bluuebunny/crossref_metadata_2025 huggingface dataset:
WP4.11 - Oral Gastrograffin Usage in Adhesive Small Bowel Obstruction: a re-audit
Authors: Hussain Mubashar
Published: September 2024

Aim

to establish the successful usage of oral gastrograffin in patients presenting with adhesive small bowel obstruction (SBO).

Methods

This is a retrospective follow-up study, using a combined data collected from two NHS Trusts, from July 2022 to January 2024. Patients presented with adhesive SBO were included in this study, who were given 100 ml of oral gastrograffin after diagnosis for SBO. Patients were arranged to have plain abdominal x-ray approximately 8-hours post-gastrograffin drinks/or infusion via nasogastric (NG) tube to ascertain if oral contrast had passed the transition point, identified on initial abdominal CT scan. Patients were then reviewed for their symptomatic relief including bowels movement.

Results

132 patients were identified but 108 patients were included, who had surgery. 24 patients were excluded because they did not have post-gastrograffin x-ray. Average age of patients was 63+/-14 years.

It was observed that 82 patients (75.9%) opened their bowels after administration of first dose of gastrograffin, while 26 patients (24%) did not. 16 out of these 26 patients required surgery; and the remaining 10 (38.4%) had 2nd dose of gastrograffin, of which 4 patients (40%) moved bowels but 6 (60%) still did not and required surgery.

Post-contrast x-rays, showed that contrast passed through into large bowel in 76 patients (70.3%) after 1st dose of gastrograffin and in further 40% after 2nd dose.

Conclusion

clinically significant number of patients responded to such conservative measures. Therefore, routine oral gastrograffin usage is suggested as an effective adjunct to non-operative measures in adhesive SBO management.
WP5.5 - Investigating the Optimal Timing for Definitive Treatment in Sigmoid Volvulus: A Retrospective Cohort Study
Authors: Walshaw Josephine , Solkar Maseera , Hugh Katherine , Munasinghe Chathura , Burke Joshua , Peckham-Cooper Adam
Published: September 2024

Aims

The evidence base is replete of guidance on the optimal timing for definitive surgical management of acute sigmoid volvulus (ASV), with limited understanding or long-term outcomes for those managed conservatively. This study aimed to assess the management and outcomes of this understudied patient population.

Methods

A retrospective cohort study was conducted in a UK tertiary centre between January 2018 and December 2022.

Results

69 patients presented with ASV (54M:15F, age 73.7 SD +/- 15.0 years). The median number of acute admissions per patient was 2 (IQR 1-4.5), with 29 patients (42.0%) presenting only once. 44 patients (63.8%) were managed conservatively. Of those patients, 22 (50.0%) were readmitted within the study period. 25 patients (26.2%) underwent operative management, with 18 (72.0%) of these patients undergoing emergency surgery (6 during their index admission, 33.3%). Elective surgical management was performed in 7 patients after an average of 3 previous admissions. All-cause mortality amongst the cohort was 47.8% (n=33), with a median life span of 1.1 years from index admission (IQR 0.3-2.6); 24.0% in the operative group (5 acute, 1 elective) versus 61.4% in the conservatively managed group. Conservatively managed patients were at greater odds of mortality compared to acutely operated patients (OR 4.129, 95% CI 1.25-13.67, p=0.02) and electively operated patients (OR 9.529, 95% CI 1.05-86.20, p=0.045). Acute operations had no significant greater odds of mortality compared to elective operations (p=0.49).

Conclusions

Conservative management of ASV was associated with greater odds of all-cause mortality compared to patients who received an operation. Operations performed in the acute setting had no greater mortality odds than in the elective setting.
WP5.10 - Improving documentation of Surgical Site Infection Reduction Bundle (SSIRB) use in emergency laparotomies
Authors: Bramer Solange , Pamias-Lopez Blanca , Down Billy , Bond-Smith Giles
Published: September 2024

Aims

Surgical site infections (SSI) are associated with significant morbidity and mortality, substantial costs for hospitals due to increased length of stays, intensive care admissions and hospital re-admissions. NICE and the WHO support evidence based SSI reduction bundles (SSIRB). An evidence based SSIRB consisting of eight steps was implemented in the Surgical Emergency Unit (SEU) of a large teaching hospital to reduce SSI rates after emergency laparotomies. An audit was undertaken to assess documentation of SSIRB use.

Methods

The first audit cycle evaluated SEU laparotomies in January 2022 (n=31). The operation notes in patients’ electronic records were reviewed to extract SSIRB use. The intervention involved altering the electronic operation note to include a section on SSIRB use, which occurred in October 2022. The surgical team were educated about the importance of documenting SSIRB use and the updated operation note. A re-audit was completed for April 2023 (n=21).

Results

The first cycle showed that SSIRB documentation was poor (ranging from 0% to 55% for each step). After the operation note was updated, documentation of SSIRB use improved significantly for five of the eight steps. 48% of operation notes used the SSIRB section and documentation was higher for these laparotomies.

Conclusions

Documentation of SSIRB use improved after the intervention. Trusts are obliged to report accurate post-operative SSI rates. Improved documentation allows evaluation of SSIRB use compliance, enabling SSIRB steps with low compliance to be targeted. A high compliance rate to a SSIRB will reduce SSI rates, ultimately benefiting both patients and trusts.
WP5.14 - Cost of conservative management of acute appendicitis: a cohort study
Authors: Gok M A , Bughio M , Akmal Y , Yim S , Sadat M M , Khan U A , Mathieson N O M
Published: September 2024

Aims

Potential benefits of non surgical treatment of appendicitis: low risk treatment, suitable for older patients, avoids negative appendicectomy & lower healthcare costs. It is associated with recurrent appendicitis, prolonged hospitization, antibiotic related complications, prolonged follow up. Aim of study is to assess costs of conservative management.

