Southmead Hospital is a large public National Health Service hospital, situated in the area of Southmead, though in Horfield ward, in the northern suburbs of Bristol, England. It is part of the North Bristol NHS Trust. The 800-bed Brunel Building opened in May 2014, to provide services (including Accident and Emergency), which transferred from Frenchay Hospital in advance of its closure. The hospital site covers 60 acres (24 ha).
The EAES released guidelines on the role of taTME in the management of rectal cancer in 2022. To develop updated, evidence-informed recommendations to support clinicians involved in the management of taTME; to provide guidance for hospital managers, policymakers, and patients with low- and mid-rectal cancers. We performed a systematic review to identify randomized trials and matched nonrandomized studies comparing transanal total mesorectal excision (taTME) to laparoscopic TME (laTME) or robotic TME (roTME) in patients with low- and mid-rectal cancer. A panel of general and colorectal surgeons, a radiologist, a pathologist, and patient partners appraised the certainty of the evidence using GRADE. The panel developed recommendations using an evidence-to-decision framework during an in-person consensus meeting. We applied a Delphi survey to establish consensus. The panel recommends taTME over laTME in patients with low- and selected mid-rectal cancers when access to surgeons with expertise in performing taTME in high-volume rectal cancer centers is available (strong recommendation). This recommendation applies to patients eligible for sphincter preservation who are at high risk for conversion to abdominoperineal resection, including male gender with BMI > 30 kg/m2. The recommendation is supported by a reduction in 30-day major complications and disease recurrence at 2 years with taTME compared to laTME. When access to a surgeon with expertise in performing taTME is not available, the panel recommends against taTME over laTME (strong recommendation). Further, the panel suggests roTME as an alternative to taTME in patients with low- and selected mid-rectal cancers when access to surgeons with expertise in performing taTME is not available (conditional recommendation). We provide evidence-informed guidance on the role of taTME in the surgical management of patients with low- and mid-rectal cancers. Patients and surgeons should exercise shared-decision making to apply patient-tailored decisions when considering treatment options.
Objective The UK faces a significant obesity crisis, and multiple management options are now available, including pharmacotherapy, endoscopic and surgical interventions. Endoscopic Sleeve Gastroplasty (ESG) has emerged as a National Institute for Health and Care Excellence-approved, minimally invasive obesity care procedure, which is a safe and effective option for selected patients. Despite its promise, National Health Service (NHS) providers lack standardised guidance for the implementation of this intervention. This initiative is aimed at creating a comprehensive pathway for the implementation of ESG within the NHS using a diverse stakeholder approach.Methods A modified nominal group technique (NGT) was employed, bringing together a diverse group of healthcare professionals (HCPs) involved in obesity management from primary and secondary care, commissioner representatives and patient groups in an iterative consensus-building process. The NGT methodology allowed for structured discussion, prioritisation of key elements and sequential refinement of the pathway through multiple rounds of expert input and feedback.Results The panel reached agreement on HCP requirements, resource allocation and identified key considerations for successful ESG implementation. Critical elements included primary care engagement, dietetic support, psychological assessment and anaesthetic involvement alongside the procedural aspects of training and mentoring, patient selection and technical factors. Notably, no areas of significant disagreement were identified throughout the process, enabling the development of a comprehensive framework for ESG delivery.Conclusion This framework provides practical proposals to facilitate ESG implementation across NHS centres, supporting multidisciplinary care delivery while acknowledging operational feasibility within existing NHS resource constraints.
OBJECTIVE:Aim: This narrative review aims to critically evaluate current evidence comparing surgical and non-surgical management strategies for acute cholelithiasis in elderly patients, focusing on outcomes, risks, and decision-making factors unique to this population. PATIENTS AND METHODS:Materials and Methods: A comprehensive literature search was performed in MEDLINER, Embase™, PubMedR, and Google Scholar™ using the terms: "acute cholecystitis," "cholelithiasis," "elderly," "surgical management," "laparoscopic cholecystectomy," "non-surgical," and "percutaneous cholecystostomy." Studies published between 2005 and 2025 were included if they evaluated outcomes such as morbidity, mortality, recurrence, and hospital stay in elderly patients. Both surgical and non-operative management strategies were compared, including antibiotic therapy and cholecystostomy. Articles were selected in accordance with PRISMA principles. CONCLUSION:Conclusions: Laparoscopic cholecystectomy remains the gold standard for acute gallstone disease but carries higher morbidity and mortality in elderly patients due to comorbidities and frailty. Non-operative approaches such as percutaneous cholecystostomy, or antibiotic therapy may reduce immediate surgical risk but are associated with higher recurrence and readmission rates. Optimal management requires an individualised, multidisciplinary approach considering physiological reserve, inflammatory markers, and patient preference. More prospective studies are needed to standardise risk stratification and management pathways specific to geriatric patients with acute cholelithiasis.
Background and objective This aim of this international expert consensus project was to clarify the appropriate use of urodynamics (UDS) in men with bothersome lower urinary tract symptoms (LUTS) who are considering prostate surgery in light of high-quality published evidence, particularly high-certainty data from the UPSTREAM study, and expert clinical experience. Methods A modified version of the Delphi method was used. Postsurgical patients, catheterised patients, and patients with neurological disease were not included. Eight questions covered UDS in specific contexts; four addressed quality assurance. Key findings and limitations Consensus was reached on the need for UDS in any of the following circumstances: if the corrected maximum flow rate is ≥13 ml/s; if bothersome urinary urgency is present; if scores are below stated thresholds for overall symptoms or voiding symptoms; if the postvoid residual volume is considered meaningfully elevated; if there is extensive comorbidity; and if incontinence (any type) is identified. Consensus was not reached on the need for UDS in men with scores below the stated threshold for the impact on quality of life. Consensus was achieved for quality assurance in terms of cross-checking UDS pressure traces and derived indices; ensuring the trustworthiness of traces by experienced health care professionals; and review within the individual clinical context. UDS was considered important when benign prostatic obstruction (BPO) is less likely and in cases in which detrusor underactivity or overactivity is more likely. In cases with severe voiding symptoms, UDS was not considered necessary to increase confidence in recommending surgery to treat LUTS. Conclusions and clinical implications UDS retains an important role in men with bothersome LUTS considering surgery for presumed BPO. Our consensus recommends specific criteria to guide selective UDS use.
