Testing purpose - publish
Ameera J M S AlHasan
In a recently published cross-sectional study in BJS1, Dr Marianna Kapestaki examines diversity amongst paediatric consultant surgeons in the UK. It comes as no surprise that the majority of consultants and full professors were men, whilst 73.5% of consultants were white. On the bright side, no gender or racial disparities were found in other academic parameters such as being affiliated with a university or having earned a PhD. Dr Kapestaki presents several other parameters in her study which may or may not be significantly associated with gender, racial or academic inequalities. She goes on to state that the findings in paediatric surgery are consistent with those in neurosurgery and neurology in the UK.
A study like this is important for several reasons. First, it sheds light on the importance of dissecting the surgical workforce for potential inequalities and possible discrimination, including highly subspecialized branches of surgery such as paediatric surgery. Second, it demonstrates that lack of diversity at consultant level is a persisting problem, but one that is definitely remediable once sufficient awareness of the issue is established. Finally, it seems fair to infer from the findings that the solution may lie in the problem itself, namely academia. If there are indeed no disparities in academic achievements such as completing a PhD or becoming affiliated with a university, then with sufficient awareness and deliberation, these same individuals should conscientiously be chosen to higher positions of consultant and full professorship. One can only hope.
TestR-Author response: Ligation of intersphincteric fistula tract (LIFT) for trans-sphincteric cryptoglandular anal fistula: long-term impact on faecal continence
van Oostendorp JY1,2, Verkade C3, Han-Geurts IJM2, van der Mijnsbrugge GJH2, Wasowicz-Kemps3, Zimmerman DDE3
This article will have this DOI
Dear Editor
Science in a flash: pain, anxiety, stress and sleep disturbances among surgical patients
Jetske Marije Stoop, Markus Klimek, MD, PhD, DEAA, EDIC, FESAIC
How often do surgical patients experience pain, anxiety, stress, and sleep disturbance during their hospital stay? And how severe are these symptoms? In collaboration with numerous Dutch hospitals, we set out to answer these questions, using an uncommon and innovative, but for our goals perfectly fitting method: a flash mob study.
A flash mob study is a novel research design in which data is collected on a single day, simultaneously in multiple centres. It’s an efficient way to address clinically relevant questions on a large scale – in our case the point prevalence of surgical patient pain, anxiety, stress, and sleep disturbance. But this approach also requires meticulous planning: there’s only one shot to get it right.
The preparation for the project took a year. We started by developing the methodology and drafting the study protocol, followed by compiling all necessary documents for submission to the Medical Ethics Review Committee (MERC). While awaiting approval, we reached out to all hospitals across the Netherlands. Through secretaries and outpatient clinics, we found surgeons and residents in 29 Dutch hospitals who were eager to participate and helped forming a local research team and arranging institutional approval from the hospital board.
Author response: Assessment of nodal staging and risk factors for nodal involvement in gallbladder cancer
Anita Balakrishnan, Petros Barmpounakis, Nikolaos Demiris, Bodil Andersson, Alejandro Brañes, Xavier de Aretxabala, Malin Sternby Eilard, Paul Gibbs, Simon J F Harper, Emmanuel L Huguet, Asif Jah, Vasilis Kosmoliaptsis, Javier Lendoire, Siong S Liau, Shishir Maithel, Jack L Martin, Colin Noel, Raaj K Praseedom, Alejandro Serrablo, Volkan Adsay, the OMEGA Study Investigators
Correspondence to: Anita Balakrishnan (email: ab2031@cam.ac.uk)
Department of Hepatopancreatobiliary Surgery
Cambridge University Hospitals NHS Foundation Trust
A tribute to Paul Sugarbaker: the father of cytoreductive surgery
Aditi Bhatt MS, MCh, Brendan J. Moran MD, Marcello Deraco MD, Naoual Bakrin MD PhD, Joel Baumgartner MD, Vahan Kepenekian MD, PhD, Alvaro Arjona Sanchez MD, Vivek Sukumar MS, MCh, Kiran Turaga MD, MPH, Laurent Villeneuve MBE, PhD, Shigeki Kusamura MD, PhD, Olivier Glehen MD, PhD
Nearly thirty years ago Paul Sugarbaker first published the classification and description of the techniques of peritonectomy procedures and organ resections as part of cytoreductive surgery1. Since then, Paul Sugarbaker has published numerous manuscripts, books and book chapters and produced videos on peritonectomy procedures. Some of these have been improvisations of the previous descriptions while others have been descriptions of new peritonectomy procedures that he had devised2,3,4. The description of the hepatic bridge and the clearance of the peritoneum in the tunnel created by it, clearance of peritoneal disease in an inguinal hernia, clearance of the foramen of Winslow and peritonectomy of the sub-pyloric space are some of the techniques published subsequently5,6,7,8,9,10. The most recent addition to the list was peritonectomy of the colonic mesentery published in 202111.