Methods

Cohort study was carried out from Mar'2020 to Dec'2023 at single centre. Descriptive demography & outcomes were evaluated for non surgical management. Appendicectomy (acute & interval) were used as controls. Costing was calculated using the standardised NHS cost ledger for resources, procurement and services.

Results

Conservative (n = 235) Appendicectomy (n = 518) Interval (n = 45) Kruskal Wallis (p value) Age(yrs) 39.0 35.9 47.9 <0.0001 Sex(M : F) 121 : 114 251 : 267 19 : 26 NS BMI(kg/m2) 26.0 25.5 26.5 NS GP(n) 69 143 NS A&E(n) 166 375 NS WCC(x109/L) 12.0 13.2 6.5 <0.0001 CRP(mg/L) 76.3 66.3 3.4 <0.0001 Open(n) 11 0 NS Lap(n) 507 45 NS ASA(med) 1 2 NS Appendgrade(n) Uncomplicated 161 186 42 <0.0001 Complicated 74 332 3 <0.0001 Diagnostic (n) Clinical 9 34 USS scan 65 138 CT scan 161 346 Op time(mins) 74.9 74.4 NS LOS(days)(med) 2 2 0 <0.0001 IP AB(days) 2 2 0 <0.0001 Post-op AB(days) 7 0 0 <0.0001 App HPA(mm) Length 66.6 55.7 <0.001 Diameter 11.2 9.9 NS Normal(HPA)(n) 41 Appendicitis (HPA)(n) 477 Cost(£) 1529 4269 1046 <0.0001

Conclusions

Appendicitis grading clinically & radiologically has facilitated safe conservative management. Costs is lower for index admission, but is associated with additional costs & workload.
WP6.4 - General Surgery Bootcamp: Improving Induction for Higher General Surgery Training
Authors: Clarke Rory , Kuligowska Anna , Cooper Adam Peckham , Biyani Shekar
Published: September 2024

Aim

To create an introductory course or “bootcamp” to assist new ST3s transition from working at core trainee to General Surgical Registrar level.

Method

Using previous expertise of “bootcamps” delivered in the region in similar specialities, a 3-day programme was designed to offer training in areas aligned to the curriculum and considered useful to newly starting higher surgical trainees. The course involved a mix of simulation-based workshops, lectures and skill-based labs. The programme was delivered by a senior faculty directing activity with support from industry partners and medical education/simulation expertise. A range of skills were targeted using animal, virtual and augmented reality models, low and high-fidelity simulation, and non-operative technical skills (NOTSS) in simulated ward and theatre environments.

Results

26 trainees (23 new General Surgery ST3s, 3 returning to training) completed the bootcamp. Feedback questionnaires using a likert scale demonstrated clear improvements in trainees’ own skill perception in endoscopy, laparoscopy, open surgery and NOTSS. 100% of responding trainees’ were confident or strongly confident post course, compared to 69% before. We also showed an increase in confidence in laparoscopic suturing (77%), duodenal ulcer repair (69%) and operating in a stressful environment.

Conclusions

A transitional “bootcamp” can provide both tangible and intangible benefits. This project showed clear improvement in trainee confidence both in key practical and non-practical skills such as communication. It also enabled registrars to familiarise themselves with new colleagues, facilitating an early welcome from the region and embedded support network.
WP7.12 - The Impact of a ‘Golden Abscess Pathway’ in a Tertiary Teaching Hospital to Optimize Acute Abscess Management
Authors: Solkar Maseera , Walshaw Josephine , Ofoezie Frank , Pha Sai Yan , Jones Sian , Peckham-Cooper Adam
Published: September 2024

Introduction

The 'Golden Patient' initiative targets operating room efficiency by pre-selecting initial patients, especially beneficial for non-urgent emergencies like abscesses. Anorectal abscesses often face treatment delays due to the prioritization of critical cases. WSES guidelines advocate prompt incision and drainage (I&D) within 24 hours, recommending outpatient management for suitable patients. This study aims to establish an ambulatory 'Golden Abscess Pathway' in a tertiary teaching hospital and assess its impact on acute abscess management efficiency.

Patients and Methods

This retrospective study at the Leeds Institute of Emergency General Surgery included individuals undergoing I&D for acute abscesses. The pre-pathway cohort spanned 03/01/2023 to 28/04/2023, with the 'Golden Abscess Pathway' implemented on 19/06/2023. The post-pathway cohort covered 19/06/2023 to 16/10/2023. The analysis focused on patient demographics and intervention timelines.

Results

The study included 199 patients, with 93 pre-pathway (55M: 38F, mean age 34.3 ± 14.5 years) and 106 post-pathway (70M: 36F, mean age 35.4 ± 13.3 years). The 'Golden Abscess Pathway' reduced the average duration from consultation to operation (1.73 days vs. 2.75 days), advanced median operation start time (09:20 vs. 09:47), and decreased overnight stays (34.9% vs. 44.1%).

Conclusion

Implementation of the 'Golden Abscess Pathway' demonstrated positive outcomes, reducing delays in patient management. These results highlight the pathway's potential to enhance efficiency and overall patient care in acute abscess management.
WP8.9 - Laparoscopic Cholecystectomy Performed by a Surgical Care Practitioner: Review of Outcomes
Authors: Mirza Muhammad , Odogwu Steve , Morris Sarah , Addison Sarah , Abbott Sian
Published: September 2024

Introduction

Surgical Care Practitioners (SCPs) are non-medical workers involved in various aspects of management of surgical patients. The role includes assisting and performing surgical procedures. Over 60,000 laparoscopic cholecystectomies (LC) are performed annually in the UK. With ever increasing pressure on waiting lists, it is important to look at fully utilising the skills of our entire workforce. We report what we believe is the first published series of LC performed by an SCP.

