bluuebunny/crossref_metadata_2025 huggingface dataset:
SP3.1.3 Optimum treatment for sigmoid volvulus remains elusive but surgery may provide considerable benefit
Authors: Issa Mohamed , Guy Richard
Published: November 2022

Background

Sigmoid volvulus is a surgical emergency and patients are often elderly with significant comorbidities. Whilst endoscopic decompression is easy and effective in the short-term, recurrence and repeated admissions are common with surgery generally being reserved for non-resolution or complications. Consensus an optimum management is lacking.

Methods

A retrospective audit of all patients admitted with sigmoid volvulus to a DGH General Surgery service between 01/01/2015–20/10/2020 was undertaken. Patient demographics, comorbidities, clinical findings, investigations and treatment were recorded.

Results

Sixty-three patients were identified (median age 71.5 years; 58.7% male]. Some 50.8% had more than one previous presentation (range 1–6), 19% presented after 3 days of symptoms and 3.2% presented with perforation. Plain radiography and CT scanning was undertaken in 90.5% and 54%, respectively.

Endoscopic detorsion was performed in 77.77% and repeated in the same admission for 33.3% of cases. Flatus tubes and rigid sigmoidoscopy was used in 47.6% with a 59.6% success rate. Seventeen patients (27%) underwent sigmoid resection, 14 having open surgery and 3 laparoscopic. Primary anastomosis was undertaken in 64.7% (11 patients), with only one anastomotic leak; the remaining 6 patients had a colostomy. The re-admission rate was 30.1% (19% non-operated patients, 11.1% operated patients).

Conclusion

Most patients with sigmoid volvulus are managed non-operatively with endoscopic detorsion which may be associated with a considerable healthcare burden and high readmission rates. Selective resection can be associated with low morbidity and good outcomes. Clinicians could reasonably adopt a lower threshold for surgical intervention, particularly for recurrent volvulus.
SP3.1.4 Benign Lymph Node Ratio (LNR) and Lymph Node Yield (LNY) as predictors of survival in resected colorectal cancer (CRC)
Authors: Issa Mohamed , Ahmad Salma , Wilson Jeremy , Magee Conor
Published: November 2022

Background

Lymphadenectomy is central to tumor prognosis. 12 LNY during CRC resection is a standard of good oncological resection, but 30–50 percent of resections do not achieve this. LNR was suggested to be a more accurate predictive factor.

Aim

To examine the prognostic significance of LNY and LNR on survival in patients with non-metastatic CRC.

Methods

A retrospective study on patients with CRC treated at a DGH from January 2015 to February 2017. Outcome measures were Disease-Free (DFS) and Overall Survival (OS).

Results

265 cases were identified. The mean age was (71.4±11.3) years with a median follow-up of 56 (range 0–72) months. Median LNY was 18 (range 0–66) nodes. 74.9% of the cases have> 12 LNY and only 25.1% of the cases have < 12 LN yielded in the specimen; however, 76.4% have LNR of 0-<0.25. Increasing LNR was associated with poorer OS and DFS (p-value 0.0001). An LNR of (0.75–1) was associated with a very poor prognosis (p-value 0.0001); it showed 30 and 33 months less in median OS and DFS retrospectively than LNR (0-<0.25). LNY did not show any statistically significant predictive factor in survival. Multivariate analysis showed OS and DFS are affected (R2= 27.3% and 26.1% retrospectively) mainly by LNR. It did not show statistical significance with the other variables, including TNM, LNY, and Dukes' stages.

Conclusion

Increasing LNR was a marker of poor survival; however, LNY was not a statistically significant predictive factor. LNR is better in predicting survival than TNM and Dukes' staging.
SP4.2.2 Recovery after Emergency Laparotomy – what do patients want?
Authors: Silva L , Crole Rees C , Watts T , Bisson J , Cornish JA
Published: November 2022

Aim

Recent focus on Emergency Laparotomy outcomes has improved mortality, but little attention has been given to recovery. The aim of this qualitative study was to explore recovery after EmLap.

Method

A focus group was established of ten EmLap patients. Inclusion criteria: EmLap<5 years ago, non-palliative. Patients were selected to provide balance of age, sex and pathology. Thematic qualitative analysis was performed by two researchers.

Results

Several key themes were highlighted;

Lack of communication on diagnosis/expectations after surgery. Little continuity of care. Long delays in seeing doctors after surgery and no way to contact them and GPs unable to help.

Financial consequences are significant, with no guidance. Took longer to recover than expected, difficult to explain to employer. Led to early retirement or change of hours/role.

Hernias; Some patients aware of hernia risk but given conflicting advice, e.g avoid lifting and rest for 6 weeks, others told to exercise regularly. Difficult to access support garments.

Diet – Conflicting advice on what they could/couldn't eat, especially fibre. Felt more by patients who had stoma or bowel resection. Poor quality food in hospital and lack of options for diet (e.g. vegan, coeliac).

Poor mental health after surgery with anxiety, depression and loss of confidence all having large impact, especially on relationships and intimacy. Key issues lack of access to services and waiting times. Too ‘complex’ for primary care.

