Torbay and South Devon NHS Foundation Trust

SummaryIntroductionDay‐case surgical activity is increasing in the UK yet there is a lack of data on the prevalence of chronic post‐surgical pain in this population. This study uses data from the POPPY study to estimate the prevalence of chronic post‐surgical pain after day‐case surgery, its relationship with quality of life and also explores associated factors.MethodsData were collected from eligible consenting adults having day‐case surgery in 199 sites across the UK. Baseline data were collected on the day of surgery, and patients were followed up by short message service‐delivered questionnaires on day 1, day 3, day 7 and day 97. Chronic post‐surgical pain was defined using pain severity scores at day 97. Multivariable logistic regression models were used to explore associations with chronic post‐surgical pain.ResultsAt day 97, 3442 patients had responded from a total of 7839 recruited. The estimated prevalence of chronic post‐surgical pain was 7.2% (95%CI 6.4–8.1%). We found the following were associated with chronic post‐surgical pain: week 1 pain scores; orthopaedic, breast and plastic surgical specialities; non‐surgical site chronic pain at baseline; deprivation; and ethnicity. Patients with chronic post‐surgical pain had a mean (SD) decrease of 0.137 (0.205) in health‐related quality of life score compared with baseline.DiscussionThis is the first large UK multicentre, prospective observational study exploring chronic post‐surgical pain after day‐case surgery. Multivariable modelling highlighted several associated factors. Chronic post‐surgical pain is common after day‐case surgery and is associated with reduced quality of life.

Endometrial hyperplasia (EH) comprises a spectrum of abnormal proliferative changes in the endometrium, ranging from benign glandular overgrowth to lesions with substantial malignant potential. The importance of risk stratification and early identification is highlighted by the growing recognition of EH as a precursor to endometrial cancer. The main causes of EH, according to epidemiological research, include obesity, polycystic ovarian syndrome (PCOS), metabolic dysfunction, and extended exposure to unopposed estrogen. Emerging molecular markers, histological analysis, and imaging are all necessary for a proper diagnosis of EH because it might appear with vague clinical symptoms such as irregular uterine bleeding. Surgical intervention or progestin therapy are two possible management techniques for EH, depending on the lesion's intricacy and the patient's medical history, including fertility issues. Personalized therapy techniques and recent developments in molecular profiling have the potential to enhance patient outcomes by matching treatment to tumor biology and individual risk profiles. This review highlights the translational potential of molecular insights while synthesizing the most recent data on the epidemiology, risk factors, diagnostic techniques, and therapy of EH. A deeper comprehension of these elements is necessary to maximize treatment results and stop the development of endometrial cancer.

Abstract Aim This study explores how accurate Intraoperative ultrasound (IOUS) is in detecting CBD stones in surgical practice. Method We reviewed patients undergoing laparoscopic cholecystectomy with IOUS over 7 years at a UK district general hospital. IOUS findings were compared with preoperative MRCP when available and confirmed intraoperatively with either transcystic exploration or on-table cholangiography as needed. We calculated the sensitivity, specificity, and predictive values of IOUS in detecting CBD stones. Results A total of 1018 patients were included (Those not known to have cbd stones preoperatively). IOUS identified stones in 340 patients. Overall, IOUS achieved a sensitivity of 98.9 % and specificity of 99.2%. Importantly, the use of IOUS reduced the need for on-table cholangiography to almost 0% over the year 2024, simplifying intraoperative decision-making. Conclusions In our experience, laparoscopic intraoperative ultrasound is a reliable and practical tool for detecting CBD stones during laparoscopic cholecystectomy. Its high accuracy, ease of use, and ability to reduce the need for additional intraoperative imaging make it a valuable addition to the gallbladder surgery, supporting safe and efficient patient care.

