bluuebunny/crossref_metadata_2025 huggingface dataset:
SP6.1.1 Cholecystectomy or expectant management after endoscopic sphincterotomy and bile duct stone removal?
Authors: Toogood Kate , Pike Thomas , Coe Peter , Everett Simon , Toogood Giles , Smith Andrew
Published: October 2021

Aims

Following ERCP, NICE guidance suggests that surgically fit patients undergo cholecystectomy to prevent recurrence of choledocholithiasis and its complications. However, for many patients who are deemed unfit or who choose not to have surgery, ERCP is their definitive management. This study examines the clinical outcomes and costs of expectant management (EM) or cholecystectomy following ERCP.

Methods

All patients that underwent ERCP, sphincterotomy and common bile duct (CBD) clearance at St James’s University Hospital between January 2015 and December 2018 were identified from a prospectively maintained ERCP database. The clinical outcomes for patients that had undergone an ERCP, sphincterotomy and CBD clearance for gallstones were identified from their electronic patient record. A cost analysis for the complete patient pathway was performed.

Results

820 patients underwent ERCP and CBD clearance for gallstones with a median 3.9 year follow up. 222 patients had undergone a cholecystectomy prior to ERCP and were excluded from analysis. 203 patients underwent planned cholecystectomy with 15% (31 patients) requiring complex surgery and 12% (24 patients) needing readmission. 395 patients received expectant management (EM). 9 (2.3%) patients returned with CBD stone symptoms, 6 (1.5%) went on to laparoscopic cholecystectomy (LC). The readmission rate in the EM group was 9%. The average cost per patient in the expectant management group was £7,487 and in the cholecystectomy group was £10,584.

Conclusion

The results from this study suggest that the need for cholecystectomy following ERCP is uncertain, with similar rates of biliary re-admissions in both groups.
SP6.1.3 Readmissions After Cholecystectomy in a Tertiary UK Center: Incidence, Causes and Burden
Authors: Omar Islam , Hafez Ahmed
Published: October 2021

Context

Although cholecystectomy is a widely performed procedure, postoperative readmissions place a heavy burden on healthcare facilities.

Aims

This study assesses the incidence, causes and burden of 30-day readmissions after cholecystectomy in a tertiary UK center.

Settings and Design

University Hospital, Retrospective Cohort Study.

Methods and Material

Information was obtained from our prospectively maintained database and hospital’s computerised records.

Statistical analysis

The encounters are expressed in numbers and percentages. The hospital stay, BMI and age are expressed in mean, standard deviation (SD), min-max and median. Microsoft Excel® was used to calculate the means, SD, min-max and median.

Results

Out of the 1,140 cholecystectomies performed over this time, there were 75 true readmissions and 29 revisits; thus, the actual readmission rate is 6.58%. Non-specific abdominal pain ± deranged liver function tests (LFT) is the most common cause of readmission at (38;36.54%) cases, followed by (18;17.31%) wound infections and (12;11.54%) collections/bile leaks/abscess. This costed the center 93 scans; 30 procedures and 295 days of hospital stay.

Conclusions

Non-specific abdominal pain ± deranged LFT is the most common cause of readmissions/revisits in the center. Readmissions after a cholecystectomy are a significant encumbrance.
SP7.1.7 The impact of surgical subspecialisation on patient outcomes in those admitted with gallstone disease in the North of England: a retrospective cohort study
Authors: McGovern Julia , Young John , Brown Leo , McLean Ross
Published: October 2021

The management of gallstone disease has evolved over time and includes laparoscopic and open cholecystectomy, interventional radiology, endoscopic intervention and conservative management. Subspecialisation within general surgery is commonplace, allowing development of specialist skillsets. The aim of this study is to assess the impact of consultant subspecialisation on patient outcomes in those admitted with gallstone disease.

A retrospective cohort study - data was collected on patients admitted with gallstone disease in the North of England between 2002 and 2016. Subspecialisation was categorised as Upper GI or other general subspecialties. The primary outcome of interest was overall 30-day mortality; secondary outcomes included surgical approach and length of stay.

A total of 62,286 patients were admitted with gallstone disease. Overall 30-day mortality was 2.1%. The UGI specialists had a higher operative rate - 21.5% vs 10.7% (<0.001) than their colleagues including performing more laparoscopic cholecystectomies– 15.6% vs 6.4% (<0.001), and on-table cholangiogram (OTC) – 3.5% vs 1.5% (p < 0.001).

22,071 patients were diagnosed with acute cholecystitis. Non-UGI Consultants preferred conservative management (76.5% vs 59.0% - p < 0.001) which did not significantly affect 30-day mortality. Data was analysed using IBM SPSS Statistics. Categorical data were compared with chi-square test, and continuous data with t-test or ANOVA. Statistical significance was defined as a p value of ≤ 0.05.

UGI consultants performed significantly more “hot gallbladders” than their non-UGI counterparts. UGI consultants choose to operate laparoscopically and perform significantly more OTCs, likely reducing need for pre-operative MRCP but not significantly reducing overall 30-day mortality or length of stay.
SP7.1.16 Endoscopy and biopsy for chronic diarrhoea: an audit and cost analysis
Authors: Abdelrahman Shadi , Kim Woo Jae , Daneshyar Adam , Odogwu Stephen
Published: October 2021

Aims

The aim of the study is to analyse the costs of performing diagnostic endoscopy with histopathological sampling for patients suffering with chronic or persistent diarrhoea.

