Background and Objectives:The use of routine versus selective intra-operative cholangiogram (IOC) for laparoscopic cholecystectomy (LC) remains an area of debate. In this study, we investigated the routine use of IOC in a single center, to determine whether it confers a reduced risk of common bile duct (CBD) injury and improved patient outcomes. We also identified several preoperative predictive factors for CBD stone detection on IOC to investigate the feasibility of a predictive model.Methods:We identified 1005 LCs with routine IOC over a 2-year period at the Norfolk and Norwich University Hospital from October 1, 2013, to September 30, 2015. Outcomes measured included CBD stone detection on IOC, CBD injury, complication rates, readmission rate, and mortality. We also calculated sensitivity, specificity, and likelihood ratios for detection of CBD stones on IOC from preoperative biochemistry and radiological investigations.Results:We identified a CBD stone detection rate of 10.1% and a readmission rate of 0.03%, with no reported CBD injuries and 1 reported mortality. Of the preoperative predictive factors investigated, the most specific for CBD stone detection on IOC was bilirubin at 89%. The most sensitive was preoperative MRCP at 77%.Discussion:This study demonstrates that routine IOC is an effective method of detecting CBD stones and CBD injuries, resulting in improved patient outcomes and economic benefits for health services. We have also identified several predictive factors for CBD stones on IOC.
Background: There is evidence that the outcome of arteriovenous fistula surgery is dependent on the surgeon performing the operation. Vascular access surgery provides excellent technical training for surgical trainees. The effect of surgical trainees on the outcome of fistulas was evaluated. Methods: The grade of the main operator for all first attempted (primary) upper limb arteriovenous fistulas, between February 1998 and August 2001, was identified. Median follow-up was 18.0 months (IQR, 6.5-30.1 months). Successful use of fistula for dialysis, fistula patency and survival were assessed. Results: 441 primary fistulas were formed in the study period. Median age was 67.5 years (IQR, 54.0-75.2 years). 71% of all fistulas were formed at the wrist. Trainees performed 31.1% of all operations. The two groups (trainees and consultants) were well matched for age, sex, diabetes, and fistula type. Only 70.5% of patients proceeded to long-term haemodialysis. There were no significant differences in the successful use of AVF for dialysis or patency rates between the two groups. One and two year fistula survival in this group was 87.7% and 78.3% for trainees and 80.8% and 71.1% for consultants (P = 0.288 log rank). Conclusions: Surgical trainees can perform primary AVF surgery without significantly reducing fistula outcomes. Vascular access surgery can be utilised as a training operation.
Through a trainee research collaborative, we have studied the changes in practice of 12 T&O departments across the East of England over the first four weeks of the UK lockdown and COVID-19 pandemic, comparing to activity levels with the corresponding period in 2019.
We focused on changes in T&O practice, training and redeployment of Trainees.
Units differ considerably in several aspects of practice. We found a 97% reduction in elective operating, 64% reduction in elective outpatient activity and 37% reduction in operative trauma. 58% of trainees continued working in T&O clinics, with an average of 6 operative cases over this period.
Our modelling suggests that the impact on training will persist; counter-measures must be incorporated into central recovery planning.
Only four early years postgraduate surgical training posts in the UK meet nationally approved minimum quality standards. Specific recommendations are made to improve training in this cohort and to bolster recruitment and retention into Higher Surgical Training.
Postoperative fistula flow of less than 300 ml/min identifies AVFs at high risk of early failure. These may be candidates for early intervention with balloon assisted maturation. The findings of this retrospective cohort study strongly support the need for a more robust prospectively designed trial identifying haemodynamic factors that can predict mid and long-term AVF patency.
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