Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Intestinal malrotation with midgut volvulus: associations and role of elective surgery in adults

Intestinal malrotation, a congenital anomaly of rotation of midgut, with paediatric dominant presentation is increasingly being observed in adult population. Here, the severity of presentation ranges from asymptomatic to life threatening midgut volvulus. Presentation with midgut volvulus, managed by an emergency surgery with definitive Ladd’s procedure is the current standard. Presently, there is no data to support elective repair in stable patients with chronic midgut volvulus. Management of asymptomatic adult with malrotation is also a topic of controversy with no recommended guidelines. We herein, present two cases of malrotation with midgut volvulus with initial conservative management followed by elective Ladd’s procedure. Rare associations like nutcracker phenomenon and pancreatitis were also observed in one of our patients. Our study aims to correlate our findings with the published literature, to understand these associations better and to review the need for an emergent operation for chronic midgut volvulus.</jats:p

Ganglioneuroma mimicking adrenal tumor

Ganglioneuromas arise from neural crest sympathogonia and are rare benign neurogenic tumors. The most common affected sites are posterior mediastinum and the retroperitoneum. They rarely affect adrenal glands. Ganglioneuromas often present as solitary, painless and slow growing mass and are benign in nature. These tumors are closely related to major vessels. Hence, surgical management of retroperitoneal pathologies may require multiorgan resection in order to achieve complete surgical resection while preservation of surrounding organs especially in case of benign tumors. We present a case report of a 21 year old male with a 12×10×10 cm size right sided retroperitoneal ganglioneuroma which on computed tomography (CT) mimicked adrenal tumor crossing the midline and abutting the aorta and splaying the inferior venal cava and renal vein. Present paper is an attempt to review the various surgical options available while dealing with these benign retroperitoneal tumors which are related closely to retroperitoneal organs and major vessels.</jats:p