Methods

300 patients were identified who required an endoscopy in 2019 according to the British Society of Gastroenterology guidelines. Patient’s presenting complaint, endoscopic and histological diagnosis and follow up plans were noted. 147 patients were included into our study whose presenting complaint was solely chronic or persistent diarrhoea. Those who presented with acute diarrhoea, PR bleeding or other concomitant indication for lower gastrointestinal endoscopy were excluded. Data from the national schedule of NHS costs was used to calculate expenditure.

Results

The total expenditure calculated for the 147 patients was £55,973. There was a total of 126 colonoscopies and 21 flexible sigmoidoscopies performed by the department. The number of patients who received medical treatment following endoscopy was 13/147 (9%) 8 of whom had nonspecific colitis on histology. There were 29 patients (20%) who required symptomatic treatment and there were 98 patients (66%) who received no intervention or were discharged immediately and 7 patients (5%) that required surgical intervention. The total cost of procedures not leading to surgical or medical management with steroids or immunomodulators was £47733 which is 85.3% of the total expenditure.

Conclusion

A significantly large proportion of investigations lead to no intervention or symptomatic treatment of the patient. Given this lack of diagnostic yield and financial burden, there could be room for advancement in the current guidelines for managing persistent diarrhoea.
SP8.1.5 Breast cancer follow up; Is routine mammography indicated?
Authors: Polak Petr , Beattie Declan , McIlmunn Colin , Kirk Stephen
Published: October 2021

Aim

This paper aims to review the outcome from yearly mammography in detecting breast cancer recurrence and new primary tumours in patients with a history of breast cancer.

Methods

From 2014, following treatment for breast cancer, patients were enrolled in a program of self-directed aftercare (SDA). They were given open access to the Breast service. Regular planned appointments were not offered. All patients underwent annual mammography for 5 years.

Retrospective analysis of the SDA database from 2014 to 2016 was undertaken, time to and mechanism of detection of breast cancer recurrence in this population was determined.

Results

352 patient records were analysed (1760 mammograms), 29 recurrences were identified. 12 locoregional, 12 systemic, 5 locoregional and systemic. Median time to diagnosis of recurrence was 30 months.

Locoregional recurrence was detected by surveillance mammography (4 patients), clinical examination following patient request (7 patients), non-breast radiological investigation (5), by non-breast cancer care Doctors (1). No contralateral cancers were detected in patients who had mastectomy or WLE.

Conclusion

Despite limited evidence for regular clinical assessment post breast cancer treatment, the practice remains recommended.

In this study regular clinical review was replaced by open access. Annual mammography was retained.

Mammographic value out-with detection of malignancy (new/recurrent) was not assessed. The number of tumours detected (4 out of 1760 mammograms) would suggest that non-stratified routine mammography is of limited value for most patients.

Further study is required to determine the risk or value and the cost/benefit analysis of mammographic follow up of breast cancer.
SP9.1.1 The Impact of Anaesthetic Use on Healing in Sub-cutaneous Abscess Management: A Retrospective Before and After Cohort Study
Authors: Elkadi Hannah , Dodd Eleanor , Poulton Theodore , Bolton William , Burke Joshua , Jayne David
Published: October 2021

Aims

Despite being the most common surgical procedure, there is wide variation that exists in the management of simple subcutaneous abscesses with no national guideline describing best practice. During the COVID-19 Pandemic national guidelines promoted the use of regional or local anaesthetic (LA) instead of general anaesthesia (GA) to avoid aerosol generating intubation associated with GA. This study aimed to assess the impact of anaesthetic choice in outcomes following incision and drainage of subcutaneous abscesses.

Methods

Two cohorts of patients undergoing abscess incision and drainage at St. James’ University Hospital Leeds were retrospectively identified over a 14-week period before and after the introduction of the new COVID-19 anaesthetic guidelines. Wound healing surrogate endpoints were used: i) total number of follow up appointments and ii) attendance to healthcare services after 30 days from I&D.

Result

133 patients were included. Significantly more procedures were performed under LA after the intervention (84.1% vs 5.7%; p < 0.0001) with a significant reduction in wound packing (68.3% vs 87.1%. p=0.00473). Follow up data found no significant difference in the average number of follow-up appointments (7.46 vs 5.11; p = 0.0731) and the number of patients who required ongoing treatment after 30 days (n = 14 vs n = 14, p = 0.921).

Conclusion

Drainage of simple subcutaneous abscess under 5 cm is safe under local anaesthetic with no significant difference in surrogate endpoints of wound healing observed in this patient cohort. Recurrent packing may not be required. Future work should explore patient reported measures such as pain management and the health economics of this intervention.
SP9.1.3 Abdominal X-Rays in the Emergency Setting- A Review of Current Practice
Authors: Armstrong Lará , Monaghan Helen , Jeffers Sarah
Published: October 2021

Aim

Abdominal radiographs (AXRs) are commonly used in the setting of acute abdominal pain. However, with low diagnostic yield, they can increase workload within the radiology department, increase patient radiation exposure and ultimately delay further diagnostic imaging. The average cost of an abdominal film, excluding staffing costs, is £45. This study aimed to investigate the appropriate use of AXRs in the emergency setting, as per the Royal College of Radiologists Guidelines (RCR).

