bluuebunny/crossref_metadata_2025 huggingface dataset:
TH2.3 Elective versus emergency management of gallstone disease at a tertiary referral centre amidst the COVID-19 pandemic - should the protocol be altered?
Authors: Renna Maxwell , Sinha Aaditya , Pinto Kevin , Roe Caitlin , Koh Chloe , Cheung Katie
Published: November 2022

Background

Gallstones are a common pathology affecting approximately 15% of the population in UK, 20% of which are symptomatic. It is suggested symptomatic patients undergo cholecystectomies. Guidelines recommend this is performed within one week of initial emergency presentation or 52 weeks for elective case. Surgical capacity to manage emergency cholecystectomies was limited due to the COVID pandemic. We assessed wait time discrepancy between elective and emergency cholecystectomies.

Methods

A retrospective review of all patients undergoing cholecystectomies between January and November 2021 in a major tertiary referral centre in London was undertaken. Initial pathology at the time of presentation, elective vs emergency presentation, pre-surgical biliary complications along and wait times were reviewed.

Results

219 (74 elective, 145 emergency) patients underwent surgery, mean age 48 years (23% Male and 77% Female). Average wait times for elective cholecystectomies were 69.7 days (min 0, max 246) in comparison to 68.9 days (min 1, max 253) for emergency surgery. 22 (15%) of the patients of initial emergency presentation re-attended hospital and 6 (4%) had adverse events such as gallbladder perforation or pancreatitis due to delayed treatment. Comparatively, 9 (12%) elective patients attended A&E due to pain, with no adverse outcomes.

Conclusions

Overall wait time of emergency vs elective cholecystectomies were similar. This review indicates emergency cases require prioritisation over elective cholecystectomies due to the higher number of re-attendance and adverse events. Emergency cases need to be prioritised to meet guidelines, which could also reduce complication rates whilst awaiting surgery and lead to fewer adverse outcomes.
TH2.6 Evaulation of the prognostic utility for hENT 1 transmembranous protein in resected hilar cholangiocarcinoma patients
Authors: Bird Nicholas , Manu Nichola , Shehata Zak , Fenwick Stephen , Jones Robert , Malik Hassan
Published: November 2022

Aims

Human equilibriative nucleoside transporter protein 1 (hENT1) facilitates nucleoside transport into the cell. Immunohistochemically-detected hENT1 is increased in cholangiocarcinoma tumour cells and in highly metabolising cells. The Mackey 10D7G2 hybridoma has demonstrated prognostic utility in Pancreatic Ductal Adenocarcinoma. The Proteintech Polyclonal hENT1 antibody's prognostic utility has not been assessed. Cellular Ki67 expression is linked to tumour proliferation. This study aims to assess the antibodies’ prognostic utility for resectable hilar cholangiocarcinoma.

Methods

Between 2009–2016, 54 patients underwent resection for peri-hilar cholangiocarcinoma. Formalin-Fixed Paraffin Embedded blocks from 44 specimens were retrieved. A Tissue-Matched Array was constructed and stained for each antibody. H-scores were utilised to determine expression intensity. Correlation of expression was determined by Pearson correlation co-efficient and Chi-squared. Silencing RNA for transfected HepG2 cell-lines was used to determine accurate hENT1 staining by the Proteintech antibody. Demographic and survival characteristics were acquired from a prospectively held database, and were calculated with global log-rank calculations.

Results

There was significant correlation between the Mackey and Proteintech antibodies (p<0.001), and between the Proteintech antibody and Ki67 expression (p= 0.02). Knockdown of hENT1 with silencing RNA transfected HepG2 cells was confirmed by Western blot. The antibodies (Mackey; Proteintech; Ki67) showed no significance for predicting OS (p= 0.75; 0.63; 0.22 respectively). Nodal stage (p= 0.03) and tumour differentiation (p= 0.02) showed prognostic utility.

Conclusion

While the Proteintech antibody demonstrates concordance with the 10D7G2 antibody in determining hENT1 expression, they didn't demonstrate significant prognostic ability. Standard histopathological co-variates retain prognostic utility within the cohort.
TH2.8 Continuing fast-track (Expedited) pancreaticoduodenectomy service during the Covid-19 pandemic: Experience from an established pancreatic surgical centre
Authors: Trivedi Dharmadev , Lee Sheah Lin , Takhar Arjun , Armstrong Thomas , Primrose John , Arshad Ali
Published: November 2022

Aim

Avoiding preoperative biliary drainage (PBD) can facilitate early curative surgery for patients with periampullary tumours. However, the evidence over PBD is conflicting. This prospective re-audit aimed to assess compliance to NICE guidelines (NG85) and surgical outcomes at a well-established HPB surgery unit after achieving additional theatre sessions following prior audit.

Methods

Prospective data collection and analysis for all patients undergoing pancreaticoduodenectomy with curative intent was performed as re-audit at a tertiary pancreatic centre between September 2020 to August 2021.