Conclusions

The impact of emergency surgery on patients is significant, particularly mental health and financial impact. Recommend standardised information (leaflets/website/signposting) and key support worker.
SP5.2.3 Protocolised MRI as an Adjunct to CT in the Diagnosis of Femoral Neck Fracture in High Energy Ipsilateral Femoral Shaft Fractures – a Breakeven Analysis
Authors: MacKinnon Thomas , Selmi Hussein , Reilly Peter , Sarraf Khaled , Sabharwal Sanjeeve
Published: November 2022

Background

In high-energy femoral shaft fractures, ipsilateral femoral neck fractures can be missed by conventional trauma computed-topography (CT) imaging, resulting in increased treatment costs and patient complications. Evidence suggests that a rapid, limited-sequence pelvis and hip magnetic resonance imaging (MRI) protocol can identify these occult fractures and be feasibly implemented in the trauma setting. This study aims to analyse the economic viability of implementing a such an MRI protocol for all high-energy femoral shaft fractures.

Methods

We used an adapted break-even economic tool to determine whether the costs of an MRI protocol can be offset by cost-savings achieved through prevention of missed fractures (thus avoiding prolonged inpatient admission, re-operation and implant costs). Sensitivity analyses were performed to demonstrate the reliability of the economic modelling across a range of assumptions.

Results

Assuming a baseline of hip fractures missed on CT of 12%, an MRI cost of £129 and cost of treating each missed hip fracture of £2633.5, the equation yielded a breakeven rate of 7% and absolute risk reduction (ARR) of 5%, indicating that for every 100 femoral shaft fractures, MRI would need to diagnose 5 of the 12 missed hip fractures to be economically viable (NNT=20). Economic viability was maintained even at double the cost of MRI, while increasing the cost of treating each complication served to reduce the ARR further, increasing cost effectiveness.

Conclusion

A rapid, limited-sequence MRI protocol to exclude occult ipsilateral hip fractures in all femoral shaft fractures would be an economically justified measure.
SP5.2.9 Perioperative immunonutrition in reducing the infectious complications in patients undergoing colorectal cancer resections: a meta-analysis of randomized controlled trials
Authors: Mohamed Mazin , Nour Hussameldin M , Sajid Muhammad , Sains Parv , Baig Mirza K
Published: November 2022

Objective

Perioperative nutritional interventions have been reported to improve colorectal rectal cancer surgery outcomes. The objective of this article is to assess the influences of immunonutrition intervention during perioperative period in patients undergoing colorectal cancer resections.

Method

Meta-analysis was conducted according to the PRISMA guidelines. Systematic search of medical databases like MEBASE, MEDLINE and pubmed was performed to find studies exclusively reporting the perioperative use of immunonutrition in patients undergoing colorectal cancer resections and relevant published randomized, controlled trials (RCT) were shortlisted according to the inclusion criteria. The analysis of the pooled data was done using the RevMan statistical software.

Result

Ten RCTs on 1218 patients with colorectal cancer fulfilled the inclusion criteria. In the random effects model analysis, the use of perioperative immunonutrition in patients undergoing colorectal cancer resections statistically reduced the risk [odds ratio 0.59, 95% CI (0.35–1.0), z= 1.96, p=0.05] of infectious complications. However, there was significant heterogeneity [Tau2 = 0.35; Chi2= 19.11, df = 9 (P < 0.02; I2 = 53%)] among included studies. The variables of postoperative mortality [odds ratio 2.1, 95% CI (0.33–12.36), z= 0.75, p=0.45] and length of hospitalization [standardized mean difference 0.16, 95% CI (-0.08–0.39), z= 1.31, p=0.19] were statistically similar in patients using immunonutrition or standard conventional perioperative nutrition.

Conclusion

Perioperative immunonutrition in patients undergoing colorectal resections seems to reduce infectious complications but this study failed to demonstrate its role in reducing the postoperative mortality and length of hospitalization.
SP6.1.7 Radio-frequency ablation using the STRETTA© is a feasible treatment option for GORD and reduces need for primary fundoplication
Authors: Joel Abraham , Konjengbam Alakh , Hammond Emily , Franks Helen , Viswanath YKS , Cowie Stuart
Published: November 2022

Introduction

The STRETTA© system of using radiofrequency (RF) energy to the gastro-oesophageal junction (GOJ) for management of refractory gastro-oesophageal reflux disease (GORD) has shown to improve baseline symptoms, PPI dependence and reduce the need for anti-reflux operations in select group of patients. We aimed to review our outcomes of STRETTA© for patients with medically refractory GORD.

Methods

A retrospective review of a prospectively maintained database was carried out in a tertiary British centre. All patients who underwent STRETTA© procedure from 2015 were reviewed. General practises and individual patients were followed up to obtain the proton pump inhibitor (PPI) free time after undergoing STRETTA© procedure.

Results

A total of 200 patients underwent STRETTA© procedure from 2015. All patients were reviewed once in clinic between 4–6 weeks with an overall median follow-up of 34.5 months. Preliminary analysis suggest over half of the patients (54%, n=108) remaining without PPI usage. Data for median time before restarting proton pump inhibitors (PPI) after STRETTA© is being collected. No patients needed further STRETTA© treatment and 2 patients (1%) has gone onto have anti-reflux procedure for non-resolution of symptoms.

Conclusion

Our preliminary findings suggest STRETTA© as a valuable and feasible option for treating refractory GERD. It may help reduce the need for fundoplication procedures and our data suggests that it increases the time before which surgery is required.
SP6.2.3 Boerhaave's Syndrome vs Iatrogenic Oesophageal Perforation - A Comparison Between Aetiology
Authors: Alasmar Mohamed , Shehata Zak , Altarawni Mohammad , Casey Patrick , Melhado Rachel , Sultan Javed
Published: November 2022

Aim

Oesophageal perforation is a rare surgical condition with high mortality. Boerhaave's syndrome (BS) may be associated with worse outcomes due to the degree of mediastinal contamination when compared to ‘clean’ iatrogenic perforations. This study aims to assess the differences in treatment and outcome between these two groups.

