bluuebunny/crossref_metadata_2025 huggingface dataset:
FTP6.2 Utility of Ultrasound Imaging in a Successful Ambulatory Emergency Surgical Unit
Authors: Claxton Mary , Quinn Marcus , Williams Lian , Barton Jessica , Hollyman Marianne
Published: August 2023

Aim

Drives towards ambulatory management in emergency surgery have been supported by same day imaging to expedite decision making. We aimed to assess the frequency of surgical pathology identified by ultrasound, and subsequent requirement for operation.

Methods

All acute general surgery referrals to the ambulatory clinic of a large District General Hospital between 01/01/2021 and 22/07/2022 were included. Information regarding presentation, imaging, and diagnosis were collected in prospectively maintained databases, and subsequently analysed.

Results

Over an 18-month period, 3154 patients were seen, with a 91.7% successful ambulation rate (n=2938). 1099 patients (34.8%) underwent ultrasound, the majority were upper abdominal (63.7%, n=698); a further 33.1% (n=364) were pelvic.

Ultrasound diagnosis was suggested in 52.7% of scans (n=588); upper abdominal ultrasound provided a diagnosis in 54.9% (383/698), compared to 28.8% (105/364) of pelvic ultrasounds (p<0.001).

61 patients (5.6%) were admitted following ultrasound, of whom 36% (n=22) had no ultrasound diagnosis. Admission rate for diagnostic ultrasound was 6.9% (39/567).

Some 204 (18.6%) patients proceeded to operation; 25 (2.3%) underwent an emergency operation, 88 (8%) were operated on ambulatory lists, and 91 (8.3%) were listed electively.

Conclusions

Ultrasound is a commonly used adjunct in the ambulatory setting, particularly for assessment of biliary pathology. It has an acceptably high pathology pick up rate, and significant proportions go on to require surgical intervention, which can be ambulatory for the majority.
FTP6.10 Acute Pancreatitis complicated with splanchnic vein thrombosis; our 12 months experience
Authors: McGurk Catherine , Bradley Angus , Peristeri Dimitra , Kenington Cleo
Published: August 2023

Objectives

Splanchnic vein thrombosis (SVT) is a relatively common observation in severe acute pancreatitis (AP) and is associated with pancreatic necrosis and peripancreatic collections. Currently, there is no consensus on whether patients presenting with splanchnic vein thrombosis in the setting of AP should receive therapeutic anticoagulation. We aimed to determine current practices in the management of splanchnic vein thrombosis complicating AP, in our hospital.

Methods

An audit of retrospectively collected data for all patients presenting with AP was conducted. Patients with splanchnic vein thrombosis were grouped according to vessel involvement and whether or not systemic anticoagulation was administered.

Results

Of 172 consecutive patients admitted with AP between January and December 2022, 10 had splanchnic venous thrombosis; in all cases, the thrombosis was associated with a severe attack of AP. Involvement of the splenic vein (SV), portal vein (PV) and superior mesenteric vein (SMV) was observed in 3, 2 and 3 patients, respectively. Involvement of more than one vessel was observed in two patients (SV and PV). The most common etiological factor for AP was alcohol. Seven patients received systemic anticoagulation with therapeutic LMWH initially, followed by oral DOAC for 3 months. No complications associated with systemic anticoagulation occurred. None of the patients developed liver failure, and we did not observe any fatal outcomes.

Conclusions

SVT represents a diagnostic and therapeutic challenge. Based on limited evidence, treatment decisions should be individualized with the evaluation of bleeding risks versus SVT recurrence or extension. Additional research is needed to further assist prompt management.
FTP6.11 The Quality of Service of Emergency Appendicectomy in Children in a Rural General Hospital between 2013 and 2022
Authors: Mohamed Samy , Sganga Mailen , Saleh Francesca , Lee Stanley , Unais Mohamed , Khan Kausik
Published: August 2023

Aims

To evaluate our service of emergency appendectomy for children (3-16 years) against the quality indicators identified by the Association of Surgeons of Great Britain and Ireland commissioning guidelines and the British Association of Paediatric Surgeons. This study was carried out between January 2013 and September 2022. We evaluated 5 main qualities; time to surgery, operative techniques (laparoscopic, open), length of stay (LOS), 30 days post-operative re-admission rate, and the rate of “negative” appendicectomy.

Methods

A retrospective analysis was conducted. Patients were identified from the hospital database. Data including demographics, above qualities and histology were collected from the hospital clinical information system “Myrddin” and Welsh Clinical Portal.

Results

Total number of children who had emergency appendicectomy over this 10 years period of time was 194, age range between 3-16 years old, 87 females, and 107 males. Mean time from admission to surgery was 12.8 hours. Total in-hospital stay was 2.7 days. There has been an increase in rate of laparoscopic appendectomy from 17.4% in 2013 to 84.6% in 2021. Total laparoscopic appendicectomy was performed in 40.2% of this cohort (7-16 years old) without conversion. Negative appendicectomy was 14.9%. Re-admission rate was 4.6% and it was mainly due to wound infection.

