bluuebunny/crossref_metadata_2025 huggingface dataset:
O104 The effects of elective abdominal surgery on protein turnover: a meta-analysis of stable isotope techniques to investigate postoperative catabolism
Authors: Jaconelli M , Greenhaff PL , Atherton PJ , Lobo DN , Brook MS
Published: November 2022

Introduction

Elective surgery induces skeletal muscle wasting driven by an imbalance between muscle protein synthesis and muscle protein breakdown. From examination of diverse stable isotope tracer techniques, the dynamic processes driving this imbalance are unclear. This meta-analysis aimed to investigate the mechanistic driver(s) of postoperative catabolism through stable isotope assessment of protein turnover before and after surgery.

Methods

Meta-analysis was performed of randomized controlled trials and cohort studies in patients undergoing elective abdominal surgery that contained measurements of whole-body or skeletal muscle protein turnover via stable isotope tracer methodology pre- and postoperatively. Postoperative changes in protein synthesis and breakdown were assessed through subgroup analysis of tracer methodology.

Results

Surgery elicited no overall change in protein synthesis [SMD -0.47, 95%CI: -1.32, 0.39]. However, subgroup analysis revealed significant suppressions via direct-incorporation methodology [SMD -1.53, 95%CI: -2.89, -0.17] within skeletal muscle distal to the site of trauma. Changes of this nature were not present among arterial-venous [SMD 0.61, 95%CI: -1.48, 2.70] or end product [SMD -0.09, 95%CI: -0.81, 0.64] whole-body measures. Surgery resulted in no overall change in protein breakdown [SMD 0.63, 95%CI: -0.06, 1.32]. Yet, separation by tracer methodology illustrated significant increases in urinary end-product measurements (urea/ammonia) [SMD 0.70, 95%CI: 0.38, 1.02] that were not present among arterial-venous measures [SMD 0.67, 95%CI: -1.05, 2.38].

Conclusion

Elective surgery elicits suppressions in skeletal muscle protein synthesis that are not reflected on a whole-body level. Lack of uniform changes across whole-body tracer techniques are likely due to contribution from tissues other than skeletal muscle.

Take-home message

Further research investigating postoperative catabolism should employ tracer methodologies specific to the metabolic pool of interest.
O105 Human adaptation to immobilisation: novel insights of impacts on glucose disposal and fuel utilization
Authors: Shur NF , Simpson EJ , Chivaka PK , Crossland H , Constantin D , Cordon SM , Constantin-Teodosiu D , Stephens FB , Lobo DN , Szewczyk N , Narici M , Pratts C , Macdonald IA , Greenhaff PL
Published: November 2022

Introduction

Bed-rest (BR) reduces whole-body insulin-stimulated glucose disposal (GD) and alters muscle fuel metabolism. However, little is known about metabolic adaptation from acute to chronic BR, particularly when volunteers are maintained in energy balance.

Methods

Healthy males (n=10, 24±1.25 years) maintained in energy balance underwent 3 days of BR (acute BR; ABR). A second cohort matched for gender and body mass index (n=20, 34±1.8 years) underwent 56 days of BR (chronic BR; CBR). A hyperinsulinaemic euglycaemic clamp (60 mU/kg lean mass/min) was performed before and after BR. Indirect calorimetry was performed before and during the clamp steady-state to calculate rates of whole-body fuel oxidation. Vastus Lateralis muscle biopsies were taken before and after each clamp. Two-way repeated measures ANOVA was used to detect differences in end-point measures.

Results

ABR reduced insulin-mediated glucose disposal (GD; p<0.001), which was unchanged in magnitude following CBR (p<0.05). This reduction in GD following both acute and CBR was paralleled by the elimination of a 35% increase in insulin-stimulated muscle glycogen storage seen Pre BR. ABR had no impact on insulin-stimulated carbohydrate (CHO) and lipid oxidation, but CBR reduced CHO oxidation (p<0.05) and blunted the magnitude of insulin-mediated inhibition of lipid oxidation (p<0.05). Neither acute nor CBR increased muscle intramyocellular lipid content.

Conclusion

ABR suppressed insulin-stimulated GD and glycogen storage, and the extent of suppression increased no further after CBR. However, GD and storage were dissociated from substrate oxidation during CBR. Moreover, the shift in substrate oxidation after CBR was not explained by IMCL accumulation.

Take home message

Acute bed rest impairs insulin-stimulated glucose disposal and glycogen storage which is the same magnitude as that seen in chronic bed rest.
O107 Endotoxaemia rapidly impacts on skeletal muscle mrna expression under conditions of controlled nutrient availability in humans
Authors: Marimuthu K , Constantin D , Chikani M , Murton A , Nixon A , Mallinson J , Constantin-Teodosiu D , Lobo DN , Greenhaff P
Published: November 2022

Introduction

Inflammation induces changes in muscle protein turnover and mass and dampens insulin stimulated glucose disposal and oxidation. Limited information is available regarding the molecular regulation of these events. We determined the acute effects of lipopolysaccharide (LPS) infusion on targeted muscle mRNA expression.

