for LC. There was 20.6% of recurrence of biliary events in EM group as compared to 3.9% in LC group. The median time from first ERCP to recurrence of biliary events in the EM group was 14 months. Overall complications of LC group was low (5.4%) with nil operative-related mortality. However, there was a significant higher proportion of elderly patients in EM group in comparison to LC group (88.2% vs 31%) and 51.4% of EM group died during follow-up period with only one biliary-related death., CONCLUSION: Prophylactic cholecystectomy should be recommended for patients who have undergone ERCP clearance of CBDS. A watch-and-wait approach may be justified for elderly populations who are not ideal surgical candidates and a follow-up duration of up to 2 years is recommended. Copyright ┬® 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

  • Legal changes to informed consent and application to clinical practice in surgery
    Gruber, Elizabeth (2024)
    For consent to be fully informed, it must be tailored to each patient, who must be appraised of alternative treatments (including that of no treatment) and informed of the material risks which an individual would wish to know and consider significant. This also includes Covid-19 related risks. Whilst surgeons had at times to offer sub-optimal treatments due to pressures caused by the pandemic, patients should still be given the choice to delay their treatment. Consent obtained remotely via digital technology must comply with the same requirements as in a face-to-face setting.

  • Using interactive study days to enable staff to appropriately manage patients’ wounds
    Al-Azzawi, Bev; Lambert, Emily (2021)
    Background: Surgical site infection (SSI) rates within the division were high at 3%. Staff lacked confidence in the management of wounds. There was no specialised training within the Trust that focused on the management of surgical wounds. Aims: The surgical practice development team aimed to create a 2-day training programme that overhauled educational delivery of wound management and improved patient outcomes. Methods: The surgical practice development team introduced a series of fun and innovative days where staff learned through interactive teaching sessions. The effectiveness of this was measured through audit of the SSI rates within the division and assessment of individual competency in aseptic non-touch technique (ANTT). We also undertook a qualitative survey assessing whether staff within the division felt competent and identifying the barriers to achieving competence when managing wounds. Results: Following delivery of the education days rates of SSI fell to 1% in total knee replacements and to 0% in other specialities. Following the training 79% of staff felt confident in managing wounds by being able to select appropriate dressings and plan appropriate care. There was an improvement in the rates of ANTT assessments passed on first attempt from 57% to 83%. Conclusions: Introduction of fun, educational days improves SSI rates within the division and, therefore, enabled us to improved patient outcomes.