Conclusions

These results showed that these children are accurately diagnosed and treated in a timely manner according to the published guidelines & recommendation. Laparoscopic technique is increasingly used safely in appropriate cases.
FTP6.12 The Quality of Service & “Negative Appendicectomy” Rate in a Rural General Hospital between 2013 and 2022
Authors: Mohamed Samy , Sganga Mailen , Saleh Francesca , Lee Stanley , Unais Mohamed , Mohamed Omnia
Published: August 2023

Aims

This annual audit was carried out to assess the quality of emergency appendicectomy service in our hospital between January 2013 and September 2022. We audited 5 main qualities; time to surgery, operative techniques (laparoscopic, open), length of stay (LOS), 30 days post-operative re-admission rate, and the rate of “negative” appendicectomy. These parameters were compared against the available national audit outcome.

Methods

A retrospective analysis was conducted. Patients were identified from the hospital database. Data including demographics, above qualities and histology were collected from the hospital clinical information system “Myrddin” and Welsh Clinical Portal.

Results

Table shows the outcome of emergency appendicectomy between January 2013 and September 2022.

Conclusions

The increase of rate of laparoscopic appendicectomy over 10 years time reaching 98% was associated with decrease in the 30 days re-admission rate. Rate of “Negative Appendecectomy” is comparable to national outcome and has decreased significantly during COVID time.
FTP7.3 Retrospective Cohort Study of the Efficacy of Magnetic Resonance Cholangiopancreatography in the Diagnosing Choledocholithiasis in Risk-Stratified Patients
Authors: Stevenson Carla , Ng Shou Kee , Stewart Brian , Di Rollo Domenic , Mahmud Sajid , Khan Khurram
Published: August 2023

Aims

National guidelines emphasise the role of magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of choledocholithiasis to guide further management. The aim of this study was to determine the risk factor(s) associated with choledocholithiasis on MRCP.

Methods

A retrospective cohort study of all consecutive adult MRCPs was conducted in a single centre from October 2021 to September 2022. Patient demographics, laboratory results, other imaging modalities and MRCP results were analysed. Peak liver function test values were used pre-MRCP. Patients found to have hepatopancreatobiliary malignancies were excluded.

Results

A total of 442 patients were identified, 278 (62.9%) were female. Median age was 63 (IQR 50-74). 293 (66.3%) were inpatient scans whilst 178 (40.3%) were urgent requests. Median time from admission to MRCP performed for inpatients was 2.2 days (IQR 1.4-4.1). 121 (27.4%) MRCPs reported positive for choledocholithiasis.

Choledocholithiasis on MRCP was positively correlated to raised alkaline phosphatase (p=0.004), hyperbilirubinaemia (p<0.001), jaundice (p<0.001) and evidence of ductal dilatation on ultrasound and/or CT imaging (p<0.001). It was not correlated to upper abdominal pain, age and gender.

Conclusion

The incidence of choledocholithiasis on MRCP in this study is comparable to recent published data. Patients should be risk-stratified and MRCP performed only if they have high-risk features to maximise the utility of MRCP.
FTP7.6 Management of Colorectal Cancer with Synchronous Liver Metastases: A systematic review of national and international clinical guidelines (CoSMIC-G)
Authors: Chan Anthony , Siriwardena Ajith
Published: August 2023

Introduction

The contemporary management of patients with colorectal cancer and synchronous liver metastases is complex. Variation in interpretation of the limited body of evidence may introduce inequality in practice. This study appraises the recommendations made by national/international guidelines on the management of patients with synchronous liver metastases from colorectal cancer.

Methods

A systematic review of national and international professional body guidelines published between 2012-2022 was carried out using PubMed and Guidelines International Network and evaluated using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. Guidance in was assessed for strength of recommendation and levels of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. The protocol was registered with PROSPERO (CRD42021243744).

Results

Searches returned 385 articles with 11 guidelines eligible for inclusion. One (9%) guideline defined ‘synchronous disease’ at outset, 2 (18%) recommended neo-adjuvant chemotherapy. Two guidelines provided “moderate” support for synchronous liver and bowel resection, 5 recommended against synchronous hepatic and colorectal resection and four made no comment. No guidelines described either hepatic or colorectal criteria for synchronous surgery.

Discussion

This study demonstrates important variations between clinical guidelines on management of synchronous liver metastases in colorectal cancer.
FTP7.10 Preoperative C-reactive protein-to-albumin ratio and its ability to predict outcomes of pancreatic cancer resection: a systematic review
Authors: Romman Saleh , Ghassemi Nader , Hajibandeh Shahin , Hajibandeh Shahab , Laing Richard , Bhatt Anand
Published: August 2023

Aim

To evaluate the ability of c-reactive protein-to-albumin ratio (CAR) in predicting outcomes in patients undergoing pancreatic cancer resection.

Methods

We conducted a systematic search of multiple electronic information sources and bibliographic reference lists. We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases. Survival outcomes and perioperative morbidity were the evaluated outcome parameters.