Methods

Seven healthy, males (age 21.9±0.6 yrs, BMI 23.4±1.2 kg.m-2) participated in this ethically approved randomised crossover design study. On 2 occasions separated by >2 weeks, subjects underwent a 4h hyperinsulinaemic euglycaemic clamp combined with a primed mixed amino-acid (6 g.h-1; to create a ‘fed-state’) infusion, immediately following bolus saline (control) or LPS (4 ng.kg-1) infusion. Vastus lateralis muscle biopsies were obtained at baseline, 120 and 240 min. Muscle mRNA expression was measured (191 targets deemed to be representative of insulin sensitivity, carbohydrate and fat metabolism, inflammation, and protein turnover) using microfluidics TaqMan array cards.

Results

Plasma [TNF alpha] was markedly elevated above control following 60 min of LPS infusion (P<0.05) and remained elevated. Following gene filtering (>1.5 fold change in muscle mRNA expression from baseline, P<0.05), Ingenuity Pathway Analysis identified several metabolic functions significantly altered from baseline after 120 and 240 min in control. The magnitude of change in each metabolic function (-log p value) and the size of each gene network was substantially greater after LPS.

Conclusion

Muscle mRNAs respond rapidly to insulin and amino acid infusion in humans, but the magnitude of response was greater in the presence of LPS and may underpin changes in muscle protein and fuel metabolism seen under these conditions.

Take-home message

Endotoxaemia acts rapidly (within 2 to 4 hours) to alter the expression levels of muscle mRNAs known to be intimately involved in the molecular regulation of muscle mass, insulin resistance and fuel oxidation in human volunteers under controlled conditions of insulin and nutrient availability. This may play a role in the changes in muscle metabolism seen under such conditions.
O108 Central adiposity influences serum calcium concentrations and increases risk of kidney stone disease
Authors: Lovegrove CE , Wiberg A , Allen N , Littlejohns T , Mahajan A , McCarthy M , Hannan F , Thakker R , Holmes M , Furniss D , Howles S
Published: November 2022

Introduction

Serum calcium (SCa) and adiposity are associated with kidney stone disease (KSD). We used conventional and genetic epidemiological approaches to further understanding of these relationships.

Methods

Waist-hip ratio (WHR), a marker of central adiposity, SCa and KSD data were analysed by adjusted linear regression using UK Biobank participants. Univariable, multivariable and mediation Mendelian randomisation (MR) were undertaken using 316 and 246 genetic instruments for WHR and SCa, respectively.

Results

Observational analyses of 3,466 KSD cases and 489,944 controls showed that participants of normal BMI (20–25kg/m2) but in the fifth quintile for WHR have greater risk of incident KSD compared to the first quintile (HR=1.39 (95%CI=1.18–1.63)). After adjustment for sex, age, serum vitamin D, and phosphate, higher WHR was positively associated with SCa (ß=0.04, 95%=CI 0.04–0.05, P<0.001). Univariable MR demonstrated that relative risk of KSD increases with increasing WHR and SCa; 1 standard deviation (SD) increases relative risk by 46% (95%CI=1.27–1.67, P=5.9e-8) and 63% (95%CI=1.37–1.93, P=2.0E-8), respectively. A 1 SD increase in WHR increases SCa by 0.11mmol/L (95%CI=0.07–0.14, P=1.8e-8). Multivariable MR revealed that SCa and WHR independently increase KSD relative risk (OR=1.71, 95%CI=1.49–1.96, P<0.001 and OR=1.41, 95%CI=1.17–1.69, P<0.001 respectively). Mediation MR established that 14% of the effect of WHR on KSD risk is mediated via alterations in SCa.

Conclusion

Central adiposity is causally linked to KSD, partly by raising SCa. Mechanisms by which central adiposity increases KSD risk, independent of and via SCa, remain to be revealed and may identify novel therapeutic methods for KSD.

Take-home message

Central adiposity and serum calcium are independent, causal risk factors for kidney stone disease. One mechanism by which central obesity increases risk of kidney stone disease is by influencing serum calcium concentrations.
EP-3 Quality improvement project analysing the impact on antimicrobial prescribing in a General Surgery department after introducing access to guidelines via a mobile phone app
Authors: Bharadwaj Aniket , Donald Neil
Published: November 2022

Introduction

Antimicrobial prescribing forms a central pillar of treatment in surgical admissions. This project aimed to analyse the impact of increasing access to antimicrobial guidelines for doctors in a general surgical department via mobile and laptop apps. Prior to this guidelines were only available in a pdf format accessible via the trusts intranet.

Method

An initial audit of 238 antimicrobial prescription from 109 patients in the month of October 2020 was performed. The data was collected was compared against the antimicrobial stewardship NICE guidelines (NG 15 1.1.2.4). This showed that only 57% of antibiotic prescriptions were in line with the correct treatment guidelines. After discussion with the lead microbiology consultant and lead pharmacist, trust guidelines were introduced for the first time on the Micro-guide, made accessible to all doctors via the mobile app and laptops. Information was circulated within the surgical department via educational posters and a presentation. 6 months later we closed the audit look. We aimed to review whether increasing access via technological means would lead to greater standards of antimicrobial prescribing.

Results

Results following the increasing the access to guidelines significantly improved the accuracy of antibiotic prescriptions. Some improvement was also seen in the other parameters such as documentation of indication and duration of antibiotic prescriptions.