Methods

Data was collected from a tertiary centre from 2009–2021 (n=73, 42 BS, 31 Iatrogenic). Data was collected retrospectively using the electronic patient record. Complications were quantified using the comprehensive complication index (CCI). Univariate analysis was used to determine statistical significance.

Results

BS had a higher 30-day mortality compared to iatrogenic perforations (21.4% vs 3.2% p=0.025), however this was no longer significant at 90 days and 1 year (21.4% vs 16.1% p=0.57, 21.4% vs 19.4% p=0.83). Iatrogenic perforations were more likely to be managed non-operatively (73.8% vs 25.8% p<0.001). All of the iatrogenic deaths that occurred between 30 days-1 year had been managed non-operatively. Median length of intensive care stay was higher in BS (15 days vs 6 days p=0.047), with no significant difference in median overall length of stay (48 days BS vs 38 days iatrogenic p=0.88). Median CCI was greater in BS (53.9 vs 29.6 p=0.002).

Conclusion

Whilst CCI and 30-day mortality was higher in Boerhaave's there was no difference in 90-day and 1 year mortality suggesting that long-term survival is not dictated by aetiology of the perforation. Most of the iatrogenic perforation were managed non-operatively which raises the question whether iatrogenic perforation should be managed more aggressively.
SP7.3 Behind Every Stereotype is a Grain of Truth: Perceptions of a Career in General Surgery Amongst Doctors
Authors: Sheridan Kelda , Quinton Naomi
Published: November 2022

Introduction

General Surgery (GS) educational community of practice faces crisis. Recruitment challenged by cultural norms of postponing post-foundation training; and retention with perceptions of elitism, discrimination and inflexibility. Surgical pedagogy has been examined through skill acquisition but what of the hidden curriculum. Three research aims were posed: who is a General Surgeon, what are the enablers or barriers to pursuing this career and is our current UK training system fit for purpose.

Methods

Qualitative methodology within a constructivist research paradigm was utilised. Recruitment via the snowballing technique included representative sampling of junior doctors, including men, women and those from diverse ethnic backgrounds. 1:1 Semi-structured interviews explored participant perspectives of training, recruitment and work-life balance. Data was transcribed, familiarised, de-constructed and generated. Latent data analysis, coding and development, maintained reflexivity. ‘Data sets’ were transformed to a thematic map and key themes identified.

Results and Discussion

Foundation, specialty doctors, core and higher surgical trainees were included (60% men, 40% women). Fundamental themes of support, attitudes and sacrifice were identified, interacting to influence educational narrative. Support comprised personal, institutional, academic and cultural forms. Attitudes of elitism, implicit and explicit gender bias, microaggressions and overt discrimination concealed as surgical tradition. An overarching concept of sacrifice was noted: personal, professional, fiscal and emotional, the so-called surgical currency.

Conclusions

The study explored phenotype, motivation, intellect and philosophy within GS. Highlighting issues in the system surrounding negative attitudes, cultures and behaviours, education is a powerful tool which can be used to challenge perceptions and improve training.
SP7.10 Improving Our Preop Fasting Practice
Authors: Khalid Ayesha , Iqbal Faisal , Keen Muhammad Irfan , Tiwari Mr , Waqar Hamza
Published: November 2022

Aims

Preoperative fasting has always been a tussle between patient and surgery staff. Keeping patient nil by mouth unnecessarily not only increases the anxiety, thirst, hunger, postoperative insulin resistance but can also lead to serious hypoglycemic events in diabetic patients. The objective of our study to standardize the habits of pre-operative fasting according to AABGI guidelines and make sure to curtail the fasting period to the required minimum to 2 hours for liquids.

Method

This retrospective study included all inpatients who had any vascular surgery done under general anaesthesia from Sep 2020 to Nov 2020 in Birmingham Heartland Hospital. As per departmental practices every patient is fasted from 0300. Anaesthesia induction time was noted for every patient from theatre logbook to calculate the fasting interval. After data analysis meetings were done with the ward sister, anaesthetic & vascular surgery consultants to draw an action plan.

Results

Data collected from a total of 50 patients showed that average fasting period was 11 hrs 2 mins with longest fasting interval was 14 hrs 55 mins. Blanket allowance of clear fluids till 7 am, late dinner and communication of theatre list priority to the ward resulted in achieving an average fasting period of 2 hrs 53 minutes.

Conclusions

Identification of this simple but crucial problem is the first step towards compliance with the standard. These unassuming butchallenging implementations can significantly affect patient satisfaction and help achieve recommended fasting intervals. Pre-op fasting can easily be optimized by good communication between staff. As further evidence arises, structured peri-operative care can progress.
SP7.11 Preliminary results from the TACKoMesh RCT; comparing the patient experience of pain following elective laparoscopic incisional hernia repair with ‘Protack™ versus Reliatack™’, IPOM and sutured fascial closure
Authors: Pilkington James , Wilkinson Fiona , Pritchett Jim , Shah Shaneel , Fullwood Catherine , Sheen Aali
Published: November 2022

Aims

Provide a report on all patients who underwent laparoscopic incisional hernia repair as part of the TACKoMesh RCT prior to unblinding of treatment arms.

Methods

Trial recruitment was for primary incisional hernia with a defect diameter of 3–10cm. 63 patients (target 74–136) were operated on prior to the outbreak of COVID-19. Post-operative pain is the primary trial outcome.