Results

Eight observational studies reporting a total number of 1,056 patients undergoing pancreatic cancer resection were identified. The median cut-off value for CAR was 0.05 (range 0.0003- 0.54). Using multivariate analysis, all the included studies demonstrated that a higher CAR value was an independent and significant predictor of poor overall survival in patients undergoing pancreatic cancer resection. The estimated hazard ratio provided by the included studies ranged from 1.4 to 3.6. There was significant heterogeneity among the included studies; for example use of neoadjuvant or adjuvant chemotherapy, pTNM staging, lymph node metastasis, preoperative Ca19-9 and CEA levels, neutrophil-to-lymphocyte ratio, and modified Glasgow prognostic score. Furthermore, important prognostic characteristics such as tumour site and size, pathological T factor, and vascular involvement were poorly reported.

Conclusions

Preoperative CAR value seems to be an important prognostic score in predicting survival outcomes in patients undergoing pancreatic cancer resection. However, the current evidence does not allow determination of an optimal cut-off value for CAR considering the heterogeneous reporting of cut-off values by the available studies and lack of knowledge of their sensitivity and specificity. Future research is required.
FTP7.11 The role of percutaneous cholecystostomy in the management of acute cholecystitis in critically ill surgical patients, a single-centre experience, UK
Authors: Dhillon Syra , Hamed Adel , Saleem Mohamed , Khan Mansoor , Sajid Muhammad
Published: August 2023

Percutaneous cholecystostomy (PC) is a minimally invasive procedure that aims to stabilise critically unwell patients with acute cholecystitis. Particularly important for poor surgical candidates, PC facilitates therapeutic benefit with fewer complications and allows patient stabilisation before definitive cholecystectomy. A large 2018 study demonstrated the role of PC to be as effective as emergency laparoscopic cholecystectomy, with no significant difference in mortality. There are no UK national guidelines for the safe practice of PC. This study reports the outcomes in patients admitted as emergency cases undergoing PC for acute cholecystitis.

This was a retrospective descriptive study evaluating 24 consecutive patients admitted with acute cholecystitis to a tertiary centre, and underwent PC from 1st May 2019 to 27th January 2021. The data was collected and analysed on Microsoft Excel.

The mean age of patients was 76.1 (range 56-107 years) and predominantly female (67%). Mean duration of antibiotics therapy was 13.1 (7-24) days. The most common indication for PC was failed antibiotic therapy (16 patients) followed by gallbladder empyema (4 patients) and severe frailty (4 patients), with 21 patients ASA grade III or above. Mean duration for PC drain in-situ was 31.9 (3-164) days. In five patients, the PC drain fell out spontaneously and 9 patients underwent tubogram before removal. Interval cholecystectomy was performed in 7 patients. No patients died during their acute admission.

PC is a safe, established technique to manage acute cholecystitis in critically ill and high-risk surgical patients with favourable outcomes. More research to develop guidelines that identifies suitable patients through emergency admission would be beneficial.
FTP8.1 International expert opinion on the mitigation of the effects of the COVID-19 pandemic on surgical training
Authors: Kwan Jing Yi , Long Judith , McClean Adam , Chetter Ian , Lockwood Sonia , Yiasemidou Marina
Published: August 2023

Background

The declaration of the SARS-CoV-2 pandemic imposed population-wide measures to contain the virus. This had a knock-on effect on surgical training. An international survey by our group highlighted the need for consultant mentor to lead the recovery of training. Therefore, this project assesses the perspective of trainers on the impact of COVID-19 on surgical training and to explore ways of mitigating this.

Methods

This is a quantitative study encompassing semi-structured interviews of international educationalists. The verbatim transcriptions, underwent thematic analysis.

Results

Eleven educationalists were interviewed. Thematic analysis revealed ten topics: (1) Main areas affected (2) Intensity of impact (3) Causes of impact (4) Pro-activeness (5) National guidance (6) Ways to mitigate impact (7) Effects on minimally invasive training (8) Staff morale, mental health and staff support (9) Mentorship and (10) Recovery of training. The following mitigation techniques were suggested: (i) supervised training throughout the patient journey (ii) trainer led simulation training (iii) use of immersive technologies (iv) individualised training targets (v) dedicated training lists (vi) trainee proactiveness, enhanced by the introduction of a chief resident (vii) structured mentorship (viii) need for national guidelines.

Conclusion

Although surgical services and training are normalising, surgical trainees have a significant gap of surgical exposure accounting for the two years of the pandemic. The current qualitative study explores the perceptive of international experts on effective ways of bridging that gap and provides a practical pathway to achieving recovery of training in the post pandemic era.
FTP8.2 The Development of a Peer Led Plastic Surgery Teaching Programme for Junior Doctors working in a University Based Teaching Hospital
Authors: Tan Wei Wen , Hughes Dominique , Saghir Mohammed , Al-Masri Kazem , Mills Kelsey , Wensley Katherine
Published: August 2023

Background

The busy nature of Plastic Surgery departments often means that formal teaching and learning opportunities can be somewhat scarce. This can result in junior doctors struggling to manage their work duties effectively. The aim of this study was to assess the impact of implementing a peer led teaching programme on the ability of junior doctors to manage their workload.

Methods

A teaching programme including elective and trauma topics on Plastic Surgery aimed at the level of junior trainees was implemented following discussion with our five juniors. The sessions were led by the registrar team and varied from formal lecture-based teaching to case-based discussions. After each session attendees completed a survey which included questions regarding their knowledge on the topic and their confidence on managing these cases before and after the session and on general aspects of the session.