Materials and Methods

A retrospective review of a prospectively collected database was performed. Primary outcome was any complication requiring intervention. Secondary outcomes were minor complications, operative time, length of stay, conversion and readmission.

Results

170 patients were operated on. Indications were biliary colic in 127 (74.7%), cholecystitis 30 (17.6%) and pancreatitis in 13(7.6%). Mean operating time was 65 minutes (Range 35-152). 53 operations were assisted by a consultant, 110 by a senior SAS grade and 7 by a CT2. 139 (81.7%) patients were discharged on the day of surgery. 24 (14.1%) stayed one night in hospital. There were no major complications. Four patients required readmission. Two with pain and 2 with port site infections. There were no conversions or transfusions required.

Conclusion

There is a paucity of published data on surgical outcomes of procedures performed by SCPs. With a structured, supervised approach SCPs could be trained to take on more complex procedures and further strengthen the surgical workforce. This study demonstrates that elective LC can be safely performed by an appropriately trained and supervised SCP.
ThP1.8 - Margin re-excision after Wise pattern or Vertical scar therapeutic mammoplasty for early breast cancer - a single institution 4-year review
Authors: Badawi Marwa , Khatun Azra , Agrawal Avi , John Edward St , Alder Louise , Cook Lorna
Published: September 2024

Introduction

Therapeutic mammoplasty is a technique which facilitates large volume cancer excisions whilst maintaining breast cosmesis in patients with breast cancer. The aim of this audit was to evaluate the rates of positive margins and cancer recurrence in this cohort and determine any risk factors for requiring margin re-excision.

Methods

All patients undergoing therapeutic mammoplasty using a Wise-pattern or vertical scar technique for the treatment of breast cancer over a 4-year period (November 2019- October 2023) were included. Data was collected on patient demographics, tumour characteristics, re-excision rates and cancer recurrence.

Results

Of a total of 61 patients who underwent therapeutic mammoplasty, 10 (16.4%) required margin re-excision. DCIS alone was present at the margin in the majority (70%). Re-excision specimens contained further cancer in 4/10, of which 2 had clear new margins, one required further re-excision and one underwent completion mastectomy. Half of those who required re-excision had a cancer that was either mammographically occult or was non-concordant with the pre-operative imaging on final histology in terms of extent and/or focality. There was one case only of in-breast recurrence, in a patient who had not previously required margin re-excision.

Conclusions

Therapeutic mammoplasty is an oncologically safe technique and in the vast majority of patients the breast can continue to be preserved even when margins are close or involved. Patients undergoing therapeutic mammoplasty who have mammographically occult tumours may be at higher risk of margin re-excision even with the addition of MRI imaging.
ThP1.9 - Seroma in Pre-pectoral Acellular Dermal Matrix-based procedures
Authors: Gavisiddappa Chandana , Parmeshwar Rishikesh
Published: September 2024

Aims

Pre-pectoral reconstruction has gained popularity in recent years and is now considered to be the preferred technique in immediate breast reconstruction. This is done with silicone implants and various synthetic, biological acellular dermal matrix (ADM). Seroma is a well-recognized issue after these IBRs with a wide range of reported incidence (iBAG study). This study reviews incidence and management after Pre-pectoral IBRs with the use of one such porcine ADM (Braxon®).

Methods

A retrospective audit from a single institution, single surgeon prospectively kept data. The data concerning seroma and its effective management was audited in this study.

Results

Over an eight-year period, a total of 74 patients with 86 procedures (12 bilateral) were analysed. The mean age was 52.6 and BMI 23.5. Reconstruction was carried out in 89.1% for malignancy, 9.4% had prophylactic surgery and 5.4% had revisions (Subpectoral to Pre-pectoral) for animation. All patients had drains in situ for a mean duration of 7 days. Seroma was seen in 15%(11 patients) of patients but only 18%(2patients) needed intervention in terms of aspiration and/or re-exploration. The authors’ indications for seroma aspiration were based on an algorithm (clinical signs of progression of seroma, skin changes along with signs of poor integration rather than US findings alone)

Conclusions

From the audit, we could conclude that the formation of seroma is common after ADM and pre-pectoral implant-based IBR but careful monitoring and selective use of aspiration can be practiced thereby minimizing the risk of infection and implant loss as a result of intervention.
ThP2.8 - Reducing postoperative length of stay after thyroidectomy through a standardised multidisciplinary postoperative care protocol does not compromise patient safety
Authors: Naseer Afifa , Elkorety Mohamed , Belbase Sushen , Jamil Sanober , Bhatti Tahir
Published: September 2024

Aims

Our unit had a significantly longer length of stay after thyroid surgery. We introduced change of practice through a standardised multidisciplinary postoperative care protocol. We analyse the effect of the protocol on postoperative length of stay and any impacts on patient safety.

Methods

A multidisciplinary protocol was implemented and embedded into clinical practice. Data was collected prospectively on consecutive patients undergoing thyroid surgery. Outcomes with reference to adverse events, length of stay and readmissions were audited. Comparisons were made with unit's pre-protocol data and national figures published in BAETS (British Association of Endocrine and thyroid Surgeons) audit report.

Results

A total of 78 patients underwent 37 total thyroidectomies and 41 lobectomies. Three (8.3%) of the total thyroidectomies had transient hypocalcaemia but none were permanent. None had voice changes or recurrent laryngeal nerve palsy. Three patients were reviewed few days after discharge with mild hypocalcaemia symptoms treated with calcium supplements. One was re-admitted 5 days post discharge with wound infection. Twenty-seven (75%) were discharged on 1st postoperative day as opposed to 0% pre-protocol (BAETS audit report 66%).

