bluuebunny/crossref_metadata_2025 huggingface dataset:
FP2.12 - 'To Evaluate Lower Threshold of Polyp Size for Tattooing Routinely, a Single Trust Observational Study.'
Authors: Riad Mahmud , Moosvi Raza , Bailey Charles , Joshi Sanjay , Gupta Sneha , Birchall Cara , Henrika Bonor Elisabeth , Iordanov Iordantcho
Published: September 2024

Aim

The goal of the study is to establish the lowest polyp size for clinically effective tattooing routinely.

Method

Retrospective data collection of colonoscopy and flexible sigmoidoscopy for bowel screening and non-bowel screening patients; 450 patients underwent polypectomy of <20mm from September 2021 to September 2022 in MTW NHS Trust. Patients were included according to 'single patient single polyp' criteria. We excluded 20+ mm polyps, multiple polyp, known FAP, lynch syndrome and other genetic predisposed colorectal polyps. Histology was obtained from electronic patient records (Allscripts). SPSS version 25.0 was used for the statistical analysis, which also included ROC curve analysis and Chi-Square test.

Results

A total of 450 participants, 288 males (64.0%) and 162 females (36.0%), were enrolled. Polyp sizes: 0-9mm (42.2%) and 10-19mm (57.8%). 8.0% were tattooed. Polyps found in right- hemicolon, transverse, left-hemicolon, sigmoid and rectum accordingly 29.78%, 20.5%, 9.1%, 28.4% and 12.22%. Pedunculated polyps were found in 143 individuals (31.8%), while sessile polyps were observed in 256 individuals (56.9%). Furthermore, in histological analysis, 251 individuals (55.8%) exhibited tubular adenomas and the majority of the cohort (77.6%) presented with low-grade dysplasia. Malignant invasion was detected in 27 subjects (6%). Receiver operating system (ROC) curve analysis indicated that polyp size was a predictive factor for malignancy development, with a cut-off lower point identified at 8.5 mm.

Conclusions

The findings confirm the advice to tattoo polyps bigger than 8-9 mm to make tracing and follow- up easier.
FP4.11 - Patient Reported Outcome Measures (PROMs) of Altemeier’s Procedure
Authors: O’Sullivan Arun , Manku Bhagat , Bleehen Laura , Abdelgalel Khaled , Ramcharan Sean , Singh Sandeep
Published: September 2024

Rectal prolapse (RP) is a debilitating condition that can be managed using Altemeier’s procedure (AP). We aimed to evaluate patient-reported long-term outcomes following AP focusing on symptoms, post-procedure pain and overall satisfaction.

Patients who underwent AP in a District General Hospital between January 2015 and December 2022 were reviewed. Patients were contacted by telephone and interviewed using a standardised questionnaire. Likert scores and a Numeric Rating Scale (NRS) were used to assess functional outcome and pain respectively. Indication for surgery, recurrence, and data on further procedures were also collected.

Out of 38 patients identified, 20 who underwent AP over the study period (mean age 78 years, s.d. 7.44, Female=20) were contactable and included in our study. In combination with RP, indications for surgery included faecal incontinence, obstructive defaecation symptoms, pain and rectal bleeding. At the time of follow up, 75% of patients reported their initial symptoms to be slightly or much better, 10% reported no change and 15% reported slightly worse symptoms. Prior to AP, 45% of patients reported no pain compared to 70% post-procedure. Severe pain was reported by 30% of patients pre-Altemeier’s compared to five percent post-procedure. Recurrence of RP occurred in 40% patients. 30% of patients required a second procedure. Overall, 80% of patients were satisfied with their outcome and 90% would recommend AP to friends and family.

Most patients reported better functional outcome and good overall satisfaction, despite 30% requiring a further procedure. Our study was limited by small sample size and subjectiveness of patient reporting.
FP5.4 - Improving Assessment of General Surgical Trainees in Multidisciplinary Team Working as a Capability in Practice: Perceptions of General Surgical Trainees and Trainers
Authors: Johnston Judith , Quinton Naomi
Published: September 2024

Aim

To explore how Higher Surgical Trainees (HST) and Trainers feel multidisciplinary team (MDT) working as a capability in practice (CiP) can be improved.

Methods

Within a deanery, 8 General Surgical HST and 4 Consultants were recruited to participate in virtual semi-structured interviews. Once transcribed, reflexive thematic analysis was performed. Ethical approval was granted.

Results

MDT is not worked into most trainees’ rotas. Participants felt that by formalising MDT, as with other CiP, it could be better assessed. Trainers, half of whom are MDT leads, stated that responsibility for MDT training and assessment should be placed on all consultants, rather than solely the leads. Participants explored how pathways could be instituted for HST to maintain ‘ownership’ of some patients from assessment clinic to MDT meetings to fully engage. In order to build to this level, a baseline of preparing patients but not presenting was suggested by one of the consultants. While, with one exception, no participants favoured a further work-based assessment, it was advocated by all that further clarification from ISCP regarding expectations of trainees at MDT would allow for more comprehensive assessment in the future. Most participants proposed that all members of MDT contributed to an assessment rather than relying on the Multi-Consultant Report. To prevent issues with timing or resources, a shadow or simulated MDT was suggested for HST.