Conclusion

It is evident that improving access to trust guidelines via trusted mobile applications and trust laptops can facilitate improvement in antimicrobial stewardship standards and help slow the emergence of resistance in communities.
EP-10 Is selective histology of cholecystectomy specimens for benign gallbladder disease a future surgical practice?
Authors: Matias Mariana Rita Afonso , Kronberga Madara
Published: November 2022

Cholelithiasis, known as gallstone disease, is highly prevalent in developed countries population, with symptomatic cholelithiasis being one of main indications for cholecystectomy (BMJ Best Practice, 2021). Elective or emergency laparoscopic cholecystectomy has become a gold standard with a common practice all over the world to proceed with routine histopathological examination of all gallbladder specimens. The rationale behind this established practice is to exclude the presence of incidental gallbladder malignancy (Lundgren et al., 2018). Despite being the most common cancer of the biliary tract, gallbladder cancer is a rare benign entity in developed countries. It is generally associated with a poor prognosis (Lundgren et al., 2018). Gallbladder cancer often mimics the clinical features of benign gallbladder disease with 60 to 80% (Emmett et al., 2015) of the cancers being diagnosed following cholecystectomy.

Different authors have reported a low incidence of GC (0.19 to 3.3%) (Emmett et al., 2015) in cholecystostomy specimens. Therefore, recent literature reviews (Khan et al., 2021) have challenged the surgical community to change their clinical practice. They suggest a selective histopathology examination of gallbladder specimens based on patients’ risk factors and thorough intraoperative macroscopic assessment by the surgeon as a safe and cost-effective practice (Lundgren et al., 2018; Khan et al., 2021).
EP-19 The innate aptitude's effect on the surgical task performance
Authors: El Boghdady Michael , Ewalds-Kvist Béatrice Marianne
Published: November 2022

Aims

Surgery is a craft profession requiring individuals with specific innate aptitudes for manipulative skills, visuospatial and psychomotor abilities. The selection process of surgical trainees excludes aptitude testing for the psychomotor and manual manipulative skills of candidates for required abilities. We scrutinize the effect of innate aptitudes in surgery and its skill-training by systematically reviewing its significance on the surgical task performance.

Methods

A systematic review was performed by PRISMA guidelines. A search on PubMed/Medline for English language articles was performed from January 2001 to January 2021. Search terms were ‘aptitude for surgery’, ‘innate aptitude and surgical skills’, ‘manipulative abilities and surgery’ and ‘psychomotor skills and surgery’. The quality of quantitatively researched citations was assessed by MERSQI scores.

Results

The results yielded 1142 studies and 21 met the inclusion criteria and 6 high-quality citations rejected our 3 null hypothesis and all medical students cannot reach proficiency in skills necessary for a career in surgery. Playing video games and/or musical instruments do not promote surgery skill; yet, a valid test with predictive value for novices aspiring for a surgical career is helpful. MERSQI mean score was 11.07 (SD= .98; range 9.25 to 12.75).

Conclusion

Visuospatial aptitude, rate of skill acquisition and quality of surgical performance predicted baseline surgical ability. Additionally, visuospatial aptitude along with psychomotor skills and perceptual talent, furthered laparoscopic simulator performance. The selection process for candidates suitable for a career in surgery requests a simulated surgical environment, where the candidates’ skills also in forms of non-technical aptitudes are assessable.
EP-20 Postoperative music, a non-pharmacological pain relief: a randomized controlled trial
Authors: Aghakhani Nader , Ewalds-Kvist Béatrice Marianne , El Boghdady Michael
Published: November 2022

Aims

Postoperative moderate to severe pain disrupts patients’ sleep and affects their quality of life. Non-pharmacologic pain relief such as music therapy were considered beneficial. We therefore evaluated preferred type of music as pain relief in patients with abdominal surgery in a non-UK teaching hospital.

Methods

Patients undergoing open abdominal operations were included. Patients with laparoscopic or rectal surgery and/or spinal or epidural anesthesia were excluded. Routine postoperative analgesics were used. Demographic variables were recorded and VAS pain scale (0–10 most severe pain) was assessed in first day postoperative. Patients or their relatives gave informed consent.

Results

Sixty patients (Md age 39 years) were included; 30 patients allocated in experimental group who listened to preferred music using headphones (20 min) vs Control group used headphones without music.

Fisher's exact test and independent t-tests were computed. The pain intensity decreased from 6.94 (SD .13) to 6.21 (SD .21) in the control group (n.s,) and in the experimental group from 7.06 (SD .31) to 3.25 (SD .21), (p <.0001, 2-tailed) with no significant difference between the two groups before intervention. Pain intensity in experimental group decreased due to the intervention. There was a significant difference in pain intensity between the experimental and control groups after music therapy (p < .001, 2-tailed).

Conclusion

The patients who listened to preferred music after surgery, experienced less pain compared to their controls. A long-term follow-up with larger sample size may conform the efficacy of post-operative music as a pain-relief in UK settings.
EP-21 The adequacy of consent forms for post-operative inguinal hernia complications relative surgeon's grade of training
Authors: Quefferus Michael , El Boghdady Michael
Published: November 2022

Aims

Inguinal hernia repair is known to be one of the most commonly performed general surgery procedures in the UK. Pre-operative consenting is essential to be aware of potential complications and for patients to make fully informed decisions. We aimed to assess the adequacy of consent for elective inguinal hernia repair in a UK-teaching hospital.