Results

64 or 71 patients received curative pancreaticoduodenectomy (43 Kausch-Whipple & 23 pylorus-preserving pancreaticoduodenectomy, 7 inoperable). Of 29 patients without PBD, 10 were jaundiced with median bilirubin levels of 138 Micromole/L (range 27–357 Mmol/L). Median time (range) from diagnostic imaging to surgery with curative intent was 21 days (3–42) for patients without PBD compared to 62 days (22–305) for those with PBD (p=0.00028). No statistically significant difference in median HDU/ITU stay (4 Vs 3 days, p=0.849), postoperative complications (C-D>2) (30% Vs 27.8%, p=0.755), R0 resection rates (42.8% Vs 75%, p=0.364), and median hospital stay (17 Vs 10 days, p=0.076) was observed for patients without or with PBD respectively. Interestingly, inoperable patients had shorter time delay from diagnostic imaging to surgery (29 Vs 49 days, p=0.010)

Conclusion

Fast-track (expedited) pancreaticoduodenectomy is feasible and safe for selected group of jaundiced patients without PBD. The constraints and challenges posed by Covid-19 pandemic are likely reflected in higher number of patients receiving PBD (42/ 71) despite clear referral pathway established following prior work at our institute.
TH2.12 Difficulties in managing acute gallstone disease at a Tertiary Referral Centre admist COVID-19
Authors: Pinto Kevin , Roe Caitlin , Koh Chloe , Cheung Katie , Sinha Aaditya , Ebied Husam , Renna Maxwell
Published: November 2022

Background

Acute biliary disease, a surgical emergency, is predominantly treated conservatively initially. Specialist units aim to follow guidelines set by the Royal College of Surgeons and NICE to provide a cholecystectomy within a set time. Clinical practice at St Thomas’ Hospital was reviewed along with the difficulties during the COVID-19 pandemic.

Aims

Reassess practice at a specialist unit failing to meet guidelines during the start of COVID-19. Prospective data collection, on patients booked for a laparoscopic cholecystectomy (LC) after emergency attendances.

Method

Initial retrospective data analysis, reviewing pre-COVID (PC19) practice (03/19–02/20), initial COVID-19 (IC19) management (03/20–12/20). Prospective data (01/21–11/21) after implementing changes (AC19).

Identifying demographics, pathology, length of stay during acute admission, average wait for surgery and readmission rate prior to surgery. Patients receiving surgery within 6 weeks, which has been set by our trust as an acceptable standard.

Results

Patients with acute presentation (acute cholecystitis, gallstone pancreatitis, cholangitis) 162 (PC19), 80 (IC19), 145 (AC19). Gender Ratio M:F 1:2 for all groups. Average wait to surgery 93 (PC19), 44 (IC19), 69 (AC19) days. Patients receiving surgery within 6 weeks 24.7% (PC19), 32.5% (IC19), 51.7% (AC19). Patients who were still awaiting surgery at the end of each time frame 49% (PC19), 51% (IC19), 48% (AC19). Mean length of surgical stay 1.75 (AC19) days.

Conclusions

Further changes are required, as guidelines are still not being met, with average wait times significantly above the recommended wait to undergo laparoscopic cholecystectomy.
TH3.4 Perineal reconstruction following standard and extralevator abdominoperineal excision: results of a national practice questionnaire
Authors: Shah Rushabh , Kamble Rituja , Herieka Mohammad , Dalal Milind
Published: November 2022

Aims

Challenging perineal defects resulting from extralevator (ELAPE) and standard abdominoperineal excision (APE) have resulted in a growing multidisciplinary approach between colorectal and plastic surgery colleagues. Currently there is a paucity of evidence on best practice in this emerging field. This study aims to define and describe current national practice within the United Kingdom (UK) in perineal reconstruction following APE/ELAPE.

Methods

A national practice questionnaire was designed using ‘Google Forms' and circulated via email to 41 units across the UK performing perineal reconstruction following APE/ELAPE.

Results

Complete responses were received from 23 units (response rate 56%), representing 12 regions across the UK. All units had a dedicated APE/ELAPE service. 70% had a standardised approach to reconstruction, with the Inferior Gluteal Artery Perforator (IGAP) flap being the most common approach (n = 11). Significant variation was observed in the reconstructive approach with regards to flap choice and routine use of pelvic acellular dermal matrix or mesh. Similar differences were observed in the perceived importance of various surgical factors that guide the reconstructive decision making process.

Conclusions

Our national practice questionnaire responses report nationally well established local networks between colorectal and plastic surgeons. However, the variation in results reflects a lack of national consensus on the optimal reconstructive method after APE/ELAPE. Our study highlight the need for the development of collaborative evidence based national guidance on best practice.
TH3.10 An audit assessing factors contributing to the 5-year disease recurrence rate after curative resection of rectal cancer
Authors: Youssef Nadia , Sinha Ishani , Williams Gethin
Published: November 2022

Aim

To study the 5-year recurrence rate of rectal adenocarcinomas following curative surgery in a cohort of patients from a single Health Board, and to identify statistically significant risk factors of disease recurrence.

Method

This audit included a total of 95 patients who underwent elective resections of primary rectal cancer between January 2014 and January 2016 at a single health board. The 5-year disease recurrence rate was documented. Medical records were accessed via the Clinical Workstation system and a number of factors were recorded and statistically analysed on Microsoft Excel using z-score for two populations portions. A p-value of <0.025 was considered statistically significant.

Results

Of the 92 patients included in this audit, 23 suffered disease recurrence. Younger age at diagnosis, tumour perforation, positive lymph nodes, tumour involvement of circumferential resection margin, and extramural vascular invasion were all associated with significantly increased risk of disease recurrence and poorer prognosis. Postoperative complications were observed in 26% of the cohort and it was significantly (p=0.009) associated with disease recurrence. Although more patients who developed disease recurrence received chemoradiation as part of their initial disease management, the number was not statistically significant.

