PROTECT is a national platform trial designed to deliver multiple multi-centre randomised and non-randomised comparisons in adult surgical patients. Individual trial components will span phase II to…

As a pelvic health physiotherapist, I’ve spent my career standing at the intersection of two worlds—where conservative rehabilitation meets surgical expertise. Working alongside surgeons has taught…

Background Individualized management of early fluid therapy in acute pancreatitis (AP) remains challenging. Traditional studies primarily focus on static fluid balance, overlooking the heterogeneity of dynamic trajectories. Methods Based on a single-center retrospective cohort, 3,142 AP patients admitted within 72 h of onset were included. Daily fluid therapy-to-body weight ratio (FWR) and CumFWR (trapezoidal AUC) were calculated. Latent Class Growth Modeling (LCGM) identified dynamic FWR trajectories within 72 h. Multivariate Cox regression analyzed the relationship between FWR and in-hospital mortality risk. Three-dimensional fitted surface plot analysis evaluated interactions between CumFWR and hematocrit. Results LCGM successfully identified five distinct dynamic fluid therapy trajectories within 72 h, showing significant clinical differences: Low Stable Group (LSG1, n = 229, 7.3%), Low-Moderate Sustained Group (LMSG2, n = 340, 10.8%), Moderate Stable Group (MSG3, n = 2073, 66.0%), Moderate-High Fluctuating Group (MHFG4, n = 231, 7.4%), and High Sustained Group (HSG5, n = 269, 8.6%). Multivariate Cox regression revealed significantly increased in-hospital mortality risk compared to MSG3 for both MHFG4 (adjusted HR = 2.08, 95%CI 1.15–3.78) and HSG5 (adjusted HR = 2.91, 95%CI 1.77–4.79). Furthermore, each 1 standard deviation increase in CumFWR was associated with a 47% increased mortality risk (HR = 1.47, 95%CI 1.26–1.72). Three-dimensional fitted surface plot demonstrated high mortality risk between high CumFWR and abnormal hematocrit (low/high HCT), particularly prominent in the HSG5 group (p < 0.001). Conclusion This study reveals five distinct dynamic trajectory patterns of early fluid therapy in AP. High-load sustained or fluctuating therapy significantly increases mortality risk. Dynamic monitoring of HCT (within a 35–44% safety window) and therapy trajectories offers a potential strategy to optimize fluid management.

Each year, more than 2,000 below-knee amputations are performed in the UK, often as a result of diabetes and/or arterial disease. They mostly occur in patients over 50 years. This patient group is…

Background Single Anastomosis Sleeve Ileal (SASI) bypass combines sleeve gastrectomy with a single anastomosis to the ileum, preserving digestive continuity to reduce deficiencies while treating obesity-related conditions. Methods This study systematically reviewed SASI bypass outcomes and conducted a single-arm meta-analysis to assess its efficacy and safety. A comprehensive literature search across PubMed, Scopus, Embase, and Cochrane databases initially identified 387 articles, with 38 studies meeting inclusion criteria, contributing data on a maximum of 2,555 patients. Follow-up ranged from 6 to 60 months. Results Meta-analysis showed significant weight loss, with pooled Excess Weight Loss Percentage (EWL%) of 63.07% at 6 months, 82.44% at 12 months, and 93.21% at 24 months. The procedure demonstrated high remission rates for obesity-related conditions, including diabetes (92.67%), hypertension (79.06%), dyslipidemia (82.64%), gastroesophageal reflux disease (GERD) (81.63%), and obstructive sleep apnea (OSA) (81.04%). Postoperative complications were classified using the Clavien-Dindo grading system, with an overall mean complication rate of 13.70%. Mild complications (Grades I-II) accounted for 7.74%, while severe complications (Grades III–IV) had a mean rate of 5.18%. No deaths were reported. Conclusions These findings suggest SASI bypass is a highly effective metabolic and bariatric procedure, achieving substantial weight loss and high remission rates for multiple obesity-related conditions. Given its efficacy, SASI may benefit patients with higher body mass index (BMI) and multiple obesity-associated medical conditions. While most complications are mild and severe ones infrequent, further comparative studies are needed to establish its advantages over other bariatric techniques. Graphical abstract

Simon Fleming presents part four of our series on ‘The makings of a modern surgeon,’ first presented at our BJS Academy Workshop in April 2025.

Welcome to a new video series exploring surgical instruments. First up, we have the needle holder. Presented in both English and Spanish by Dr Luis Felipe Cabrera Vargas (MD, MACC, FACS, MACCVA,…

George Washington. Served as president April 30, 1789 – March 4, 1797. Painting by Gilbert Stuart, oil on canvas, 1821. Library of Congress, in the public domain. When George Washington was sworn in…