Conclusion

General HST and consultants expressed concerns with the current way in which MDT is assessed as a CiP however they proposed ways in which it could be improved in the future.
FP5.9 - Improving the pre-operative administration of medications for patients requiring emergency surgery who are ‘nil-by-mouth’ (NBM)
Authors: Patel Nishita , Wentworth Elizabeth , Nanda Akriti , Kumar Arvind , Fong Agnes , Rothnie Alex
Published: September 2024

The statement ‘nil-by-mouth’ can be misleading with regards to drug administration. Inappropriate pre-operative drug omission or administration can lead to poor patient outcomes, experiences and increased hospital stays. The aim of this quality improvement project was to reduce the number of patients who had regular medications incorrectly administered, omitted or experienced pre-operative medication-related complications.

Two interventions were delivered targeted at educating junior doctors and nursing colleagues. Electronic records of general surgical patients requiring emergency surgery in a district general hospital were reviewed. Data on incorrect medication omission, administration and medication-related perioperative complications was retrospectively collected.

The percentage of patients who had medications incorrectly administered was 11% pre-intervention, 11% after intervention 1, and 6% after intervention 2. There was a reduction in the number of medications incorrectly omitted from 57% pre-intervention, to 40% after intervention 1 and 0% after intervention 2. One peri-operative medication-linked complication was recorded prior to the interventions which fell to zero cases following both interventions.

A sustained reduction in incorrect drug omission and medication-related perioperative complications has been shown following interventions 1 and 2 together, highlighting the importance of involving all members of the multidisciplinary team when aiming to improve how medications are handled preoperatively. No statistically significant change was made to the incorrect administration of medications pre-operatively. This is likely a reflection on the prescribing clinicians within the on-call team who rotate twice weekly. Other interventions targeting a consistent member or process within the on-call team should be explored to ensure follow-through going forward.
FP6.2 - A survey of the estimated cost of consumables amongst UK medical students
Authors: Divekar Omkaar , Stephen Sarah , d'Souza Hanna , Pandya Krushi , Kumar Abhinav , Kanegoankar Rahul
Published: September 2024

Aims

With increasing financial difficulties for the NHS, clinician’s awareness of the cost of consumable items utilised is vital. Despite this, clinician’s cost-awareness and exposure to health economics amongst students is limited. We hence undertook this survey to assess cost-awareness amongst medical students.

Methods

An online questionnaire was distributed to London medical students. Participants were asked their demographic data and to estimate the cost of 10 consumable items. Each item’s actual cost was compared with the average, median and interquartile range of the estimated price. An estimate was deemed ‘correct’ if it was within 20% of the actual price.

Results

Across all items 9.63% of estimates were ‘correct’. There was no correlation between medical school or academic year and accuracy of cost-estimation. The most accurately estimated item cost was the ‘10ml syringe’ (19.55%), the least was the ‘1 litre bag of intravenous normal saline’ (0.50%). The most overestimated item cost was the ‘vial of 1.2g intravenous co-amoxiclav’ (median estimate/actual cost = 9.43), the ‘pair of standard sterile surgical gloves’ was the only underestimated item cost (median estimate/actual cost = 0.97).

Conclusions

We found a poor understanding of the cost of consumables amongst medical students. Whilst a lack of year 6 students and the London geographic limited this study, we believe this is the first large-scale survey assessing the cost of consumables amongst UK students. By providing a benchmark of current knowledge, this survey could serve as a catalyst for the inclusion of health economics in medical school curricula, improving cost-awareness amongst students and doctors.
FP7.18 - Early Operative Risk Assessment Using Modified Mannheim Peritonitis Index in Patients with Generalised Peritonitis at a Tertiary Hospital in Abuja, Nigeria
Authors: Situ Oladele , Okoye Onyedika , Olaomi Oluwole , Akhigbe D i
Published: September 2024

Aim

This study assessed the usefulness of a modified Mannheim Peritonitis Index (MPI) as a risk stratification tool in predicting surgical outcomes in the management of patients with generalized peritonitis in Abuja, Nigeria.

Methods

This is a prospective study of consecutive adult patients managed for generalized peritonitis at a tertiary hospital in Abuja Nigeria within a one-year duration. The MPI was modified using respiratory rate and SpO2. Patient characteristics and outcome of treatment obtained were entered into a structured proforma, checked and analysed using the SPSS, version 25. The threshold score of the modified MPI, as well as the accuracy, sensitivity, and specificity, were derived from the receiver-operator characteristic (ROC) curve analysis and its coordinates.

Results

There were 49 patients with generalised peritonitis during the study period with a male-to-female ratio of 2.5:1. The commonest cause of peritonitis in this study was penetrating abdominal injury (30.6%) followed by complicated appendicitis (24.5%). This study's mortality and morbidity rates were 14.3% and 63.3%, respectively. On the ROC curve, the modified MPI best predict mortality at a threshold score point of ≥26 (Accuracy of 79.4%, sensitivity of 85.7% specificity of 61.9%, P-value = 0.013), and morbidity at a threshold score of ≥23 (Accuracy 78.4%, sensitivity of 77.4%, specificity of 72.2%, P-value = 0.001).