Conclusion

The audit supports lowering the age of bowel cancer screening. Strategies are required to minimise the risk of postoperative complications in patients undergoing elective rectal cancer resections. Reasons must be identified as to why patients with a higher risk of recurrence, undergoing curative surgical resection of tumours, do not have higher uptake of adjuvant and neoadjuvant chemoradiation.
TH4.2 To do or not to do, Branch ligation of a non-maturing arterio-venous fistula for haemodialysis
Authors: Abdelwahed Abdallah , de Figueiredo Fatima , Gambhir Raghvinder Pal Singh
Published: November 2022

Aim

Up to 20% of arterio-venous fistulas (AVFs) may fail to mature to become usable for renal access in patients on Haemodialysis (HD). There is no consensus on benefit of branch ligation. This study aimed to assess the outcomes of branch ligation on maturation of these AVFs.

Methods

Electronic patient records and Renalware were accessed to obtain data of branch ligation procedures done at secondary care centre from 2016 till 2021.

Results

With a prevalent dialysis population of over 771 patients and incident dialysis population of 147 in 2021, we as a centre perform 250–300 access procedures annually.

A total of 23 ligation procedure were done in the above-mentioned period. Less than 50% of patients had a large branch documented on Duplex scan report to be draining a significant and measurable flow away from the AVF. The other procedures were done based on clinical judgement. All procedures were done under Duplex guidance and under Local or Regional anaesthesia. About two thirds of the fistulas that required branch ligation were Radio-Cephalic AVFs, the rest Brachio-Cephalic AVFs. No complications were reported though one patient needed a fistuloplasty due to vein pinch.

In 16 out of the 23(69.5%) patients there was clinical and sonological improvement in flow, and or vein diameter after the branch ligation making them usable for HD.

Conclusion

Branch ligation of non- maturing fistula in selected cases can help maturation and make these arteriovenous fistulas usable.
TH5.2 Gender differences in patients undergoing emergency appendicectomy
Authors: Khan Khurram , Gall Lewis , Miller Gillian , Al-Azzawi Yassir , Macdonald Andrew
Published: November 2022

Aims

Although appendicectomy is common, there exists minimal published literature exploring whether there are differences between adult males and females undergoing appendicectomy. This study aimed to investigate the demographics, pre-operative investigation, intra-operative findings and clinical outcomes between both genders having an emergency appendicectomy (EA).

Methods

A multicentre retrospective observational study was carried out across four hospitals who had an EA between August 2018 and November 2020. Patients were identified through pathology records. Data was extracted from electronic records for demographics, pre-operative (peak) blood results, pre and post-operative imaging, operative details, and the clinical outcomes. Patients were dichotomised by gender and results compared. Data was analysed using unpaired Student t test or Chi-squared test as appropriate with p < 0.05 considered statistically significant.

Results

1,128 emergency appendicectomies (57.5% male) were included. Males undergoing EA were younger (median age: 34 vs 40 years, p<0.001). There was no difference in peak pre-operative white cell or neutrophil count; however, C-reactive protein was lower in male patients (median 72 vs 97, p<0.001). Pre-operative imaging was performed more often in females: ultrasound (20.7 vs 1.5%, p<0.001) and CT scan (61.8 vs 54.9%, p=0.020). Male patients underwent more open surgery (14.0 vs 6.5%, p<0.001). There was no difference in the severity of appendicitis, rate of negative appendicectomy, median total hospital stay, post-operative complication or 30-day readmission rates.

Conclusions

This study demonstrates that differences exist between males and females who have EA in terms of age, use of pre-operative imaging and operative approach, however, clinical outcomes are similar.
TH5.3 Improving the Quality of Surgical Discharge Summaries Using a Discharge Summary Checklist- A Prospective Closed Loop Audit
Authors: Lee Melody , Lim Ju Lyn , Khun Ng James Chean , Chowdury Abeed
Published: November 2022

Aim

Discharge summaries (DS) form the mainstay of communication between primary and secondary care following inpatient episodes. Poor quality DS often leads to poor continuity of care. We aim to audit the quality of DS following admission under general surgery and improve DS by implementing a DS checklist.

Methodology

A prospective audit was conducted for 100 DS across 4 surgical wards (emergency and elective) between 1/1/2021 to 1/3/2021. Data collection included the clinical summary, operation details, significant investigation results and follow up plans. A DS checklist was created and introduced at junior doctor induction. A re-audit was conducted prospectively on 100 DS produced from 1/8/2021 to 1/10/2021.

Results

A general improvement in quality of DS is seen across different domains. In particular, operation date (76.1% vs 90.1%, p=0.019), abnormal blood test results (89% vs 97%, p=0.323), outpatient investigations (72% vs 85%, p=0.025) and their urgency (39.6% vs 43.3%, p=0.741), GP plans and actions (73% vs 81%, p=0.178) and outpatient appointments (85% vs 93%, p=0.037). Interestingly, details of clinical summary (98% vs 94%, p=0.149) and duration of venous thromboembolism (VTE) prophylaxis (99% vs 90%, p=0.005) were worse on reauditing.