Surgery was performed with spiral-tack mesh-fixation devices (Protack™ (permanent) or Reliatack™ (absorbable)), Symbotex™ IPOM mesh, and sutured fascial closure using extracorporeal knot ties.

Data was collected on trial forms and lifestyle questionnaires (SF-36 and CCS). All data were explored and described in RStudio v1.4.1106.

Results

Patients were aged 36–80 and 57.1% male. Mean preoperative BMI was 30.91.

Mean operating time was 81minutes. In 20.6% patients multiple hernia defects were identified. A good degree of fascial closure was achieved in all patients using a median 3 knots.

Median mesh-fixation time was 286seconds and a mean of 25 tacks/patient were used. Median length of hospital stay was 3.5days.

Patients were asked “Please indicate on this scale [VAS 0–10] the pain that you currently experience from your incisional hernia during activity?”. Median responses for Day0/pre-op, Day1, Day6, Day30 and Day365 were 4.5, 8.0, 6.0, 3.0 and 1.5 respectively.

At one year, 11% patients had experienced hernia recurrence and 52% a post-operative seroma.

Conclusions

Target recruitment was not possible owing to COVID-19. This technique has comparable recurrence rates. Reported pain increases post-operatively but is reduced at post-operative day30 and day365.
SP8.2.1 Robotic versus laparoscopic left lateral hepatic sectionectomy: a systematic review and meta-analysis
Authors: Hajibandeh Shahin , Hajibandeh Shahab , Qayum Mohammed Kaif , Dosis Alexios
Published: November 2022

Aims

To evaluate comparative outcomes of robotic and laparoscopic left lateral hepatic sectionectomy (LLS).

Methods

A systematic search of PubMed, Web of Science, EMBASE and bibliographic reference lists with application of a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits was conducted. Overall, minor (Clavien–Dindo gradeIII) postoperative complications, mortality, volume of blood loss, conversion to an open procedure, procedure time, length of hospital stay, cost-effectiveness, and R1 resection were the evaluated outcome measures.

Results

Seven comparative observational studies reporting a total of 319 patients of whom 150 underwent robotic LLS and the remaining 169 patients underwent laparoscopic LLS were included. The robotic approach was associated with significantly longer procedure time (MD: 29.40 minutes, p=0.01) and higher cost (MD: $4170, p<0.00001) compared to the laparoscopic approach. There was no significant difference in overall postoperative morbidity (OR: 1.29, p=0.62), Clavien-Dindo grade  III (OR: 1.18, p=0.85), perioperative mortality (RD: 0.00, p=1.00), volume of blood loss (MD: 1.96 mls, p=0.91), conversion to an open procedure (RD: -0.02, p=0.46), length of hospital stay (MD: 0.22 day, p=0.52) or R1 resection (RD:0.00, p=1.00) between two groups.

Conclusions

Meta-analysis of the best available evidence (level 2) demonstrated that robotic LLS is associated with significantly longer procedure time and higher cost and similar perioperative outcomes compared to the laparoscopic approach. Future randomised studies are required to evaluate short-term perioperative, long-term oncological and surgeon-centred outcomes.
SP9.1.3 Colorectal Cancer Referrals During COVID-19: The Use of CT and qFIT in Triaging Patients in NHS Grampian
Authors: Ashad Fabbiha , Ramsay George , Morrisey Brian
Published: November 2022

Introduction

The COVID-19 outbreak resulted in fundamental changes to clinical practice for patients referred to secondary care with lower gastrointestinal symptoms. The use of colonoscopy services was reduced due to a perceived risk of viral transmission. Resultantly, computed tomography abdomen pelvis (CTAP) scans were utilised to triage patients. This study aimed to assess the accuracy of CTAP and qFIT in triaging patients at risk of colorectal cancer.

Methods

This study retrospectively gathered data on patients referred via the urgent suspected cancer (USC) pathway from the start of lockdown over a 6-month period in a single Scottish Health Board. Data were collected on presenting symptoms, qFIT levels, vetting decision, investigations, and subsequent diagnosis. Patients were vetted into one of five pathways: CTAP, direct to colonoscopy, downgraded from assessment, flexible sigmoidoscopy, or CT colonography.

Results

The overall cancer detection rate was 6.4%. Of the patients with cancer on the CTAP pathway, 22.9% had cancer undetected on CTAP which was later identified on colonoscopy. In the cohort of patients with colorectal malignancy, 7.5% had a negative qFIT value (<10 ug/g).

Conclusion

CTAP alone may not be accurate in detecting colorectal cancers. One should consider the whole clinical picture and decide whether further imaging is warranted following a negative CTAP scan. Additionally, qFIT remains the leading laboratory investigation within screening programmes, however, it should not be used in isolation to rule out colorectal malignancy.
SP9.1.7 The effect of the COVID-19 pandemic on Colorectal Cancer (CRC) diagnosis, management and outcomes
Authors: Harris Matthew , Kuhdr Jamal , Rooney Paul
Published: November 2022

Aim

We studied differences in stage, treatment modality, morbidity and mortality, two week wait referrals (2WW) and rate of 2WW cancer diagnosis.

Method

All 2WW referrals to the NHS trust colorectal department were analysed and their rate of diagnosis of any cancer. Using data extracted from the Somerset Cancer Database, we compared CRC patients diagnosed in the NHS trust 6 months prior to (Pre-PAN) and following (PAN) national lockdown on 23/02/2020.