Results

There were 8 teaching sessions included. The feedback rate for each was 100%. The results showed that all trainees either agreed or strongly agreed that the sessions were useful, and the content was delivered clearly and effectively. All trainees reported an improvement in confidence in their knowledge following the sessions. Trainees agreed and strongly agreed that the knowledge they gained would help them manage their elective and on-call duties more effectively.

Conclusion

This study shows that the establishment of a peer led teaching programme by utilising ideas from junior and senior members of staff, can allow trainees to be more confident in managing their workload. Thereby, potentially, allowing for delivery of a more effective service within Plastic Surgery Departments.
FTP8.3 Staff Reported Experience Measure (SREM) survey highlight discordance
Authors: Riyazati Mahta , Gouaalla Hafsah , Ali Fizza , Nyantakyi Maame , Gambhir Raghvinder Pal Singh
Published: August 2023

Aims

Our study aimed to assess the results of the Staff Reported Experience Measure (SREM) survey compared to the Patient Reported Experience Measures (PREM) survey in renal care and evaluate if there was a difference in perception of care received and delivered.

Methods

Following on from our initial study on PREMS for patients on Dialysis, we adapted the same survey for the staff to get the provider's perspective. The 38-question SREM survey covered the same 14 domains and measured experience using a 1-7 rating scale. The results from the surveys were analysed and compared to results from the patient surveys.

Results

We had 49 PREMs and 20 SREMs in the study period of 3 months. On average, staff responses were 0.8 points higher than patients’, with their greatest difference seen in questions for emotional wellbeing (on average, staff responses were 1.95 points higher), kidney support groups (2.08 points higher), and efficiency of communication between the renal team with the GP (1.41) and non-healthcare workers such as social workers (1.64). Questions relating to communication of the patients’ kidney disease treatment, complications and addressing anxieties were consistently scored lower by patients than staff (difference of 0.83, 1.19 and 1.01, respectively).

Conclusions

Our study found a discrepancy between the perception of the patients' experience of the renal care they receive to what the staff thinks they provide. The disconnect between staff and patients’ perception can be addressed through more patient focus group support and staff education.
FTP8.11 Impact of COVID-19 on operative timing for plastic surgery hand trauma in a plastic surgery tertiary referral centre
Authors: Ishak Lisa , Bramhall Russell , Murphy Adrian
Published: August 2023

Aim

To evaluate the impact of COVID-19 on operative timing for hand trauma in a plastic surgery tertiary referral centre.

Methods

Data was collected retrospectively on 80 patients who underwent surgical management for closed hand fractures, digital nerve injuries, and tendon injuries. Forty patients were in the pre-covid group (Jan-Mar 2019) and 40 in the post-covid group (Jan-Mar 2022).

Outcome measures:

Results

There was a statistically significant difference in operative delay time between the pre-covid group and the post-covid pre-vaccine group for hand fractures (2.5 vs 3.9, P=0.0503), tendon injuries (1.4 vs 2.2, p=0.016), and overall (1.9 vs 3.3, p=0.0024). There was no significant difference between the 2 groups for nerve injuries (3.8 vs 1.8, p=0.3062).

In the post-covid group, BSSH operative timing requirements were met for a lower proportion of patients than the pre-covid group for hand fracture fixations (85% vs 100%), nerve repairs (87% vs 100%) tendon repairs (85% vs 100%). Overall, there was a statistically significant difference between the 2 groups (85% vs 100%, p=0.0214)

Operative delays were documented as being related to COVID-19 in 100% of patients who did not meet BSSH operative timing requirements.

Conclusion

COVID-19 has had a significant impact on operative timing for plastic surgery hand trauma. Further studies are needed to evaluate the usefulness of various interventions in the recovery of services following the COVID-19 global pandemic.
FTP8.12 An Audit Evaluating Collection of Urine for Culture Prior To Administration of Antibiotic In The Treatment of Urinary Tract Infection
Authors: Bryce Amy , Clayton Elizabeth , Thu-Ta Flora , Lavin Victoria
Published: August 2023

Aims

This audit aims to evaluate current practice, and potentially improve adherence to NICE guidelines, of collection of urine for culture prior to the administration of antibiotics for suspected urinary tract infections (UTI).

Methods

A retrospective audit was completed of patients seen by the urology on-call team at Freeman hospital, who were treated for a UTI at any point during their admission during the month of December 2022. It was noted if they had a urine culture obtained during their presentation, and if obtained whether this was collected before or after administration of the antibiotic. Other information collected included choice of antibiotic and if culture returned positive for growth.

Results

A total of 45 patients received antibiotics for a UTI during this time period. Of those treated 41 (91%), had a urine culture sent during this presentation, whilst 4 (9%) had no culture sent. Of those who had cultures sent, (34, 83%) were sent prior to commencing antibiotics, and 7 (17%) sent after the first dose.