Methods

A 4-months retrospective data analysis of consent forms was performed. Elective open and laparoscopic inguinal hernia repairs were reviewed for consent forms, including demographic data, date of surgery, grade of consenting surgeon, re-admissions and complications.

Results

A total of 132 operations were included, 108 open and 24 laparoscopic. The most commonly recorded risks were bleeding (97%) and recurrence (96%). Serious testicular complications such as testicular artery injury/orchidectomy were consented in 35% of patients. The consultants consented 63% of overall complications, specialist registrars (SpR) 66.9% and senior house officers (SHO) consented the most with 77.1%. Testicular complications were mostly consented by consultants 66.7% vs registrars 16.3% and 12% SHOs. Consultants consented for the fewest complications overall (63.7%). Six patients were readmitted with postoperative complications, 2 were readmitted for orchidectomies, 3 haematoma and 1 had recurrence.

Conclusion

There are significant shortcomings in consenting patients for serious testicular inguinal hernia complications. SHOs consented for the most complications, followed by SpRs then consultants with the least. To mitigate these shortcomings we would envisage having a standardised format for consenting, including patient information leaflets provided to the patients prior to their operations.
EP-33 Migrated Esophageal Stent Causing Imminent Perforation. A Case Report
Authors: Al Ain Atif Qurrat , Raza Mehdi , Essiet Edidiong , Ahmed Kazi
Published: November 2022

Introduction

Esophageal stents are being used more frequently for maintaining esophageal lumen patency in benign as well as malignant conditions. But the stents do not come without complications. The most common complication is stent migration. It can go unnoticed in asymptomatic individuals whereas timely exclusion of more urgent complications associated with migration is necessary to avoid morbidity and mortality.

Case Presentation

We present the case of a 58-year old patient with inoperable esophageal cancer. He underwent esophageal stenting twice, for palliation, and on both occasions, the stents did not maintain its position. He presented with abdominal pain, abdomen was peritonitic on examination and computerised tomography (CT) scan showed that the esophageal stent had migrated into his ileum. Upon laparoscopy, stent was found lodged in distal ileum causing ischemia and imminent perforation. We found the radiology and per-operative images interesting and are sharing herewith.

Conclusion

With the growing use of esophageal stents, it is important to recognize the possible immediate and delayed complications to manage them effectively. Surgeons need to be aware of the possible complications and have a high index of suspicion to diagnose and treat these.
EP-34 A rare cause of upper abdominal pain – left gastric artery trapped in gastric band
Authors: Kam Cheuk Tung , Rait Jaideep
Published: November 2022

Introduction

Gastric banding has become one of the most commonly performed bariatric operations worldwide. Recognised complications are divided into; the laparoscopic approach, the band or the procedure itself. Gastric band misplacement is a rare but recognised early complication.

Case description

A 58-year-old patient presented to a district general hospital with a 6 day history of epigastric pain, incomplete dysphagia, vomiting, and constipation. Gastric band surgery had been performed 10 years prior in a UK tertiary centre. Diagnostic workup suggested the left gastric artery was trapped in the gastric band with no features of necrosis, perforation or obstruction. The patient was referred to the upper gastrointestinal surgical team and the band was removed laparoscopically and the patient had an uneventful recovery.

Discussion

Symptoms of gastric band misplacement may include nausea, vomiting, dysphagia, and upper abdominal pain. It is unusual that a malpositioned gastric band resulted in symptoms over 10 years after the procedure. Radiological evidence of gastric band misplacement in the literature is only reported in 0.07% of cases in plain radiograph. Surgical technique and experience are important to prevent band slippage, especially when considering the chosen placement and securing method.

Conclusion

This case describes an important late rare finding of complication following gastric band surgery. Consideration should be made in management for patients with gastric band presenting with gastrointestinal symptoms and a high level of clinical suspicion is needed to investigate and manage these patients.
EP-42 Adherence to Guidelines of Pre-operative Antibiotics Prophylaxis in Bahrain
Authors: Alanzi Ahmed , Almukhodher Sundus
Published: November 2022

Background/Introduction

Appendicitis is most an acute sickness that manifests within 24 hours, although it can also manifest as a chronic disorder.

Aims/Objectives

The current study was aimed to evaluate the adherence to the antibiotics prophylaxis guidelines in appendectomy in patients admitted to the surgical department of Salmanya medical Complex-Bahrain in 2020.

Method

The study included the patients admitted to the surgical department of Salmanya medical Complex-Bahrain in 2020.

Only adult patients, who underwent appendectomy, were included in the study while pediatric patients were excluded.

The records of the patients, who underwent surgical procedures, were evaluated.

From the records of these patients, information.

Results

Among 273 patients who were administered with the antibiotics, no one was administered with correct antibiotics as per guidelines of the hospital. 72 (26.37%) patients were administered with antibiotics within or equal to 60 minutes prior to surgical procedure remaining

Discussion/Conclusion

The current study revealed that the majority of the patients (72%, N=273) admitted to the Salmanya Medical Complex-Bahrain were not administered the antibiotics within the prescribed time as per guidelines from the hospital.

Also, the antibiotics administered for prophylaxis prior to the appendectomy procedure were not according to the guidelines i.e. Cefazolin 1g with Metronidazole 500mg.

Out of a total of 278 patients included in the study, no one was administered with the right choice as provided by the local guidelines.