Thirty-seven (90%) of lobectomies were discharged on 1st postoperative day (Units pre-protocol 42%, BAETS audit 81%). There was no postoperative bleed or hypocalcaemia. One patient with a large recurrent retrosternal goitre had transient recurrent laryngeal nerve palsy that recovered subsequently.

There were no readmissions or adverse events directly related to early discharge.

Conclusion

A well embedded dedicated postoperative care protocol can significantly reduce postoperative hospital stay after thyroid surgery without compromising patient safety.
ThP2.17 - Efficacy of Mesenchymal Stem Cells in the Treatment of Osteonecrosis of Femoral Head
Authors: Lim Jun Sing , Cui Xiangmei , Konan Sujith
Published: September 2024

Introduction

Osteonecrosis of the femoral head (ONFH) has substantial morbidity and impacts patient populations worldwide. Mesenchymal stem cells (MSCs) are implicated for their potential in ONFH treatment. The objective of this study is to examine the effectiveness of MSC when compared to existing surgical options in the treatment of ONFH.

Method

A literature search is conducted through Pubmed, MedlineOvid, and Cochrane. The studies were selected using PRISMA and ROBVIS. Four randomised controlled trials and two preliminary studies with a total of 599 participants were included in the study.

Results

Progression to advanced stages of ONFH was reduced in bone marrow mesenchymal stem cells (BMMSC) applied in conjunction with core decompression (CD) when compared to CD alone (3.77% vs. 22.7%, p<0.05) and reduced femoral head collapse (28% vs. 72%). Improvement in Hip Harris Score (HHS) when compared to CD alone (31.85 vs. 19.72 control, p = 0.03) was also observed. The joint preservation rate of applying BMMSC in tantalum rod insertion with vascularized iliac grafting in end-stage ONFH patients was greater than that of vascularized iliac grafting alone (83.33% vs. 57% in stage IV patients) and associated with a better outcome (HHS 6.29±6.11 to 77.23±14.75). Improvement in WOMAC, VAS and Lequesne index was also observed when comparing CD with bone grafts and CD, bone grafts and BMMSC.

Conclusion

The use of MSC applications along with current surgeries has been shown to improve post-operative outcomes and progression to advanced ONFH stages in the treatment of ONFH compared to surgeries done alone.
ThP4.7 - The outcome of a single stage Laparoendoscopic rendezvous ERCP and laparoscopic cholecystectomy for cholecystocholedocholithiasis in a DGH
Authors: Thompson Luke , Fultang Joshua , Gao Neng , Cullen Fraser , Apollos Jeyakumar
Published: September 2024

Cholecystocholedocholithiasis is managed surgically by laparoscopic cholecystectomy (LC) and simultaneous common bile duct (CBD) exploration or by preoperative Endoscopic Retrograde Cholangiopancreatography (ERCP) followed by LC. Rendezvous ERCP (RERCP) is an innovative laparoendoscopic technique combining LCs and ERCPs. As a single staged procedure, a LC is performed and selective canulisation of the CBD is aided by laparoscopic transcystic placement of a guide-wire into the duodenum. We present a case series of RERCPs within a DGH.

This case series collected retrospective data (2014-2023) involving 33 patients, of which 21 underwent RERCP. Preoperative variables included age, indication, gender, ASA grade, Charlson comorbidity index (CCI), frailty score and indication. Postoperative variables analysed were operating time, complications, 30-day re-admission rates and length of stay in hospital (LOSH).

Of the 21 patients who underwent a RERCP, 76% (n=16) were female. The average age was 60±17years and 59% (n=13) of all procedures were elective. The ASA range was I to III, average CCI and frailty score were 2.4±1.9 and 0.1±0.4 respectively. 52% (n=11) of patients had a previous failed ERCP. The average operating time was 152±39mins. The average LOSH was 3.5±2.8days and 2.5±2.1days following the RERCP. Biliary (including pancreatitis) and non-biliary complications were 9.5% (n=2) and 9.5% (n=2) respectively. The 30-day readmission rate was 9.5% (n=2). There was no significant difference in the operating time (p=0.16), LOSH (p=0.19) complication (p=0.13) and readmission rates (p=0.50) between emergencies and elective procedures.

RERCP remains a valuable option when managing cholecystocholedocholithiasis in emergency and elective settings.
ThP4.8 - Establishing a Hot Gallbladder Pathway: An Optimal and Advantageous Intervention
Authors: Cui Xiangmei , Zaman Osama , Naqvi Mushal
Published: September 2024

Introduction

NICE, AUGIS and Tokyo guidelines recommend early laparoscopic cholecystectomy (ELC) in symptomatic gallstone disease. We highlight our implementation of a hot gallbladder (HGB) pathway, dedicated to HGB cases in a district general hospital with a 550-bed capacity.

Methods

To implement a HGB service we established a formal evidence-based SOP alongside two theatre lists and six clinic slots a week. Ongoing retrospective data collection allowed us to analyse the efficacy of our interventions between January and December 2023 (n=244).

Results

In our cohort, biliary colic remains the commonest diagnosis (51.2%) versus acute cholecystitis (27.5%), with female predominance (80% v 20%). Prior to HGB pathway introduction in April (January–March, n=73), 13.7% underwent HGB surgery. After HGB pathway implementation (May–Dec, n=171), 28.7% had HGB surgery with a mean waiting time of 9.6 days from admission. There has additionally been an 18% decrease in patients awaiting cholecystectomy since HGB pathway implementation. Significant delays exist in obtaining an MRCP (8.48 days) and ERCP (5.87 days) when required. Complication and readmission rates were consistent with those published in literature.