Outcome measures included: cancer stage, resection rate, stoma rate, Clavien-Dindo score and 90 day mortality. Statistical analyses included Chi-squared and Mann-Whitney-U tests.

Results

2WW referrals dropped significantly during the pandemic (p=0.02). However, the rate of diagnosis of cancer of any kind was not significantly different (PAN=12.4%, Pre-PAN=11.4%,p=0.89).

There were significantly fewer CRC diagnoses during the pandemic (Median monthly diagnoses: Pre-Pan=13.5, Pan=8.5 p=0.010). There was a significantly higher proportion of Dukes A cancers in Pre-Pan compared to Pan (Pre-PAN=31.3%, PAN=14.3%, p=0.036). There was a significantly higher proportion of Dukes B cancers in Pan compared to Pre-Pan (Pre-PAN=13.8%, PAN=33.9%, p=0.032). There was no excess morbidity or mortality between the two groups.

Conclusion

There was no excess mortality or morbidity, demonstrating the efficacy of COVID surgical protocols. PAN patients presented with advanced tumour stage. There were fewer 2WW referrals from GP and fewer diagnoses of CRC in the PAN group. However, the proportion of cancers picked up from 2WW referrals was not significantly different. Decreased diagnoses and stage migration may be due to loss of investigative resource or patient factors such as fear precipitating late presentation.
SP9.2.2 Implementation of a straight to test colorectal cancer referral pathway significantly improves cancer targets and reduces outpatient requirements
Authors: Satti Suren Reddy , McKenzie Sevra , Yao Caroline , Arnold Steve , Venkatasubramaniam Arcot , Di Fabio Francesco
Published: November 2022

Aims

The main aim of this study is to determine the impact of the “Straight to Test” (STT) colorectal cancer pathway on the NHS England 28-day faster diagnosis and 62-day-treatment targets. The secondary aim is to evaluate the effect of the pathway on reducing outpatient clinic appointments and the proportion of colorectal cancers diagnosed within 2 week wait (2WW) referrals.

Methods

This case-controlled single-centre study included 1000 patients. Five-hundred consecutive patients were managed through the STT colorectal cancer pathway between February 2021 to May 2021 (study group), with a dedicated colorectal nurse triaging the referrals for straight to colonoscopy or outpatient clinic, for complex cases that do not fit the STT criteria. This group was compared with 500 consecutive patients referred on the 2WW colorectal cancer pathway prior to the implementation of the STT pathway and therefore all reviewed in outpatient clinic, between April 2019 to July 2019 (control group).

Results

The 28-day time-to-diagnosis and 62-day time-to-treatment targets improved after the introduction of STT pathway from 59% to 86% (p<0.0001) and from 35% to 60% (p=0.095), respectively. In the study group, 234/500 (47%) patients were triaged for straight to colonoscopy, freeing up an equal number of outpatient colorectal clinic appointments. The proportion of colorectal cancers diagnosed within the 2WW referrals was 5.2% in the study group and 4.2% in the control group.

Conclusion

Implementation of a STT 2WW colorectal cancer pathway has significantly improved our colorectal cancer targets and reduced outpatient clinic requirements.
SP9.2.3 Role of single or double ringed circumferential wound protectors in reducing surgical site infections following colorectal resections: an evidence synthesis by the meta-analysis of randomized controlled trials
Authors: Nour Hussameldin M , Ahsan Amiya , Baig Mirza K , Sains Parv , Sajid Muhammad S
Published: November 2022

Objective

The objective of this article is to explore whether the use of single or double ringed wound protectors (WP) in patients undergoing colorectal resection (CRR) is associated with reduced risk of surgical site infections (SSI).

Method

Analysis was conducted according to PRISMA guidelines. With the help of expert local librarian, systematic search of medical databases like MEBASE, MEDLINE and pubmed was conducted to find appropriate randomized controlled trials (RCT) according to predefined inclusion criteria. The analysis of the pooled data was done using the principles of meta-analysis on statistical software RevMan.

Result

Eighteen RCT on 3744 patients fulfilled the inclusion criteria. There were 1885 patients in the WP group and 1889 patients in the no-WP group. In the random effects model analysis, the use of WP during CRR was associated with the reduced risk of SSI [odds ratio 0.63, 95% CI (0.47–0.86), z= 2.94, p=0.003]. However, there was significant heterogeneity (Tau2 = 0.18; Chi2= 34.77, df = 17; (p=0.007; I2 = 51%) among included studies.

Conclusion

Use of WP seems to reduce the risk of SSI and therefore, may routinely be used during both open and laparoscopic CRR.
SP10.1.2 Novel Predictors of Mortality in Emergency Bowel Surgery: A Single Centre Cohort Study
Authors: Darbyshire Alexander , Kostakis Ina , Meredith Paul , Toh Simon , Prytherch David , Briggs Jim
Published: November 2022

Aims

Pre-operative risk stratification is a key part of the care pathway for emergency bowel surgery, as it facilitates the identification of high-risk patients. A limitation of current risk models is that they utilise operative data in their calculation and are not designed to provide pre-operative risk-predictions. This study aimed to investigate the ability of variables that are routinely available pre-operatively to predict 30-day mortality after emergency bowel surgery.

Methods

A single centre cohort study was performed using local National Emergency Laparotomy Audit database (01/12/2013 to 31/01/2020). Further data was then extracted from electronic hospital records (n=1,561). The National Early Warning Score (NEWS), Laboratory-Decision-Tree-Early-Warning Score (LDTEWS) and Hospital Frailty Risk Score (HFRS) were then calculated. The most abnormal NEWS/LDTEWS scores in the 24/72-hours prior to surgery were used in analysis.