Conclusion

The introduction of DS checklist has significantly improved the quality of documentation and instructions for primary care for most domains. This was not seen for the domain of duration of VTE prophylaxis.
TH5.13 Stoma reversal post emergency laparotomy
Authors: Ng Hwei Jene , Clark Maggie , Alhoweris Ala Eldin , Teo Serene , McGuigan Mark , Moug Susan
Published: November 2022

Aims

Approximately a fifth of stomas have to be sited in emergency setting and the National Bowel Cancer Audit found almost one third of patients undergoing anterior resection do not have reversal of their stoma within 18 months following surgery. We aim to explore the reversal rate of stoma post emergency laparotomy (EmLap).

Methods

Retrospective analysis was performed on all patients undergoing EmLap over 12 months (2018) from one site using the local ELLSA (Emergency Laparoscopic and Laparotomy Scottish Audit) database. Demographic, indication for surgery, stoma formation/ type, 30-days morbidity and mortality were collected. Follow-up and stoma reversal data were evaluated at 12 months postoperative.

Results

205 patients underwent EmLap (52.5% female, median age 66 years). 42% (n=85) had emergency stoma formation: 58% ileostomy, 42% colostomy.

Of those who had stoma formed (51% female, median age 67 years), 45% presented with bowel obstruction and 24% had new colorectal cancer diagnosis. Of those alive at follow-up (89%), 19% had stoma reversed (1:1 ileostomy:colostomy; mean reversal time 11 months). Of the 81% not reversed: 28% declined, 12% were unfit, 4% technically not feasible, 4% on waiting list, 11% had 30-day mortality. The remaining 22% had no documented stoma reversal discussion (5%) or no follow-up (17%).

Conclusions

Compared to the elective setting, the stoma reversal rate post-EmLap is significantly lower (reversal of ileostomy 9.5% in this study vs 85% in Close-IT study). Although this may reflect a higher risk surgical population, post-EmLap pathways should consider routine follow up to ensure shared decision making.
TH5.14 Surgical Telephone Virtual Clinic: A Safe and Effective Alternative to Hot Clinics for Semi-Urgent, Ambulatory Patients
Authors: Osunlusi Oluwafemi , Patel Sima , Ashok Apurva , Stonelake Stephen
Published: November 2022

Introduction

Many ‘Hot Clinics' deal with ambulatory patients only requiring semi-urgent investigation and treatment, potentially avoiding hospital admission. These clinics often use the same staff and resources being utilised for acute surgical admission and treatment. We present data showing that “Virtual Clinics” (VC) are safe alternatives to this system, improving patient service and relieving a significant burden on the acute surgical units.

Method

78 patients who came through the established VC between 23/12/2020 and 19/01/2021 (4 weeks), were assessed for delays in scan date, call-backs, diagnosis, referral patterns, readmission rates and eventual outcomes for those who needed surgical interventions.

Results

83% of patients had their scans within the set-out time of 72 hours. 89.7% of scans were reported on the same day. Only 18% of the patients had a surgical diagnosis. 51% had no diagnosis at all and were discharged safely from the clinic. 16.7% were still symptomatic at the time of the VC with 3.8% of these having a surgical pathology. 22% were referred to other specialities. 2 patients were referred to MDT.

In total, 6 patients were re-admitted to the hospital (7.6%). 4 patients were listed for surgery following the VC.

Conclusion

The VC proves to be a safe and effective system for semi-urgent, ambulatory patients. Re-admission rates are low, justifying the discharge of these patients from the acute surgical assessment unit to a virtual follow up environment.
TH7.3 Is CT a valid tool for diagnosing acute appendicitis in patients aged 40 or older?
Authors: Stockdale Thomas , Lam Angela , Thiruppathy Kumaran
Published: November 2022

To establish whether computerised tomography abdomen and pelvis (CTAP) with contrast is a necessary tool in the diagnosis of acute appendicitis in those aged 40 years or older compared to clinical assessment alone.

The study was performed in a district general hospital in England. A retrospective analysis included 314 patients aged 40 years or older who presented between 3rd October 2020 and 31st October 2021 and received a CTAP with contrast where the request queried appendicitis. An Alvarado score was calculated for each patient as a measure of clinical likelihood of appendicitis based on documentation from their initial assessment by a General Surgeon.

CTAP demonstrated evidence of acute appendicitis in 46.1% of patients. CTAP diagnosed alternative pathologies in 41.1% of patients. These included diverticulitis (10.5%), gynaecological pathology (4.5%), urological pathology (3.2%), malignancy (2.9%) and others (19.4%). 11.8% demonstrated no cause for symptoms. Furthermore, those with an Alvarado score of 9 or more, 94.9% had a CTAP reporting appendicitis. With scores of 3–8, only 49.4% had a CT finding of appendicitis and this dropped to 5.0% with scores of 0–2.

This study supports using CTAP to aid in diagnosing appendicitis in patients aged 40 years or older with Alvarado scores of 8 or less. However, patients scoring 9 or more had a 94.4% positive finding of acute appendicitis on CTAP, thus potentially negating the need for a CTAP scan pre-operatively. Alvarado scores of 2 or less suggest an alternative diagnosis is more likely, however CTAP may still be a valid investigation.
TH7.9 A retrospective audit of the investigation and management of acute pancreatitis (AP) in a tertiary referral hospital in Ireland
Authors: Ankatiah Sarita , Julius Barbara , Falusi Juliana , Baban Chwanrow , Merrigan Anne , Tormey Shona
Published: November 2022

Aims

This audit aims to determine if standards of best practice according to NICE guideline pancreatitis (September 2018) are being met.