Conclusion

Establishing a HGB pathway facilitated earlier treatment for patients and notably decreased the numbers awaiting cholecystectomy. Significant delays in obtaining MRCP/ERCP could be improved with dedicated MRCP or ERCP slots. Favourable patient outcomes alongside the almost double NHS tariff payments given to ELC compared to elective cholecystectomy, provides incentive for hospitals to implement HGB lists.
ThP4.14 - Updated surveillance guidance for Intra-ductal Pancreatic Mucinous Neoplasm (IPMN) – a 10-year cohort study in a tertiary care Surgical unit
Authors: Davis George Neelankavil , Shah Faizan , Jain Shubham , Dorkeh Da-costa , Ganesh Radhakrishnan , Ghazanfar Mudassar
Published: September 2024

Aims

To investigate the adequacy of current frequency of surveillance of IPMN in a single tertiary surgical unit

Methods

This was a retrospective cohort study over a 10-year period (2013-2023), patient age range 30-85 years old. The data collected included gender, age at diagnosis, size(mm) of largest cyst, high risks(HRF) or worrisome features(WRF) and interventions required.

Analysis undertaken pertaining to the incidence of IPMN with malignant potential as well as progression of disease on surveillance.

Results

Total of 61 patients. On presentation - Cyst size <1cm – 51%, 1-2cm- 33%, 2-3cm- 16%. <1cm group - no growth on surveillance scans and no interventions required. 1-2cm group - 35% had HRF, 25% of which underwent surgical intervention. 15% showed WF of which 33% required surgical intervention. 2-3cm group - 20% of patients with WF showed growth in cyst size. 40% of patients with WF - underwent surgery.

Conclusion

The malignant potential of IPMN correlates with the initial cyst size. Guidelines recommend that cysts <1cm should be under 2-yearly surveillance. However, when compared to those with cyst>1cm, none of the patients with cyst size<1cm displayed progression.

Therefore, we propose that for patients with an initial cyst size of less than 1cm, who are above the age of 70 and/or Performance status (PS) =>2 – no active surveillance is required. If the PS <2 and patients are less than 70 years old, we recommend 5-yearly surveillance. For patients with cyst size >1cm, we recommend adhering to the current guidance. With this revised guidance, already scarce resources may be better utilised.
ThP5.13 - Lessons learnt from a neuroendocrine tumour presenting as choledocholithiasis
Authors: Kumar Anusha , Bath Michael , Hussein Halil , Nair Manoj
Published: September 2024

A 79 year old male presented to A&E with obstructive jaundice. A computerised tomography (CT) scan of his abdomen and pelvis showed intra- and extra-hepatic duct dilation, a small calculus within the lumen of the common bile duct (CBD), and gallbladder distension. His liver function tests were deranged, with an alkaline phosphatase of 280IU/L. Successful stone retrieval was achieved by endoscopic retrograde cholangiopancreatography (ERCP), with an interim CBD stent inserted. Within the same admission, the patient underwent an uncomplicated emergency cholecystectomy. Histological analysis highlighted moderate chronic inflammation and fibromuscular hyperplasia, cholesterolosis, and ruled out dysplasia or malignancy.

Four weeks later, the patient re-presented with septic obstructive jaundice. A repeat CT scan identified a dilated CBD of 2.2cm, suggesting an occluded stent. On ERCP for stent removal, ampulla narrowing was identified, hence concurrent brush cytology was performed. Due to clinical suspicion, a CT Positron emission tomography (PET) was requested, which identified metabolically active disseminated malignancy, likely pancreatic in origin, and with nodal, liver, and likely peritoneal metastases. A Ca 19-9 subsequently came back raised at 157 kIU/L. Liver biopsy confirmed a poorly differentiated neuroendocrine carcinoma (NEC) with intermediate features between small and large cell NEC.

In such cases with discrepancies between treatment success and lack of biochemical improvement, a low threshold of suspicion for further investigation and oncological consideration is imperative.
ThP5.15 - "Unusual Impaction: A Rare Case of Gallstone Ileus''
Authors: Anwar Kehkashan , Abdel-Halim Mostafa
Published: September 2024

Introduction

Gallstone-related mechanical gastrointestinal tract obstruction is infrequent, manifesting in only 0.3%-0.5% of cholelithiasis cases. Typically, stones exceeding 2 cm find themselves lodged in the terminal ileum. However, in Bouveret's syndrome which is observed in 1 to 3% of instances the impaction occurs in the duodenum causing gastric outlet obstruction. The epidemiology and prevalence of gallstone impaction in the proximal jejunum remain inadequately documented, making this a rare case.

Case Report

An 83-year-old patient with known cholelithiasis and choledocholithiasis presented with acute abdominal pain and vomiting a week after undergoing ERCP, sphincterotomy and partial duct clearance. The presence of repeated bilious vomiting prompted investigation with abdominal CT scan. This revealed an approximately 4.5 cm gallstone impacted in the proximal jejunum, prompting emergency laparotomy which confirmed that the stone was impacted 10-15 cm from the dudeno-jejunal junction. Jejunotomy, stone extraction with primary closure was performed. Post-operative recovery was uneventful.