Methods

A single centre retrospective review was conducted of all patients referred to the emergency surgical team over a 21 day period. Data was retrieved from electronic handover records. Demographics, radiology request forms and imaging results were obtained from up to date electronic care records.

Results

A total of 160 patients presented within the audit window, with a median age 49 (16-94) and 61.3% male. Overall, 36.9% of patients underwent an abdominal x-ray, 66.1% of which were not indicated in accordance with RCR guidelines. 71.2% of patients who underwent an abdominal x-ray required further diagnostic imaging by means of CT or USS. Only 10.2% of AXRs provided diagnostic information. Total cost expenditure for inappropriate AXRs = £1,755, excluding staffing costs.

Conclusions

Approximately two thirds of AXRs performed did not comply with the published RCR guidelines. Adherence to RCR guidelines can reduce needless radiation exposure, hospital costs and delay to diagnosis. We plan to conduct a teaching session on the RCR guidelines alongside the development of information posters, and re-audit our results.
SP9.1.5 Compliance with the NELA pathway at a District General Hospital. Reducing time to theatre by limiting CT-associated delay - A prospective closed loop audit
Authors: Ahmad Shahrukh , Hasbullah Nazhatul , Handa Siddhartha , Patel Panna
Published: October 2021

Aim

NELA recommends rapid request, conduct and reporting of CT to reduce the delay in time to theatre and thus ultimately improving patient outcomes. Our aim was to identify and reduce delays with regards to CT scanning and reporting.

Methods

Our Local Laparotomy Pathway standard recommends that CT scans be performed within one hour of being requested and reported within one hour of being performed. NELA data and electronic records were reviewed over a 3 month period (January 2020 to March 2020) - revealing that only 59% of pre-laparotomy CTs done (n = 17) complied with this standard.

A dedicated “CT Emergency Laparotomy” protocol was introduced, which assigned the scan as top priority for both radiographers and radiologists. After making this change, data was prospectively collected to see if there was reduced time from CT request to report.

Results

Compliance with the pathway standard for the three month period from October 2020 to January 2021 increased to 81% (n = 21). Reasons for non-compliance included patient instability, awaiting renal profile; and COVID-related deep cleaning between patients. Out of hours, CT reporting was outsourced, which led to even quicker reporting – with multiple scans being both performed and reported within one hour of the request. Of the 16 patients that fit the criteria for urgent laparotomy, 87.5% (14 patients) were operated on within 6 hours of initial intention to operate.

Conclusion

Our re-audit showed that after the introduction of a dedicated laparotomy CT protocol, there was reduced time to CT report and ultimately reduced delay to Laparotomy.
SP9.1.7 Emergency Laparotomy for Trauma in the United Kingdom and Ireland: a Prospective Multicentre Study
Authors: Vulliamy Paul , Marsden Max , Carden Richard , Brohi Karim , Davenport Ross ,   National Trauma Research and Innovation Collaborative NaTRIC
Published: October 2021

Aims

Trauma patients requiring abdominal surgery have significant morbidity and mortality, but are not included in existing national audits of emergency laparotomy. The aim of this study was to examine processes of care and outcomes among trauma patients undergoing emergency abdominal surgery in the UK and Ireland.

Methods

A prospective trainee-led multicentre audit was conducted over six months from January 2019 across the national trauma system. Patients undergoing laparotomy or laparoscopy within 24 hours of injury were included. Subgroup analysis was conducted in those requiring major haemorrhage protocol (MHP) activation.

Results

The study included 363 patients from 34 hospitals (22 major trauma centres). The majority were young males with no co-morbidities who required surgery for control of bleeding (51%) or exploration of penetrating injuries (46%). Over 85% received consultant-led care in the emergency department (318/363) and operating theatre (321/363). The MHP subgroup made up 45% of the cohort but accounted for 97% of deaths and 79% of ICU days, with a mortality rate of 19% and a massive transfusion rate of 32%. Compared to non-MHP patients they had shorter times to theatre (122 vs 218 minutes, p < 0.001), higher rates of advanced prehospital care (60% vs 33%, p < 0.001) and higher rates of consultant-led care (95% vs 85%, p < 0.001).

Conclusion

The majority of trauma patients requiring emergency abdominal surgery receive consultant-delivered perioperative care which is appropriately tailored to patient risk profile. Despite this, mortality and resource utilization among high-risk patients remains substantial, justifying ongoing performance improvement initiatives and research into novel therapeutics.
SP9.1.9 Are Tertiary Trauma Surveys a worthwhile use of time and resource?
Authors: Knight Chris , Smith Stella
Published: October 2021

Introduction

Patients sustaining major trauma undergo primary and secondary surveys in the emergency department to rapidly identify and treat injuries. Tertiary trauma surveys (TTS) are performed once the patient has been stabilised, within 24 hours of admission, to assess for further injuries. In December 2019, the major trauma service at our trauma centre was reconfigured to include a larger clinical team. Following this, we have assessed compliance with TTS completion and rate of new injuries identified.

Methods

Data was prospectively collected via hospital and TARN databases from 100 consecutive major trauma patients admitted over a two-month period from 1/8/20. Demographic data and key measures including, date and time of arrival to the hospital, date and time of TTS, performing clinician, injuries identified, mechanism of injury and ISS were collected.

Results

TTS was completed on 79/100 patients during their admission with 16.5% (13/79) of TTS performed identifying at least one additional injury. 18 separate injuries were identified which were categorized by AIS score: 22.2% AIS 1, 61.1% AIS 2 and 16.7% AIS 3. Of these injuries, 17/18 required further imaging and 3 required operative management. In 38.5% (5/13) of cases, the additional injuries increased the patients overall ISS.