Paul Sugarbaker started working on the treatment of peritoneal malignancies in the early eighties and coined the term cytoreductive surgery for a surgical procedure that involved resection of all macroscopic tumor, including electrosurgical removal of the peritoneal tumor deposits, combined with administration of intraperitoneal chemotherapy12,13. The body of publications by Sugarbaker on peritonectomy procedures is the most comprehensive resource on these procedures in the literature, both in terms of the included procedures and the technical descriptions of these procedures. In 2016, Grey’s anatomy, for the first time, included a chapter on the anatomy of the peritoneum by Paul Sugarbaker14. Paul Sugarbaker has set the bar for the quality of operative surgical images published in these manuscripts. Cytoreductive surgery addresses different regions of the peritoneal cavity, and organ systems, and can appear disjointed and unstructured, especially in the setting of extensive peritoneal disease. The intraoperative images in his manuscripts are pristine, demonstrating each anatomical structure with great clarity15. This attention to detail underlines the importance of meticulous surgical technique, and the pursuit of perfection, which to those who have trained and worked with him, are his well-known hallmarks.
Paul Sugarbaker has over the years laid great emphasis on minute technical aspects of cytoreductive surgery, such as the incision and exposure of the peritoneal cavity, meticulous excision of previous surgical scars, use of high voltage electrocautery and copious lavage of the peritoneal cavity16,17,17. One of his most famous aphorisms ‘It’s what the surgeon does not see that kills the patient’ is a manuscript focusing on meticulous surgical technique to reduce peritoneal dissemination from colorectal primary tumors19. In current times, this aphorism incorporates , and underlines, the importance of ‘complete’ cytoreductive surgery which requires meticulous exploration of the abdominal cavity and identification and resection of all sites of disease. However, the original aphorism refers to another important concept that he introduced whereby he described the technique of centripetal surgery which involved starting the dissection far away from the tumor, and employing local peritonectomy procedures to contain the colorectal primary tumor19. While most of his work was on peritoneal metastases of gastrointestinal origin, the principles and concepts introduced by him are applicable to all surgical approaches for peritoneal malignancies. Another very significant Sugarbaker concept is that the peritoneum helps prevent retroperitoneal dissemination of peritoneal malignancy and is thus “the first line of defense” again peritoneal metastases20.
The BJS Instrumentalist Collection in association with the Hunterian Museum
Alice Watkinson-Deane
At the heart of the Royal College of Surgeons of England lies the Hunterian Museum, a space dedicated to the history of surgery from ancient times to the present day. Many visitors are drawn to the specimens on display - over 2,000 preparations of human and animal tissue collected by John Hunter in the 1700s. However, the story of surgery is equally told through the wealth of surgical instruments in the collection, from the simplest probes to the latest minimally invasive technologies.
Mick Crumplin, a retired surgeon and Honorary Curator of Instruments at the Royal College of Surgeons of England, delves into this fascinating history in his series of 20 articles for ‘The Instrumentalist’ in the BJS. This brilliant resource reviews the origin of a wide range of instruments, some of which will be very familiar to today’s surgeons, while others are less well-known.
Liston pattern bone-cutting forceps. © 2014 All rights reserved. Courtesy of Surtex Instruments Ltd.
