Maano : a creative collaboration for a creative community

There is a gap in the local tourist market for value-added goods. Curios are available in abundance at the National Zoological Gardens nearby the Panagos Building, but these are of an inferior quality and are unsuitable for export. A craft node at which the local and tourist communities intersect creates an ideal platform for related activities through which these communities can support each other. At this node, training of local talent for the production and trade of value-added craft products will take place. These activities must be undertaken at the same locale so that each activity can respond quickly to the other activities.Please note that the different chapters are not bookmarked and therefore not linked.Dissertation (MInt(Prof))--University of Pretoria, 2008.Architectureunrestricte

SBO ACTION: Conservative Small Bowel Obstruction management in the absence of standard ConTrast agents ON outcomes

© The Author(s) 2025. Published by Oxford University Press on behalf of BJS Foundation Ltd.Bowel obstruction is a common condition, accounting for 12–16% of acute surgical admissions1. Small bowel obstruction (SBO) is the most frequent site, comprising half of all emergency laparotomies performed in England and Wales between 2019 and 20202. The leading cause of SBO is intra-abdominal adhesions, with adhesional small bowel obstruction (aSBO) accounting for approximately 60% of cases3. Optimal management of aSBO remains a subject of ongoing debate.Unfunde

Global anaesthesia practice using inguinal hernia surgery as a tracer condition: A secondary analysis of an international prospective cohort study

© 2025 The Author(s). Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists.INTRODUCTION: Restoration of surgical capacity is essential to post-COVID-19 recovery. This study explored the use and safety of anaesthesia options for inguinal hernia surgery, a common tracer condition, to describe current global practice and highlight opportunities to build the capacity of health systems. METHODS: This is a secondary analysis of an international prospective cohort study of consecutive patients who underwent elective inguinal hernia surgery. We used a consensus process to define generalisable outcomes to measure patient selection, utilisation of hospital capacity and peri-operative safety in patients who received locoregional, spinal or general anaesthesia for their surgery. RESULTS: In total, 16,554 patients from 83 countries were included. Locoregional anaesthesia was performed in 1536 (9.2%) of patients, compared with 9165 (55.4%) who had general and 55,853 (35.4%) who had spinal anaesthesia. Patient selection outcomes were comparable across anaesthesia groups. As a measure of hospital capacity, adjusted day-case rates were higher for locoregional anaesthesia (OR 6.62, 95%CI 5.13-8.54, p < 0.001) but not for spinal anaesthesia (OR 0.97, 95%CI 0.84-1.12, p = 0.68) compared with general anaesthesia. Complications were lower in patients who underwent locoregional anaesthesia (OR = 0.67, 95%CI 0.52-0.87, p = 0.001) but not for spinal anaesthesia (OR = 0.90, 95%CI 0.77-1.05, p = 0.167) compared with general anaesthesia after risk adjustment. DISCUSSION: This study has filled knowledge gaps of anaesthesia practice in common surgeries across the world. Locoregional and spinal anaesthesia could be adopted as safe options to increase surgical volume when there is limited access to general anaesthesia.The study was prospectively registered in ClinicalTrials.gov (NCT05748886O). Funding was provided by the National Institute for Health Research (NIHR) Global Health Research Unit Grant

ColoRobotica: Structured training in robotic colorectal surgery

The adoption of robotic surgery has increased rapidly. The robotic surgery market is projected to reach $14 billion globally by 2026, with an increasing number of robotic platforms entering the market. Structured training remains an important issue in robotic colorectal surgery. ColoRobotica at the European School of Coloproctology, the European Society of Coloproctology, was established in 2018 to benchmark robotic colorectal training in Europe. A multidisciplinary team was formed, and a framework was established. Building the infrastructure of the programme took 2 years. A training pathway was designed to provide a structured training programme with quality assurance interventions embedded in the programme. The programme was launched in 2022. Preliminary results showed clinical outcomes of trainees are comparable to those of expert robotic surgeons. The model could serve as a template for both other scientific societies and different specialties to provide structured robotic surgical training.The study is part of the ongoing project for ColoRobotica. Intuitive Foundation provided the educational grant for the programme but did not influence the selection of the experts/trainees, the design and conduct of the research, data collection, analysis or preparation of the manuscript

Outcomes of intended temporary stomas in Crohn's disease (INTESTINE study): International, multicentre, retrospective study

