Surgery

The robotic platform is the minimally invasive tool of choice- Improving techniques and outcomes (2024)

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Type of publication:

Conference abstract

Author(s):

Mohamedahmed A.; Abdalla H.E.; *Ismail A.; Yassin N.A.

Citation:

Colorectal Disease. Conference: 19th Scientific and Annual Conference of the European Society of Coloproctology, ESCP 2024. Thessaloniki Greece. 26(Supplement 2) (pp 239), 2024. Date of Publication: 01 Sep 2024.

Abstract:

Aim: This study aimed to assess the clinical outcomes of robotic compared with laparoscopic surgery within a transformation of minimally invasive total surgical practice. Method(s): A series of 201 consecutive patients relating to a single surgeon's experience when transforming total minimal invasive practice from laparoscopic to robotic surgery were included. Patients underwent laparoscopic and robotic surgery between 2018 and 2023. Short-term and long-term outcomes were evaluated and compared between the Laparoscopy (LG) and robotic (RG) with subgroup analyses according to procedure. Result(s): The median age and length of hospital stay (LOS) were 64 years and 6 days, respectively. Indications for surgery were CRC (62.2%), IBD (27.4%) and other general surgery conditions (hernia, appendicectomy, de-functioning loop colostomy, complex diverticular disease and rectal prolapse) (10.4%). The surgical approach was laparoscopic in 62 patients (30.8%) and Robotic in 139 patients (69.2%). Conversion to open was 12.9% in the LG versus 0% in the RG (p = 0.001). Regarding postoperative complications, the RG showed lower rate of overall complications [CD>=2 complications 14.3% in RG versus 16.1% in LG, p = 0.02], paralytic ileus [p = 0.03] and shorter LOS (p = 0.001) in comparison to LG. Moreover, both groups showed no difference in anastomosis leak [RG 1.3% vs LG 0%, p = 0.3], abdominal collection [RG 2.8% vs LG 2.5%, p = 0.5], re-operation [RG 1.4% vs LG 1.6%, p = 0.9], 30-day re-admission [RG 7.9% vs LG 8%, p = 0.9] and 30-day mortality [RG 0.7% vs LG 0%, p = 0.5]. Moreover, the RG remained superior when subgroup analyses were applied for anterior resection (39.3%), Right hemicolectomy (28.4%) and subtotal colectomy (13.4%). Conclusion(s): Robotic colorectal surgery improves clinical and surgical outcomes. This minimally invasive approach is the choice in a total transformation of practice from laparoscopic to robotic surgery, leading to significant reductions in LOS, rapid postoperative recovery, and an earlier return of gut function.

DOI: 10.1111/codi.17125

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Factors associated with conversion from day-case to in-patient elective laparoscopic cholecystectomy surgery across England: an observational study using administrative data (2025)

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Type of publication:

Journal article

Author(s):

*Olagunju, Naomi; *Cheetham, Mark; Savage, Katrein; Briggs, Tim W R; Gray, William K.

Citation:

Surgical Endoscopy.  2025 Dec 18. [epub ahead of print]

Abstract:

PURPOSE: Elective laparoscopic cholecystectomy is increasingly being conducted as a day-case procedure. However, some patients planned for day-case surgery stay in hospital for at least one night. The aim of this study was to identify factors associated with conversion from planned day-case to in-patient management for elective laparoscopic cholecystectomy.

METHODS: This was an exploratory retrospective analysis of observational data from the Hospital Episode Statistics dataset for England. All patients aged >= 17 years undergoing a planned elective day-case laparoscopic cholecystectomy between 1st April 2017 and 31st March 2024 were identified. The exposure of interest was discharge on the day of admission (day-case) or requiring overnight stay. For reporting, providers were aggregated to an Integrated Care Board (ICB) level.

RESULTS: A total of 286,754 elective LCs planned as day-case were identified over the seven-year study period. Of these, 74,957 (26.1%) stayed in hospital for at least one night and were classed as day-case to in-patient stay conversions. In multilevel, multivariable modelling, conversion to in-patient stay was associated with great age (odds ratio (OR) 2.54 for 17-29 vs >= 70 years, p < 0.001), male sex (OR = 1.11, p < 0.001), deprivation (OR 1.14, first vs fifth quintile, p < 0.001), open surgery (46.93, p < 0.001), and low annual surgeon volume (OR 1.73, < 10 vs >= 80 LCs per year, p < 0.001). Comorbidities and post-procedural complications were also strongly associated with conversion. Across the 42 ICBs in England, model-adjusted conversion rates varied from 14.5% to 39.0%, 18 (42.9%) ICBs had conversion rates above the 99.8% control limit.