Conclusions

NICE guidelines recommend that urine should be obtained for culture for if a UTI is suspected, ideally prior to commencing treatment to allow for reliable identification of organisms and their sensitivities. Most patients treated for a UTI during this time did have a urine culture sent for culture. As a department, we were less adherent to guidelines in our timing of culture being obtained prior to antibiotic. We will be making interventions to improve our adherence and re-auditing data in the coming months.
10 Ward and Hospital Simulation in Unity
Authors: Hutton Michael
Published: August 2023

Aims

To investigate ward and hospital design and its effects on efficiency and queues.

Methods

A starter project in C# and Unity simulates two different ward designs and the effects of gender on waiting times.

Results

Initial results show the queue for single bed bays can be substantially reduced (possibly by up to a half) in appropriately designed wards. Video: https://youtu.be/Hw9NXONCRTc

Conclusions

Due to gender issues, it is common for bays to be assigned single genders which can create virtual ring fencing of beds which can impact on waiting times. Current models are often Excel based and are static and do not reflect the actual physical properties of the hospital. This project shows the potential of a dynamic simulation in new ward designs. It is possible that each hospital in the NHS could have its own model, linking its physical attributes (the actual building) to a mathematical model and these can be compared for efficiency. New buildings could be simulated and compared for costs and efficiencies substantially reducing guesswork and challenge building orthodoxy and introduce evidence into hospital design.
28 ‘’Junior doctor confidence in conducting and documenting microbiology ward rounds on neurosurgical wards: A single centre study’’
Authors: Shams Sahar
Published: August 2023

Aims

This study aims to analyse junior doctors’ confidence in conducting and safely documenting microbiology rounds, across two neurosurgical wards in a large tertiary hospital. It also aims to make locating microbiological plans easier and in doing so identity potential areas for improvement.

Methods

Initial feedback from junior doctors (n=12) on their confidence conducting and safely documenting the discussions from the microbiology round was received through a survey sent out. Subsequent documentation guidance was provided and developed using the ‘Start Smart, Then Focus’ antimicrobial stewardship toolkit set out by Public Health England. The initial survey along with two further questions was used to reassess confidence after 2 weeks of implementing the guidance.

Results

There was a 37% increase in confidence with 91.7% of doctors rating their confidence at 5 on the 5-point Likert scale after implementation of the guidance. The guidance was well received and found to be helpful by 100% of respondents. Improvements were seen as there was a 75% increase in responses saying ‘Yes’ it was easy to locate entries. The responses from the qualitative questions identified time restraints as the main theme in determining (1) overall difficulty of the microbiology round (2) ability to document effectively and (3) barriers to using the guidance.

Conclusion

Although there was an increase in confidence in the junior doctors’ ability to conduct and document the microbiology round well the data suggests improvements are required. Recommended improvements include setting dedicated time for all staff to conduct the round and enhancing senior support available.
51 Evaluating the Impact of International Surgical Society Research Grant Funding
Authors: Huo Bright , McClean Adam , Kwan Jing Yi , Antoniou Stavros , Francis Nader , Yiasemidou Marina
Published: August 2023

Introduction

Research impact is defined as the influence of research beyond academia. The European Association of Endoscopic Surgery (EAES) supports research through financial and training support. With the current project we aim to define and objectively measure the impact of research supported by one of the biggest surgical societies in Europe.

Methods & Procedures

A Steering Committee finalised the questionnaire through a Delphi process. This was disseminated to all previous EAES Research Grant recipients since 2011. Results were used to generate open ended questions for semi-structured interviews. Thematic analysis was performed.

Results

The questionnaire response rate was 22/30(73%). The median number of presentations was 2.5, highest number of citations/year was 19. Seven respondents participated on guideline committees, while 15 were involved in further research, including six multicentre trials. Three studies instigated changes in clinical policies. Two intellectual property designs were produced. Eight recipients received further funding. Experts rated a median positive impact of 5/7 on their career progression, while supervised non-experts rated 6/7. The framework from interview thematic analysis included the following topics: (i)benefits of EAES involvement (ii)career progression (academic-clinical) (iii)impact on skills (iv)network impact (v) overall impact (vi)EAES project support (vii)project challenges (viii)EAES project results (ix)study design suitability, and (x)EAES future scope.

Conclusions

The impact of research funding by EAES was significant; both academically and outside academia. The semi-structured interviews identified the facilitators and barriers to project progression and impact.
80 Has the global pandemic health and social situation affected the management of obstructive jaundice secondary to tumuor pathology? A review of our experience in two years of the pandemic
Authors: Aguilera Beatriz Carrasco , Garcia Lorena Solar , de Leon Alberto Miyar , del Val Ruiz Pablo , López-Negrete Emilio , Pinto Ignacio Gonzalez
Published: August 2023

Objectives

SARS-CoV-2(COVID19) infection forced a redistribution of hospital resources, including reduction and delay of scheduled surgical activity. We analysed the management of obstructive jaundice (OJ) in patients with potentially resectable periampullary pathology in a tertiary care centre during the pandemic.

Methods

Observational, single-centre, retrospective study, during the years 2020-2021. The main inclusion criterion was the indication for cephalic duodenopancreatectomy. Patients with criteria of unresectability or indication for neoadjuvant treatment were excluded. We analysed OJ drainage techniques (endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage (PTCD) as well as associated complications. Indications for drainage were: bilirubin >10 mg/dl, cholangitis or expected surgery >2 weeks after inclusion on the waiting list.