Abstract Aim This study assesses the environmental impact of a change in practice at Torbay hospital, replacing routine MRCP with intraoperative ultrasound cholangiogram for the assessment of bile duct stones. Method: All laparoscopic cholecystectomies with indices suggestive of CBD stones were included. Data were collected from a prospectively maintained departmental database from Feb 2018 to Jan 2025. We collected data on the number of MRCP and IOUS procedures performed and how many MRCP we spared by performing IOUS cholangiogram. We also compared the average energy use and carbon emissions were estimated using published UK data. Results 1065 patients undergoing cholecystectomy at our institution had indices suggestive of choledocholithiasis. All of these patients were assessed using intraoperative ultrasound cholangiography (IOUS). CBD stones were detected in approximately 340 patients (32%) of the cases. By 2024, 97.5% of patients in this study did not require MRCP before or after surgery. Each MRCP requires approximately 20 kWh of electricity and produces 17.5 kg of CO₂ emissions, compared to just 0.2 kWh and 0.5 kg CO₂ for intraoperative ultrasound (IOUS). 1065 patients underwent IOUS, with only 57 requiring MRCP. Assuming IOUS replaced MRCP in the remaining 1008 cases, this equates to an estimated saving of 19,947 kWh of electricity and 17.1 tonnes of CO₂ emissions. Conclusions: Our data shows a major reduction in environmental impact when IOUS replaces MRCP in detecting CBD stones. This approach supports the NHS Net Zero strategy. We recommend that NHS guidelines consider IOUS as a first-line option in these cases.

Abstract Aim Evaluate use of biodegradable biliary stent in outcomes following choledochotomy bile duct exploration (BDE). Method Retrospective analysis comparing all choledochotomy BDE undertaken from 2023-2025. Primary outcome considers rate of bile leak. Secondary outcome includes pancreatitis, operative time and length of stay. Results 33 cases were undertaken; 26 had primary closure alone. Q3 Medical Archimedes stents were placed intra-operatively with use of guide wire, to facilitate drainage of the biliary tree, prior to primary closure of choledochotomy in 7 patients. Bile leak was much reduced in the stent group (31% vs 14% p=0.64). Leak was managed conservatively in the stent group. Five unstented patients required ERCP, four unstented patients returned to theatre. One patient required return to theatre three times. One patient, who was not stented, developed pancreatitis post procedure, however this was ERCP related. Although the two groups were similar in terms of gender, age, BMI, operative urgency and approach, average bile duct size was significantly higher in the stented group (12.8 vs 15.3mm p=0.049). Notably, stent insertion was attempted but not possible in one patient. Stent insertion was associated with a non-significant increase in operative time (173 vs 222 minutes, p=0.18). However, overall length of stay was shorter in the stent group, (8 vs 5days) and in the specific post-operative period (5 vs 4 days), this was not significant. Conclusions Archimedes stent insertion is associated with reduction in bile leak rate and subsequent reintervention. Insertion does not significantly increase operative time and has been shown to reduce length of stay.

ABSTRACTBackgroundIn the United Kingdom (UK), newly qualified doctors are routinely responsible for out‐of‐hours (OOH) care, often managing acutely unwell patients with limited supervision. Despite national recommendations encouraging OOH experience during medical school training, there is no formal curriculum for OOH practice.ObjectivesThis scoping review aimed to identify the range of educational interventions designed to prepare UK medical students for OOH clinical responsibilities and assess their reported effects on perceived and actual preparedness.MethodsFollowing Joanna Briggs Institute methodology, a systematic search of seven databases and grey literature sources was conducted. Eligible studies involved UK‐based medical students and reported empirical outcomes on educational interventions focused on OOH preparedness. Data were extracted and synthesised using the Template for Intervention Description and Replication checklist and Kirkpatrick's evaluation hierarchy.ResultsEighteen studies were included, primarily using quasi‐experimental designs of simulation‐based teaching. Interventions targeted a wide range of competencies, including prioritisation, communication, clinical decision‐making, and leadership. Thirteen studies demonstrated improvements in learner confidence or attitudes (Kirkpatrick Level 2a), while only three showed measurable performance improvement (Level 2b), and one demonstrated behavioural change (Level 3). Most lacked long‐term follow‐up. Grey literature analysis revealed inconsistent institutional expectations for OOH experience.ConclusionsEducational interventions on OOH are well‐received and enhance perceived preparedness. Current interventions often lack objective assessment and long‐term evaluation. This review was limited to published sources and may not reflect all current practice. Nationally standardised, longitudinal curricula supported by robust evaluation strategies are needed to improve graduate preparedness for OOH practice.

