Cutting edge blog

Correspondence to: Sabaretnam Mayilvaganan (drretnam@gmail.com)

Additional Professor

Department of Endocrine Surgery

Correspondence to: Chahrazed Dous

(email: douschahrazed@yahoo.com)

Tazoult City

Correspondence to: Gang Bian (e-mail: bianganglingling@163.com)

Department of Gastroenterology

Qingdao Third People's Hospital Affiliated to Qingdao University

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!

Correspondence to: Shelley Potter (email: Shelley.potter@bristol.ac.uk)

Translational Health Sciences

Bristol Medical School

Correspondence to: Janhavi Venkataraman (email: Janhavi.Venkakataraman@hcahealthcare.co.uk; janhavivraman@gmail.com)

The London Breast Institute

Princess Grace Hospital

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.

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Correspondence to: Harivinthan Sellappan (e-mail: hari.vs@gmail.com)

Department of Surgery

Queen Elizabeth Hospital

Correspondence to: Dr Saburi Oyewale (email: saburioyewale@yahoo.com)

Division of General Surgery

Department of Surgery

The BJS Foundation editor assistant bursaries aim to encourage young surgeons to take an interest in medical publishing.

Recruited annually, editor assistant bursaries are suitable for applicants at or near the end of higher surgical training, or recently appointed to a substantive post. Although no previous publishing experience is expected, the successful candidate will have scientific curiosity, as well as strong writing skills and a willingness to receive constructive criticism.

Editor assistants will have the opportunity to be fully involved in the BJS publication process and contribute to all strategy and policy discussions.

*Corresponding author: Yiren Hu (email: yirenhu@hotmail.com)

Department of General Surgery

The Third Clinical Institute Affiliated to Wenzhou Medical University

Correspondence to: Simon Lundström (e-mail: Simon.Lundstrom@med.lu.se)

Department of Surgery

Skåne University Hospital

Correspondence to: Antonio Manenti (e-mail: antonio.manenti_2024@libero.it)

Department of Surgery

Polyclynic Hospital

Correspondence to: Min Ni (email: 15278054120@163.com)

Department of Gastrointestinal Surgery

The Second Nanning People’s Hospital

In the book “The Idea Factory,” the CEO of the then monopolized telephone services American Telephone and Telegraph Company (AT&T)) in the US (circa 1880-1930) decided that although the business was highly profitable as a result of the massive laying down of cable across the world, hiring someone who could advance an understanding of how the telephone actually worked was needed. He decided that a more fundamental understanding of electricity and sound would improve the business model and overall telephone services. He hired a physicist from the University of Chicago who was offered a salary of $25,000/year to head up the project. This person was thrilled to just be able to obtain employment, given that a PhD in those days was no guarantee of employment, even when graduating from an elite university.

When the newly appointed physicist asked the CEO “what is my job?” he responded — you are to spend your time in “idle curiosity” so you can think and perform experiments. So began the independently funded and famous Bell laboratories, designed so that its faculty could walk its outdoor paths, think great thoughts and perform solution-agnostic experiments. More Nobel Prizes were won by the faculty at that institution than all other private free-standing research facilities in the US. Imagine what it felt like to be hired by a powerful CEO of a company and being told spend all your time in idle curiosity. Yet without that level of trust in the very process of science itself, the development of radio astronomy, the transistor, the laser, the photovoltaic cell, the charge-coupled device, information theory, the Unix operating system, and several programming languages would not have occurred. This approach led to eleven Nobel Prizes and five Turing Awards.

This story illustrates that a key element of success in research is the recognition of the value that idle curiosity brings to a scientific project. It is inefficient and costs money, time and resources. Yet without it, the foundational knowledge needed to drive innovation cannot emerge. The CEO of AT&T’s idea to let “scientific inquiry run its natural course” was not only visionary but demonstrated his trust in scientists and the process of science itself. And remember science is a process, not a result and is “true whether you believe it or not”, to quote Neil deGrasse Tyson.

Correspondence to: Raafat Gendy (email: raafat.gendy1@nhs.net)

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Correspondence to: Dr. Davide Serrano (email: davide.serrano@ieo.it)

Division of Cancer Prevention and Genetics

European Insitute of Oncology

It is becoming increasingly common to dedicate days, or even months, to ‘health awareness’. These events should help people to learn about these conditions. From these, we can hope that people might learn about symptoms that help them get a diagnosis, or learn about new treatment options for their conditions. It also provides a focal point where we can come together as a community to recognise those impacted, and find ways to address these serious health conditions. It may even act as a clarion call, moving charities, governments, and individuals, to make efforts to fund and deliver research to further understand and improve outcomes for these conditions.