Results

We analysed 75 patients (53.3% male) with an age range of 28-80 years. 59% of patients required drainage by OJ, ERCP was performed in 23 cases and PTCD in 21 cases. Twenty-three stents were placed, 52.1% of which were metal-covered. The most frequent complications associated with ERCP (43.4%) were cholangitis and pancreatitis. The most frequent complication associated with PTCD (28.5%) was cholangitis.

Conclusion

The correct management of OJ secondary to resectable periampullary tumours is early surgery without preoperative drainage. In case drainage is necessary, the endoscopic approach with placement of a metallic stent seems to be the most indicated. In our series, the COVID19 pandemic led to more preoperative biliary drainage due to longer delays in surgical scheduling, as well as more PTCD approaches due to greater accessibility, this technique also being valid.
84 Emergency General Surgery medical records standards at a tertiary referral hospital: Lessons learned from Royal College of Physicians
Authors: Youssef Mark , Nada Hany , Boghdady Michael El
Published: August 2023

Introduction

The record keeping standards published by the Royal College of Physicians (RCP) aimed to maximize patient safety, quality of care, support professional best practice and assist compliance with Information Governance and NHS Litigation Authority. We aimed to study the medical records keeping in emergency general surgery admissions at a London tertiary hospital.

Methods

A randomized retrospective analysis of 30 patients was performed in a period from 1st May 2022 to 1st August 2022. Results of the first cycle were presented at a local meeting, followed by action plans and recommendations. A teaching session has been delivered for junior doctors about the RCP standards and planned to be delivered every 4 months for all new staff members. A closing loop has been carried with same methodology and number of emergency surgical admissions from 1st November 2022 to 22nd of November 2022.

Results

Good standards of records keeping in the first cycle was reached in 8 (100%) out of the 12 RCP criteria, with multiple areas that needed improvement. In the closing loop, a significant improvement was reached: discharge letters standards with 93.3% compared to 86.7 % in the first cycle, 3.3% records contained information filled in irrelevant section compared to 20%, 10 % of the cases in the second cycle had advanced decisions documentation compared to 0% in the first cycle.

Conclusions

The maintenance of good medical record keeping requires regular audit and formal education of junior doctors to reach a high standard in emergency surgical admissions according to the RCP record keeping criteria.
103 Botulinum Toxin Type A (Botox) Injection for Plantar Fasciitis: An Audit of Findings
Authors: Olivelle Joseph , Olivelle Arun
Published: August 2023

Introduction

Plantar fasciitis is commonly seen in the musculoskeletal clinic and accounts for around 8-10% of running injuries. NICE recommended corticosteroid injections for patients whose “symptoms are having a significant impact on the person”, however, symptoms lasted for 4 weeks post injection. The use of Botox for the treatment of myofascial pain has increased, with studies showing greater reduction in patients symptoms and improved duration of action.

Material and methods

42 patients (27 male, 15 female) were included in this audit. All patients received 100 units of botox.

Inclusion/Exclusion criteria

All patients who had clinically diagnosed plantar fasciitis and had received the first line treatments of stretching and orthotics.

Patients yet to begin a stretching program or had systemic disease or previous surgery were excluded.

Outcome measure

A patient assessed (VAS) and a physician assessed (Heel Tenderness Index) outcome measure was used.

Results

42 patients were assessed.

VAS

All the patients reported an improvement in symptoms at the 4 week follow up, 38 (90.48%) of whom reported pain free. Of the remaining 4 all advised their symptoms had improved by at least 50%

HTI

38 (90.48%) had no pain on palpation of the heel post injection, whilst prior to the injection all patients had pain in differing degrees. 15 patients (35.71%) had severe pain prior to the injection, post injection no patient had severe pain. 40 (95.24%) patients had improved HTI scores.

Conclusions

Botox is effective in the treatment of plantar fasciitis, however, its effectiveness in the longer term needs to be assessed.
106 Life expectancy of octogenarians following EVAR
Authors: Sultana Emiko , Seraj Shaikh , Jones Steven
Published: August 2023

Background

The aim of elective Abdominal Aortic Aneurysm (AAA) repair is to prevent premature death from rupture. The Endovascular Aneurysm Repair (EVAR) 2 trial showed that patients with AAA who are not fit for open repair do not benefit in terms of life-expectancy from EVAR. In our region, the average life expectancy for men is above the national average but controversy remains when offering octogenarians expensive procedures with the aim of prolonging life. This study aimed to quantify the life-expectancy following an EVAR between octogenarians and younger patients.

Methods

A retrospective review was performed of the electronic notes of all patients receiving EVAR at our unit between October 2009 to October2019. Survival post EVAR was compared between the octogenarian group and the younger patient group. A survival analysis was undertaken using SPSS software to calculate a Kaplan-Meier curve.