Benign prostatic hyperplasia (BPH) is more prevalent with increasing age, leading to presentations with lower urinary tract symptoms (LUTS). Transurethral resection of the prostate (TURP) remains the gold standard surgical treatment, but its limitations and complications have prompted the development of minimally invasive surgeries. This review evaluates the efficacy and safety of holmium laser enucleation of the prostate (HoLEP), water vapor therapy (Rezum), and robotic water-jet resection (Aquablation) in benign prostate surgery. A narrative review was conducted using PubMed and Google Scholar to identify current literature published between January 2000 and August 2025. Meta-analyses and randomized controlled trials (RCTs) were preferred, but all levels of evidence were considered for this article. Search terms included "benign prostatic hyperplasia", "BPH", "Rezum", "HoLEP", and "Aquablation". These emerging minimally invasive prostate surgeries show promising outcomes and have a role to play, depending on patient choices, surgical expertise, and anatomical factors. HoLEP provides good long-term outcomes and is non-inferior to TURP outcomes in International Prostate Symptom Score (IPSS) and maximum urinary flow rate (Qmax), particularly in larger prostates. Rezum can be performed in an outpatient setting and is effective in preserving sexual function. Aquablation is also effective in preserving sexual function and is suitable for larger prostates. In conclusion, surgical options for managing BPH are evolving technologies that are increasingly replacing the gold standard TURP. More multicenter RCTs comparing all techniques are required to ensure that the data are representative across all populations.

<h3>Background</h3> Clinical outcomes for NTM-PD are often poor. The NTM Network UK Standards of Care were launched in 2024 to support consistent, high-quality practice including pharmacological and non-pharmacological treatment. We aimed to document NTM-PD management prior to this to identify opportunities to improve care. <h3>Methods</h3> Centres were invited via the NTM Network UK to complete an online retrospective survey. At each site, anonymised clinical data were recorded from three consecutive adults (≥18) newly diagnosed with NTM-PD from 1 January 2022. <h3>Results</h3> 48 centres participated (Northern England, n=12; Southern England, n=12; London, n=9; Wales, n=7; Midlands, n=6; Scotland, n=2) They reported having the following resources: physiotherapy for airway clearance (n=42/48, 88%), dietitian and pulmonary rehabilitation (each n=32, 67%), specialist nurse (n=30, 63%), and health psychology (n=9, 19%). Respondents contributed data on 137 patients. 72 (53%) were female and 115 (84%) identified as White-British. 45 (34%) were aged 61–70. 62 (45%) had COPD and 55 (40%) bronchiectasis. Common radiological findings were nodular-bronchiectatic change (n=62, 45%), fibro-cavitary disease (n=40, 29%), and emphysema (n=39, 28%). <i>Mycobacterium avium complex</i> (MAC) was identified in 106 (77%), <i>M. kansasii</i>(n=14, 10%) and <i>M. abscessus</i> (n=9, 7%). Eighty-one (59%) patients were discussed in an MDT. Treatment plans included involvement of specialist nurses (n=91, 66%), physiotherapists (n=52, 38%), dietitians (n=34, 25%), and pulmonary rehabilitation (n=16, 12%). Forty-two (31%) were advised on airway clearance using Active Cycle Breathing, 25 (18%) Positive Expiratory Pressure devices, 17 (12%) mucoactive drugs, and 12 (9%) hypertonic saline. Written resources were provided to 39 (28%) patients, 22 (16%) were directed to patient-focused websites, and 13 (10%) signposted to peer-support networks. During a median follow-up from diagnosis of 21 (IQR 14–29) months, 124 (91%) started antibiotics for NTM-PD. Forty-five (33%) remain on follow-up and using antibiotics, 53 (39%) are not on antibiotics, 26 (19%) were discharged, and 12 (9%) died. <h3>Conclusion</h3> This UK-wide assessment of NTM-PD management reveals significant variation in available services and care provided. Most patients started specific antimicrobials, though non-medical health care support and patient information provision were limited. We have identified important areas for re-audit against the 2024 Standards.