Methods

Using the Hospital In-Patient Enquiry (HIPE) system, 129 admissions with AP during 2020 were retrospectively identified. Audit targets included adequate fluid resuscitation and nutritional support, frequency of radiological investigations, emergency cholecystectomy, lifestyle advice and appropriate follow up.

Results

Aetiologies identified were biliary (33.3%), alcohol (33.3%), idiopathic (7.8%), hypertriglyceridemia (3.8%), autoimmune (1.6%), medication (0.8%), anatomical variant (0.8%) and the remainder (18.6%) were unidentified since not fully investigated (NFI). 47.3% (n=61) had ultrasound while 61.2% (n=79) had computed tomography of abdomen and pelvis (CTAP) during hospital-stay. Out of 33.3% (n=43) with biliary aetiology, 25.6% (n=11) had successful ERCP and 41.9% (n=18) were referred for outpatient clinic or already awaiting outpatient laparoscopic cholecystectomy. No emergency cholecystectomies were performed. Out of 28 readmissions, biliary pathology accounted for 35.7% (n=10), alcohol 25% (n=7) and NFI 17.9% (n=5). 37.2% (16) of alcoholic pancreatitis admissions had documented cessation advice either as in-patient or on discharge. There was no documentation for HbA1C in 6 months or DEXA scan in 2 years’ time, or a yearly fecal elastase for chronic pancreatitis patients.

Conclusion

Audit of current practice identified areas for improvement, including bettering access to emergency theatre, increased focus on encouraging lifestyle modification and monitoring pancreatic endocrine and exocrine function. We aim to create an institutional standard operating procedure for investigating and managing pancreatitis, and re-audit next year to discern if management has moved closer to the established standard.
TH7.11 Developing a new TAMIS service at a district general hospital. A dual consultant experience
Authors: Lord Ian , Ward Nicholas , Mishra Ami
Published: November 2022

Aim

To evaluate the development of a Transanal Minimal Access Surgery (TAMIS) service at a district general hospital.

Method

In 2017, a TAMIS service was set up at our hospital by 2 consultants trained in single port laparoscopic and transanal endoscopic techniques. Benign rectal polyps and early cancer cases were performed as dual consultant procedures. All cases were reviewed in the colorectal MDT pre-operatively. Data was collected prospectively for patient demographics, co-morbidity, length of stay, complications, pathology and surveillance outcomes.

Results

Between May 2017 and July 2021, 31 TAMIS procedures were performed. The median age was 73(34–87) with 17(55%) male and 14(45%) female patients. The indication for resection was adenomatous polyps in 20(65%) patients and adenocarcinoma in 11 (35%) patients. The median diameter of benign polyps was 44mm(25–105mm). At a median follow up of 8 months (0–48 months) there were no recurrent polyps.

Rectal cancers had a median size 23mm (11–32mm). Nine cancers were T1 (82%), one T2 (9%), and one T3(9%). All cancers were R0 resections. At a median follow up of 15 months (3–43) there were no locoregional or distant recurrences. The median length of stay was 1 day (0–2). There was no post operative mortality. The readmission rate was 5% with two Clavien-Dindo grade 1 complications.

Conclusions

Dual consultant operating in the early phase of this service's development has allowed for experience to be concentrated and shared problem solving, resulting in encouraging early outcomes with no local recurrence, short inpatient stay and minimal morbidity.
TH8.3 Single incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy- A rural center experience
Authors: Ravindran Sharanya , Venkat Shruthi
Published: November 2022

Aim

Single Incision Laparoscopic Surgery (SILS) is a new technique of minimally invasive surgery using a single incision to minimize all ports to one site for a perceived scar less abdomen compared to conventional laparoscopic surgery in terms of complications and patient satisfaction.

Materials & Methods

We report our study conducted in southern India from September 2015 to October 2016, evaluating the possible advantages of SILS versus CLC through a randomized controlled trial. The study population includes patients diagnosed as cholelithiasis. A total of 50 patients underwent cholecystectomy, Patients were randomly assigned to either SILS cholecystectomy or conventional cholecystectomy in 1:1 ratio. Primary end points were operative time, postoperative pain quantified using visual analogue scale, post operative hospital stay and patient satisfaction.

Results

The pain scores measured at 48 hours were significantly lower in SILS (1.3) group than CLC group (2.03). Patients had significant satisfaction score in terms of cosmesis in SILS group (4.25) than Lap cholecystectomy group (3.08) measured at 6 weeks after cholecystectomy. However the post operative stay was similar in both the groups. There was no conversion to open cholecystectomy in both the groups. Patient satisfaction score in SILC (4.25) as found to be higher than CLC (3.08). Operating time was significantly more in SILC (85mins) and post operative stay was lower in SILC.

Conclusion

Based on this SILS offers better cosmetic outcome, however, due to prolonged operating time and steep learning curve CLC is considered a better procedure.
TH8.6 Thoracic sarcoma: three-year data from a tertiary referral centre
Authors: Saifuddin Sarah , Hoppe Solveig , Williams Matthew , Cosker Thomas , Stavroulias Dionisios , Di Chiara Francesco
Published: November 2022

Aims

The rarity of thoracic sarcomas leads to challenges in their diagnosis and evidence-based management. We aim to investigate the management and outcomes of primary thoracic sarcoma patients under the care of our tertiary centre Sarcoma Service over a three-year period.