Secondly, 1.8% of patients (N=278) were not administered with any of the antibiotics for prophylaxis prior to surgical procedure for appendicitis.
EP-43 Soup and sweet is not enough to eat: Postoperative nutritional intake is inadequate following open colorectal resection
Authors: Hardy Edward , Quinn Anna , Bergin Emma , Phillips Beth , Lund Jon
Published: November 2022

Aims

Adequate postoperative nutrition reduces complications and may modulate the metabolic stress response to surgery. In particular, protein intake may reduce loss of muscle mass and function thereby enhancing recovery to a normal functional level. This study aimed to assess the adequacy of nutritional intake in patients following an ERAS protocol after open colorectal resection.

Methods

Dietary intake on postoperative day (POD) 1 to 4 was recorded. Energy (Kcal) and protein (g) intake was calculated using information from the hospital's food supplier. Values were compared to the European Society of Clinical Nutrition (ESPEN) guidelines for perioperative patients (25Kcal/kg and 1.5g/kg of protein per day, based on ideal body weights).

Results

Eleven patients were recruited. Mean daily energy intake was 490.0Kcal (± 470.7), 505Kcal (± 251.8), 541.0Kcal (± 488.1) and 610.5Kcal (± 900.5) on POD 1–4 respectively. Mean daily protein intake was 13.9g (± 14.1), 14.9g (± 10.2), 15.0g (± 15.6) and 18.5g (± 25.6) on POD 1–4 respectively. Excluding patients who developed ileus (n=4), total energy and protein intakes over POD1–4 were 42.6% (± 19.7) and 21.1% (± 11.4) of the ESPEN recommended daily amount respectively. In patients with ileus these values reduced to 12.8% (± 2.6) and 5.7% (± 0.9). Two thirds of meal choices were soup, jelly or ice cream.

Conclusions

Early postoperative nutrition after open colorectal resection in inadequate. Further strategies are required to counteract this. Examples may include protein fortification of popular postoperative meal choices and prehabilitation to improve patient's nutritional reserves.
EP-44 Improving Patient Education About Pre-Diabetes
Authors: Carey Charles , Natarajan Shanthi
Published: November 2022

Pre-diabetes is a common condition and although its development is heavily linked to lifestyle factors, many patients are unaware of interventions that can improve their condition. One-to-one consultations between patients and GPs focused on reducing carbohydrate consumption have been shown to be effective at improving pre-diabetes. This QIP aimed to improve patients’ understanding of pre-diabetes and reduce their carbohydrate intake.

Patients were included if they had 2 HbA1c measurements between 42 – 48mmol/mol and the ability to make dietary changes independently. A questionnaire based on the UK Diabetes and Diet Questionnaire was constructed and used to ask patients about their concern about pre-diabetes, knowledge of foods that contribute to the condition and the frequency at which they consumed various carbohydrates. Advice about reducing carbohydrate intake was given verbally and patients were provided with a diet sheet produced by Unwin et al. Patients were called again after 7–14 days to assess dietary changes and the impact of the advice.

31 patients responded to the initial telephone call of which 58.1% were concerned about pre-diabetes and 38.7% mentioned foods high in carbohydrate as a cause of pre-diabetes. 90.3% of patients consumed food high in carbohydrate on 4 or more days per week. 22 patients responded to the follow up telephone call of which 63.6% reported a reduction in carbohydrate intake, 95.5% knew more about pre-diabetes and 90.9% found the dietary advice helpful. These results suggest that pre-diabetic patients should be given verbal and written information about lowering carbohydrate intake at GP consultations.
EP-48 Laparoscopy in Emergency Colorectal Surgery: A 7-Year Retrospective Single Centre Cohort Study
Authors: Darbyshire Alexander , Smythe Rachel , Richardson John , Khan Jim , Mercer Stuart
Published: November 2022

Aim

Colonic diseases requiring urgent resection account for a third of emergency intestinal surgery. Laparoscopy is being increasingly used for emergency surgery, but its role is still being defined. This study describes our centre's experience of adopting a laparoscopic approach for emergency colorectal resection.

Method

A retrospective single centre cohort study was performed using local NELA data from January 2014-December 2020. All patients who had a colorectal resection were included, regardless of indication. Patient demographic, operative and in-hospital outcomes were compared for resection type and operative approach. Logistic and linear regression were performed for 30-day mortality and post-operative length of stay.

Results

A total 507 colorectal resections were performed. 48.1% were started laparoscopically and 27.6% successfully completed. Attempted laparoscopy rates increased over the study period to over 50% for the last 4 years. Colorectal specialists were more likely to start and complete cases laparoscopically (82.4% and 91.4% vs 60.3% for open). Cases started laparoscopically had significantly lower post-operative length of stay (10.5 vs 16.5 days, p<0.001) and 30-day mortality (6.1% vs 17.9%, p<0.001) than open surgery. Cases completed laparoscopically had a 30-day mortality comparable to elective surgery (2.1%, p<0.001). Patients undergoing laparoscopy were statistically significantly younger, with lower ASA grade and P-POSSUM predicted mortality than open surgery.