Results

Individual NEWS, LDTEWS and HFRS scores were reasonable predictors of mortality (c-statistic 0.689–0.735) but all poorly calibrated. NEWS scores of ≥4 were associated with a high overall mortality rate (>10%). A logistic regression model (Pre-Op) was developed using age, NEWS, LDTEWS and HFRS scores as predictor variables. The Pre-Op model demonstrated good discrimination (c-statistic 0.778) and excellent calibration, but was outperformed by the NELA score (c-statistic 0.855). Interestingly, APACHE II and P-POSSUM displayed poor calibration and fair-to-good discrimination (c-statistic 0.687–0.789).

Conclusion

Pre-operative patient vital signs, blood tests and markers of frailty can be used to accurately predict the risk of 30-day mortality after emergency bowel surgery.
SP10.1.4 Association between public holidays and acute admission with biliary colic: a retrospective analysis
Authors: Dick Lachlan , Young Jamie
Published: November 2022

Introduction

Biliary colic symptoms are often post-prandial, particularly following fatty foods. Public holidays and festive periods are frequently celebrated using such foods. We aimed to determine the rates of admission following public holidays at a Scottish district general hospital.

Methods

Emergency admissions with biliary colic from June 2016 to June 2019 were included. Public holiday dates were extracted from the Scottish government website. To include those with delayed presentation, the 3-days following a public holiday were also considered to be public holiday-related (PHR). Statistical analysis was performed to determine any differences in demographics or outcome.

Results

Of the 273 patients included, 1 (0.4%) was admitted on a public holiday with a further 27 (9.9%) admitted on a PHR day. PHR days accounted for 104 (9.2%) of the 1125 days included in the study. Comparing those admitted on a PHR and non-PHR day, there was no difference in age (61.6 vs 61.1 years, p=0.895), female gender (75 vs 66.5%, p=0.365), length of stay (6 vs 4 days, p=0.250) or operative intervention (53.5 vs 37.6%, p=0.09).

Conclusion

The majority of PHR admissions with biliary colic occur during the 3-days following a public holiday. It is therefore likely that the need for radiological investigation and access to emergency theatre will be greater during this period. Future work could assess the impact of other cultural holidays which are not reflected in public holidays.
SP10.1.5 Hajibandeh Index and intraperitoneal contamination: A cohort study and meta-analysis
Authors: Hajibandeh Shahab , Hajibandeh Shahin , Evans Louis , Miller Bethany , Waterman Jennifer , Maw Andrew
Published: November 2022

Aims

To validate the performance of the Hajibandeh Index (HI) in predicting the presence and nature of intraperitoneal contamination in patients with acute abdominal pathology.

Methods

The STROCSS guidelines and the PRISMA statement standards were followed to conduct a cohort study and a meta-analysis, respectively. All adult patients undergoing emergency laparotomy for acute abdominal pathology were eligible. The accuracy of the HI was evaluated using ROC curve analysis in the cohort study and using weighted summary AUC under the fixed and random effects modelling in the meta-analysis. The QUADAS-2 criteria were used for methodological quality assessment of the included studies.

Results

A total of 1437 patients were included (700 from the cohort study and 737 from the literature search). ROC curve analysis of the cohort study showed that the AUC of HI for presence of contamination was 0.79 (P <0.0001) and meta-analysis showed that the pooled AUC of HI was 0.79 (0.75–0.83). In terms of nature of contamination, the cohort study showed that the AUC of HI for purulent and feculent contamination was 0.76 (P<0.0001) and 0.83 (P<0.0001), respectively. The pooled AUC of HI for purulent and feculent contamination was 0.78 (0.74–0.81) and 0.80 (0.77–0.83), respectively.

Conclusions

The HI is a strong and accurate predictor of the presence and nature of intraperitoneal contamination. We encourage other researchers to validate performance of HI in predicting the presence of intraperitoneal contamination and more importantly in predicting mortality following emergency laparotomy.
SP10.1.7 Assessment of interhospital transfers of acute surgical patients within an NHS trust
Authors: Hazemi-Jebelli Yasmin , Weigel Katharina , Gunnell Rachel , de Wolf Maisie , Patel Mital , Patten Darren
Published: November 2022

Acute surgical services at our trust were moved from two sites to a single site, due to COVID-19. This project was inspired by cases of transfer whereby significant time delays resulted in poorer patient clinical outcome.

Aims

Methods

Results

Conclusion

Interhospital transfer must focus on maintaining optimal health and outcomes for the patient. A guideline and framework for safe transfers must be implemented and adhered to strictly.
SP10.2.2 Emergency Management of Incisional Hernia
Authors: Omar Islam , Townsend Abby , Williams Catrin , Jones Annabel , Wilson Jeremy , Magee Conor
Published: November 2022

Introduction

Incisional hernia is a common complication after abdominal surgery. Operating on a hostile field renders the management of incisional hernia quite challenging. Presentation with incarcerated or obstructed incisional hernia can further complicate the picture. This study aims to describe the outcomes and burden of emergency management of incisional hernia.

Methods

A retrospective study has been conducted. We reported the patients' demographics, primary surgery details, hernia characteristics, and mode of presentation and management.