Conclusion

This data demonstrates the importance of tertiary survey completion to ensure that all injuries sustained during major trauma are identified and treated promptly. Further development of this project will include expansion to a larger data set over a prolonged period to further evaluate the rate and significance of injuries discovered via TTS.
SP9.1.10 Penthrox for management of fractures, dislocations and more: Orthopaedics in the Emergency Department during the COVID-19 pandemic
Authors: Stephens Christian , Dias Ana , Brennan Ciaran , Lazizi Mohamed , Skinner Edward , Angel Charlotte
Published: October 2021

Aim

Methoxyflurane has undergone a renaissance using a smaller dose in a handheld ‘Penthrox’ device. There is minimal literature regarding its use in common orthopaedic management. Our Minor Injury Unit (MIU) was created due to COVID19 pandemic. The aim of this study was to investigate whether a Penthrox device could improve fracture/joint dislocation management and decreased the need for theatre resources at our MIU.

Methods

We reviewed all cases where Penthrox was used to facilitate minor procedures within a two month period. We recorded patient demographics, injury, time of admission, discharge and management. Success was defined as fracture manipulation into an adequate position, joint congruence achieved or completion of a planned procedure.

Results

101 Penthrox doses were given to 89 patients over 97 episodes between 24/3/2020 and 26/5/2020. No complications were recorded. There was 100% success rate on fracture manipulation. For joint dislocation: 65% on native shoulder reduction; 30% on prosthetic total hip arthroplasty reduction; 100% on native elbow reduction. Penthrox was also used for other procedures such as wound reviews, removing external fixators, and applying braces with 100% success rate.

Conclusion

We have shown that Penthrox is safe and can be used for common emergency Orthopaedic procedures, particularly fracture manipulation. This helped keep operating theatres and other anaesthetic resources free which were especially vital and scarce during the COVID19 pandemic.
SP10.1.1 Incidence, Risk Factors, and Outcomes of ARDS in Patients Admitted to Intensive Care with Asymptomatic SARS-CoV-2 Infection
Authors: Devarakonda Sreekar , Narayanan Sankara , Lingamdenne Paul Emerson , Kandasamy Subramani , Korula Pritish John
Published: October 2021

Aims

Many patients were found to have SARS-CoV-2 infection on admission to our ICU for non-COVID-19 related illness. This may alter the expected course of their presenting condition, especially when they develop ARDS. Hence, we wanted to study the incidence, risk factors, and ARDS outcomes of these patients admitted to our ICU.

Methods

We reviewed all admissions (medical, surgical, and obstetric) to our ICU from May to October of 2020 and studied their age, gender, comorbidities, admission diagnosis, APACHE II score, and in-hospital course. ARDS was defined as PaO2/FiO2 ≤ 300 mmHg (with PEEP or CPAP ≥ 5 cmH2O) in the absence of cardiac failure or fluid overload. Arterial Blood Gas, chest radiographs, and bedside echocardiography were used to diagnose ARDS.

Results

Of the 832 patients, 119 (14.3%) had SARS-CoV-2 infection. 41 of 119 (34.5%) patients developed ARDS. Among the comorbidities studied, only systemic hypertension (OR 2.6; 95% CI 1.0-6.2) seemed to increase the ARDS odds. Patients with sepsis (OR 5.8; 95% CI 2.4-13.7) and APACHE II score ≥10 (OR 5; 95% CI 2.0-12.3) had higher odds of developing ARDS. These patients required invasive ventilation, vasopressors, steroids and had prolonged hospital stays. Age, gender, trauma, and recent surgery did not seem to increase the risk of ARDS.

Conclusions

Asymptomatic COVID-19 patients with systemic hypertension, sepsis, and APACHE II score ≥10 are at a higher risk of developing ARDS. However, further research is needed to predict the extent to which SARS-CoV-2 infection will influence the course and outcomes of their presenting illness.
SP10.1.5 Are we utilising the predictive potential of FIT during a time of resource scarcity?
Authors: Carswell Victoria , MacLeod Campbell , Watson Angus , MacKintosh John , Docherty James
Published: October 2021

Aims

The COVID-19 pandemic has resulted in an unprecedented challenge. With the abolition of all non-urgent endoscopies nationwide, there has been concerning implications on colorectal cancer (CRC) diagnosis. Rationing of these scarce colonoscopy slots has become a priority. Faecal immunohistochemistry test (FIT) results are predictive of bowel pathology. Here we audit the clinical outcomes of patients that have undergone FIT in our health board in the pre and COVID-19 era.

Methods

Using business intelligence methods, an automated system for NHS eHealth data collection has been established. All patients who have undergone FIT testing are audited for clinical outcomes including investigation and pathology. Results from December 2018-2019 (pre-COVID) were compared to December 2019-January 2021 (COVID).

Results

There was a 70.12% increase in FIT uptake. 58.88% were female. Median age 73 (range 1-100). FIT results are compared below.