Conclusion

The modified MPI can be used as a risk assessment tool in predicting postoperative outcomes in adult patients operated for generalised peritonitis within 30 days of operative intervention at Abuja. This modification can be useful in low-resource centres with limited access to arterial blood gas analysers.
FP8.10 - Sustainability in Hand Surgery
Authors: Dias Ana , Sebastiao Alexandra , Kennedy Grace , Dunlop Rebecca
Published: September 2024

Aims

Carpal tunnel release surgery (CTR) is a widely performed procedure in the NHS with significant contributions to waste and carbon emissions within surgery. 36,704 CTRs were preformed from 2022-2023 with an average carbon footprint of 12.0 kg CO2e. The aim of this quality improvement project is to reduce the carbon footprint of CTR through a lean and green model, and examine the rates of infection with this model compared to standard practice.

Methods

Retrospective data was collected for CTRs performed at the Royal Cornwall Hospital between 31/05/2022 and 01/02/2023 for the first audit cycle using standard set up and equipment. The primary outcome was rates of infection post-CTR. The lean and green model included reducing the number of instruments in the handset (36 items to 14 items), use of a smaller drape, and no gown for the procedure. The second cycle will be examining rates of infection following this intervention.

Results

Out of 100 patients in the first cycle, 1 patient was treated with antibiotics via a General Practitioner telephone consultation. These eco-changes were well received by staff members, with significant waste reduction this far (over 50 gowns and 25 aperture drapes). Data collection for the second cycle is currently underway.

Conclusions

CTR surgery is a commonly performed procedure with significant contributions to waste and carbon footprint within surgery. Through simple and low-cost changes to current practice we can promote sustainability in surgery and have a lasting positive impact on the environment.
EP4 - Beyond the Surface: A Comprehensive Clinical Audit of Radiological Studies in Mastalgia
Authors: Borg David , Borg Justine , Zammit Clive , Borg Luke , Galea Joseph , Farrugia Ronnie , Agius John
Published: September 2024

Aims

Breast pain is a common symptom in women, frequently presenting to primary care physicians and breast specialists. Despite its prevalence, the causes and optimal treatment of mastalgia often remain unclear (1).

Methods

We established predefined inclusion and exclusion criteria to create a patient cohort comprising individuals who underwent radiological investigations for mastalgia between January 2021 and December 2021.

Results

The choice of initial investigation varied based on the patient's age and clinical examination findings. Mammography was the initial investigation for 91 patients (55.49%), while 73 patients (44.51%) underwent ultrasound examinations. No patients required histological investigations due to the absence of significant findings suitable for biopsy.

Conclusions

Our results suggest that diagnostic imaging for breast pain does not significantly contribute to increased cancer detection. This observation held true when we stratified the data by patient status, age, gender, and imaging modality. Notably, the rate of cancer diagnoses in our audit population was 0%, which contrasts with international literature reporting rates within the range of 0-3% (9)(10).

Our findings highlight the concern of overutilization of diagnostic imaging in healthcare settings. Furthermore, it underscores that normal test results do not necessarily offer reassurance to patients and can sometimes increase their anxiety levels (10)(11).
EP24 - Ileal metastasis masquerading as Crohn’s in lobular carcinoma of the breast, years after initial treatment- a rare case and review of literature
Authors: Haji Altaf , Vijayaraghavalu Shashikanth , Sivakumar Naveen , Zehra Sadaf , Lourdusamy Selvam , Kalimuthu Marimuthu , Piramanayagam Bala
Published: September 2024

Gastrointestinal (GI) metastases masquerading as Crohn’s years after treated lobular carcinoma of breast is a diagnostic challenge. In some cases, the interval between the primary breast cancer and gastrointestinal metastasis is so long (3- 20 years) that the medical records for diagnosis including history might be missed. The susceptibility of invasive lobular cancer (ILC) to metastasize to gut is many times greater than invasive ductal carcinoma (IDC) (4.5% versus 0.2%, respectively). We report the case of lobular breast carcinoma metastasizing to the terminal ileum and ileocecal junction 7 years following treatment of right sided lobular breast cancer in 60 plus-year-old women. Radiological and endoscopic findings can be difficult to distinguish from inflammatory bowel disease or from primary carcinoma of the GI tract. Histopathological and immunochemistry assessments usually help in reaching the diagnosis. A high index of suspicion and awareness regarding such presentations can help in making an accurate diagnosis and subsequent treatment planning.
EP41 - A Terrorist drone attack: A tragic experience with learning potential
Authors: Almoshantaf Mohammad Badr
Published: September 2024

Introduction

A drone strike struck at the Homs Military Academy on October 2023. The strike injured over 277 persons and killed at least 89.

One nearby public hospital was the first to receive the first wave of casualties. With a very limited staff and resources, huge efforts were employed to save as many lives as possible even if this meant breaking common protocols.

Purpose

to remind doctors, especially surgeons that desperate times call for desperate measures and wise judgment is critical in the darkest times.

Overview

Right after receiving the tragic news of the incident, the hospital declared to give up paperwork, discharge observational admissions, stop non-life-threatening admissions, assign non-clinical staff to assist clinical staff, and call for off-duty workers. As injuries started to present, the hospital prioritized head, thorax, and abdominal injuries. The nurse workforce was assigned to manage the minor injuries while doctors focused on the major ones. While treating and operating on patients, the healthcare providers overlooked sterilization protocols. Due to a shortage of operation rooms, surgical teams have performed operations on some patients in non-operative rooms without monitors, relying solely on IV anaesthesia and portable oxygen cylinders. Some have died, some have suffered from a lifetime disability, yet the prioritizing mentality has saved a lot of lives that day.