Results

Forty-five patients were included in the analysis. Mean age was 66.78;SD±15.32. Thirty-one (69%) were females. Mean BMI was 35.49;SD±10.46. They had significant comorbidities including diabetes, CKD, COPD, and malignancy; 31.1%, 13.3%,11.1%, 11.1% respectively.

Twenty-two (48.8%) had incisional hernia after midline incision. 25(55.6%) presented with bowel obstruction. Thirty-two had a surgical repair, and ten were managed conservatively. The mean time from admission to surgery was 1.4;SD±2.1. Meshes were used in 10(31.25%) patients. The mean duration of surgery was 114.03;SD±60.55 minutes.

Ten patients needed HDU/ITU; 9 of them were managed surgically. Complications rate (CD≥III) was 20%. The 30-day mortality rate was 8.89%. Six (18.75%) patients had recurrence after surgical repair.

Thirty patients had CT, 7 had X-rays, and one had US. The mean hospital stay was 8.71;SD±8.8, with an overall hospital stay of 392 days. Fifteen patients were readmitted, and seven came back without staying >24 hours.

Conclusion

Emergency presentation of incisional hernia carries a high risk of morbidity and mortality and represents a high burden.
SP11.10 Assessing the utility of surgical instruments in breast surgery at a tertiary referral centre
Authors: Knight Lucinda , Khun Ng James Chean , Haigh Constance , Cash Julie , Isherwood Jennifer , Oni Georgette
Published: November 2022

Introduction

Most surgical specialties have standardised surgical trays, which are used for a variety of their operations. Any unused instruments require re-sterilisation, with costs relating directly to the number of instruments. This has further environmental implications. In 2019, we performed over 1600 breast surgeries in our unit. This study aimed to look at the utility of the breast reconstruction tray (BRT), which is the most commonly used surgical tray, in the unit to see if there was scope for cost efficiencies.

Methods

All BRTs (averaging 55 instruments) used for breast operations were recorded from October to November 2021. Data collection included operation type, individual instruments used and additional instruments requested during the procedure. Quantitative analysis was performed on the collected data.

Results

A total of 55 BRTs were used during the study period. 17 were bilateral cases. An average of 42% (n=23, range 10–33) of instruments were used from each tray, with 16% (n=9) of instruments never used. There was no difference in instruments used in relation to the type of surgery performed (range 42%-46% across operation types). 67% (n=12) of bilateral cases required an additional tray to allow simultaneous operating on both sides. Despite this, 20% (n=11) of the operations required specific additional instruments to be opened.

Conclusions

This study has shown a significant number of instruments remaining unused but being re-sterilised. If a reconfiguration of the standard instruments were to occur this could lead to a potential cost saving of over £25000 per annum purely on sterilisation costs.
TU1.1 Applying Lessons from MI6 and the Stockmarket to the Management of Paraoesophageal Hernias: Creation of a Bayesian Computer Model to Support Clinical Decision-Making
Authors: Bradley Alison , Dougal Jennifer , Wong Li Siang , Vakeesan Branavan , Buter Anton
Published: November 2022

Aims

Decision-making in the management of paraoesophageal hernias is complex. Surgery carries the risk of significant complications yet a ‘watch-and-wait’ approach can result in the need for emergency surgery. The aim of this study was to create computerised models that makes personalised predictions of morbidity and mortality for patients undergoing both elective and emergency surgery for their paraoesophageal hernia.

Method

Using AgenaRisk software, Bayesian Network models were created that made personalised predictions of postoperative morbidity and mortality. Bayesian Networks are based on probability theory and have been widely used in military intelligence and finance to perform risk assessment and predict outcomes across competing strategies. Through Baye's theorem, they can explicitly represent the conditional probability of dependencies between multiple variables. The prior probabilities within these model algorithms were calculated from published studies that identified variables associated with morbidity and mortality following paraoesophageal hernia repair (n=22483). The model's performance was validated against a prospectively maintained dataset of 35 patients.

Results

The model had an area under the receiver operator curve of 0.875 (P value 0.0027; standard error 0.125, 95% confidence interval 0.717 – 0.962) and a sensitivity of 75% and specificity 100% for predicting significant postoperative morbidity (Clavien-Dindo grade 3+). There were no cases of 30day or 90day mortality in the dataset and the model correctly predicted this.

Conclusion

This study marks a move towards the delivery of more personalised realistic medicine by potentially supporting better shared decision-making. The predictive performance of these models was strong but further prospective validation is required.
TU1.12 Video Presentation: The OVESCO Clip for Endoscopic Treatment of Gastrocutanoeus Fistula
Authors: Zugaj Konrad , Fernandes Roland , Black Rebecca
Published: November 2022

Background

Percutaneous endoscopic gastrostomy (PEG) is an important route of nutrition in many patients. PEG removal usually leads to spontaneous closure in a few days. Gastrocutaneous fistula (GCF) after PEG removal is an uncommon complication occurring in 2% of patients. Despite its rarity, it is responsible for significant morbidity and reduced quality of life. Treatment is initially focused on medical management and endoscopic clipping, with advanced endoscopic techniques and surgery reserved for selected cases.

Method

We present a video presentation demonstrating successful endoscopic treatment of GCF using the OVESCO Over the Scope clip with resolution of symptoms and closure of the fistula tract. The device is a novel innovation designed to achieve tissue apposition and compression without ischaemia. It is licensed for Gastrointestinal iatrogenic defects, endoscopic perforation, bleeding and GCF. The 72 year old patient had debilitating symptoms of gastric leakage for over a year despite previous attempts at endoscopic clipping, fibrin glue and curettage of the fistula tract.