Methods

Data of all thoracic sarcoma patients discussed at the tertiary centre multidisciplinary meetings from 2017–2019 were collected from the local electronic database.

Results

65 patients met the inclusion criteria. The most common histological subtypes were chondrosarcomas and spindle cell sarcomas. 60% of cases were high-grade sarcomas. 14 out of 19 deaths occurred in patients with high grade sarcomas (p=0.0586). 78.3% of patients underwent surgical resection, with 35.4% undergoing surgical resection as their sole treatment modality. Surgical intervention was associated with a statistically significant improvement in survival (p < 0.0001*). Clear marginal status was associated with better survival outcomes (p = 0.026*). Local recurrence was seen in 15 cases, and 93.3% of these were in high-grade sarcomas. There was no association between recurrence and marginal status. 8 of the 15 cases with recurrence received surgical intervention for the recurrence. 4 of the cases with recurrence passed away within the study time frame.

Conclusion

Primary resection should remain the gold standard for treatment of thoracic sarcomas due to its significant improvement in survival. Variability between outcomes and overall survival is likely multifactorial – diversity of histological subtypes, predominance of high-grade sarcomas, and a wide range of age at diagnosis. Prospectively maintained databases and cross-centre collaboration would be beneficial for future study in thoracic sarcomas.
TH8.7 Impact of routine G&S in Laparoscopic Cholecystectomy on the Trust Resources
Authors: Afonso Matias Mariana Rita , Elnabil-Mortada Ahmed , Money-Taylor John , Gill Emma , Rees Ben , Boyes Simon
Published: November 2022

Background

Despite consistently low bleeding rates in laparoscopic cholecystectomy (LC) (0.1 – 0.46%), preoperative testing of ABO group and Rh (D) – G&S – remain common practice throughout UK hospitals. Current NICE guidelines for routine pre-operative tests for elective surgery don't include routine G&S. Additionally, there have been few recently published articles regarding elective and emergency LC suggesting that the routine practice of G&S are unnecessary, potentially delaying surgeries with significant financial impact. Based on published data, if a patient undergoing LC requires perioperative blood transfusion there is no time to cross match, therefore the major hemorrhage protocol is activated and patient is transfused O negative.

Aim

This project aimed to assess the need for routine G&S in laparoscopic cholecystectomy including impact on Trust resources, national shortage of blood tubes.

Methods

Retrospective data collection regarding 448 patients that underwent LC at Northern General Hospital, Sheffield in 2020.

Results

Between January and December 2020 401 G&S samples were taken during the preoperative assessment, and 425 second G&S samples taken on the day of surgery. Antibodies were identified in 8 patients, although they were not cross matched. Furthermore, none of the 448 patients required blood transfusion during the perioperative period.

Conclusions

Our results highlight that current compliance with NICE guidelines/recent published data is suboptimal. Overall, collecting G&S samples perioperatively takes up resources, time and can delay surgery. Furthermore, Trust savings could be in excess of £8000 in one year. Hence, we are currently reviewing our local policy.
87 Surgical Versus Conservative Management of Acute Achilles Tendon Ruptures; A Systematic Review and Meta-Analysis
Authors: Damisa J
Published: November 2022

Aim

To compare the functional outcomes including re-rupture rates, number of participants failing to return to work or sports and scoring scales between surgical and conservative treatment in a systematic review.

Method

A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA) protocol. Studies were identified from these databases: PubMed, Cochrane and CINAHL. Risk-ratio analysis to compare rupture rates and failure to return to work/sports, whilst a standard mean difference analysis compared the functional outcome scores from both treatment groups.

Results

Seven randomised controlled trial studies included with a total of 486 participants involved in the trials, comprising of 245 participants for surgical intervention and 209 participants for conservative management. There is a higher re-rupture rate in the conservative group compared to the surgical group with a risk ratio (RR) of 0.38 (95% CI 0.16–0.92, P = 0.03). Statistically, there was no significant difference in number of individuals failing to return to work/sports in both treatment modalities, RR for all the three studies were 0.85 (95% CI 0.51,1.41, P = 0.52). A standardised mean analysis with an overall effect Z of 0.40 (std MD 0.09; P 0.69; 95%CI -0.35,0.53) indicate no statistically significant difference in the functional outcomes between the three different studies.

Conclusions

Surgical intervention only shows an advantage over conservative treatment in terms of re-rupture rates but similar results with conservative treatment when other outcomes including number of participants returning to previous activity levels, plantar flexion and functional scoring systems were assessed.
327 To Fuse or Not to Fuse: The Elderly Patient with Lumbar Stenosis and Low-Grade Spondylolisthesis. Systematic Review and Meta-Analysis of Randomised Controlled Trials
Authors: Abdel-Fattah AR , Bell F , Boden L , Ferry J , McCormick C , Ross M , Cameron I , Smith T , Baliga S , Myint P
Published: November 2022

Aim

The optimum surgical intervention for elderly patients with lumbar spinal stenosis(LSS) and low-grade degenerative-spondylolisthesis(LGDS) has been extensively debated. We conducted a systematic review and meta-analysis of randomised-controlled-trials(RCTs) comparing the effectiveness of decompression-alone against gold-standard decompression-with-fusion(D+F) in elderly patients with LSS and LGDS.