CONCLUSIONS: Conversion from day-case to in-patient stay was associated with increasing age, male sex, deprivation, open surgery, low surgeon volume, comorbidity and post-procedural complication. Our findings will help surgical team identify patients suitable for day-case laparoscopic cholecystectomy.

DOI: 10.1007/s00464-025-12480-z

Endoscopic Follow-up after Acute Diverticulitis (2025)

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Type of publication:

Conference abstract

Author(s):

*Sultana E.; *Chakrabarty A.; *Ball W.

Citation:

British Journal of Surgery. Conference: Annual Congress of the Association of Surgeons of Great Britain and Ireland. Edinburgh United Kingdom. 112(Supplement 13) (pp xiii59), 2025. Date of Publication: 01 Aug 2025.

Abstract:

Introduction: Acute diverticulitis is one of the most common causes for surgical emergency hospital admissions in the UK. The guidelines for endoscopic follow-up for patients with diverticulitis has changed over the last few years. This study aimed to assess the local follow-up of patients who present with diverticulitis. The objective was to identify the outcome of patients with diverticulitis and establish the new local guidelines for endoscopic follow-up. Method(s): A single-centre retrospective study was done for all patients who had CT proven diverticulitis at the Royal Shrewsbury Hospital in 2022. Data was collected about the patient demographics, vital statistics on presentation, Hinchey Classification, mode of management, previous admissions with diverticulitis, readmissions in one year, surgery in one year, and their follow-up results. Result(s): There were 193 patients in the study with a median age of 61 (IQR: 51-73) and 37.8% were male. Follow-up endoscopy was done in 45.6% (87/193) of the patients, amongst which 85.1% (74) had uncomplicated diverticulitis. There was one cancer detected in colonoscopy and one in flexible sigmoidoscopy both of which were suspicious on the initial CT scan. 13 patients had a follow-up CT scan within 1 year, of which 2 confirmed cancer. Median time for endoscopy and CT scan was 10 and 26 weeks from discharge, respectively. Conclusion(s): Diagnosis of cancer on an isolated follow-up colonoscopy or flexible sigmoidoscopy after uncomplicated diverticulitis is rare. These investigations should be reserved for patients with complicated diverticulitis or suspicious features of cancer on the initial CT scan.

DOI: 10.1093/bjs/znaf166.222

Factors associated with conversion from day-case to in-patient elective laparoscopic cholecystectomy across England: An observational study using administrative data (2025)

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Type of publication:

Conference abstract

Author(s):

*Olagunju N.; *Cheetham M.; Briggs T.; Gray W.K.

Citation:

British Journal of Surgery. Conference: Annual Congress of the Association of Surgeons of Great Britain and Ireland. Edinburgh United Kingdom. 112(Supplement 13) (pp xiii25), 2025. Date of Publication: 01 Aug 2025.

Abstract:

Aims: Day-case laparoscopic cholecystectomy is safe, cost-effective and patient friendly; however, some planned day case patients may convert to in-patient stay following an elective laparoscopic cholecystectomy. The aim of this study was to determine the rate of conversion from planned day-case to in-patient laparoscopic cholecystectomy across England and trends in same-day discharge over the study period. This study also aimed to evaluate factors contributing to these conversions. Method(s): This was an exploratory analysis of administrative data from the Hospital Episode Statistics (HES) database for England of planned day-case laparoscopic cholecystectomies from April 2017 to March 2024. Result(s): Of 286,754 planned day-case patients, the conversion rate to in-patient stay was 26.1% (74,957). Patients who converted to in-patient stay were older, more likely to be male and have open surgery, more comorbidities and were more likely to be operated on by a low annual volume surgeon. Post-procedural complications of haemorrhage, pain and venous thromboembolism were strongly associated with conversion. Across the 42 ICBs in England, model-adjusted conversion rates varied from 14.5% to 39.0%. Conversion to in-patient stay was associated with higher emergency hospital admissions within 30 days of discharge (4,290, 5.7%) when compared with same-day discharge (8,306 3.9%). Conclusion(s): The rate of conversion from planned day-case to in-patient laparoscopic cholecystectomy across England have declined over the past 7 years. Our study highlights patient selection, intra-operative haemostasis, and peri-operative pain management as target areas for centres hoping to improve day-case laparoscopic cholecystectomy rates.

DOI: 10.1093/bjs/znaf166.094

Assessment of Predictors of Recurrence, Surgical and Radiological Intervention in Acute Colonic Diverticulitis: A Multicentre Study with One-Year Follow-Up (2025)

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Type of publication:

Conference abstract

Author(s):

Mohamedahmed A.Y.; Albendary M.; Issa M.; *Sultana E.; Hamid M.; Zaman S.

Citation:

British Journal of Surgery. Conference: Annual Congress of the Association of Surgeons of Great Britain and Ireland. Edinburgh United Kingdom. 112(Supplement 13) (pp xiii1), 2025. Date of Publication: 01 Aug 2025.