Conclusion

Our business intelligence approach has improved uptake of FIT in our community. There have been proportionally higher rates of colorectal cancer diagnosis with less resources. FIT specificity is 98.64% and therefore should be further widely accepted to ration resources.
SP10.2.4 COVID-19 impact on Surgical Training and Recovery Planning (COVID-STAR) - A Cross-Sectional Observational Study
Authors:   COVID-STAR Collaborative
Published: October 2021

Aims

The COVID-19 pandemic has led to changes in the delivery of surgical services which impact on surgical training. This study aimed to investigate the qualitative impact of COVID-19 on surgical training in the United Kingdom (UK) & Republic of Ireland (ROI)

Methods

A national, collaborative, cross-sectional study involving 13 surgical trainee associations distributed a pan-surgical specialty questionnaire on the impact of COVID-19 on surgical training (11th May - 8th June 2020). Various aspects of training were assessed. This study was reported according to STROBE guidelines.

Results

810 completed responses were analysed (M:401/F:390) from all deaneries and training grades. A significant negative impact of the pandemic on surgical training experience was observed. (Weighted average = 8.66). 41% of respondents (n = 301) were redeployed. Complete loss of training was reported in elective operating (69.5%), outpatient activity (67.3%) and endoscopy (69.5%). A reduction of > 50% was reported in emergency operating (48%) and completion of work-based assessments (WBAs) (46%). 3.3% (n = 17) of respondents reported plans to leave medicine altogether. Cancellations in study leave and regional teaching programmes without rescheduling were reported in 72% and 60% of the cohort respectively. Elective operative exposure and WBAs completion were the primary reported factors affecting potential trainee progression. Overall, > 50% of trainees (n = 377) felt they would not meet the competencies required for that training period.

Conclusions

COVID-19 has had a negative impact on surgical training across all grades and specialties, with implications for trainee progression, recruitment and retention of the surgical workforce.
TP1.2.7The stuck colonoscope
Authors: Sebastian B , Mirshekar-Syahkal B , Athisayaraj T , Ward N
Published: October 2021

Background

With the increased awareness and push for earlier diagnosis of colorectal cancer, the number of patients undergoing colonoscopy is increasing. Being a common condition, a number of these patients will have herniae. We describe a rare complication during a Sigmoidoscopy in a patient with an Inguinal hernia.

The case

A 75-year-old man was booked for a flexible sigmoidoscopy for rectal bleeding. The scope was successfully inserted to the Splenic flexure. During withdrawal, the scope stopped moving. It was still possible to advance the scope, but not to withdraw. The patient confirmed the presence of a left inguinal hernia. Physical examination and the position on magnetic scope imager confirmed the loop in the hernia.

Various manoeuvres to withdraw the scope were unsuccessful. A colleague was called for a second opinion. We came up with a plan to maintain a ‘long loop‘ position in the hernia, by holding the scope through the scrotum and allowing it to slide on withdrawal. This was successful and the patient was discharged.

Discussion

Incarceration of the scope in the hernia occurs when the hernial defect permits entry and exit of the scope, leaving a loop in the hernia, in a long loop position. During withdrawal, the configuration changes to a short loop, crowding the hernial defect, preventing the scope from sliding. On searching literature, we found that this technique has been described by Koltun et al and is known as the “Pulley” technique. We suggest that colonoscopists are familiar with this technique.
TP5.2.10 Ligation Versus Repair of Isolated Traumatic Peripheral Deep Venous Injury: A Systematic Review And Meta-analysis
Authors: Shahzad Noman , Moosa Asad , Shaikh Fareed , Siddiqui Nadeem , Macierewicz Jan
Published: October 2021

Optimal management of isolated peripheral deep venous injuries remain controversial with no clear evidence based guidelines on repair vs ligation. We aimed to compare the morbidity and mortality after venous reconstruction versus ligation of isolated peripheral venous injuries in patients with trauma.

Methods

We conducted systematic review and meta-analysis of all literature reported on management of isolated vascular injuries in adult trauma patients excluding case reports from 1950 to 2020. Primary outcomes of interest were mortality and amputation while secondary outcomes of interest were compartment syndrome, chronic venous hypertension, deep venous thrombosis and pulmonary embolism. Pubmed, Google Scholar, Cochrane database and Web of Science were searched for relevant literature. Study selection and sysnthesis was done following PRSMA Guidelines. Protocol was registered with PRSPERO (Registration Number: CRD42019143136).

Results

A total of 25 studies met our selection criteria and reported at least one of outcomes of interest. All the data is from observational studies with mostly retrospective data collection. Results of our meta-analysis show that ligation is significantly associated with higher rate of amputations [OR: 1.73 (1.20 – 2.48), p = 0.003] and mortality [OR: 1.5 (1.09 – 2.06), p = 0.01] whereas there is no significant difference in rate of chronic venous insufficiency, deep venous thrombosis and pulmonary embolism. There is not sufficient data to analyze various types of repair. Also data is lacking to account for clinical severity at time of presentation.

Conclusion

Our results favor repair over ligation of isolated peripheral deep venous injury.
TP6.1.6 The management of pancreatic fluid collections with AXIOS stenting in Belfast HSCT
Authors: Doyle Joseph , Latip Nadiah , McCain Stephen , Magee Claire , Jones Claire
Published: October 2021

Aims

To assess the viability of using lumen-apposing self-expandable AXIOS stents, inserted under endoscopic ultrasound guidance, in the management of pancreatic fluid collections (PFCs) within the Belfast Health and Social Care Trust.