Results

294 patients received EVAR between 2009-2019. Patients were between ages 45 and 89 (Median 75); 87.4% were male. 169 patients died during follow up (n=64 ≥80 years, n=105 <80 years). Time of death post-EVAR in octogenarians (average age 82.91 years) ranged between 0- 131 months, whilst those under 80 years (average age 71.77 years) ranged between 1-152 months. Log rank (Mantel-Cox) analysis demonstrated statistical significance (p=0.017). Median years post-EVAR for ≥80 years was 3.02-4.98 and <80 years was 5.12 – 6.87.

Conclusion

Octogenarians undergoing EVAR have a shorter life-expectancy compared to those under 80 years of age. This should be taken into account when discussing elective options with patients and their relatives.
130 Using Abdominal Fat Ratio to predict difficult laparoscopy – a potential indicator for Robotics/TaTME?
Authors: Walls Martin , Winstanley Joseph , Wallace-King Sabina , Collier Toni , Mishreki Andrew
Published: August 2023

Introduction

Minimally-invasive surgery has revolutionised colorectal cancer surgery. Intra-abdominal/visceral adiposity increases the chance of conversion to open surgery. Abdominal fat ratio (AFR) has been identified as predictive for this. New techniques, such as robotic platforms and Trans-anal Total Mesorectal Excision (TaTME), are generally less susceptible to visceral obesity. We hypothesise that AFR can predict difficult laparoscopic surgery and promote selective use of alternative surgical techniques.

Methods

Hospital coding data identified 117 anterior resection and abdominoperineal excision of the rectum procedures between April 2017 and March 2020. Planned/actual procedure and histological factors were recorded. AFR was calculated using the method from Scott et al (Ann R Coll Surg Engl 2017). Mann-Whitney U testing and binomial logistic regression were used to compare AFR between laparoscopic completed (LC) and conversion to open (CtO) groups.

Results

73 cases were completed laparoscopically, 35 converted to open. 9 cases were planned open. AFR between LC and CtO groups was comparable (Median LC = 3.94; CtO = 3.64; U = 1220, p=0.71). Binomial logistic regression showed no relationship between AFR and conversion to open surgery (OR 1.11 95% confidence interval 0.92-1.36, p=0.27).

Conclusion

No statistically significant differences were found. This may result from the small numbers included but may also reflect the multifactorial nature of intra-operative decision-making. Post-chemoradiotherapy effects and difficulties obtaining safe views through inadequate small bowel retraction or bulky mesentery were cited more often in the conversion group than problematic visceral obesity. Other recognised factors should be considered in future, larger series analysis.
151 Isolated tuberculosis liver abscess in an immuno-competent patient – A case report
Authors: Sabir Alifa , Rauf Fatima , Hamza Muhammad , Khan Huma Sabir , Malik Naveed Akhtar , Hanif Muhammad
Published: August 2023

Introduction

Tuberculosis presenting as an isolated liver abscess is extremely rare.

Case Summary

A 55 year old woman presented with complaints of pain right hypochondrium associated with low grade fever and weight loss for last 1 year. Abdominal examination revealed mild tenderness in right hypochondrium. Rest of system examination was unremarkable. Laboratory investigations and chest radiograph were normal. Ultrasound abdomen showed coarse heterogeneous liver parenchyma with increased echogenicity. Single irregular hypoechoic area in segment IV A of the liver was noted. CECT scan of abdomen showed a single well defined focal lesion of 4.2*5.5*4.9 cm in segment V/VI, which was hypovascular on both arterial and venous phases. Delayed imaging revealed thick rim of contrast enhancement suggestive of fibrous capsule. Ultrasound guided biopsy of the lesion was done which showed chronic caseating granulomatous inflammation suggestive of tuberculosis. Patient was started on anti- tuberculous therapy. However, she showed worsening of symptoms. A repeat triphasic CT scan showed a complex multiseptated thick-walled necrotic lesion measuring 8.5*6.9*6.4 cm in segment V/VI of the liver. Her total leucocyte count was 14,500/mm3, CRP levels 19.4 mg/l and ESR 99mm3. Ultrasound guided drainage was done and a drain was placed in right hypochondrium. Patient was discharged on oral antibiotics. The follow- up CT scan showed a significant decrease in the size of abscess (3.8*4.2*5.8 cm) with marked improvement in the symptoms.

Conclusion

An isolated tuberculous liver abscess poses challenge to the clinical acumen of the treating physician and an early diagnosis can help reducing the morbidity and mortality associated with it.
178 Damage Control Surgery in Severe Ballistic Trauma
Authors: Lamara Abdelhak
Published: August 2023

Introduction

Severe ballistic lesions are the cause of hemodynamic disorders and early coagulopathy causing a high mortality rate, their management needs to be adapted to each situation.

Materials & Methods

This retrospective study aims to evaluate the feasibility and outcomes of abbreviated laparotomy and early re-exploration. It includes patients suffering from severe ballistic injuries who had to undergo a Damage Control Surgery (DCS) due to a high severity trauma score. Moreover, morbidity and mortality rates were analysed.

Results

The sample included 73 male patients with an average age of 31years.

Most patients suffered from haemorrhagic shock 74%, respiratory distress 40%, and peritoneal contamination 63%. The severity score was 64. After (DCS), the re-exploration was impossible in certain cases. The mortality rate was 28, 8%.