Method

A systematic literature search was performed on published databases from inception to October-2021. English-language RCTs of elderly patients (mean age over-65) with LSS and LGDS, who had undergone DA or D+F were included. The quality and weight of evidence was assessed, and a meta-analysis performed.

Results

Seven RCTs (n=581; mean age:65.9 years; 59.9% female) were included. There was no difference in visual-analogue-scale(VAS) scores of back-pain(BP) or leg-pain(LP) at mean follow-up of 28.6 months between both DA and D+F groups (BP: mean-difference (MD)-0.22, 95%CI:-0.76–0.32; LP: MD:-0.26, 95%CI:-0.79–0.27). In addition, subgroup analysis of long-term follow-up (>3 years) showed lower VAS scores for BP and LP in patients who underwent DA (BP MD:-1.70, 95%CI:-2.8-(-0.60); LP MD:-1.00, 95%CI:-1.77-(-0.23)). No difference in disability, measured by Oswestry-Disability-Index(ODI) scores, was found between both groups (MD:0.50, 95%CI: -3.31–4.31). However, patients in DA group had less hospital complications and fewer adverse events (total-surgical-complications OR:0.57, 95%CI:0.36–0.90), despite a higher rate of post-operative DS (OR:8.63, 95%CI:3.35–22.26).

Conclusions

DA is not inferior to D+F in elderly patients with LSS and LGDS. DA has better pain outcomes at three-years follow-up and carries lower risk hospital-complications and fewer adverse-events. Surgeons should weigh these findings with increased risk of DS-progression.
532 Safety in Pregnancy for Female Surgeons: A Pilot Study
Authors: Magill Hayley , Kazzazi Fawz , Noton Toby
Published: November 2022

Aim

With an increasing number of female surgeons, it is important to ensure that the workplace is safe for pregnant women, or appropriate adjustments are made. The aim of this study is to ascertain how knowledgeable female surgeons are about potential risks during pregnancy, adaptations they have made, and to guide the design of a bigger study.

Method

A literature search was carried out to identify potential risks to pregnant female surgeons. A survey was created to ascertain women's understanding of key which activities are safe in pregnancy, and adjustments some had made whilst pregnant.

Results

100 women responded to the survey, ranging from SHO to consultant. 40% of respondents had children, whilst 78% of those who did not, hoped to have them someday. Only 44% of all respondents felt that they knew what was safe at work during pregnancy, with the majority being unaware of increased risk of complications such as miscarriage, intrauterine growth restriction, placental abruption and gestational hypertension.

Conclusions

There is a lack of knowledge of potential risks amongst female surgeons, and most information acquired comes from personal research. Many female surgeons reported complications during their own pregnancies, and many were unaware of these risks prior to pregnancy. A more detailed study including fertility issues, and variations between subspeciality alongside a detailed literature search could start to provide more detailed guidance for female surgeons.
589 Reducing Single-Use Surgical Instruments During Laparoscopic Appendicectomy: Using Sustainable Quality Improvement as a Catalyst to Encourage Wider Behavioural Change in a Surgical Department
Authors: Ford Bryony , Labib Peter , Kanwar Aditya , Sanders Grant , Douie Walter , Winfield Michelle
Published: November 2022

Aim

Consumables are responsible for 32% of surgery associated CO2 emissions after excluding anaesthetic gases. We aimed to reduce the carbon footprint of laparoscopic appendicectomies by addressing equipment issues whilst also meeting the triple bottom line of financial, environmental, and social impacts.

Method

In a single-centre, a questionnaire was distributed to establish the frequency of, and reasons for, single-use instrument use. A separate questionnaire identified areas for improvement within existing appendicectomy sets.

An evaluation of 25 appendicectomies was undertaken, documenting single-use instrument usage. New appendicectomy sets were developed, including additional reusable instruments, and procuring new ports, trialling these in subsequent appendicectomies.

Financial impact was calculated based on current procurement prices. Environmental impact was calculated by carbon costing the production, transport and disposal of consumables using published emission factors. Social impact was assessed using staff surveys.

Results

110 single-use instruments were opened in 25 appendicectomies. Our trust performs ∼500 appendicectomies/year, therefore equating to ∼2180 instruments/year that could be avoided by using reusable alternatives. Based on an estimated 75% reduction in consumables, the new set saves £34,423 and 512kg CO2e per year over the predicted seven-year life span of the instruments. Based on existing practice, the capital investment required for new instruments (£19,731) will pay for itself within six months. Reduced consumable reliance decreases the volume of waste being incinerated, tackling scope one emissions and local air pollution.

Conclusions

These results demonstrate that sustainable changes can be cost saving and reduce carbon emissions. This approach has translational potential across all surgical specialities using single-use instruments.
224 One-Year Outcomes in Patients with Colorectal Malignancy and Low Functional Capacity on CPET
Authors: Tay Tricia , Ryska Ondrej , Johnson T
Published: November 2022

Aim

Many patients with colorectal carcinoma (CRC) undergo Cardio-Pulmonary Exercise Test (CPET) to risk-stratify their suitability for surgery. This study aims to evaluate the 1-year outcomes of patients with colorectal malignancy and low functional capacity on CPET. The secondary aim is to evaluate the correlation between P-/CR-POSSUM scores and one-year outcomes.