Conclusion

Laparoscopy can be used effectively and sustainably for emergency colorectal resections in a centre experienced with minimally invasive surgery. This study adds to the body of evidence supporting the safety and efficacy of laparoscopy in the emergency setting.
EP-49 First reported case of preperitoneal herniation of small bowel causing intestinal obstruction after total extraperitoneal hernia [TEP] repair- case report and review of the literature
Authors: Samarakoon Lasitha Bhagya , Chandraprakash Samip , Fernandes Roland , Basnyat Pradeep
Published: November 2022

Introduction

A pre-peritoneal hernia is a very rare complication following laparoscopic inguinal hernia repair. We report a patient who developed a preperitoneal hernia following an accidental breach of peritoneum following Total extraperitoneal repair [TEP]. Even though it has been described following total abdominal pre peritoneal repair [TAPP], to the best of our knowledge this is the first reported case following TEP repair.

Case presentation

A 57-year-old male underwent right inguinal hernia TEP repair on 20/10/2021. Initial recovery was uncomplicated but on POD 10 he developed sudden onset of vomiting and abdominal pain. Initial imaging showed small bowel obstruction without a definite transition point. We maintained a high index of suspicion for internal hernia and he was offered urgent diagnostic laparoscopy after careful counseling. A preperitoneal defect was noted with distended proximal ileum and collapsed distal ileum and colon. Small bowel run through which did not reveal any pathological abnormalities. A presumptive diagnosis of preperitoneal hernia was made, and the defect was closed with a running V lock suture. The patient made an uneventful recovery post-operatively.

Conclusion

An inadvertent breach in peritoneum during TEP repair can lead to preperitoneal of small bowel and intestinal obstruction postoperatively. This is the first-ever reported case of this very rare complication following TEP that hernia and general surgeons should be aware of. A high degree of suspicion is needed and early diagnostic laparoscopy is indicated if suspected to avoid morbidity and mortality from bowel ischemia.
EP-51 Acute presentations of Jejejunal diverticulosis – a literature review of the uncommon entity
Authors: Samarakoon Lasitha Bhagya , Pangeni Annang , Florance Charlotte , Sontenam Venkat Satya , Shrestha Ashish K
Published: November 2022

Introduction

Jejunal diverticula are distinctly less common than their colonic counterparts, 60% of patients with small intestinal diverticula have concomitant colonic diverticula. Although Jejunal diverticula are relatively asymptomatic, they can present with life-threatening complications such as perforation, bleeding, obstruction.

Due to their rarity, reporting radiologists, as well as emergency surgeons, may be unfamiliar with the imaging findings of complicated Jejunal diverticular disease.

Methods

A retrospective review of medical records was carried out for a period of 6 years from 2015–2021, in a large district general hospital in Kent, UK. We included all patients who had complications of Jejunal diverticulosis and were treated by the surgical teams during this period, regardless of whether they were managed operatively or conservatively. Following a retrospective review of the medical records epidemiological data, comorbidities of patients, we reviewed the images of CT scans obtained during the emergency admissions retrospectively with a consultant radiologist with more than 20 years of gastrointestinal radiology.

Conclusion

Although Jejunal diverticula are very rare and mostly asymptomatic, their complications can be lethal. Therefore emergency surgeons should suspect their presence, especially in elderly patients presenting with nonspecific abdominal pain and acute abdomen with no clear etiology identified for complications seen on cross-sectional imaging. A high index of suspicion and Surgical exploration [minimally invasive if the expertise is available] can be both diagnostic and therapeutic.
EP-53 The ambulatory care of unusual presentation of Boerhaave's syndrome
Authors: Loganathan Santhosh , Gul Rahman , Whittaker Laura
Published: November 2022

Boerhaave's syndrome is a rare but well established clinical condition with spontaneous longitudinal rupture of the oesophagus. It is a life-threatening condition with a mortality rate of up to 40%. The symptoms are variable or classical Mackler triad of Vomiting, chest pain and subcutaneous emphysema are noted. However, it is challenging or missed to diagnose this condition in patients with chronic symptoms.

We present an unusual presentation of Boerhaave syndrome in a 27-year-old female with no comorbidity presented to the emergency department with acute onset of shortness of breath and chest pain. Blood tests showed elevated D-Dimer on initial evaluation, and the rest of them were unremarkable. A CT pulmonary angiogram was done, which showed thickened lower oesophagus. She was reassured and sent home from the emergency department. Further discussion of the CT images in the upper GI MDT revealed that she had a small sealed off perforation of the oesophagus. The repeat scan after a few days as Outpatient demonstrated a sealed oesophageal perforation and a small collection. The water-soluble contrast swallow did not reveal any leak or stricture in the oesophagus. The patient had a gastroscopy after two months which was reported to be normal. Retrospectively, the patient mentioned that she had an episode of vomiting a few weeks earlier to this acute presentation to the hospital.

The knowledge about this condition and high suspicion in patients with chronic presentation is vital to diagnosing this potentially lethal condition which could be critical in preventing mortality and morbidity from this condition.
EP-55 Subclinical Spigelian hernia: sailing with the hidden iceberg
Authors: Goswami Aakansha Giri , Basu Somprakas , Shukla Vijay Kumar
Published: November 2022

Background

Spigelian hernia quaintly designated as occult anatomical distortion is no less than a conjurer. Its diagnosis is extremely exigent and is complicated by a lack of physical findings and the surgeon's supposition. Therefore, a thorough physical examination along with high-level clinical suspicion remains crucial in diagnosing Spigelian hernia.

