Abstract AimThe enhanced recovery after surgery (ERAS) program has been well established for patients undergoing colorectal surgery. However, there has been a lack of studies on its use for elderly patients. Our unit implemented the ERAS program in September 2018. The aim of this study is to evaluate the outcome of the ERAS program in patients over 75 years who are undergoing colorectal surgery.Patients and MethodsIn this retrospective study, we compared all patients aged 75 and above who were admitted to Queen Elizabeth Hospital for elective colorectal cancer surgery before the implementation of the ERAS program (1 January 2016 to 31 August 2018) with those treated after its implementation (1 April 2019 to March 2022). The primary end point was the post‐operative length of stay. The secondary end points were wound infection, retention of urine, pneumonia, deep vein thrombosis, pulmonary embolism, use of total parenteral nutrition, acute coronary syndrome, blood transfusion, reoperation, in‐hospital mortality, unplanned readmission within 28 days and Clinical Fragility Score.ResultsA total of 258 patients were included. The median length of stay was 8.4 days in the pre‐ERAS group vs 6.8 days in the ERAS group. In‐patient death (1.4% in the pre‐ERAS group vs 0.9% in the ERAS group) and readmission rate (7.7% in the pre‐ERAS group vs 12.2% in the ERAS group) were similar between the two groups. About 31.5% of patients in the pre‐ERAS group had higher Clinical Fragility Scale post‐operatively as compared with 7.8% in the ERAS group.ConclusionThe ERAS program shortened the length of hospital stay by 1.6 days, and patients had lower Clinical Fragility Scale post‐operatively. Adverse events were not increased. The ERAS program can be safely applied to elderly patients with colorectal cancer.

Abstract IntroductionAcute appendicitis is a common surgical emergency. This study aims to determine whether there are any delays in patients attending the emergency department, potentially leading to an increase in the rates of complicated appendicitis and post‐operative complications during the fifth wave of the coronavirus disease 2019 (COVID‐19) pandemic in a local cluster in Hong Kong.MethodsIn this retrospective cohort study, we analysed 138 patients diagnosed with acute appendicitis during the fifth wave of the COVID‐19 pandemic and pre‐COVID‐19 period. The main study parameters were the duration between the onset of symptoms and attendance to the accident and emergency department, severity of appendicitis, post‐operative complication(s), operation time and total hospital length of stay.ResultsThere was no delay in presentation between the two groups of patients. The rates of complicated appendicitis and post‐operative complications were comparable between the two groups. There was a significantly shorter length of stay for patients with acute appendicitis patients during the fifth wave of the pandemic.ConclusionThe perspective of the general public towards the COVID‐19 pandemic is changing. Increased understanding of the COVID‐19 infection and availability of antiviral medications against COVID‐19 could be useful to eliminate patient's anxiety when attending medical care in public hospitals.

Abstract ObjectivesThe effects of using an abdominal binder after abdominal surgery on the development of incisional hernias in the long term are far from certain. This study aims to analyse the effects of abdominal binder use on the development of incisional hernia in the long term.MethodsThe population of this prospective cohort study included 84 patients, who underwent abdominal surgery and were evaluated for the effects of abdominal binder use between September 2013 and April 2014. The study sample comprised 57 patients (30 used an abdominal binder and 27 did not use one), who took part in the first research and agreed to participate. We conducted a telephone survey with the participants in September 2017 and asked them to answer the questions on the symptoms of and the risk factors associated with incisional hernia.ResultsComparison of the two groups in terms of patient, surgical and treatment characteristics revealed no statistically significant difference (P > .05). Incisional hernia occurred in eight patients who used an abdominal binder and in five patients who did not use one. There was no statistically significant relationship between abdominal binder use and the development of incisional hernia 3 years after the abdominal surgery (P > .05).ConclusionsThis study found that abdominal binder use after abdominal surgery had no effects on the development of incisional hernia in the long term. Data on abdominal binder use were self‐reported by the patients. Better designed cohort studies on larger populations may be conducted in the future.

Abstract AimPatients with chronic subdural haematoma (CSDH) are at a significant risk for venous thromboembolism (VTE). Surgeons should weigh the advantages versus disadvantages of anticoagulants in the postoperative period.Patients and MethodsThis study was a randomized clinical trial conducted in Isfahan, Iran, from May 2016 to April 2021. Patients with CSDH eligible for bur‐hole craniostomy were primarily enrolled. All of them underwent bilateral lower limb Doppler ultrasonography (DUS) for deep venous thrombosis (DVT) screening. The patients were randomized into the case (n = 66, enoxaparin initiation 24 h after operation) and control (n = 70, enoxaparin initiation 72 h after operation) groups. Routine postoperative brain computed tomography scans were obtained 1 and 3 days after surgery. A second DUS was performed 96 h after operation to screen newly developed venous thrombosis; P value <.05 was defined significant.ResultsA total of 73 patients (59.8%) were female and 49 (40.2%) were male. The mean age was 65.1 ± 10.19 years; 9.9% of the patients had previously used antiplatelets. One patient had asymptomatic preoperative DVT. The mean values for enoxaparin dosage were 40.4918 ± 5.43 mg/day. Postoperative DVT or rebleeding prevalence was 0% in both groups. The mean follow‐up duration was 19.139 ± 2.2 months. Long‐term recurrence rate was 2.4% (n = 3). Postoperative pneumocephalus was associated with a higher recurrence rate (P = .031).ConclusionIn terms of VTE chemoprophylaxis, following bur‐hole craniostomy for CSDH, enoxaparin will effectively prevent VTE development without any clinically significant rebleeding.