Method

All patients with stage I-IIICRC who underwent CPET between January 2013-August 2020 with Anaerobic Threshold (AT)<10ml/min/kg follow-up for one year were included. Major complications were classified using Clavien-Dindo classification of Grade III or higher.

Results

We included 77patients(64%males) with median age of 77(range 53–90). Thirty-one patients received best supportive care;46 underwent elective resection with median AT of 7.9(5.3–9.5)ml/min/kg and 8.7(6.4–9.9)ml/min/kg respectively(p=0.001).Of those treated surgically,9(20%)had major complications. There was no 30-day mortality. Median postoperative length of stay (LOS) was 8(3–42) days. Median overall survival(OS) among patients with surgery versus best supportive management was longer–42(8–106)months vs.25(2–59)months(p<0.0001).1-year survival rate was higher-57%vs.19%(p=0.002)in patients who had surgery compared to those with non-surgical management. Presence of major complications correlates with AT(p=0.003), LOS(p=0.007), OS(p<0.0001) and death(p=0.002).

P-/CR-POSSUM scores(n=11) showed no significant correlation with major complications or LOS. One-year survival demonstrated no correlation between P-/CR-POSSUM with OS.

Conclusions

Surgical treatment of CRC showed survival benefit and should be considered for patients with low functional capacity. Due to our small sample size, P-/CR-POSSUM were not correlated with major complications, LOS and OS.
825 Local Excision Versus Total Mesorectal Excision Following Neoadjuvant Chemoradiotherapy for Rectal Cancer. a Systematic Review and Meta-Analysis
Authors: McLoughlin Morgan , Creavin Ben , Early Helen , McCullough Peter , Cooke Fiachra , Neary Peter
Published: November 2022

Aim

Total mesorectal excision with or without neoadjuvant chemoradiotherapy remains the gold standard treatment for rectal cancer. This systematic review aims to establish if Local Excision (LE) in conjunction with neoadjuvant therapy can be used to improve morbidity and functional outcomes without significantly impacting oncological outcomes.

Method

A systematic review and meta-analysis was performed using the PRISMA guidelines. All studies comparing neoadjuvant chemoradiotherapy and local excision versus TME were included from 2000 to 2020. Primary endpoint included local recurrence rates. Secondary outcomes included distant recurrence, disease free survival and overall survival. Subgroup analysis was performed on randomised control trials (RCT).

Results

Of the 9 studies included, 2 were RCTs. A total of 1161 patients underwent neoadjuvant chemoradiotherapy and surgical excision (LE n=252, TME n=909). Local recurrence was 10% in the LE group compared to 7% in the TME group (OR 0.60, 95% CI 0.33–1.09, p=0.09). Furthermore, there was no significant difference in distant metastasis (OR 1.37, 95% CI 0.84–2.26, p=0.21), Disease Free Survival (DFS) (OR 1.08, 95% CI 0.65–1.82, p=0.76) or Overall Survival (OS) (OR 1.14, 95% CI 0.56–2.35, p=0.71). In subgroup analysis of RCTs, local recurrence rates of 7.2% were seen in the LE group compared to 6.6% in the TME group (OR 0.90, 95% CI 0.34–2.43, p=0.84).

Conclusions

Neoadjuvant chemoradiotherapy and local excision is oncologically safe in select patients. A higher non-significant local recurrence rate was seen in the LE group; however, this may be due to heterogeneity in patient selection. Similar local recurrences and oncological outcomes were verified in the RCTs.
49 DCM-Related Degenerative Spinal Changes in the Healthy: Meta-Analysis & Comparison to a Symptomatic Cohort
Authors: Banerjee Arkaprabha , Mowforth Oliver , Nouri Aria , Budu Alexandru , Newcombe Virginia , Kotter Mark , Davies Benjamin
Published: November 2022

Aim

Degenerative cervical myelopathy (DCM) is a progressive cervical spinal cord injury brought about by mechanical stress from degenerative changes in the cervical spine. It is typically diagnosed on clinical symptoms, examination findings together with MRI findings. The objective was to determine the significance of category of degenerative pathology (identified in Nouri et al, 2017) to onset of DCM, by comparing symptomatic and asymptomatic populations.

Method

A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines, cognizant of their adaptation for epidemiological studies. A search strategy was used to identify original research carrying out MRI screening of cervical spines of asymptomatic patients in MEDLINE and Embase from 1985 to the present day.

Results

The search yielded a total of 1,098 studies of which 17 were included in this meta-analysis, covering a total of 5,059 patients. Ossification of posterior longitudinal ligament (pooled asymptomatic prevalence of 0.4%), enlargement of ligamentum flavum (pooled asymptomatic prevalence of 11.8%) and degenerative multilevel disc pathology (pooled asymptomatic prevalence of 64.5%, I2 100%) were found to be significantly lower in asymptomatic populations (factor of 25 times, 4 times and 1.5 times respectively), and thus associated with DCM.

Conclusions

Ossification of posterior longitudinal ligament and enlargement of ligamentum flavum were found to be markedly lower in asymptomatic populations, possibly significantly implicating ligamentous pathology in the onset of DCM. Understanding the natural history of DCM is a recognised research priority, and whilst these perspectives require further evaluation, they may be of significance to the evolving biomechanical understanding of the disease.