Conclusion

Adhering to protocols is essential. However, many experienced surgeons have come across numerous puzzling situations for which there are no clear standards. We stress the need for a surgeon to take action during these challenging periods and act with their wise judgment.
EP94 - Occurrence of Clavicle Tumors and its Surgical Outcome
Authors: Vasantha Rahul Ananda , Shankar Kiran
Published: September 2024

Clavicle tumors have an occurrence of around 1% of all bone tumors. They have a very limited literature regarding their features and outcome which makes the treating physician face a big diagnostic obstacle. This study aims to provide a systematic review on the clinicopathological characteristics and the management outcome. Twenty seven cases of primary clavicle tumors were studied and analyzed during 2021-2023. All cases underwent the initial investigations and were confirmed on histopathology. The Age, sex, location, type and surgical outcome was analyzed and compared.

Malignant tumors were found in 55.6%of the cases, 44.4% were benign.

The histopathological types in this group were osteosarcoma(9 cases),giant cell tumour(6 cases),Ewing sarcoma(5 cases), Aneurysmal Bone Cyst(4 cases), Simple bone cyst(2 cases),Mixed fibroma(1 case). Majority were located in the sternal end and the middle area was the least. Complete or Partial Claviculectomy was done in all our cases. Resection of the medial end/partial claviculectomy was done in 66.6% of the total 18 cases and 33.33% of the cases were giant cell carcinoma (6 cases), no complications found post operatively.

The patients were examined for functioning and adequacy of the involved limb and the end result of all were satisfactory. No patients had any limitations in their daily activities and all patients had a full range of motion. No neurovascular deficit was found. Reconstruction of any manner was not required following claviculectomy which is supported by the above assessed report. Our study also highlights that the dispersal of tumors in the clavicle is quite different as compared to long bone tumors.
EP127 - Audit on Acute PR Bleed Admissions to the Surgical Assessment Unit and the Use of the Shock Index and Oakland Score
Authors: Arshad Serish , Lockwood Sonia
Published: September 2024

Aims

The British Society of Gastroenterology recommend using the Shock Index (SI) and Oakland Score (OS) as an assessment tool to safely discharge patients presenting with acute PR bleeding. This study audited the use of these scores in the surgical assessment unit (SAU) of a large teaching hospital.

Methods

A retrospective list of patients presenting to SAU in October and November 2023 and their main presenting concerns were sought. Patients presenting with PR bleeding were identified and their notes reviewed. Data including age, sex and use of OS and SI were retrieved. OS and SI was calculated. A threshold of ≤1 for SI and ≤8 for OS was used for safe discharge. A threshold of ≤8 for OS equates to a 95% safe discharge probability.

Results

44 PR bleed admissions were identified but 7 excluded due to known cause. 18/37 were male and 19/37 females. The median age was 53, with interquartile range 33-76. On surgical clerking, 0/37 patients had SI documented and 1/37 patients had OS calculated. 3 further patients were excluded due to lack of clinical information. No patient had SI over 1. 12/34 (35%) patients were managed appropriately. OS (threshold ≤8) identified 20/34 (58.9%) were incorrectly discharged. 2 other patients inappropriately had a CTA: one could have been safely discharged and the other managed with inpatient endoscopy.

Conclusion

Currently, discharges of PR bleed presentations to General Surgery does not follow national guidance. The validated OS should be used to provide a safe and objective tool for discharge.
EP187 - Can appendiceal adhesions cause small bowel obstruction? A rare case presentation managed laparoscopically
Authors: Pal Shreya , Pangeni Anang , Allu Veera
Published: September 2024

Aims

Adhesions are the commonest cause of small bowel obstruction world-wide. However, a band adhesion from the appendicular tip to the small bowel causing small bowel obstruction is rarely reported in literature. We report such a presentation and successful management by laparoscopic approach with good outcome.

Methods

61-year-old female, presented with abdominal pain, mild distension & vomiting for 3-days. She had undergone ultrasound-guided-drainage of appendicular abscess 3-months ago. CTAP showed small-bowel obstruction with transition point in pelvis - possible cause being adhesions. After initial conservative management, since she was not improving for 2-days, she was consented for diagnostic laparoscopy.

Results

Intraoperatively, an adhesive band was found between the appendicular tip and distal ileum around 100cm proximal to Ileo-colic junction, resulting in mechanical bowel obstruction.

Laparoscopic division of band was performed followed by appendicectomy, and patient had an uneventful recovery and discharged on post-operative day-2.

Conclusion

Though an uncommon cause of adhesive small bowel obstruction, a band from appendicular tip causing mechanical bowel obstruction can be managed effectively by laparoscopic approach. In future when dealing with complications of appendicitis, like appendicular abscess - it needs to be addressed with clinical suspicion in such presentations.
EP194 - Colorectal cancer TNM staging: A single centre Cohort Study
Authors: Gok M A , Bughio M , Riaz K , Aris R , Sadat M M , Khan U A
Published: September 2024

Aims

AJCC has replaced Dukes staging with TNM classification for colorectal cancer. It relies on characteristics of primary tumour(T), regional lymph nodes involvement(N) and metastasis(M). Aim of study to assess prognostic value of TNM staging at a single centre.

Methods

Cohort study evaluated post-operative outcomes in malignant CRC resections from Jan'2008 to Jan'2024. Descriptive demographic data was obtained for stage 0, 1, 2, 3 & 4 CRC disease.