The BJS Academy, alongside BJS & BJS Open, feel it is an important part of our mission to contribute to these awareness months. So much research is published with enthusiasm, but then resides solely within the pages of a journal (or latterly, as a lonely PDF on a server). It is important to ensure that new information is shared with people who might find it useful. This is particularly important when it comes to conditions which currently have a poor prognosis, or may affect only a small number of people. With this in mind, our team will contribute to the online discussion for disease months by highlighting 2-3 papers from BJS and BJS Open, and sharing them across our social media channels. This will include a short summary and a link to the paper.

This move comes as part of our commitment to sharing key clinical research to support the knowledge of surgeons around the world, and to ensure our patients receive care informed by evidence of the highest possible standard.

Correspondence to: Khalid Hureibi (email: khalid.hureibi@nhs.net)

Kettering general Hospital

Rothwell Rd

Correspondence to: Natasha Houghton (e-mail: tashmh@gmail.com)

Department of Surgery & Cancer

Faculty of Medicine

In recognition, we present seven of the most important liver studies published in BJS and BJS Open over the past year. These articles highlight significant advancements in the understanding and management of liver-related conditions, particularly hepatocellular carcinoma (HCC). Covering topics such as innovative surgical techniques, comparative treatment outcomes, and prognostic markers, this collection showcases the latest research aimed at improving care and outcomes for patients with liver diseases.

Dive into these key contributions to the field and join us in raising awareness of liver health this January.

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The perioperative care of the patient with obesity continues to attract significant scientific interest. Modern obesity management medications are emerging as valuable tools for addressing obesity and complementing metabolic bariatric surgery, highlighting the need for a tailored, multimodal approach to optimise perioperative outcomes.1,2 A recent consensus panel has provided recommendations for integrating obesity management medications into perioperative care.2 Nonetheless, metabolic bariatric surgery currently remains the most effective long-term treatment for clinical obesity and its complications, highlighting the need for optimal perioperative care.1,2

Since its publication, the 2020 review "Perioperative Care of the Obese Patient" in BJS has garnered significant and enduring interest from the scientific community, remaining a seminal reference in the field five years later.3 The review emphasised the importance of comprehensive preoperative evaluation for patients with obesity, including encouraging preoperative weight loss to prevent or address obesity-related co-morbidities and improve surgical conditions.3 It also highlighted the need for experienced teamwork, appropriate equipment and monitoring, meticulous anaesthetic and analgesic management, and an effective perioperative ventilation strategy3 to enhance postoperative outcomes.3,4 A multidisciplinary approach remains crucial for achieving optimal patient outcomes.3,4

While several studies have been published since, the original review's insights remain largely valid, with some gaps now addressed.3 Regarding anaesthetic choices, conflicting data on propofol versus desflurane3 was clarified by a meta-analysis showing desflurane promotes faster emergence but increases postoperative nausea.5 Multimodal prophylaxis for nausea and vomiting remains essential for patients with obesity undergoing general anaesthesia.3 For neuromuscular block management, sugammadex has proven superior to neostigmine in patients with obesity, providing faster, more predictable reversal of rocuronium-induced neuromuscular block3, while reducing early postoperative pulmonary complications,3,6 as confirmed by a subsequent meta-analysis.6 Multimodal analgesia strategies remain essential for reducing opioid use and related complications in patients with obesity.3 A network meta-analysis demonstrated that intravenous non-opioid analgesics significantly reduce opioid consumption, postoperative nausea, and respiratory complications.7 Another network meta-analysis confirmed the superiority of the transversus abdominis plane block over other regional anaesthesia techniques in reducing pain and nausea, further supporting the findings of the original review.8

Correspondence to: Professor Aneel Bhangu (email: a.a.bhangu@bham.ac.uk)

NIHR Global Surgery Research Unit

University of Birmingham

The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) has released a consensus position statement addressing the integration of obesity management medications (OMMs) with metabolic bariatric surgery (MBS)1.

Currently, obesity treatment encompasses four primary modalities: lifestyle modification, OMMs, endoscopic bariatric and metabolic therapies (EBMTs), and MBS. The recent introduction of newer-generation OMMs, such as semaglutide and tirzepatide, has sparked a surge in their use and increased awareness of obesity as a treatable chronic disease2,3. While these medications show significant promise, they also have limitations, including non-response rates, potential adverse events, and challenges with long-term adherence.

This position statement is particularly timely, as an increasing number of patients who have tried or discontinued OMMs are now seeking additional interventions to support their weight management or maintenance goals. Furthermore, since not all patients respond optimally to MBS, incorporating adjunctive therapies, such as adding OMMs after surgery, should enhance outcomes.