Methods

Data for all AXIOS stents inserted endoscopically between May 2016 and July 2019 were included. Electronic care records (ECR) and Radiology reports were reviewed for each patient. PFCs were categorised into walled-of pancreatic necrosis (WOPN) and pseudocysts, and the number of repeat procedures, OGDs with lavage, or the need for definitive surgery were recorded. The timeframe to surgery and whether PFCs recollected was also noted.

Results

45 AXIOS stents were inserted for PFCs in the audit period. n = 17 (37.8%) were for WOPN, n = 28 (62.2%) for pseudocysts. Mean duration of stenting was 38 ± 19.7 days. n = 11 (35.6%) patients were readmitted for sepsis with stent in situ, and n = 16 (35.6%) required OGD and lavage for stent blockage (n = 11 WOPN; n = 5 pseudocyst). n = 2 (4.4%) stents accidentally dislodged during lavage necessitating surgical removal. n = 4 (8.9%) patients required a second AXIOS stent following removal, n = 2 (4.4%) required CT guided drainage and n = 8 (17.8%) ultimately required surgical intervention.

Conclusions

Despite some drawbacks, including the need for intermittent OGD and lavage to maintain patency, AXIOS stenting appears to be effective first-line management for PFCs. Our audit showed they were successful in 71% of cases, requiring no further intervention. In PFCs that do require surgical management, AXIOS stenting may represent an effective bridge to surgery allowing for patient optimization before definitive care.
TP6.2.1 Does the use of Negative Pressure Wound Dressings decrease superficial Surgical Site Infections in the Emergency Laparotomy?
Authors: Smith Eleanor , Merriman Hannah , Haidar Safia , Knudsen Grace , Kinkaid Victoria , Burton Sarah
Published: October 2021

Aims

Surgical site infection (SSI) can be a significant cause of morbidity in the emergency laparotomy patient. Previous research into the role of negative pressure wound dressings to improve the rate of SSI culminated with NICE guidelines in 2019 recommending the use of negative pressure wound dressings in people who would be considered high risk for developing an SSI. Based on this guideline, we changed our policy to recommend the use of PICO dressings for all emergency laparotomies in order to decrease our rate of SSI. Our aim of this study was to assess the success of this policy change.

Methods

In this closed-loop audit we analysed data from all laparotomy patients at Frimley Park Hospital over 12 months. We retrospectively analysed the data of the pre-intervention group between January – June 2019, and prospectively audited all laparotomy patients between July – December 2019.

Results

We found that there was no significant decrease in the rate of superficial SSI, from a pre intervention rate of 22.2% to a post intervention 24.1%. Similarly, we found no significant decrease in the rate of wound dehiscence, which increased from 13.8% to 17.7%. In further assessment we saw no significant difference in the rates of contamination, ASA grades, or closure techniques to account for these increased rates.

Conclusion

While other studies have demonstrated a decrease in SSIs following the use of PICO dressings, we did not show such a result, leading us to question the cost-effectiveness of negative pressure wound dressings in the emergency laparotomy patient.
TP6.2.3 Abnormal liver function tests: A helpful diagnostic test and a predictor of severity in acute appendicitis
Authors: Telfah Muwaffaq , Mason Mathew , Hollyman Marianne , Noble Hamish , Mahon David , Welbourn Richard
Published: October 2021

Aim:

Acute appendicitis (AA) is the commonest surgical emergency worldwide. The diagnosis usually is clinical but imaging and bloods tests are helpful. The study aims to establish the role of abnormalities in liver function tests (LFTs) in the diagnosis and in predicting the severity of AA.

Methods

Retrospective, observational study performed in district general hospital between June 2018 and June 2019. Patients with abdominal pain and appendicectomy (excluding children <16 years with isolated ALP rise) were categorized into two groups based on presence (Group-A) or absence (Group-B) of abnormal LFTs. Demographics data, diagnosis and severity of appendicitis, hospital stay and postoperative complications were analysed.

Results

Two hundred and seventy nine patients were included: Group-A (n = 146, mean age 37.5 years, M: F 1.3/1.0) and Group-B (n = 133, mean age 29.7 years, M:F 1.0/1.8). Appendicitis occurred in 85.6% of Group-A (125/146) and in 62.4% (83/133) of Group-B with positive predictive value 85.6%. The appendix was normal in 14.4% of Group-A (21/146) and in 37.6% of Group-B (50/133) with specificity of 70%. Laparotomy was required in 6.1% in Group-A (9/146) compared to 1.5% in Group-B (2/133). Average hospital stay was 4.7 days (range: 1-21) in Group-A versus 2.7 days (range 1-14) in Group-B. Readmission rate due to a postoperative complication was 16.4% in Group-A (24/146) compared to 6% in Group-B (8/ 133).

Conclusion:

Deranged LFTs is an additional diagnostic tool in AA and a good predictor of its severity. This may help to decrease the negative appendicectomy rate and guide surgeon in the decision-making process.
TP6.2.8 Impact of patients’ characteristics on operative difficulty and clinical outcomes of laparoscopic cholecystectomy
Authors: Orabi Amira , Di Mauro Davide , Njere Ikechukwu , Ratano Marco , Thavakumar Sankavi , Manzelli Antonio
Published: October 2021

Background

Laparoscopic cholecystectomy (LC) is a common surgical procedure. Intraoperative findings are highly unpredictable and the operative difficulty varies from straightforward to very challenging procedures. Several studies described predictors of technical difficulty and graded intraoperative findings of LC, however none specifically reported on the effect of such factors on clinical outcomes. This study aims to evaluate the impact of patients’ preoperative characteristics on operative difficulty of LC and clinical outcomes.