Conclusion

This case demonstrates gallstone impaction in the proximal jejunum causing bowel obstruction and necessitating emergency intervention. Timely diagnosis and prompt surgical intervention led to a successful outcome. The case highlights the need for awareness and consideration of the entire spectrum of possible gallstone-related complications in the acutely presenting patient with gall stones.
ThP6.5 - Anorectal Abscess and Diabetes Mellitus: An Overlooked Association?
Authors: Ramdin Ashling , Smith Christopher , Marsden Max , Agboro Stephen , Chatzikonstantinou Michail
Published: September 2024

Aims

Patients with anorectal abscesses often require treatment from Emergency General Surgery. Prior European epidemiological studies report 6% of patients with anorectal abscesses have diabetes mellitus (DM). This study primarily quantified prevalence of DM, and secondarily, adherence to the WSES-AAST anorectal emergencies guidelines, which recommend routine HbA1c and serum glucose testing.

Methods

A retrospective analysis identified all surgically managed patients with anorectal abscesses at an urban DGH over a two-month period from 1st December 2023. Data were collected on demographics, existing DM status, HbA1c and blood glucose testing from the electronic health record.

Results

The study included 17 patients, 59% male (10/17), with a mean age of 45 years (range 20-72). Among the group, 4/17 (24%) had a known DM diagnosis. Only 2/13 (15%) without a pre-existing DM diagnosis underwent DM testing. No new cases of DM were diagnosed. HbA1c and serum glucose testing were performed more commonly in patients with known DM compared to those without a prior diagnosis, but not significantly (3/4 vs 2/13, p=0.09).

Conclusions

The proportion of anorectal abscess patients with DM in our study is markedly higher than previously reported in the literature. Compliance with DM testing guidelines is poor, and the causes are uncertain. Routine DM screening for anorectal abscess patients could lead to earlier detection and improved outcomes. The actual incidence of newly detected DM in this patient group remains unknown due to inadequate testing, underscoring the need for further research to evaluate the real-world benefit and cost-effectiveness of following diabetes detection guidelines in these patients.
ThP6.13 - A closed loop clinical audit on adherence of weight-based and renal function-adjusted venous thromboprophylaxis prescribing to local guidelines in emergency general surgical patients
Authors: Hassan Merna , Krahelski Oliver , Arbis Alexander
Published: September 2024

Aims

to audit adherence of venous thromboembolism (VTE) prophylaxis according to local trust guidelines in a single-centre emergency general surgery department, adjusting doses based on weight and renal function (creatinine clearance). Following initial audit of practice, intervention to improve local practice was implemented with informative posters and teaching sessions, aiming to improve overall adherence to guidelines and limit risk of complications from incorrect dosing.

Methods

A two-cycle snapshot audit of VTE prophylaxis prescribing was conducted in a district general hospital emergency general surgery department against local guidelines concerning VTE prophylaxis. All current inpatients admitted under general surgery were included in the study reviewing baseline characteristics including age, weight, and creatinine clearance.

Results

The first cycle audited the adherence of departmental practice against guidelines in 57 inpatients. 49 (86.0%) were prescribed VTE prophylaxis in accordance with local guidelines. Of the 8 patients who did not adhere to guidelines, 5 (62.5%) had no VTE prophylaxis prescribed, while 3 (37.5%) had incorrect doses prescribed for their weight or renal function. The second cycle audited 43 inpatients. 39 (90.7%) adhered to guidelines. All re-audited patients had the correct VTE prophylaxis prescribed, although there was no VTE prophylaxis prescribed in 4 (9.3%) patients. There were no bleeding or thromboembolic complication in any patients over the course of admission in both cycles of this audit.

Conclusion

Adherence to local guidelines concerning VTE prophylaxis was increased following intervention. This eliminated VTE prophylaxis prescribing errors, although did not improve the amount of VTE prophylaxis prescription omissions.
ThP7.10 - Perioperative Temperature in Relation to Theatre Temperature in Orthopaedic Trauma Patients in a District Hospital in NHS
Authors: Arifuzaman Mohammed
Published: September 2024

Aim

To understand the relation between intraoperative hypothermia and theatre temperature in Orthopaedic trauma list.

Method

Prospective analysis of patients listed in the trauma list at a busy district general hospital in NHS. The data collected included duration of surgery, preoperative temperature, pre induction temperature, intra-operative, post procedure, temperature in recovery and temperature post recovery, and mean ambient theatre temperature. Statistical calculations were performed on StatsDirect3 software.

Results

A total of 100 patients were included in the study from 1 Aug 2023 to 30 September 2023. Intraoperative hypothermia (core body temperature <= 36) was 21%. Preoperative temperature (p=0.033) and preinduction temperature (p<0.001) was statistically significant factor in influencing the intraoperative temperature. Theatre temperature was an independent predictor of intraoperative hypothermia on regression analysis (p<0.001).

Conclusions

Theatre temperature of 19.5 to 20.5 °C results in a core body intraoperative temperature of 36.3 to 37.3°C. Temperatures below 19.5 results in higher incidence of hypothermia. Preinduction temperature of 36.4°C results in intraoperative temperature of 36°C and a preinduction temperature of 37.1°C leads to intraoperative temperature of 36.7°C. This indicates that preoperative warming as well as a theatre temperature of 19.5 to 20.5 °C will help in reduction of the intraoperative hypothermia.
ThP7.18 - Post-operative management and outcomes in emergency laparotomy - an audit of the updated 2023 NELA Standards in a busy district general hospital
Authors: Adegboye Oluwatobi , Vucicevic Aleksandar , Zadeh Reza Arsalani
Published: September 2024

Background

The updated NELA Standards, encourage pre-operative decision-making, were published and utilised from April 2023. Our busy district general hospital has not been audited against these updated standards.

Methods

Single-centre, retrospective audit of emergency laparotomies between April 2023 and December 2023. Patients were included if the NELA risk score was ≥5% (‘high-risk’) or if they were deemed ‘high-risk’ based on clinical judgement. Demographic, management, and outcome data were collected from the local NELA database and EPR. The primary outcome was the proportion of ‘high-risk’ patients directly admitted to critical care. The secondary outcome was to investigate differences between high-risk patients admitted to critical care and those admitted to ward care using length of stay (LOS) and 30-day observed/expected (O/E) mortality ratio.