Conclusion

Abbreviated laparotomy and DCS are effective practices for stabilizing victims of gunshot and maintaining the function and integrity of the organism.
191 Minimally Invasive General Surgery Landmark Trials and Lessons Learned - A Narrative Review
Authors: Walshaw Josephine , Huo Bright , McClean Adam , Gajos Samantha , Kwan Jing Yi , Yiasemidou Marina
Published: August 2023

Aims

The aim of this review is to explore the history of minimally invasive (MI) surgery and landmark trials that guide modern practice.

Methods

A narrative review was conducted according to the four steps outlined by Demiris et al.

Results

MI surgery has become the gold-standard for many operations. Laparoscopic surgery has equivalent operative outcomes to open surgery with reduced recovery time and hospital stay. Randomised controlled trials (RCTs) investigating complex laparoscopic upper gastrointestinal oncological resections demonstrate reduced blood loss and postoperative pain.

Within colorectal surgery, the CLASSIC and COREAN trials described comparable mortality and oncological clearance in MI colorectal cancer resections versus open surgery. Conversely, ALaCaRT and ACOSOG raised concerns about oncological results.

Robotic surgery provides a high degree of instrument freedom and stabilises hand tremors, however substantial associated costs remain a barrier. Robotic cholecystectomy (RC) is a safe and effective tool, and RC outcomes are comparable to laparoscopic surgery in the elective setting; although more evidence is required for more complex disease outcomes. For rectal cancer, the ROLARR trial found no difference in complications, conversion rate, or circumferential margin positivity for robotic-assisted versus laparoscopic surgery. Recently, the Smart Tissue Autonomous Robot performed the first autonomous intestinal anastomosis on porcupines, outperforming expert surgeons for both consistency and accuracy, demonstrating the potential future of robotic surgery.

Conclusion

This review gives an overview of MI general surgery; demonstrating the advantages as well as some concerns for the different surgical techniques, and raises suggestions for future uses.
206 Impact of theatre cancellation on surgical training
Authors: Nessa Ashrafun , Pawloy Karola , Ganeshamoorthy Kajenthiny , Ganesh Radhakrishnan , Ghazanfar Mudassar
Published: August 2023

Introduction

The COVID-19 pandemic has had significant consequences on healthcare delivery worldwide, with a particular impact on surgical services and training. In preparation for the influx of COVID cases, non-urgent appointments, investigations, and operations were cancelled. As a result of the cancellation of cases, elective and emergency case exposure was inevitably reduced. Over 65 percent of trainees lost all training and only 9% reported that they would meet the essential skills. One in eight trainees in their final year have had their training extended due to failure to meet curricular requirements, while a quarter of trainees reach their final year behind their planned training trajectory. The primary objective was to identify the case with the highest cancellation rate to perceive its impact on surgical training.

Method

This is a retrospective study of data gathered by Department of eHealth in a tertiary hospital. Data collected from December 2020 to September 2021were analysed.

Results

121 elective cases were cancelled over the course of 9.5 months. More than thirty types of elective operations were cancelled, with Laparoscopic cholecystectomy - 33 (27.3%) and EUA rectum - 10 (8.3%) being the two most often cancelled procedures. Twenty percent (n=20) of the cancelled cases were malignant.

Conclusion

The recovery of surgical training requires a joint effort from all – the trainers, the trainees and those involved in the delivery of surgical training. The training opportunities for trainees of any grade should be maximised in the theatre setting along with other training opportunities focussed on specific index procedure.
221 Prevalence of breast cancer patients with distant metastases at the time of presentation – A retrospective cohort study
Authors: Shanmugharaj Yogita , Hughes Tara , Jaskani Sadia , Shah Elizabeth
Published: August 2023

Introduction

About 8% of new breast cancer patients have distant metastases at presentation.[1] Current local practice is to perform staging CT on selected patients. The aim of this study was to investigate the prevalence of distant metastases in a cohort of newly diagnosed breast cancer.

Methods

A single-institution retrospective analysis of prospectively collected database of all newly diagnosed patients between January and June 2019 (pre-covid era). Patients with previous history of breast cancer were excluded. Data was collated from hospital medical records. SPSS version 21 was used for analysis.

Results

A total of 85 patients with a mean age of 66±15.593 were included. Tumour size ranged from 1.4 to 83mm. 22.4% were ER Negative, 14.8% HER2 positive and 37.3% node positive. Almost half of the patients (49.4%) underwent staging investigations at first presentation. The incidence of distant metastases within 1 year of presentation was 10.6% (9/85). 4/9 (44.4%) presented late with symptoms greater than 3 months duration. On applying one-way ANOVA to compare means, distant metastases at presentation was significantly related to grade (p-value= 0.002) and nodal status (p-value=0.006). There was no statistically significant relationship to age, ER/HER-2 status, tumour size or duration of symptoms.

Conclusions

Metastatic breast cancer at presentation in our cohort appears concordant with the literature. Distant metastases within a year of presentation is significantly related to grade independent of nodal status, and staging investigations should be considered in early breast cancer patients with higher tumour grade irrespective of other factors.

1. https://pubmed.ncbi.nlm.nih.gov/35018787/