Abstract:

Background: Recurrent acute diverticulitis (AD) significantly impacts patient's quality of life and increases morbidity and healthcare costs. This study aims to assess risk factors for recurrence and the need for surgical and radiological intervention during one year from index presentation. Method(s): This multicentre study was performed in four UK hospitals. All patients presented with a CT scan confirmed colonic AD during 12 months were included. Patients were followed up for one year from the index presentation. Outcomes of interest were the patient factors associated with recurrent episodes of diverticulitis and the requirement for a radiological or surgical intervention, using both univariate and multivariate logistic regression. Statistical analysis was performed using R version 4.4. Result(s): A total number of 542 patients were included; the median age was 62 (51-73) years, and 64.2% had Hinchey 1a AD. The recurrence rate over 1 year was 19.5%, with increased likelihood in patients with previous diverticulitis (P=0.006), Temperature >= 38degreeC on index admission (P=0.021), and LOS >= 3 days (P=0.009). Surgical and radiological intervention during follow-up was reported as 11.8% and 2%, respectively. Factors associated with increased likelihood of surgical intervention within 1 year were previous diagnosis of complicated diverticulitis (P=0.002), pyrexia(P=0.009) and hypotension(P=0.013) on index admission, CRP >300 (P=0.037), WCC >=15(P=0.007), and Hinchey grades >= 2 (P=0.001). Conclusion(s): High inflammatory markers, prolonged LOS and previous history of diverticulitis are associated with an increased risk of recurrence of diverticulitis. Treatment of acute diverticulitis must be tailored according to the patient's risk stratification.

DOI: 10.1093/bjs/znaf166.003

Losing Sense of Direction or Anatomical Variation? - Failure of Biliary Duct Clearance Through Endoscopic and Surgical Interventions (2025)

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Type of publication:

Conference abstract

Author(s):

*Lakshmipathy G.; *Pattar J.; *Jain R.;

Citation:

British Journal of Surgery. Conference: Annual Congress of the Association of Surgeons of Great Britain and Ireland. Edinburgh United Kingdom. 112(Supplement 13) (pp xiii122-xiii123), 2025. Date of Publication: 01 Aug 2025.

Abstract:

Clinical Details: 61-year-old man with obesity and type II diabetes, presents with abdominal pain and obstructive jaundice. MRCP showed gallstones and 12mm common hepatic duct (CHD) stone. However, ERCP could not identify calculus in the then thought CHD. Second MRCP and bloods demonstrated the same CHD stone and worsening bilirubin. Therefore, laparoscopic cholecystectomy and common bile duct (CBD) exploration were done; with the extraction of three proximal CBD stones and flushing two distal CBD stones. Operative choledochoscopy of CBD and the then presumed CHD were considered clear. Post-operatively, bilirubin climbed and MRCP confirmed the persistent CHD stone and identified anatomical variation in drainage of right posterior sectoral duct (RPSD). Subsequently, ERCP could not retrieve the large CHD calculus and spyglass ERCP referral was made. Discussion(s): Negative operative choledochoscopy and endoscopy of CHD occurred because of preferential entry into aberrant RPSD rather than CHD. This aberrant RPSD drained into cystic duct, which is type 5 variation in prevalence-based classification of anatomical biliary variants or type 3C of Choi classification. Aberrant RPSD is the least prevalent bile duct variant seen in 0.6% of patients. Type 4 and 5 variants are relevant in operative choledochoscopies and ERCP, as RPSD could be mistaken for CHD. This case demonstrates a rare anatomical variation of the biliary tree which can derail surgeons and endoscopists in diagnosing and managing patients with choledocholithiasis. We therefore emphasise high index of suspicion and utilise three-dimensional reconstruction of biliary tree, pre-procedurally in all cases of CBD exploration.

DOI: 10.1093/bjs/znaf166.475

Standardisation of colorectal robotic-assisted surgery (RAS) training: A roundtable discussion (2025)

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Type of publication:

Conference abstract

Author(s):

*Kawar L.; Shakir T.; *El-sayed C.

Citation:

Colorectal Disease. Conference: Association of Coloproctology of Great Britain and Ireland Annual Meeting. Harrogate United Kingdom. 27(Supplement 2) (no pagination), 2025. Date of Publication: 01 Sep 2025.

