Not based on previous communication to a society or meeting.

Circumcision is one of the most commonly performed surgical procedures in the world. Despite this, the practice of paediatric circumcision remains highly controversial, and continues to generate ongoing debate. This debate has become more relevant recently with the provisional guidelines from the Centers for Disease Control and Prevention recommending a change of practice. In this review article, we provide an overview of the history and incidence of circumcision, normal preputial development, types of phimosis, the absolute and relative indications for circumcision as well as the evidence base for its use as a preventative measure. Our aim is to provide paediatricians with a greater understanding of this common surgical procedure and the conditions it treats, to guide their clinical practice and parent counselling.

No abstract

No abstract

Background Small bowel obstruction (SBO) is a common general surgical presentation and there has been a shift towards non‐operative management (NOM) for patients with previous abdominal surgery. Historically, exploratory surgery has been mandated for SBO in patients with a virgin abdomen. However, there is increasing evidence for NOM in this group of patients. Methods A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. A search was undertaken between 1995 and 2020 on Ovid MEDLINE, EMBASE and PubMed. Primary outcome measures were success and failure rates, whereas secondary outcome measures were morbidity, mortality rates and identifying underlying aetiologies. Results Six observational studies were included, with 205 patients in the NOM and 211 patients in the operative group. There was a high success rate of 95.6% and low morbidity rate of 3.1% in the NOM group compared to 88.6% and 26% in the operative group, respectively. Both groups reported no mortalities. The most common aetiologies for SBO in a virgin abdomen were adhesions (63%), malignancy (11%), foreign body/bezoar (5%), internal hernia (4%) and volvulus (4%). Conclusion NOM for SBO is a safe and feasible option for a select group of clinically stable patients with a virgin abdomen without features of closed‐loop obstruction. Adhesions are the most common cause of SBO in this group of patients. Further large‐scale prospective clinical studies with standardized NOM modality, homogenous clinical resolution indicators and long‐term follow‐up data are warranted to allow for quantitative analysis to reinforce this evidence.

Background Anastomotic leak (AL) after colorectal resection leads to increased oncological and non‐oncological, morbidity and mortality. Intra‐operative assessment of a colorectal anastomosis with intra‐operative flexible sigmoidoscopy (IOFS) has become increasingly prevalent and is an alternative to conventional air leak test. It is thought that intra‐operative identification of an AL or anastomotic bleeding (AB) allows for immediate reparative intervention at the time of anastomosis formation itself. We aim to assess the available evidence for the use of IOFS to prevent complications following colorectal resection. Methods Following Preferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines, a systematic review of the literature between January 1980 and June 2020 was performed. Comparative studies assessing IOFS versus conventional air leak test were compared, and outcomes were pooled. Results A total of 4512 articles were assessed, of which eight were found to meet the inclusion criteria. A total of 1792 patients were compared; 884 in the IOFS arm and 908 in the control arm. IOFS was associated with an increase in the rate of positive leak test (odds ratio (OR) 5.21, P > 0.001), a decrease in AL (OR 0.45, P = 0.006) and a decrease in post‐operative AB requiring intervention (OR 0.40, P = 0.037). Conclusion In a non‐randomized meta‐analysis, IOFS increases the likelihood of identifying an anastomotic defect or bleeding intra‐operatively. This allows for immediate intervention that decreases the rate of AL and AB. This adds impetus for performing routine IOFS after a left‐sided colorectal resection with anastomosis and highlights the need for randomized controlled trial to confirm the finding.

Background While complete mesocolic excision (CME) has been shown to have an oncological benefit as compared to conventional colonic surgery for colon surgery, this benefit must be weighed up against the risk of major intra‐abdominal complications. This paper aimed to assess the comparative oncological benefits of CME. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines, a systematic review of the literature until May 2020 was performed. Comparative studies assessing CME versus conventional colonic surgery for colon cancer were compared, and outcomes were pooled. Results A total of 700 publications were identified, of which 19 were found to meet the inclusion criteria. A total of 25 886 patients were compared, with 14 431 patients in the CME arm. CME was associated with a significantly higher rate of vascular injury (odds ratio 3, P < 0.001). Rates of local and distant recurrence were lower in the CME group (odds ratio 0.66 and 0.73, respectively, both P < 0.001). CME patients had a significantly higher lymph node yield (P < 0.001). While no significant differences were noted between the two groups in terms of pooled 3‐ or 5‐year disease‐free survival, pooled 5‐year overall survival was significantly higher in the CME group (relative risk 0.82, P < 0.001). Conclusion Based on the available evidence, CME is associated with improved oncologic outcomes at the expense of higher complication rates, including vascular injury. The oncological benefits need to weighed up against a multitude of factors including the level of hospital support, surgeon experience, patient age, and associated comorbidities.

No abstract