Results

112 laparotomies were performed and 43 (38%) were deemed ‘high-risk’. Of ‘high-risk’ patients, the median age was 73 (44 - 95), 56% were male, and the median mortality risk was 10.5% (3.1% – 62.7%). 38 ‘high-risk’ patients were directly admitted to critical care. They had a median LOS of 14 days (3 – 72) and 7 died within 30 days with an O/E mortality ratio of 1.12. None of the 5 patients admitted directly to the ward died and they had a median LOS of 8 days (3 – 39).

Conclusion

The mortality risk score is a tool for post-operative management in emergency laparotomy but appropriate clinical judgement can prevent excessive care and preserve critical care beds.
ThP8.12 - To do or not to do-Temporal artery Biopsy in Giant Cell arteritis
Authors: Brandao Mayra , Valenti Domenico , Turner Tulin , Gambhir Raghvinder Pal Singh
Published: September 2024

Aims

Temporal artery biopsy (TAB) remains the gold-standard diagnostic test for giant cell arteritis (GCA). Our aim is to evaluate the correlation between initiation of corticosteroid therapy, timing of biopsy, and histological diagnosis of GCA through TAB. Moreover, analyse the usefulness of this practice.

Methods

Operative notes of TABs performed by a Vascular Surgery department at a teaching hospital between August 2021 and January 2023 were reviewed. We looked into the relationship between histological findings and the timing of corticosteroid treatment initiation prior to TAB.

Results

A total of eight patients had a TAB, with a male-to-female ratio of 2:6. The median age of the patients was 68-years-old (range 53-84). TABs were performed within 16 days of the referral (range 2-16). All were performed on elective theatre lists and none on emergency theatre lists (CEPOD). All patients had started corticosteroids by the time they had TAB, with a median duration of 11.5 days before TAB (range 2-16).

The histopathology report was positive for active GCA in 1 case (12.5%) where the TAB was performed on day 3. In another performed on day 16, histopathology showed signs of healed inflammation (12.5%). In all other cases the report was negative (75%). All patients completed a full weaning course of steroids regardless of histological findings.

Conclusion

GCA is a systemic inflammatory vasculitis. Prompt initiation of high-dose corticosteroids is the mainstay management to reduce risks of ischaemic-related complications. Our work suggests the timing of biopsy is a key determinant of histological diagnosis of GCA.
FP1.6 - Prospective analysis of outcomes of colorectal resections in the over 75 age group. A single centre study
Authors: May Victoria , Ramsay George
Published: September 2024

Objectives

Cancer is a disease of ageing. Additionally, the population of the UK is getting older. Therefore, colorectal operations in the elderly population is becoming more frequent. Herein we analyse the outcomes of patients over 75 who have had elective or emergency colorectal surgery in a single Scottish Healthboard.

Methods

A prospective review was conducted of 408 patients aged 75 years and over who underwent elective or emergency colorectal surgery in our region between 2018 and 2023 was performed. Patient characteristics, operative intervention, short- and long-term post operative outcomes were noted.

Results

Of 408 Colorectal surgery patients, 303 were elective and 105 were emergency cases. Of these cases, 40.6% (n = 123) of elective cases and 28.6% (n = 30) of emergency patients did not experience any complications. Of these patients, 8.6% of emergency patients went from being independent to requiring full care. Emergency patients (n = 34, 32.4%) demonstrated a higher mortality rate at one year than elective cases (n = 59, 19.5%).

Conclusion

Colorectal Surgery in patients aged 75 years and older are associated with poor post operative outcomes, functional decline, and increased mortality. Whilst these findings are intuitive, the scale of functional decline is important to discuss with future patients when counselling future patients for such procedures.
FP1.12 - How many Colorectal cancer patients had negative Faecal Immunochemical Testing (FIT) within the previous 1 year?
Authors: Taufik Abdulahad , Johnston Dorothy , Coulston Rachael , McElvanna Kevin , Neill Adrian
Published: September 2024

Introduction

Colorectal cancer (CRC) accounts for approximately 10% of all cancer diagnoses and 9.4% of all cancer deaths worldwide. Since its introduction, quantitative faecal immunochemical testing (qFIT) has become a vital tool in bowel cancer screening and triaging of symptomatic patients. Our trust has seen a 20% increase in lower gastrointestinal referrals over a 12-month period.

The aim of this investigation was to identify how many patients with a negative qFIT were diagnosed with CRC within 12 months and if there is potential to downgrade referrals with negative qFIT.

Methods

This retrospective study reviewed new CRC diagnoses in one hospital trust, diagnosed from January to December 2022, who were referred as symptomatic red flag referrals. All patients in this timeframe had records reviewed for qFIT performed within the 12 months prior to their diagnosis. A negative qFIT test was defined as lab result of <7ugHb/g.

Results

Two hundred and forty-seven patients were diagnosed with CRC from January to December 2022. One hundred and three patients did not have a documented qFIT within the timeframe and therefore were excluded from analysis. One hundred and forty-four cases were further reviewed, of which 14 (9.7%) had a negative qFIT within the 12 months before diagnosis.