© The Author(s) 2025. Published by Oxford University Press on behalf of BJS Foundation Ltd.BACKGROUND: Patients with ileocolic Crohn's disease often require surgery that can result in temporary stoma formation. Stomas are associated with a morbidity and can negatively impact quality of life. This study aimed to investigate the short-term (6-month) and mid-term (18-month) outcomes of intended temporary stomas in patients with Crohn's disease. METHODS: A trainee-led, international multicentre, retrospective study was conducted on all patients who underwent surgery for Crohn's disease in collaborating centres over 4 years (2017-2020). The primary outcome was the proportion of patients with Crohn's disease who underwent stoma reversal surgery by 6- and 18-month postoperative follow-up. Secondary outcomes included: the time interval between formation and reversal of stoma and predictors for non-reversal and stoma-related morbidity (postoperative complications, related readmissions and complications due to stoma reversal surgery). RESULTS: A total of 401 patients underwent stoma formation for Crohn's disease over the 4 years across the 44 collaborating centres. The temporary stomas had been reversed in 30.2% of patients at the 6-month and 56.9% at the 18-month follow-up. Reasons for non-reversal included ongoing medical treatment for Crohn's disease (respectively 6-month and 18-month: 37.6%, 39.3%), patient unfit for surgery (respectively 6-month and 18-month: 14.5%, 16.8%), patient preference (respectively 6-month and 18-month: 12.1%, 20.2%) and due to waiting lists (respectively 6-month and 18-month: 12.1%, 8.1%). Overall, 63.3% of patients had a temporary stoma reversed with a median time interval of 6 months. The stoma-related overall morbidity rate was 29.4%. CONCLUSIONS: A large proportion of temporary stomas for Crohn's disease were not reversed at 6 and 18 months following initial surgery. Patients are exposed to the risk of non-reversal and risk of developing stoma complications for significantly longer intervals of time and, in some cases, indefinitely.Unfunde

ACPGBI position statement on robotic‐assisted colorectal surgical training

© 2025 The Author(s). Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.The uptake of robotic-assisted colorectal surgery (RACS) across the UK and Ireland has increased exponentially over the last 5 years. It is anticipated that most 'conventional' laparoscopic procedures will eventually move to a robotic approach within a National Health Service that is committed to embracing robotic-assisted surgery. Working in collaboration with the surgical Royal Colleges, a more structured framework is necessary for robotic training. Inequality in robotic access and the impact that RACS is having on current colorectal surgical trainees need to be addressed, The Association of Coloproctology of Great Britain and Ireland (ACPGBI) has set out a framework to help support training in RACS at basic, advanced and trainer levels. Safer, better-trained robotic surgeons will ensure improved patient outcomes, which is the overriding goal of the ACPGBI.Unfunde

The ACPGBI AI taskforce report: A mixed‐methods roadmap for AI in colorectal surgery

© 2025 The Author(s). Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.Aim: The ACPGBI has commissioned a taskforce to devise a strategy for integrating artificial intelligence (AI) into colorectal surgery. This report aims to (i) map current AI adoption amongst UK colorectal surgeons; (ii) evaluate knowledge, attitudes, perceptions and experience of AI technologies; and (iii) establish priority recommendations to drive innovation across the specialty. Methods: A prospective 45‐item questionnaire was circulated to the ACPGBI membership. Questionnaire findings were explored at a multidisciplinary round table of surgeons, allied professionals, computer scientists and lawyers. Strategic recommendations were then generated. Results: 122 members responded (75.4% consultants; 72.1% male; modal age 41–50 years). Although 43.5% used AI daily, only one third said they could explain key concepts within AI. 86.9% anticipated routine future‐AI use, with documentation and imaging ranked highest. 88.5% endorsed formal AI training. Major obstacles were unclear regulation, cost, medicolegal liability and professional or patient distrust. The round table generated 17 recommendations across clinical, educational and research domains and a ten‐point action plan, including the establishment of a Colorectal AI Committee and the creation of an open‐source colorectal foundational data initiative. Conclusion: This taskforce report combines questionnaire insights from the ACPGBI membership and expert debate into 17 key recommendations and a ten‐point action plan that will set the direction of future colorectal AI practice. The objective is to establish a framework through which colorectal surgical practice can be augmented by safe, trustworthy AI.Unfunde

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research