Early observations from the initial impact of the current COVID-19 pandemic on surgical services in the United Kingdom: a comprehensive review.

OBJECTIVE: The COVID-19 pandemic has resulted in a serious impact on health services. In this comprehensive review, the authors have explored the published evidence that has looked into the early effects of this impact on various aspects of delivering surgical services during the crises in the United Kingdom. MATERIALS AND METHODS: Electronic literature search of the databases (Medline/PubMed, EMBASE, NICE guidelines and Google Scholar). The key words used were COVID-19, SARS-CoV-2, Coronavirus, pandemic, surgery, surgical services. The retrieved studies were systematically reviewed and critically analyzed to construct this comprehensive review. RESULTS: The surgical interventions have been focused on emergency and cancer surgery during the pandemic. Since the service situation is changing quickly; surgeons should be up to date with the local and national guidelines. It is vital to safeguard the specialized clinical professionals to fulfill their tasks through the pandemic; especially that another wave of the pandemic is still a possibility in the horizon. Attention should be given to surgical training and medical education during the crises by the training providers. CONCLUSIONS: The aftermath period is still going to be a serious challenge to the service. Therefore, a strategy of shared responsibility, planning ahead with consideration of developing a transitional period should be adapted.

Small bowel intussusception in adults.

Intussusception is the telescoping of a proximal segment of the gastrointestinal tract into an adjacent distal segment. This rare form of bowel obstruction occurs infrequently in adults. We report a case of small bowel intussusception in an adult male patient. We have also performed a literature review of this rare condition.

An update on the management and treatment of deep vein thrombosis.

Deep venous thrombosis (DVT) with its associated complications of pulmonary embolism and postthrombotic syndrome are an important cause of morbidity and mortality. This review article provides an overview of the pathophysiology, risk factors and the guidelines for thromboprophylaxis. It also reviews the available modalities in the diagnosis and treatment of DVT. The newer methods of treatment are also discussed.

Varices of the round ligament mimicking an inguinal hernia--an important differential diagnosis during pregnancy.

Pregnancy is a recognised risk factor for the development of inguinal hernias due to an increase in intra-abdominal pressure. Whilst often managed conservatively until after the pregnancy, if the hernia presents acutely as a painful or tender groin lump, urgent or emergency repair may be required. Many clinicians rely heavily on clinical examination alone in order to diagnose the presence of such a hernia. In pregnancy, however, in order to prevent unnecessary surgery, the use of ultrasound has a more important role to play in reaching this diagnosis. We report a cautionary case that highlights the need for ultrasound evaluation of all painful groin lumps in pregnant women prior to considering surgery.

Endovenous therapy of varicose veins: a better outcome than standard surgery?

In the UK approximately one million people are affected with varicose veins. Nearly half a million patients seek advice from their GPs about lower limb varicose veins related symptoms every year. Therefore, they constitute an important part of the elective operations and waiting lists in NHS hospitals. About 40,000 operations for varicose veins were performed in the NHS in 2001. The majority (60-70%) of those patients had an incompetent saphenofemoral junction (SFJ) and great saphenous vein (GSV) reflux. The traditional and most common approach for treating SFJ incompetence and GSV reflux is saphenofemoral disconnection and GSV stripping to the knee. Despite being considered a minor surgical procedure, complications are not uncommon. The minimally invasive endovenous treatment of lower limb's varicose veins has been used over the last few years in many centres across the world. It would appear to be equal to, if not superior to, traditional surgery. It has also been proven to be safe with few serious complications. The most common treatments are endovenous laser ablation and endovenous radiofrequency ablation and chemical sclerotherapy. The case for minimally invasive strategies appears to have been accepted by many patients already and it would appear in trials that they are 'voting with their feet'. Rigorous scientific evidence remains elusive and not yet conclusive. As in all other branches of surgery new technology should be embraced but cautiously, with all results collected and disseminated to finally prove the utility or otherwise of this technique.

A case report of hepatic and renal dysfunction complicating midgut malrotation in an adult.

A 39-year-old man had an unusual presentation of jaundice and acute renal dysfunction complicating midgut malrotation. Diagnosis by computed tomography scan enabled prompt surgery and functional correction of the malrotation, with a full return to normal life.