Author response: Tumour deposit count is an independent prognostic factor in colorectal cancer—a population-based cohort study
Simon Lundström, Erik Agger, Marie-Louise Lydrup, Fredrik Jörgren, Pamela Buchwald
Correspondence to: Simon Lundström (e-mail: Simon.Lundstrom@med.lu.se)
Department of Surgery
Skåne University Hospital
Comment on: Tumour deposit count is an independent prognostic factor in colorectal cancer—a population-based cohort study
Ranjith Kumaran Ramu, Aryan Dwivedi, Faraz Ahmad, Kushagra Gaurav Bhatnagar, Akshay Anand, Nizamuddin Ansari, Abhinav Arun Sonkar
Correspondence to: Ranjith Kumaran Ramu (e-mail: ranjithkumaran2009@gmail.com)
Senior Resident
Department of General Surgery
Non-technical error leading to patient mortality in the Australian surgical population
Jesse D Ey, Victoria Kollias, Octavia Lee, Kelly Hou, Matheesha B Herath, John B North, Ellie C Treloar, Martin H Bruening, Adam J Wells, Guy J Maddern
Despite an increasing emphasis on patient safety, modern surgical practice is still plagued by the occurrence of serious Adverse Events (AEs). A large proportion of these AEs are caused not by technical errors, but short comings in non-technical skills (NTS) or non-technical errors.1 NTS are the cognitive and interpersonal components of surgical professionalism including communication, decision-making, situational awareness and leadership.2 Few studies have attempted to quantify the significance of non-technical errors leading to patient harm. Those that have, only include small, non-representative cohorts, or have assessed for NTS shortcomings using heterogeneous, non-standardised, and non-comprehensive assessment methods.3-6 As a result, the true impact of non-technical errors, and information about how, when, and why these errors occur are poorly understood. Evidence to guide NTS improvement is lacking.
This study7 aimed to investigate the incidence of non-technical errors linked to patient death in a large representative Australian cohort, investigate factors associated with fatal non-technical errors, and whether the incidence of non-technical errors had changed over time. To achieve this, an 8-year retrospective audit using surgical mortality cases was conducted. Data were derived from the Australian and New Zealand Audit of Surgical Mortality (ANZASM) a mandatory, national surgical mortality audit overseen by the Royal Australasian College of Surgeons. In Australia, every surgical death is reported to ANZASM for external peer review for the purpose of identifying clinical management issues (CMI’s) that could be improved in future. CMI’s are rated on a three-tiered system with ‘area of concern’ or ‘Adverse Event’ representing the two most serious. All surgical deaths between 2012-2019 (excluding New South Wales), flagged with an area of concern or AE were included with no further exclusions. Each case was assessed using the System for Identification and Categorization of Non-technical Errors in Surgical Settings (SICNESS), a validated tool, developed by the study authors.8 The SICNESS enabled assessors to identify if a non-technical error linked to patient death had occurred, and if so, to which NTS domain it belonged.
There were 30,971 surgical deaths reported to ANZASM during the study. Of these, 3829 were flagged with an AE or Area of concern. Some 134 had insufficient information for assessment, leaving 3695 cases for review. A non-technical error linked to patient death was identified in 2354 cases (63.7%). Of the cases with non-technical errors, 1375 (58.4%) had decision making errors, 1328 (56.4%) had situational awareness errors, 357 (15.2%) had communication/teamwork errors, and 128 (5.44%) had leadership errors.
Author response: Impact of postoperative complications on clinical outcomes after gastrectomy for cancer: multicentre study
Sander J. M. van Hootegem, Bas P. L. Wijnhoven
Correspondence to: Sander J. M. van Hootegem (e-mail: s.vanhootegem@erasmusmc.nl)
Department of Surgery
Erasmus Medical Centre
Comment on: Impact of postoperative complications on clinical outcomes after gastrectomy for cancer: multicentre study
Anyin Wang, Tingting Fu, Xigui Tian
Correspondence to: Anyin Wang (email: Hospitalpwkedu@163.com)
Department of Gastrointestinal/Hernia Surgery
The People's Hospital of Liangping District
Aortic aneurysm screening: a personal history
Jonothan Earnshaw
____________
My first significant contact with abdominal aortic aneurysm (AAA) screening was when I was appointed as a consultant surgeon in Gloucestershire in 1991. My consultant colleague, Brian Heather, had already started an AAA screening programme for 65-year-old men in Gloucestershire. The burden of managing vascular disease single-handed for a population of 350,000 was significant for him; in addition, patients with ruptured AAA were major consumers of critical care services in Gloucestershire at the time. Brian contacted all the GP surgeries in Gloucestershire asking whether (i) they were prepared to identify the 65-year-old men in their practice each year, and then (ii) to receive a visit once a year for them to be scanned. He secured the services of a research nurse, Elaine Shaw, who took a portable ultrasound scanner to the GP surgeries to do the scans. The screening programme in Gloucestershire was born in 1988 and has run ever since1.