Results

Stage 0(n = 25) 1(n = 373) 2(n = 564) 3(n = 603) 4(n = 96) Kruskall Wallis(p value) Age(yrs) 55.0 69.2 72.4 70.1 71.3 < 0.0001 Sex(M:F) 10 : 15 214 : 159 307 : 257 340 : 263 54 : 42 NS ASA(median) 2 2 2 2 3 < 0.0001 BMI 27.5 27.5 26.2 26.5 24.9 NS Lap (n) 21 244 306 318 53 < 0.0001 Op time(mins) 114.9 198.3 176.2 179.9 88.0 < 0.0001 LOS(days) 2 ± 2.5 7 9 8 8 < 0.0001 LN(n) 12 14 17 18 14 NS Mortality(n) 30 D 1 8 21 16 8 60 D 1 10 26 26 18 90 D 1 11 28 28 23 Surv rate(%) 1styear 96.2 96.1 92.4 86.1 43.6 5thyear 84.8 86.7 77.2 63.8 16.7 10thyear 84.8 76.5 67.2 58.2 13.0 Logrank 15thyear 84.8 72.9 63.7 55.8 0 p < 0.0001

Conclusion

Short & long term survival rate decreases with worsening TNM stage. Stage 0 CRC disease were younger, with shorter LOS. Clinically TNM staging of colorectal tumour usually dictates treatment modality (surgery, radiotherapy, chemotherapy, immunotherapy), whereas pathological classification estimates prognosis.
EP198 - Negative appendicectomy: A cohort study
Authors: Gok M A , Bughio M , Yim S , Khan S , Riaz K , Khan U A
Published: September 2024

Aims

Negative appendectomy is charaterized as removal of normal appendix histopatholigically. Diagnosis of appendicitis remains a challenge, despites improved diagnostic algorithms (including scoring systems, serological & radiological tests), negative appendectomy rate remains < 20%. The aim of the study is to assess negative appendicectomy at a single centre.

Methods

Cohort study was carried out on all appendicectomies from Mar’2020 to Jan’2024. Descriptive demography & post-operative outcomes were evaluated for negative appendicectomies (Histopathological HPA confirmed normal appendix), all other appendicectomies (HPA confirmed appendicitis) were recruited as controls.

Results

Normal HPA(n = 41) Appendicitis HPA(n = 477) Mann-Whitney U(p value) Age(yrs) 26.4 36.7 < 0.005 Sex(M : F) 16 : 25 235 : 242 NS BMI(kg/m2) 24.7 25.5 NS GP 8 135 NS A & E 33 342 NS WCC(x109/L) 10.7 13.5 < 0.0001 CRP(mg/L) 43.4 ± 10.5 68.3 ± 3.9 < 0.005 Open(n) 0 8 NS Lap(n) 41 469 NS ASA(median) 1 1 NS Diagnostic(n) Clinical 0 33 USS scan 23 117 < 0.001 CT scan 18 327 < 0.01 AB (days) Inpatient 2 ± 0.5 2 ± 1 NS Discharge 0 ± 2 ± 2.5 < 0.005 Operation time (mins) 66.2 75.7 < 0.01 LOS (days) (med) 2 2 NS Appendix HPA (mm) Length 62.4 67.0 NS Diameter 8.6 11.5 < 0.0001 Cost (£) 3376 4341 < 0.05

Conclusions

Despite radiological diagnostics, the negative appendicectomy rate was 7.9 %. Laparoscopy offers an additional diagnostic modality especially in women & post op recovery is quicker. The negative appendicectomy rate has been declining in recent years, but cannot be abolished. A negative appendicectomy rate of < 10 % must be deemed acceptable, to achieve a 90 % therapeutic appendectomy (HPA confirmed appendicitis) rate.
EP244 - Improving communication and accessibility to surgical doctors with introduction of a baton bleep system
Authors: Gurung Ishani , Spellar Kayleigh , Halme Helmi , Sharma Anita , Beaton Ceri
Published: September 2024

Aims

Communication between allied health professionals and doctors is vital to patient care. When not effective and delayed, patient safety is at risk due to failure of critical information being shared resulting in medical errors. Within general surgery at our trust there are three surgical teams, with 25 doctors holding individual bleeps. Due to shift patterns, contacting the correct doctor for the correct team has resulted in concerns of poor accessibility. A team baton bleep system was therefore introduced to improve communication.

Methods

A baton bleep was introduced to each of the three surgical teams, with a doctor from each team being allocated each day. Information was sent to allied health professionals and doctors to make them aware of the new bleep, with posters places on all surgical wards. A qualitative survey was created for allied health professionals and one for doctors to assess perceived effectiveness of the new system.

Results

16 members of the surgical team were surveyed, over half found the bleep system helpful with 69% agreeing that it improved communication and collaboration within the team. 12 allied health professionals were also surveyed, 67% were satisfied with the new system. The main suggestion for improvement overall was to clearly document in the ward notes the consultant and team responsible for each patient.

Conclusions

A baton bleep system appears to be helping enhance communication and streamline workflow within the department through improving accessibility of surgical teams which is crucial for effective patient care and timely responses to critical situations.
EP274 - A clinical audit on nasogastric tube placement documentation and adherence with NICE guidelines in general surgical patients across a district general hospital
Authors: Vickers Corinna , Mukhtar Insha , Dhavala Pooja , Arbis Alexander
Published: September 2024

Aims

NICE provide clear guidelines on confirming correct nasogastric (NG) tube siting using pH testing of aspirates or with X-rays where indeterminate samples are drawn. We aimed to audit documentation following nasogastric tube insertion to ascertain adherence to NICE guidelines.