Methods

Data of patients who underwent LC from 2015 to 2017 retrospectively analysed. Subjects were divided into four groups, according to Nassar’s classification of intraoperative difficulty. Differences in frequencies were evaluated with the Fisher’s exact test; logistic regression analysis was used to identify independent variables that were predictors of postoperative morbidity and length of stay.

Results

A total of 1069 patient were included. Male to female ratio of 1:2.5. Older age, male gender and comorbidities were associated with higher Nassar score (p < 0.0001); Nassar 3 and 4 were predictors of postoperative morbidity(P£0.01). The day case rate was 88.8% (Nassar 1), 86.1% (Nassar 2), 69.6% (Nassar 3), 62.3% (Nassar 4), respectively. Age of 60 and above(P£0.018), ASA 2 or 3(P£0.04) and Nassar 3, 4 (P£0.012), were predictors of increased conversion from day case to in-patient stay.

Conclusion

LC can be performed on a day case basis even when surgery is technically challenging. However, the need of in-patient stay can be predicted in comorbid old adult men with anticipated higher Nassar’s score.
TP6.2.23 Does using intraoperative Tisseel reduce the leak rate in Cardio-Oesophagectomy: A single centre retrospective audit of anastomotic and chyle leaks
Authors: Blake Iain , Chapman Stuart , Turner Paul
Published: October 2021

Aims

Anastomotic leak and chylothorax are serious complications of cardio-oesophagectomy. The application of a tissue sealant to the anastomosis and ligated thoracic duct could be beneficial in protecting against leaks. We aimed to determine if using Tisseel, a fibrin-based tissue sealant, had any impact on anastomotic or chyle leak rates following cardio-oesophagectomy.

Methods

All elective cardio-oesophagectomys performed in a tertiary upper GI centre between 01/01/2013 and 01/01/2018 were identified. Patient records were retrospectively analysed to assess basic demographics; whether Tisseel was used; whether anastomotic or chyle leak occurred and if so whether this was managed conservatively or surgically.

Results

245 records were available, Tisseel was used in 151 cases (61.6%). Patient demographics were similar between the Tisseel and no Tisseel groups (82.7% vs 77.7% male, mean age 66 vs 65 years). There was no significant difference in anastomotic leak (4.0% vs 7.4%, p = 0.24) or chyle leak (6.6% vs 4.3%, p = 0.44) rates. For patients who had an anastomotic leak there was a significantly lower rate of re-thoracotomy when Tisseel was used (16.7% vs 85.7%, p = 0.021). There was no significant difference in re-thoracotomy rates for chyle leak (40% vs 100%, p = 0.085).

Conclusion

Our data does not show any significant difference in leak rates when Tisseel is used. However, it does show that Tisseel use is associated with lower rate of re-thoracotomy in patients with anastomotic leak. This could possibly be due to smaller contained leaks. Further work is needed to determine the true benefit of Tisseel use in cardio-oesophagectomy.
TP6.2.26 Innovations Towards Achieving Environmentally Sustainable Operating Theatres: A Systematic Review
Authors: Perry Helen , Reeves Nicola , Brennan Fiona , Morris Daniel , Torkington Jared , Horwood James
Published: October 2021

Introduction

The NHS accounts for 5.4% of the UK’s total carbon foot print, with the perioperative environment being the most resource hungry aspect of the hospital. The aim of this systematic review was to assimilate the published studies concerning the sustainability of the perioperative environment, focusing on the impact of implemented interventions.

Methods

A systematic review was performed using Pubmed, OVIC, Embase, Cochrane database of systematic reviews and Medline. Original manuscripts describing interventions aimed at improving operating theatre environmental sustainability were included.

Results

648 abstracts were screened with 33 manuscripts included. Studies were divided into broad themes; recycling and waste management, waste reduction, reuse, reprocessing or life cycle analysis, energy and resource reduction and anaesthetic gases. This review summarises the interventions identified and their resulting effects on theatre sustainability.

Discussion

This systematic review has identified simple, yet highly effective interventions across a variety of themes that can lead to improved environmental sustainability of surgical operating theatres. Combining these interventions will likely result in a synergistic improvement to the environmental impact of surgery.
TP7.2.3 The effect of immediate versus early instillation of mitomycin C after transurethral resection of bladder cancer: Is timing everything?
Authors: Fernandes Ricardo , Mukherjee Ankur , Patel Ameet
Published: October 2021

Introduction and Aims

Almost three quarters of patients diagnosed with bladder cancer have non-muscle invasive disease. The European Association of Urology (EAU) guidelines recommend the use of intravesical instillation of Mitomycin C (MMC) to reduce the rate of recurrence.

Methods

A retrospective cohort analysis was carried out of all patients who underwent a TURBT between January 2016 and January 2019 in our Trust. A comparison of recurrence outcomes was investigated between patients who had immediate instillation of MMC (within 1 hours post-TURBT) versus early instillation (within 24 hours post-TURBT). Recurrence was assessed at 3 months cystoscopy and at 1 year follow-up.

Results

201 patients were included. 100 underwent immediate MMC instillation (75% male, 25% female); 101 early instillation (72% male, 28% female). There was 11% recurrence (immediate) versus 13% (early) in instillation groups at 3 months. At first year, recurrence was seen in 12% (immediate) versus 14% (early) groups. Of these recurrences, there was an upstaging of tumour in 27% (immediate) versus 31% (early) at the 3 monthly follow-up and 25% (immediate) versus 28% (early) at the 1st year. The mean period of post-operative stay following initial TURBT was 0.8 days in the immediate versus 1.1 days in the early instillation groups.

