Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · Oct 2009
Introduction of a day-case laparoscopic cholecystectomy service in the UK: a critical analysis of factors influencing same-day discharge and contact with primary care providers.
The objective of this study was to determine the safety and acceptability of the implementation of a day-case laparoscopic cholecystectomy (LC) service in a large UK teaching hospital, and analyse factors influencing contact with primary care providers. Wide-spread introduction of day-case LC in the UK is a major target of healthcare providers. However, few centres have reported their experience. In the US, out-patient surgery for LC has been reported, though many groups have utilised 24-h observation units to facilitate discharge. Concerns remain amongst surgeons regarding the feasibility and acceptability of the introduction of day-case LC in the UK. ⋯ Introduction of day-case LC in the UK is feasible and acceptable to patients. The potential burden to primary care providers needs further study.
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Ann R Coll Surg Engl · Oct 2009
Case ReportsSuperior mesenteric artery syndrome in association with an abdominal aortic aneurysm.
Superior mesenteric artery (SMA) syndrome, also known as Wilkie syndrome, is a rare condition characterised by compression of the third part of the duodenum against the aorta by the SMA. This can cause symptomatic duodenal obstruction. It is rarely associated with an abdominal aortic aneurysm (AAA). ⋯ SMA syndrome was diagnosed with imaging and was then successfully treated by aneurysm repair. This is the smallest AAA associated with SMA syndrome in the literature. We propose an anatomical mechanism for SMA syndrome in this case.
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Ann R Coll Surg Engl · Sep 2009
Supervised exercise for intermittent claudication - an under-utilised tool.
The use of supervised exercise in the management of intermittent claudication is well supported by level I evidence upon which are based grade A recommendations by the TASC II Inter-Society Consensus for the Management of Peripheral Arterial Disease and the Scottish Intercollegiate Guidelines Network (SIGN). These include that supervised exercise should be made available as part of the initial treatment for all peripheral arteriopaths. ⋯ These results are contrary to the recommendations offered by the TASC II Inter-Society Consensus and SIGN, in particular in terms of availability and referral to supervised exercise, as well as frequency of the classes where programmes were in place. The offer of information either verbally or via leaflet is commended; however, this has been shown as inferior to supervised exercise. Quoting resource as the reason for non-implementation goes against the published quality-of-life and pharmaco-economic data, which promote supervised exercise as both functionally and financially effective. This work highlights the importance of translating the results of research into evidence-based clinical practice.
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Ann R Coll Surg Engl · Jul 2009
Military general surgical training opportunities on operations in Afghanistan.
In the UK, general surgical specialist trainees have limited exposure to general surgical trauma. Previous work has shown that trainees are involved in only two blunt and one penetrating trauma laparotomies per annum. During their training, nearly half of trainees will not be involved in the surgical management of liver injury, 20% will not undertake a trauma splenectomy and only a quarter will see a trauma thoracotomy. Military general surgical trainees require training in, and exposure to, the surgical management of trauma and specifically military wounding patterns that is not available in the UK. The objective of this study was to determine whether operative workload in the sole British surgical unit in Helmand Province, Afghanistan (Operation HERRICK) would provide a training opportunity for military general surgical trainees. ⋯ A training opportunity currently exists on Operation HERRICK for military general surgical specialist trainees. If the tempo of the last 12 months is maintained, a 2-month deployment would essentially provide trainees with the equivalent trauma surgery experience to the whole of their surgical training in the UK NHS. Trainees would gain experience in military trauma as well as specific organ injury management.