Methods

A single-cycle snapshot audit was conducted on all surgical inpatients who had nasogastric tubes inserted over their admission across a single-centre district general hospital general surgery department. Data was collected on indication for NG tube insertion (drainage or feeding), length of initial tube insertion, whether pH testing was used to confirm position, and whether correct tube placement has been confirmed by a competent person through x-ray where indeterminate samples were tested from NG aspirate (pH > 5.5).

Results

A total of 15 patients had an NG tube inserted over their admission with mean age 77.3 years (range 47-97). 60% of patients had correctly documented confirmation of NG tube siting. 4/15 NG tubes were inserted for feeding purposes (26.7%), all of which were documented correctly. Only 45.5% of NG tubes for drainage were documented correctly and only 33.3% of all NG tubes had length of insertion documented. Where pH testing was inconclusive, a chest X-ray was requested for all patients and sufficiently documented by a doctor qualified to confirm position. No complications relating to NG tubes occurred across the audit study.

Conclusions

Implementation of improvement measures are warranted to improve overall adherence with NICE guidelines and prevent risk of incorrect confirmation of NG tube siting.
EP291 - Drinking, Eating, Mobilising after elective colorectal surgery- ‘DrEaMing’, a CQUIN project
Authors: Khan Nida , Singh Anurag , Janakan Gnananandan , Hodge Sarah , Adhya Sushmit , Alnabhan Ahmad
Published: September 2024

Introduction

DrEAMing- Early drinking, eating and mobilising after elective surgery, is a simplified and key part of enhanced recovery programmes. It helps decrease post operative complications and length of hospital stay. It also helps reduce the backlog of patients waiting for surgery.

Objectives

As per commissioning for quality and innovation (CQUIN) 2023/2024 guidelines, our aim was to ensure that at least 80 percent of patients are supported to DrEaM- Drink, Eat, Mobilise, within 24 hours of surgery. Our audit includes only colorectal surgeries.

Methods

21 patients underwent elective colorectal surgery from July-September,2023. Patient’s notes, post operative notes and nursing notes were analysed to identify the inadequacies in each of the three limbs of DrEaMing.

Results

Free fluids were ordered for 21/21 (100%) and administered to 17/21 (81%) patients. Food was ordered for 16/21 (76%) and given to 12/21(57%) patients. Lastly, 16/21 patients had orders for mobilisation and 10/21 (48%) were supported for the same. The results were discussed at clinical governance meeting and interventions were advised for better implementation and compliance to guidelines.

Conclusion

There is a deficiency in effective implementation of DrEaMing project and this can be improved by better communication between surgeons and nurses. Surgeons should clearly document patients who aren’t suitable for enhanced recovery programme. We also requested changes to the built operative notes about post operative orders so that the instructions are not missed. We intend to adopt these measures and repeat the cycle of this QIP.
EP335 - Audit of the Use of WHO Surgical Safety Checklist and its Awareness, Perception and Acceptability Amongst Theatre Personnel in a Tertiary Hospital in Sub-Saharan Africa
Authors: Amusat Olanrewaju , Soneye Oluwafunmilayo , Ogundipe Habeeb , Ekwuazi Hyginus , Ogunlade Samuel , Adedeji Olufunso
Published: September 2024

Aims

The World Health Organization Surgical Safety Checklist (SSC) was developed to prevent perioperative adverse events. This study aimed to assess the utilization of the SSC and evaluate awareness and acceptability among theatre staff at a tertiary centre in sub-Saharan Africa.

Methods

We conducted a prospective audit of the SSC utilization during elective and emergency surgery, and a survey of awareness, perception and acceptability amongst theatre personnel (nurses, surgeons and anaesthetists) using a 15-item self-administered questionnaire between May 2022 and January 2023.

Results

117 surgeries were observed for compliance with SSC and 81 theatre personnel took part in the survey. The checklist was used in 52.1% of all surgeries, 80% and 5.4% of major and minor surgeries respectively.

In Time Out phase, activities were stopped in 23% of cases, and scrub nurses were asked relevant questions 31-47% of the time. Sign Out was the least completed phase. Three of five questions were asked 23-48% of the time. 28% of respondents who previously witnessed adverse events agreed that they could have been prevented by proper implementation of the SSC.

65.4% of members of the surgical team had not had any formal training on the SSC. There was no difference in its awareness, perception and acceptability based on profession of the respondents.

Conclusion

SSC was not fully utilized during the audit period. Lack of formal training may be contributory. There is broad awareness of SSC and its ability to prevent advert events.

Key words: WHO, Surgical Safety Checklist, Awareness
EP359 - Introduction of a pathway to improve post operative nutrition for patients undergoing a Whipple procedure - a closed loop audit
Authors: Nixon Gemma , Robinson Karen , Jones Claire
Published: September 2024

Aim

Adequate nutrition in the post operative phase is an essential part of recovery following pancreaticoduodenectomy. A pathway was introduced in the regional hepatobiliary unit to standardise post operative nutrition for this patient group.

Methods

Three audit cycles were completed by retrospective data collection following each intervention. The first cycle was completed between March and May 2023 (n=9).