Conclusion

Although no statistical differences were seen in this study, the results appear to favour immediate instillation of MMC after TURBT with respect to reduction in recurrence and upstaging rates. Post-operative length of stay in hospital was also shorter in patients who had an immediate MMC instillation.
TP7.2.9 Natural orifice surgery in early rectal cancer; is it the way forward?
Authors: Sharma V , Shang E , Abu Talib M , Hamer N , Garg D , Jha M
Published: October 2021

Aims

Transanal-endoscopic microsurgery (TEMS) for early rectal cancer is an attractive alternative to radical surgery. With proper patient selection, it is possible to achieve acceptable oncological outcomes with fewer complications. We aim to study the outcomes following TEMS for suspicious or proven rectal cancers performed in our unit.

Method

We performed a retrospective analysis of prospectively collected data between May-17 and Oct-20. The patients’ details, tumour specific data, short term outcomes, and recurrences were recorded.

Results

A total of 45 patients with early rectal cancer (M = 29, F = 15) were included in this study. With1 exclusion due to intraoperative rectal perforation, 44 were available for further analysis. Eleven had a diagnosis of cancer at the time of surgery, an additional 11 patients were confirmed on final histology, and 22 were benign. Final histology showed: T1=14, T2=4, T3=3 &Tx=1. The majority (68%) had clear resection margins (R1=3, R2=1, Rx = 3). Twelve patients went on to have further treatment. Seven had resectional surgery (AR = 5, APR=2) for unfavorable histology (2), residual disease (3), or recurrence (2). The other 5(23%) received chemotherapy+/-radiotherapy (unfit/patients’ choice) for unfavorable. Histology (3) or residual disease (2).

Conclusion

With judicious patient selection, it is possible to offer a less invasive option with acceptable oncological and patient related outcomes for suspicious and proven malignant rectal lesions. The majority of patients (84%) were able to avoid radical surgery or stoma, thereby reducing the associated morbidity. Whilst this is a single institution study, we believe with available expertise this could be widely replicated.
TP8.1.1 Does ultrasound quantification of suspicious axillary nodes correlate with pathological results?
Authors: Abdullah Muhammad
Published: October 2021

Aims

Fast-track axillary node clearance (ANC) leads to overtreatment of axilla. Improved quantification by axillary US (AUS) is suggested to avoid unnecessary ANC and proceed with ANC or SLNB based on the number of abnormal axillary nodes. This retrospective study was aimed to evaluate whether ANC can be omitted based on AUS quantification in patients with low axillary burden.

Methods

Retrospective data of breast cancer patients who underwent ANC following a positive pre-operative axillary nodal biopsy between 1 January 2017 and 31 December 2018 were included in this study. The patients who received neoadjuvant chemotherapy, those having ANC following positive SLNB and those with axillary recurrence were excluded. The histopathology results of ANC were correlated with axillary ultrasound findings.

Results

45 patients underwent fast-track ANC following positive axillary core biopsy. On pre-operative AUS, 18 of these patients were reported to have a single abnormal node, while 8 had two abnormal nodes and 19 patients had multiple abnormal nodes. The comparison of the number of metastatic nodes following ANC, and the reported abnormal nodes on pre-operative AUS, showed that 57.3% of patients with 1 – 2 abnormal nodes on AUS had 3 or more metastatic nodes and 26.3% of patients with multiple abnormal nodes on AUS had 1 – 2 metastatic nodes following ANC.

Conclusions

The quantification of the axillary burden with pre-operative AUS does not correlate with the number of metastatic axillary nodes. The reported relevant axillary burden on AUS is not sufficiently specific to form the basis of omission of ANC.
TP8.1.11 Discussing results and breaking bad news in breast video consultations: a pilot questionnaire
Authors: Touqan Nader , Nasir Nabila , Williams Kate , Bramley Maria , Shamim Absar M
Published: October 2021

Aim

Virtual consultations (VC) in Breast Surgery have become well-established during the COVID pandemic. They are successfully utilised in routine follow ups and low-risk new referrals. We aimed to assess the utility of VC in more complex clinical discussions.

Methods

We collected feedback anonymously via electronic link from 20 consecutive patients who specifically had more challenging video-VC including: 12 diagnostic MDT results (10 patients received bad news of new cancer diagnosis, 2 had benign results); 6 post-operative wound checks with therapeutic MDT outcomes; 2 new consultations for chest wall reconstruction.

Results

The time saved by patients was between 1 and 3 hours (median=2). All patients felt that booking and joining a VC was either very easy (12) or easy (8). 18 patients were satisfied with the quality of sound and picture and all 18 felt they were able to communicate everything to the clinician during their VCs. Compared to a face-to-face consultation, 14 patients felt that VC was better (70%), 4 felt it was similar (20%) and 2 thought it was worse (10%).

Most received comments were themed around VC had allowed patients to get their results, discuss their management plans and ask questions while they were safely at home with other family members, at times when COVID restrictions applied to outpatient clinical settings.

Conclusion

VC may be utilised selectively to provide complex consultations including discussing results, breaking bad news and wound inspections. Qualitative studies in this field can be beneficial.