Methods

A retrospective data of all subclinical Spigelian hernia cases was scrutinized for clinical presentation, physical examination, radiological investigation, surgical treatment and outcome.

Results

Of 72 patients treated for subclinical Spigelian hernia, we found that females were affected twice more. The mean duration of symptoms was 10.69 months and was more on the right side (59.72%). The most common presenting symptom was intermittent, sharp, localised pain. On examination, tender point in linea semilunaris better elicited on leg raising test was found in 70.83% cases. Fascial rupture at the lateral border of rectus was found in all patients using real-time ultrasound. All patients underwent open surgical repair with 5 patients treated with anatomical repair and 67 patients with mesh preperitoneal hernioplasty. Recurrence was seen in only 1 patient who underwent anatomical repair and 13 patients developed postoperative complications, the most common being seroma (61.53%).

Conclusion

Spigelian hernias are rare and are believed to represent the tip of a prodigious yet unperceived iceberg. Their diagnosis requires a high index of clinical suspicion given the lack of prototypical signs and symptoms. Usually, the patient presents with abdominal pain syndrome and an astute clinician couple a proper history and physical examination with preoperative imaging to secure the diagnosis.
EP-66 Omental infarct – A rare cause of Right iliac fossa pain in a child
Authors: Samarakoon Lasitha Bhagya , Chandraprakash Samip , Allu Veera
Published: November 2022

Introduction

Idiopathic omental infarction is a very rare cause of abdominal pain in the pediatric age group. We report a case of suspected acute appendicitis in an 8-year-old child, noted to have omental infarct on diagnostic laparoscopy.

Case presentation

An 8-year-old male child with no other medical issues presented to the acute surgical take with a 2-day history of right iliac fossa pain. The pain was of sudden onset and there were no other associated urinary or bowel symptoms. On clinical examination, there was right iliac fossa tenderness. There were mildly raised inflammatory markers. An ultrasound scan performed showed a possible blind-ending tubular structure measuring 7mm in the right iliac fossa with a small amount of free fluids. A presumptive diagnosis of acute appendicitis was made and the patient was taken to theatre.

Upon diagnostic laparoscopy, we noted blood in the RIF with a normal-looking appendix and area of omental infarction adjacent to the appendix. We proceeded to excise the area of mesenteric infarction using an energy device. The appendix was removed to avoid future diagnostic confusion.

Conclusion

Idiopathic omental infarction is an extremely rare cause of abdominal pain in children and may mimic acute appendicitis. Ultrasound imaging may be misleading. Laparoscopic exploration allows for accurate diagnosis as well as treatment.
EP-67 An Audit of extended Venous Thromboembolic Prophylaxis for major Laparotomy in a District General Hospital, Are We Compliance With NICE guidelines?
Authors: Elshafey Tarek , Azam Muhammad , Satchidanand Rajish
Published: November 2022

Aim

Development of Thrombo-embolic episode is a well-recognised complication after major abdominal surgery in high risk patients. studies have shown the extended VTE prophylaxis is beneficial for the patients after a major abdominal surgery.

Aim of this study was to evaluate the administration of extended VTE prophylaxis after being discharged home.

We prescribed LMWH for prophylaxis postoperatively for 28 days and patients or carers were trained to self-administer before discharge.

Method

This is a retrospective review of prospectively collected and maintained data on major abdominal surgery (Laparotomy) in a district general hospital for the length of VTE prophylaxis after discharge home. and compare the result with the standard set out by NICE. we collected the patients’ data from electronic database from January 2019 to January 2021.

Results

A total of 310 patients records were retrieved from the database system.

Our record result showed that 189(61%) patients went home with extended VTE prophylaxis. 121(39%) patients did not receive VTE prophylaxis after discharged.

Out of 121 patients 2 patients developed VTE

1 patient developed DVT and PE and one patient developed DVT only. Patient with DVT and PE was admitted for medical management.

Conclusion

Post operative DVT and PE are worrisome preventable complications for the patients after major surgery especially the elderly and patients with medical co morbidities. the morbid patients with malignancy are more challenging to mobilise after the surgery. There has been studies on extended VTE prophylaxis for such patients after discharge and benefits are documented for those patients with extended VTE prophylaxis.
EP-69 The use of IFAbond© tissue adhesive to reduce seroma rates and improve breast reconstruction outcomes
Authors: Lefroy Rebecca , Mylvaganam Senthurun
Published: November 2022

Introduction

Tissue adhesives have had uses in surgery for over 45 years. Evidence for use in haemostasis and cavity closure is growing. Seromas are a common (up to 85% incidence) but potentially serious complication in implant-based breast reconstruction (IBBR). If infected can cause implant loss and reconstruction failure. Tissue adhesives may reduce seroma rates.

Aims and Methods

Our study considered whether IFAbond© significantly reduces seroma formation following IBBR and as a pilot to evaluate the optimum use and application of IFAbond©. 7 consecutive patients undergoing pre-pectoral IBBR were recruited to the control arm (standard closure) and a further 7 patients undergoing pre-pectoral IBBR were recruited to the intervention arm (standard closure including IFAbond©). Qualitative assessment of seroma formation and IBBR objective early outcomes were assessed at 1 week, 2 weeks and 30 days.