The nutrition pathway was then updated so patients were on the same oral pathway regardless of whether they received parenteral nutrition or not. The second cycle was completed from May-June 2023 (n=8) and a third cycle was completed from August-October 2023 (n=7) after an education session with surgical trainees by a registered dietitian.

Results

Day 1 of the pathway and prescribing of CREON and supplements were consistently done well. Improvements were seen in adherence to the pathway at day 2 (22%/75%/57%) and day 3 (11%/63%/43%) post op, median number of days to establishing soft diet (from 8 to 5), median day to stopping parenteral nutrition (from 9 to 6) and median length of stay reduced from 15 to 10 days.

Conclusion

Adhering to a post operative nutritional pathway for patients following pancreaticoduodenectomy establishes patients on oral nutrition earlier, allowing for earlier stopping of parenteral nutrition (and thus removal of central venous access) and facilitating earlier discharge from hospital. Future work will involve re-audit with a larger cohort and incorporating education on the pathway into the biannual induction to the unit for trainees.
EP361 - Left Sided Gall Bladder: A Surgical Surprise
Authors: Modi Vidita , Nirhale Dakshayani , Dnyanmote Anuradha
Published: September 2024

Laparoscopic cholecystectomy is a minimally invasive surgical procedure used for the removal of a diseased gallbladder. Since the early 1990s, this technique has largely replaced the open technique for cholecystectomies. We present a unique incident where a left-sided gallbladder was incidentally discovered during a laparoscopic cholecystectomy, posing a technical challenge for the surgeon. Our patient was a 34-year-old female who visited our hospital with complaints of right upper abdominal pain and postprandial nausea lasting for three months. Ultrasound examination revealed two gallstones measuring 16mm and 13mm in the neck of the gallbladder. During the routine laparoscopic cholecystectomy, the surgeon encountered a left-sided gallbladder. To ensure a safe and effective dissection, an additional port was required during the surgical procedure. The prevalence of this rare congenital anomaly, known as a left-sided gallbladder, ranges from 0.1% to 0.7%. It is characterized by the gallbladder being located on the left side of the ligamentum teres and falciform ligament, with the cystic artery passing in front of the common bile duct from right to left. This anatomical variation is often associated with abnormalities in the biliary tree and the porto-venous system. Failing to recognize these variations can lead to serious complications, particularly in hepatobiliary surgery. Discovering a left-sided gallbladder during surgery is an infrequent finding that can increase the complexity and morbidity rate of the procedure.
EP419 - Management of acute diverticulitis in ESAU according to WSES guidelines.And it’s predisposing factors in regard to the local Trust experience
Authors: Binse Zoe , Noureldin Khaled , Yassiri Ahmed , Hardacre Conor , Lockyer Francesca
Published: September 2024

Introduction

In 2015, WSES established a framework to approach management of acute left sided colonic diverticulitis. Lifetime incidence to develop acute inflammation on top of diverticulosis is 4%.

Aim

of the study: Investigate how adherent the local colorectal department to WSES guidelines and to look at possible factors contributing to acute flare ups.

Patients and Methods

Over 6 months, 63 patients presented to ESAU with clinical and laboratory signs, indicating intra-abdominal sepsis. CTAP was utilised to diagnose acute diverticulitis and its complications.

Results

The Vast majority were females (50) with 34 patients above 60 and only 3 were under 40 years old.22.5% had NEWS > 2 and 11% had a temperature spike >38.Quarter of the cases had a CRP >150.

CT scan proved acute uncomplicated diverticulitis in 28 patients, but diagnosed Hinchey 1(8%),2(28%),3 & 4 (20%).2 cases had associated stricture, one of which proved to be malignant (1.5%).84% were managed with IV antibiotics (according to the local Trust),10% had emergency laparotomy and 6% were treated by IR-drainage. 28 patients were treated successfully and discharged with 48 hours, 10 cases had a prolonged recovery over 10 days.2 cases were deceased (3%). Interval colonoscopy (8-12 weeks) was not done in one-third of the cases.

On other hand, 60% were smokers, and two thirds had significant comorbidities; cardiovascular (42%), pulmonary (20%), CKD3(20%), DM (15%), Bowel pathology (7%).27% had multiple comorbidities and 12% were known to have diverticulosis.

Conclusion

Although the firm is adherent to WSES guidelines, interval colonoscopy service should be improved. Age, Smoking, Cardiovascular, Diabetes and pulmonary diseases are predisposing factors for acute diverticulitis. Risk of inflammation and severity in multiple coexisting morbidities.
EP427 - Are we following the RCS England Guidelines for documentation of the operation note for a laparoscopic appendicectomy: A complete audit loop
Authors: Singh Sona , Jenner Kirstie , Leak Melissa , Hussain Rahim , Singh Sandeep , Ramcharan Sean
Published: September 2024

Introduction

The audit outlines the importance of adhering to RCS England Guidelines for documenting laparoscopic appendicectomies. Following these guidelines ensures standardized documentation, facilitating effective communication and promoting patient safety. Moreover, it underscores the significance of recording key procedural steps and techniques employed during the operation. It highlights the guidelines' emphasis on legible, timely, and complete documentation, emphasizing the role of the operation note as a legal document.