Volatile versus intravenous anaesthesia for oesophagectomy: addressing confounding factors and temporal trends in clinical practice
Shuting Yin
Correspondence to: Shuting Yin (e-mail: yin13938214200@163.com)
Department of Education and Sports
Zhengdong New District
Comment on: Parathyroid vascular anatomy using intraoperative mapping angiography: the PARATLAS study
Rajni K Sah, Sabaretnam Mayilvaganan
Correspondence to: Sabaretnam Mayilvaganan (drretnam@gmail.com)
Additional Professor
Department of Endocrine Surgery
Comment on: Endoscopic appendix opening sphincter incision to remove faecolith
Chahrazed Dous
Correspondence to: Chahrazed Dous
(email: douschahrazed@yahoo.com)
Tazoult City
Author response: Endoscopic appendix opening sphincter incision to remove faecolith
Gang Bian
Correspondence to: Gang Bian (e-mail: bianganglingling@163.com)
Department of Gastroenterology
Qingdao Third People's Hospital Affiliated to Qingdao University
Introducing ‘Surgeons unscrubbed’
Dominic Slade and Prita Daliya bring you the opening teaser for their upcoming podcast: Surgeons unscrubbed! A collaboration between the British Hernia Society (BHS) and BJS Academy.
In this series, Dominic and Prita will be interviewing prominent surgeons around the world and asking them questions submitted by you!
Enhancing methodological rigor in prepectoral breast reconstruction studies
Janhavi Venkataraman, Kefah Mokbel
Correspondence to: Janhavi Venkataraman (email: Janhavi.Venkakataraman@hcahealthcare.co.uk; janhavivraman@gmail.com)
The London Breast Institute
Princess Grace Hospital
Author response: Enhancing methodological rigour in prepectoral breast reconstruction studies
Shelley Potter, Kate L Harvey, Paul White
Correspondence to: Shelley Potter (email: Shelley.potter@bristol.ac.uk)
Translational Health Sciences
Bristol Medical School
Colorectal Cancer Awareness Month 2025
In recognition, we present seven of the most important colorectal cancer studies published in BJS and BJS Open over the past year. These articles highlight significant advancements in the understanding and management of colorectal cancer, covering topics such as surgical innovations, oncological outcomes, and prognostic markers. This collection showcases the latest research aimed at improving patient care and survival.
Explore these key contributions to the field and join us in raising awareness of colorectal cancer this March.
______
Comment on: Effect of peritoneal and wound lavage with super-oxidized solution on surgical-site infection after open appendicectomy in perforated appendicitis (PLaSSo): randomized clinical trial
Saburi Oyewale
Correspondence to: Dr Saburi Oyewale (email: saburioyewale@yahoo.com)
Division of General Surgery
Department of Surgery
Author response: Effect of peritoneal and wound lavage with super-oxidized solution on surgical-site infection after open appendicectomy in perforated appendicitis (PLaSSo): randomized clinical trial
Harivinthan Sellappan
Correspondence to: Harivinthan Sellappan (e-mail: hari.vs@gmail.com)
Department of Surgery
Queen Elizabeth Hospital
Re-evaluating enoxaparin for thromboprophylaxis in liver transplantation: a closer look
Dipesh Kumar Yadav, MD, PhD, Yiren Hu, MD, PhD
*Corresponding author: Yiren Hu (email: yirenhu@hotmail.com)
Department of General Surgery
The Third Clinical Institute Affiliated to Wenzhou Medical University
Comment on: Clinical and patient-reported outcomes in women offered oncoplastic breast-conserving surgery as an alternative to mastectomy: ANTHEM multicentre prospective cohort study
Raafat Gendy
Correspondence to: Raafat Gendy (email: raafat.gendy1@nhs.net)
____
____