The myth of pre-operative isolation during the COVID-19 pandemic.

The SARS-CoV-2 (COVID-19) pandemic called for the restructuring of National Health Service (NHS) surgical departments across the country. Initial guidance advised that patients undergoing elective surgery isolate for 14 days prior to their operation. As we learnt more about COVID-19 and its incubation period, at the Princess Royal University Hospital this guidance has been decreased to 72 h. We collected retrospective data for two patient cohorts that underwent elective surgery in June and September 2020, isolating for 14 days and 72 h, respectively. We followed-up these patients with several questions allowing us to categorise the cohorts into three groups based on their compliance with isolation measures and also to assess their satisfaction with the isolation process. Our data shows that only 16% of the June cohort and 53% of the September cohort isolated in accordance with the guidelines whilst patient satisfaction was 16% and 64% respectively. These results highlight a suboptimal compliance to pre-operative guidelines as well as an adverse effect on patient mental health and raise the issue of both patient and NHS staff safety. With the possibility of a COVID-19 second wave and for future pandemics, a clear evidence-based plan for pre-operative isolation is vital. Furthermore, consideration of patient adherence and satisfaction is key in deciding which guideline will be most effective.

Novel wire-free techniques for localization of impalpable breast lesions-A review of current options.

Localization methods for breast lesions including cancers have changed and advanced since their inception. Currently, the most widely used technique in the United Kingdom is the image-guided hook wire localizer developed in the 1970s. It remains as the gold standard for localization of impalpable breast tumors. Besides its advantages, there are some disadvantages associated with this technique. In recent years, novel wire-free techniques (eg, Magseed® , SCOUT® , and LOCalizer™) have been developed to not only localize impalpable breast lesions but also negate the disadvantages of wire localization. This article reviews the variety of techniques from their origins to the most recent advancements that are used to localize breast lesions. The future is heading toward non-wire technology and wire localization may then be reserved for special cases.

Is Specialisation Needed in Laparoscopic Cholecystectomy? A Retrospective Cohort Study of 5122 Patients.

Background: Gallstone disease is a common problem and laparoscopic cholecystectomy (LC) is a common elective procedure. This operation was performed by a general surgeon, colorectal surgeons, breast and vascular surgeons according to the largest UK's audit (CholeS study). Objectives: To compare the outcomes of laparoscopic cholecystectomy performed by a specialist upper gastrointestinal (UGI) surgeon to that of CholeS and large international studies. Our hypothesis is: UGI specialist is producing better outcomes for LC patients. Methods: All patient who underwent LC between 1999 and 2019 at one hospital by an UGI consultant and 2014-2019 at another hospital by another UGI consultant surgeon were included. The inclusion criteria were LC performed by UGI surgeon. Lost to follow up, procedures done by trainees and gallbladder cancer patients were excluded. The outcome measures of bile leak, bile duct injuries, bleeding, infectious complications, bowel injuries, vascular injuries and pseudoaneurysms, neuralgia, port site hernia, mesenteric haematoma, 30-day mortality and conversion to open were reported. Statistical tests were used to assess the significant differences, the confidence interval was 95% and the p-value was taken as 0.05. Results: Two UGI specialists performed 5122 LC, 4396 (86%) were female and 715 (14%) male. The age was 13-93 year (median of 48 years). 3681 (72 %) was done as a day surgery case. 1431(28%) as an inpatient and 287 (5.6%) emergency LC. There was no death in the 30 days periods of surgery, 8 (0.15%) biliary leak from the duct of Luschka, 4 (0.19%) common bile duct (CBD) injuries, 9(0.02%) conversions and 17(0.33%) procedures were abandoned. There were significant differences in the above complications between our study and the CholeS report. Conclusions: Laparoscopic cholecystectomy is associated with acceptable outcomes, low risk of bile duct injury and no mortality when performed by a specialist upper GI surgeon.

Comparing quality of life outcomes between Laparoscopic Sleeve Gastrectomy and Laparoscopic Roux-en-Y Gastric Bypass using the RAND36 questionnaire.

BACKGROUND: Obesity surgery is an effective treatment to improve the health of patients. There is a lack of data regarding weight loss surgery outcomes and effects on Quality of Life (QoL). This study aims to compare changes in QoL following either Laparoscopic Sleeve Gastrectomy (LSG) or Laparoscopic Roux-en-Y Gastric Bypass (LRYGB). METHODS: SF36 questionnaires were mailed to all LSG and LRYGB patients who underwent surgery in 2013. Demographic data was obtained from hospital records. Statistical analysis was undertaken using Stats direct. RESULTS: 158 patients were sent postal questionnaires. 60 were returned (38%). 41 were women, 16 LSG, 44 LRYGB, mean age 52 years, mean BMI pre-surgery 41.0. Both procedures yielded similar weight loss over 2 year follow up (p = 0.01), and similar improvements in obesity related co-morbidities. These procedures yielded significant improvements in all QoL scales and domains other than the emotional role limitations scale following sleeve gastrectomy. CONCLUSION: Bariatric surgery has been shown to improve a patient's QoL. More research is needed to explain the reasons why there was a difference between Sleeve and Bypass procedures in emotional changes to patients.