Background A review of the management of splenic artery aneurysms (SAA). There is no general consensus as to when and what type of intervention should be chosen to treat SAAs. The aim of this study is to investigate the types of intervention for SAAs including complication, reintervention, rupture, mortality after intervention of SAA in a review. Method A literature search was performed using “keywords” in Medline and Embase limited to publications from 2008 to 2018. 289 articles were identified during the initial literature search. 143 articles met the eligibility criteria. 83 articles were included in the quantitative synthesis. Descriptive analysis was performed. Results 576 patients were identified with 588 reported SAAs. The mean ± SD age was 52.6 ± 5.8 years (range 17–85). The mean ± SD size of SAA was 49.9 ± 13.2 mm (range 6–180). Types of intervention reported were endovascular treatment, open surgery, laparoscopic surgery and conservative management. Mortality rate in patients with endovascular treatment was 0.5% compared to 4.9% with open surgery. 3.4% of patients with conservative management were reported to have aneurysms that grew over time and 2.8% patients had further intervention. ANOVA test to compare mortality between open surgery, endovascular treatment and laparoscopic surgery showed there is no difference between mortality between the 3 different interventions as F (2.71) < F crit (3.02) (P = 0.07). Conclusion Endovascular treatment is now the first choice of treatment for SAA, but future studies are required to determine its long-term durability. By introducing a management pathway for SAA, we hope to see an improvement in managing patients. The management algorithm will require further validation through application with careful and complete follow-up of all cases to improve the pathway depending on patient outcome.

Core Surgical Training (CST) is a 2-year UK training programme, designed to provide junior doctors interested in surgery with formal training and to introduce them to various surgical specialties. The selection process is divided into two stages. In the portfolio stage, applicants submit a score based on a published self-assessment guidance. Only candidates whose scores remain higher than the cut-off after verification will proceed to the interview stage. Finally, jobs are allocated according to the overall performance of both stages. Despite the rising number of applicants, the number of job vacancies remains largely similar. Hence, the intensity of competition has increased over the past few years. The competitive ratio increased from 2.8:1 in 2019 to 4.6:1 in 2021. Hence, several changes have been implemented in the CST application process, with the aim to combat this trend. The recurring changes in the CST application process have sparked considerable discussions among applicants. The effect of the changes on the current and prospective applicants is yet to be explored. This letter aims to highlight the changes and discuss the potential impacts. The CST application from 2020 to 2022 has been compared to identify the changes implemented throughout the years. Specific changes have been highlighted. The impact of changes in the CST application process on applicants has been divided into ‘pros’ and ‘cons’ sections. Recently, many specialties have shifted from portfolio-based assessment to Multiple Specialty Recruitment Assessments. In contrast, CST application preserves its emphasis on holistic assessment and academic excellence. However, the application process could be further refined for more impartial recruitment. This would ultimately help alleviate the challenging situation of staff shortage, increase the number of specialist doctors, reduce waiting time for elective surgeries and most importantly, provide better care for our patients in the NHS.

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