Results

Cohorts were comparable for demographics, mastectomy weight and implant size. No wound infection, healing concerns or implant loss at thirty days in either cohort. No patients developed clinically significant seroma (requiring drainage) in either arm. 4 of 7 control arm patients developed clinically noticeable seroma at 30 days compared to none in the intervention arm.

Conclusions

IFAbond© is safe and easily applied during IBBR adding little time to closure. This study suggests that IFAbond© can reduce clinically evident seroma formation in IBBR compared to standard closure. This pilot will inform a larger study to explore the statistical significance of this intervention and with longer term follow-up whether this correlates to lower rates of implant loss/failure.
EP-82 The First International Delphi Consensus Statement on Laparoscopic Gastrointestinal Surgery
Authors: Omar Islam , Madhok Brijesh , Amr Bassem , Pouwels Sjaak , Graham Yitka , Mahawar Kamal
Published: November 2022

Introduction

Laparoscopic surgery is now firmly established in the field of gastrointestinal (GI) surgery and has replaced open surgery in many areas. The purpose of this exercise was to prepare a consensus statement highlighting the important principles of laparoscopic GI surgery.

Methods

A committee of 38 experts in laparoscopic GI surgery proposed and voted on 149 statements in two rounds following a modified Delphi protocol.

Results

A consensus was achieved on 133 statements after two rounds. There was 100% consensus on informing the team of unusual complex operations, asking for a second opinion when needed and following the ergonomics principles.

Additionally, 94.7% advised to have multiple options for abdominal entry, 100% agreed on tailoring the first port site to the patient, and 84.2% advised to use Veress needles with caution.

Moreover, 97.4% consensus was reached on keeping the intra-abdominal pressure at the minimum required, and 92.1% agreed that a pressure of 12 mm Hg is adequate for most intra-abdominal surgery.

There was a complete (100%) consensus on using cartridges of appropriate height, checking the doughnuts after using circular staplers, adding any foreign body inserted into the abdomen to the operating count, ensuring the integrity of instruments on removal from the abdomen, and avoiding handing over an operation in the middle.

There was a 100% consensus on focusing on precision, not the speed, and learning to use the non-dominant hand effectively.

Conclusion

A 38 experts achieved a consensus on 133 statements. Increased awareness of these should enhance the safety of patients undergoing laparoscopic surgery.
EP-85 Abdominal hernia mesh repair in patients with inflammatory bowel disease: A systematic review
Authors: El Boghdady Michael , Ewalds-Kvist Béatrice , Laliotis Aggelos
Published: November 2022

Aims

Postoperative hernia-repair complications are frequent in patients with inflammatory bowel disease (IBD). This fact challenges surgeons’ decision about hernia mesh management in these patients. Therefore, we systematically reviewed the hernia mesh repair in IBD patients with emphasis on risk factors for postoperative complications.

Method

A systematic review was done in compliance with the PRISMA guidelines. A search was carried out on PubMed and ScienceDirect databases. English language articles published from inception to October 2021 were included in this study. By MERSQI scores quality and evidence classifying were performed in agreement with GRADE's recommendations. The research protocol was registered with PROSPERO (CRD42021247185).

Results

The present systematic search resulted in 11243 citations with a final inclusion of 10 citations. One paper reached high and 4 moderate quality. Patients with IBD exhibit about 27% recurrence after hernia repair. Risk factors for overall abdominal septic morbidity in Crohn's disease comprised enteroprosthetic fistula, mesh withdrawals, surgery duration, malnutrition, midline incision site of hernia, biological mesh and digestive concomitant procedure.

Conclusion

Patients with IBD were subject, more so than controls, to postoperative complications and hernia recurrence. The use of a diversity of mesh types, a variety of position techniques and several surgical choices in the citations left room for less explicit and more implicit inferences as regards best surgical option for hernia repair in patients with IBD.
EP-94 To see or not to see: A case of complex multidisciplinary surgical reconstruction
Authors: Afify Sarah Jane , Leon-Villapalos Jorge , Scawn Richard , Sobti Manvi , Joshi Naresh
Published: November 2022

A 4 year-old child suffered catastrophic 60% total body surface area burn injuries affecting head and neck, trunk and limbs following sulphuric acid burns. He underwent limited treatment in his country consisting of first aid and debridement and grafting in upper and lower limbs and trunk, but no treatment to the facial and ocular areas.

He was referred for assessment and reconstruction in the United Kingdom. Even though there were widespread burn scar contractures, his most severe injuries involved both eyes and adnexal structures with evidence of severe bilateral cicatricial ectropion and threat to vision.

He required multidisciplinary plastic surgery and ophthalmic complex bilateral eyelid reconstruction in two separate procedures to restore anatomical and cosmetic integrity to both eyes.

The initial procedure involved examination under anaesthesia of both eyes, release of the left upper and lower eyelids burns scar ectropion and resurfacing of the resulting defect with full thickness grafts from the left clavicular area. The grafts had full take with no evidence of infection and excellent cosmesis.

A similar procedure was performed to reconstruct the right eyelids 6 weeks later. The vision of this eye was beyond salvage but the need for cosmetic eyelid symmetry was considered as an appropriate indication to proceed to reconstruction. This was found to be successful with excellent graft take and parental satisfaction.

This case required coordination, expert holistic approach, complex surgery and extra efforts from the team to ensure compliance, communication and positive outcomes and highlights the importance of multidisciplinary team effort.