Results

As shown in the video, the clip achieved good opposition with no post procedural leak. The patient was reviewed at 3 and 12 months with no recurrence of their symptoms. The external cutaneous opening had closed at 3 months. The patient reported an increase in weight, improved mood and a greater quality of life following the intervention.

Conclusion

The OVESCO clip has been proven to facilitate successful endoscopic closure of GCF in selected patients in whom initial treatment measures have failed. This mitigates the need and risks of surgical closure.
TU2.5 Compliance of colonic polyp surveillance with British Society of Gastroenterology (BSG) and the Association of Coloproctology of Great Britain and Ireland (ACPGBI) guidelines
Authors: Ali Muhammad , Heyes Adam , Stephen Annly , Ng Sherwin , Hanif Zulfiqar
Published: November 2022

Introduction

The guidelines for post-polypectomy and post-colorectal cancer resection have recently been changed after consensus by the British Society of Gastroenterology, the Association of Coloproctology of Great Britain and Ireland and Public Health England. The aim of our study is to evaluate the rate of compliance with the recommended guidelines following polyp removal.

Methods

The data was collected retrospectively by reviewing the colonoscopy database in a single centre district general hospital for all patients who underwent polypectomy during April-September 2021. We excluded patients who had prior history of colorectal malignancy. The frequency of subsequent colonoscopic surveillance were evaluated against the BSG/ACPGBI guidelines based on the clinico-histological characteristics of the removed polyps.

Results

There were 104 colonoscopies with polypectomies performed during April-September 2021. The patient cohort had a mean age of 65 years (range, 35–85 years), with the most common diagnosis being tubular adenoma with low grade dysplasia (n=86, 82.7%). Adherence to BSG/ACPGBI colonoscopic post-polypectomy surveillance guidelines, based on the characteristics of the colonic polyps at colonoscopy and histology, was 86.5% (n=90). There were 5 (4.8%) patients who had their surveillance endoscopy requested earlier than recommended and 8 (7.7%) patients had a surveillance colonoscopy requested but did not require any surveillance. 1 patient had colonoscopy requested later than recommended. There was no significant difference in compliance between physicians (87.5%) and surgeons (86.1%).

Conclusion

There is a high compliance with post-polypectomy surveillance guidelines. However more efforts and staff training are required to improve compliance even further.
TU2.7 Surgical Management of Synchronous Colorectal Liver Metastases – A Systematic Review and Meta-Analysis
Authors: Allu Veera
Published: November 2022

Aims

Surgery with curative intent is the mainstay in management of Colorectal cancer, with timing and sequencing of the surgical resection of tumour and the metastases highly important in improving prognosis in patients diagnosed with synchronous Colorectal liver metastases. The current review aims to identify data around simultaneous and staged resection to evaluate if there is a significant difference in either approach.

Methods

PubMED and EASE's searcher® database were searched, a modified PRISMA checklist used to identify relevant data from the search results and fifteen studies were included in the quantitative analysis, defined by inclusion and exclusion criteria, and scored with the use of MINORS criteria. Meta-analysis is performed with the use of Odds Ratio or Weighted Mean Difference.

Results

There is significant heterogeneity within the pooled studies potentially due to varied techniques and surgical skills. There was no significant statistical difference in postoperative morbidity, with a slight skew in favor of the staged procedure. There was a statistically significant skew towards a higher mortality in the simultaneous resection group. Intra and Post Operative Complications showed no statistically significant difference in either group. Lack of randomization was observed in underlying studies.

Conclusion

The analysis does not show a statistically significant difference in outcomes with either intervention. There are distinct methods of thought around which method to employ in various patient scenarios, left to the discretion of the treating specialist. Research suggests further enquiry into use of neoadjuvant and adjuvant chemotherapy to treat the underlying metastases associated with primary tumor.
TU2.10 Clinicopathological Factors Affecting Lymph Node Yield and Positivity in Left-Sided Colon and Rectal Cancers
Authors: Ballanamada Appaiah Nikhil Nanjappa , Cai Wenyi , Khan Laeeq , Lovett Bryony
Published: November 2022

Background

The status of lymph node metastasis is a key factor for predicting the prognosis of colorectal cancers.

Aims

We aimed to find any significant difference in lymph node yield (LNY) between laparoscopic surgery (LS) and open surgery (OS). We aimed to identify any statistical correlation between LNY and lymph node positivity (LNP) with other patient, surgical and histopathological features.

Methodology

This is a retrospective, non-interventional review of consecutive patients who underwent left-sided colonic and rectal cancer resections over a three-year period between 01 April 2018 and 31 March 2021.

Results

A total of 102 patients were included in the study. LNY ranged between one and 43 nodes (median (interquartile range (IQR)) 17, 8). There was no statistically significant difference in LNY between laparoscopic surgery (LS) and open surgery (OS) (p=0.1449). Significant statistical correlation was identified between LNP and completeness of resection (CoR) (p=0.039), vascular invasion (VI) (p<0.001), perineural invasion (PI) (p<0.001), and circumferential resectional margin involvement (CRMI) (p=0.039).

Discussion

LNY and LNP are important prognostic indices in colorectal cancer. Patient age, tumor location, the urgency of surgery, and consultant experience did not significantly impact the LNY. Our study showed a positive correlation between LNP and CRMI, VI and PI comparable to literature. Contrary to other studies, we found no statistical significance between LS vs. OS and LNY. Whether 12 nodes per patient is an appropriate level remains controversial.