Abstract:

Purpose: The current landscape of colorectal robotic-assisted surgery (RAS) training is marked by significant variability. In order to gather opinions, a webinar was hosted by The Dukes' Club, the UK network for colorectal surgical trainees. This seeked to understand from a panel of expert RAS surgeons with various stakeholder roles in RAS training, the optimal method of delivering standardised RAS training in the UK. Method(s): This consensus study is based on a one-hour webinar held on 4th March 2024. Panellists included robotic surgery preceptors and proctors from both CMR Surgical (UK) and Intuitive (USA) respectively; members of robotic subcommittees within speciality associations, and providers of European fellowships. A thematic analysis was conducted to systematically analyse the qualitative data. Result(s): The roundtable featured two consultant urologists and three consultant colorectal surgeons. Four main themes with relevant sub-themes emerged: (1) the current state of robotic training, (2) training components of RAS, (3) challenges in delivering training, and (4) strategies for improvement. The discussion highlighted the variability in training based on geographical location and surgical speciality. Trainer readiness was discussed, with emphasis placed on the temporary nature of this. The importance of adopting RAS skills early in training with stepwise progression, was highlighted. Essential components of a standardised curriculum were identified including e-learning, simulation, and mentorship. Conclusion(s): Standardising colorectal RAS training is vital for equitable and effective skill development. Future directions include enhancing access and resource allocation, implementing stepwise certification, and integrating artificial intelligence and machine learning.

DOI: 10.1111/codi.70177

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Complications After Hydrocele Repair: Solving a Persistent Challenge (2025)

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Type of publication:

Conference abstract

Author(s):

*Lu Y.; *Abdellatif M.; *Desai C.; *Ali-Naja N.; *Han L.A.; *Kells L.; *Kachrilas S.;

Citation:

British Journal of Surgery. Conference: 49th ASiT Annual Surgical Conference. Belfast United Kingdom. 112(Supplement 10) (pp x179-x180), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Aim: Surgical intervention remains the gold-standard treatment for large or symptomatic hydroceles. Although hydrocele repair is a relatively minor procedure, complications such as haematoma and infection can have significant consequences. This study aims to evaluate the rates and severity of complications and explore strategies to minimise them following hydrocele repair Method: Aretrospective analysis was conducted of all hydrocele surgery performed in January 2021 to December 2022. Complication outcomes were classified using Clavien-Dindo grading. Result(s): A total of 85 hydrocele operations were included in the study, with an average patient age of 54.5. Post-operative complications occurred in 22 (25.88%) patients, including infection, haematoma and recurrence. Amount these, 7 complications (8.24%) were classified as Clavien-Dindo grade II, and 13 (15.29%) as grade III. No grade IV or V were recorded. Of the 22 patients with complications, 11 (12.94%) of them experienced recurrent hydroceles. Conclusion(s): Complications following hydrocele repair are relatively common, warranting further investigation. Comprehensive pre-operative counselling is essential to set realistic expectations and address potential risks with patients. Our centre implemented prophylactic antibiotics in high-risk group and the use of intra-operative betadine wash as potential solutions.

DOI: 10.1093/bjs/znaf128.718

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Mortality Related to Bariatric Surgery (MORSE Study): A Retrospective, International Collaborative Audit (2025)

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Type of publication:

Journal article

Author(s):

Balasubaramaniam, Vignesh; Wong, Geoffrey Yuet Mun; Martinino, Alessandro; *Riera, Manel; Abouelazayem, Mohamed; Pereira, Juan Pablo Scarano; Said, Amira; Graham, Yitka; *Jain, Rajesh Kumar; Imseeh, Helen; Aljaiuossi, Osama; Jayyab, Mustafa Ahmad Abu; Alyacoubi, Said N A; Mahawar, Kamal; Singhal, Rishi.

Citation:

Clinical Obesity. e70031, 2025 Jun 18.

Abstract:

Bariatric surgery is associated with low but definite early and late mortality. This study aims to further understand early (<= 90 days) and delayed (> 90 days) mortality related to bariatric surgery. This is a retrospective collaborative audit of patients who had undergone bariatric surgery and developed complications that ultimately led to death. Individuals who were 18 years or older and had undergone bariatric surgery (primary, revisional, and endoscopic procedures) and subsequently died within 90 days or after 90 days following the surgery between 1 January 2022, and 31 December 2022. A descriptive analysis was conducted. About 30 centres from 21 countries submitted data on 82 patients where patient death was deemed to be related to bariatric surgery. Mortality within 90 days post-surgery was observed in 58 individuals (70.7%), while 24 patients (29.3%) died after this period. Causes of mortality after SG include GI leak, PE, respiratory infection, and malnutrition. Causes of mortality after RYGB include GI leak, coronary heart disease, and bleeding. Reported common causes of early mortality in this study were gastrointestinal leaks, bleeding, coronary heart disease, and pulmonary embolism. Reported common causes of delayed mortality were gastrointestinal leaks and malnutrition. This study characterises patients where death was attributed to a bariatric procedure and identifies common causes of death in these patients. This could aid development of strategies for preventing and managing these complications in the future.

DOI: 10.1111/cob.70031

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