This work provides a comprehensive overview of the recent advancements in the field of radiomic diagnostics and artificial intelligence (AI) in the diagnosis of pancreatic diseases. The integration of radiochemical analysis and AI has allowed for more accurate and precise diagnoses of pancreatic diseases, including pancreatic cancer. The review highlights the different stages of radiomic analysis, such as data collection, preprocessing, tumour segmentation, data detection and extraction, modeling, statistical processing, and data validation, which are essential for the accurate diagnosis of pancreatic diseases. Furthermore, the review evaluates the possibilities of using AI and artificial neural networks in surgical and oncological pancreatology. The features and advantages of using radiochemical analysis and AI in the diagnosis and prognosis of pancreatic cancer are also described. These advancements have the potential to improve patient outcomes, as early and accurate diagnosis can lead to earlier treatment and better chances of recovery. However, the limitations associated with the use of radiometry and AI in pancreatology are also noted, such as the lack of standardization and the potential for false positives or false negatives. Nevertheless, this work highlights the potential benefits of incorporating radiochemical analysis and AI in the diagnosis and treatment of pancreatic diseases, which can ultimately lead to better patient care and outcomes.

Surgical PracticeAccepted Articles EDUCATION Vascular Training and Sub-specialization in Mainland China Hai-Lei Li, Hai-Lei Li Division of Vascular Surgery, Department of Surgery, The University of Hong Kong -ShenZhen Hospital, ShenZhen, ChinaSearch for more papers by this authorYiu Che Chan, Corresponding Author Yiu Che Chan [email protected] orcid.org/0000-0003-3764-3782 Division of Vascular Surgery, Department of Surgery, The University of Hong Kong -ShenZhen Hospital, ShenZhen, China Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, SAR, China Author Correspondence Dr. Yiu Che CHAN MB BS BSc MD FRCS(England) FRCS(General Surgery) FCSHK, Associate Professor, Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, South Wing, 14 Floor K Block, Queen Mary Hospital, Pokfulam Road, Hong Kong. Tel: +852-2255-4969, FAX: +852-2255-4967, Email: [email protected]Search for more papers by this authorStephen W. Cheng, Stephen W. Cheng Division of Vascular Surgery, Department of Surgery, The University of Hong Kong -ShenZhen Hospital, ShenZhen, China Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, SAR, ChinaSearch for more papers by this author Hai-Lei Li, Hai-Lei Li Division of Vascular Surgery, Department of Surgery, The University of Hong Kong -ShenZhen Hospital, ShenZhen, ChinaSearch for more papers by this authorYiu Che Chan, Corresponding Author Yiu Che Chan [email protected] orcid.org/0000-0003-3764-3782 Division of Vascular Surgery, Department of Surgery, The University of Hong Kong -ShenZhen Hospital, ShenZhen, China Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, SAR, China Author Correspondence Dr. Yiu Che CHAN MB BS BSc MD FRCS(England) FRCS(General Surgery) FCSHK, Associate Professor, Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, South Wing, 14 Floor K Block, Queen Mary Hospital, Pokfulam Road, Hong Kong. Tel: +852-2255-4969, FAX: +852-2255-4967, Email: [email protected]Search for more papers by this authorStephen W. Cheng, Stephen W. Cheng Division of Vascular Surgery, Department of Surgery, The University of Hong Kong -ShenZhen Hospital, ShenZhen, China Division of Vascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, SAR, ChinaSearch for more papers by this author First published: 25 April 2023 https://doi.org/10.1111/1744-1633.12627 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/1744-1633.12627. AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future. RelatedInformation

Surgical PracticeVolume 27, Issue 2 p. 123-124 CME PAGE Surgical Practice May 2022 CME for Fellows First published: 30 May 2023 https://doi.org/10.1111/1744-1633.12632Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume27, Issue2May 2023Pages 123-124 RelatedInformation

Abstract AimTo evaluate the difference between endovascular surgery and bypass/hybrid approach in treating Trans‐Atlantic Inter‐Society Consensus (TASC) D femoropopliteal occlusion.Patients and MethodsThis is a 10‐year retrospective cohort study including 75 patients with TASC D femoropopliteal occlusion with revascularisation from 2009 to 2018. Cases were retrieved from the Clinical Data Analysis and Reporting System. Demographics, lesions characteristics, operative findings and follow‐up data were reviewed.ResultsA total of 65% of patients had endovascular intervention, 23% open bypass and 12% hybrid operation. The endovascular group had fewer critical limb ischaemia (endovascular 43%, bypass 94%, hybrid 100%; P < .001), and shorter length of lesion (endovascular 26.4 cm vs bypass/hybrid 31.0 cm; P = .004). The technical success rate of the endovascular group was 87.8%. Different endovascular treatment strategies were used. The 12‐month primary patency rate of the endovascular group was lower (endovascular 69.7% vs bypass 81.3% vs hybrid 75.0%; P = .67) but the secondary patency rate at 3 years after the operation was similar across all groups (endovascular 83.3% vs bypass 78.6% vs hybrid 87.5%; P = .86).ConclusionEndovascular treatment for long and complex femoropopliteal occlusion is technically feasible with a high success rate. Close surveillance with prompt reintervention may help achieve 3 years’ comparable patency of endovascular intervention to traditional surgical bypass. Individualised plan of revascularisation should be considered.