Conclusions

This audit does not support the downgrading of Red Flag referrals based on a negative qFIT result. Further analysis is needed to ascertain how best to triage symptomatic referrals for colorectal cancer with a negative qFIT to help cope with an increasing burden of Red Flag referrals.
FP2.9 - Colonoscopy perforation: a single centre study
Authors: Gok M A , Bughio M , Zaidi M , Mathieson N O M , Sadat M M , Khan U A , Riaz Komal
Published: September 2024

Aim

Colonoscopy is increasing utilized as a diagnostic & therapeutic tool. Colonoscopy perforation is reported to occur in 1/1500 (diagnostic colonoscopy), 1/500 (polypectomy) & 1/50 (EMR) procedures. The aim of the study is to evaluate the management of colonoscopy perforation at a single centre.

Methods

Colonoscopy is carried out on patients with colorectal cancer trigger symptoms (altered bowel habit, rectal bleeding, weight loss, abdominal pain, anaemia, ano-rectal symptoms, etc), family history screening, colorectal cancer & polyp surveillance. This is cohort study carried out since 2012 to December 2023 on all colonoscopy perforations carried out at a single centre.

Results

N = 22 Age (yrs) 70.8 ± 3.4 Sex (M:F) 4 : 18 BMI (kg/m2) 25.3 ± 1.8 ASA 2 Sigmoid Perf site (n) 13 LOS (days) 6 ± 6.5 Deaths (n) 30 day 3 60 day 3 90 day 3 IBD (n) 3 DD (n) 11 WCC (x109/L) 11.3 ± 1.4 CRP (mg/L) 100.1 ± 25.7 Lactate (mmol/L) 1.3 ± 0.7 Op time (mins) 119.0 ± 15.3 Bx 6 Polypectomy 5 Colonoscopy 21 (9 incomplete) Flexi siggy 1 Sedation 16 Entonox 5 GA 1 Xray 10 CT scan 22 Conservative 9 Surgery 13 Stoma (n) 6 Lap 2 Lap open 2 Open 9

Conclusion

Colonic perforation during colonoscopy is increased in: polypectomy (especially right colonic), therapeutic EMR, diseased bowel (IBD inflammatory bowel disease, diverticular disease), & in challenging colons. The management of colonoscopy perforation should individualized with early clinical & radiological diagnosis. Site and size of colonic perforation determines management. Good bowel preparations, minimizes contamination and therefore allows safe conservative management of small colonoscopy perforation.
FP2.13 - Do we really need Antibiotics for Simple Uncomplicated Diverticulitis? Results of Meta-Analysis of Randomised Controlled Trials
Authors: Sokhal Balamrit Singh , Mostafa Omar Ezzat Saber , Ramasamy Sadhasivam , Spyridon Roditis , Hajibandeh Shahab , Hajibandeh Shahin
Published: September 2024

Aims

Acute uncomplicated diverticulitis (AUD) is a common cause of acute abdominal pain. Recent guidelines advise selective use of antibiotics in AUD patients. This meta-analysis aimed to compare the effectiveness of no antibiotics versus antibiotics in AUD patients.

Methods

This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to identify randomised controlled trials (RCTs) involving AUD patients which compared the use of antibiotics with no antibiotics. Pooled outcome data was calculated using random effects modelling with 95% confidence intervals (CI).

Results

Five RCTs with 1934 AUD patients were included. 979 patients were managed without antibiotics (50.6%). Patients in the no antibiotic and antibiotic groups had comparable demographics (age, sex and body mass index) and presenting features (temperature, pain score and C-reactive protein levels). There was no significant difference in rates of complicated diverticulitis (OR: 0.61, 95% CI :0.27-1.36, p=0.23), abscess (OR: 0.51, 95% CI: 0.08-3.25, p=0.47) or fistula (OR: 0.33, 95% CI: 0.03-3.15, p=0.33) formation, perforation (OR: 0.98, 95% CI: 0.32-3.07, p=0.98), recurrence (OR: 0.96, 95% CI: 0.66-1.41, p=0.85) need for surgery (OR: 1.36, 95% CI: 0.47-3.95, p=0.37), mortality (OR: 1.27, 95% CI: 0.14-11.76, p=0.82) or length of stay (MD: 0.215, 95% CI: -0.43-0.73, p=0.61) between the two groups. However, the likelihood of readmission was higher in the antibiotics group (OR: 2.13, 95% CI: 1.43-3.18, p=0.0002).

Conclusion

There is no significant difference in baseline characteristics, clinical presentation and adverse health outcomes between AUD patients treated without antibiotics compared to with antibiotics.
FP3.7 - Do we need to follow up perianal abscesses in clinic?
Authors: Arokianathar Doreena , Lingam Gita , Sivarajah Vernon
Published: September 2024

Aim

The Association of Coloproctology of Great Britain and Ireland (ACPGBI) states those who present with their first perianal abscess do not require routine follow up in clinic after surgical intervention. This audit aimed to assess the percentage of perianal abscess patients being referred to clinic and their subsequent clinic outcome. An additional outcome was a cost analysis of clinic waste.

Methods

We reviewed the patient records of all patients who underwent an incision and drainage of perianal abscess between 1st January 2022 to 31st December 2022 within a district general hospital setting. We recorded the number of these patients being referred to clinic and their clinic outcome. The 2022/23 National Tariff Workbook resource was used to analyse the cost of clinic wastage.

Results

A total of 72 incision and drainages of perianal abscesses were performed in 2022 and 92% (N=66) were first presentation perianal abscesses. 46% (N=33) had a post-operative outpatient clinic appointment requested; and of these 67% (N=22) were first presentation perianal abscesses. This culminated in a total cost burden of £1568; in addition to prolonging patient anxiety, increasing their need for time off work and adding to NHS clinic wait time.

Conclusion

As per guidance, first presentation perianal abscesses do not need to be seen in clinic. The results suggest that we are referring too many patients to colorectal or general surgery outpatient clinics, which is increasing workload, adding to financial costs and affecting patient care.