Method

This audit involved collecting data from September 2022 - August 2023 for the first loop to analyse operative notes of 92 laparoscopic appendicectomy cases. For the second loop, after introducing an electronic procedure-specific checklist as a guide, we reviewed 30 notes prospectively over a 2-month period (November-December 2023). The notes were compared against RCS England ‘Good Surgical Practice’ 2014 Guidelines using 18 parameters. We assessed for compliance with the guidelines and the legibility of notes.

Results

After introduction of a checklist, average compliance with guidelines increased significantly in 9 of the 18 parameters assessed, 6 remained unchanged at almost 100% compliance. Two key areas for emphasis were identified: instructions for post-op antibiotics (83%), DVT prophylaxis (53%). The most noticeable lack of documentation was in the gynaecological findings of females, recorded in only 13% of cases. There has been a noticeable effort in improving the legibility of the notes.

Conclusion

Introduction of a checklist increased compliance with guidelines. The comprehensive documentation will ultimately promote optimal patient outcomes and advance the overall quality of surgical care.
EP443 - Title: Efficacy of a dedicated "Hot Gallbladder" list in the treatment of acute cholecystitis: A single centre observational study from a District General Hospital
Authors: Sukumaran Sreekanth Nedumparambil , Thomas Pradeep , Narayanasamy Sangara Narayanan , Marzook Himaz
Published: September 2024

Aim

To evaluate the efficacy of a dedicated "Hot Gallbladder" list in the treatment of acute cholecystitis.

Methods

This was a retrospective, single-centre observational study of 43 patients who were admitted with acute cholecystitis and operated on the "Hot gallbladder" list during June 2021 to May 2022. The parameters studied were age, gender, duration of symptoms, previous admissions, investigations, imaging, surgery performed [laparoscopic cholecystectomy, laparoscopic cholecystectomy with OTC (on table cholangiogram) or laparoscopic cholecystectomy with CBD exploration], post-operative complications, re-admissions, and re-operations.

Results

Out of the 43 patients, 25 were female and 18 were male. The median age was 50 with the range from 24 to 87. 61-70 was the age group which had maximum number of patients (10). The median duration of symptoms was 2 days before admission to the hospital. 37 were first-time admissions and 6 had previous admissions. Ultrasound, CT and MRI were done on 34, 14 and 14 patients respectively. 27 patients were diagnosed to have acute calculous cholecystitis, 10 patients had acute gallstone pancreatitis and 6 had biliary colic due to lithiasis. 23 patients underwent laparoscopic cholecystectomy. 20 patients had an OTC of which 8 patients went on to have transcystic CBD exploration. No patients had re-operations. 4 patients were re-admitted.

Conclusion

A dedicated "hot gall bladder list" provides a safe and effective way to reduce the disease burden.
EP452 - Outcomes of Appendiceal Cancer Over 10 Years in a District General Hospital
Authors: Nasser Ibrahim Ali , Jatania Jignesh , Joypaul Vikram
Published: September 2024

Aims

To evaluate outcomes of appendiceal tumour patients at a district general hospital.

Methods

A retrospective review was performed to detect patients (16 years or older) with positive histology findings of appendiceal cancers post appendicectomy or colectomy between January 2014 to January 2024. Data was collected from a prospectively maintained electronic patient hospital record (Meditech, Version 6, USA).

Results

13 patients were diagnosed to have appendiceal tumours between January 2014 – January 2024. Median age of presentation was 53 (IQR 43).Total Patient Number13Male30.8%Female69.2%Appendiceal Tumour TypePercentage of Appendiceal Tumour PatientsCarcinoid (Neuroendocrine)76.9%Adenocarcinoma7.7%Low Grade Mucinous15.4%High Grade Mucinous0%

Median length of stay was 2.5 days (IQR 2.25). Emergency presentations made up 76.9% of admissions. Appendicectomy was the primary operation for 92.3%. 75% of tumours were <1cm, with 25% of tumours >1cm. Location of tumour was predominantly involving the tip in 61.5% of cases, with body and base involvement being 23.1% and 15.4% respectively. Tertiary referral was made for 84.6% of patients. 15.4% had evidence of metastatic disease. Subsequently 15.4% of patients had hyperthermic intraperitoneal chemotherapy (HIPEC), with 7.7% having HIPEC and systemic chemotherapy and radiotherapy.

Conclusions

Carcinoid (neuroendocrine) was the most common type of appendiceal tumour, mostly presenting as an emergency appendicitis. It was more commonly diagnosed in females. While appendiceal cancers are very rare, outcomes remained good with 100% five-year survival, demonstrating the importance of prompt tertiary referral if further treatment is required.
EP502 - Outcome of 5 years of endoscopic oesophageal stenting: a retrospective analysis
Authors: Johnston Magnus , Dawson A , Apollos J
Published: September 2024

Background

Oesophageal endoscopic stenting has a wide range of indications however dysphagia and use in cancer of the oesophagus is by far the most common, being the 14th most common cancer in the UK, despite advances in diagnosis and therapy with patients often presenting at advanced stages of the disease. Greater than 50% of presentations are at an advanced stage of disease where resection is often not possible and palliation is required. Palliation often is a potential combination of palliative chemotherapy, radiotherapy and endoscopic stenting to control the disease burden and improve symptoms. One of the most limiting palliative symptoms is dysphagia for which oesophageal stenting has become the standard of treatment showing immediate results. However, intra/post procedural complication rates can be high leading to: oesophageal perforation, mediastinitis, aspiration pneumonia, failed stent insertion or slippage.

Method

A retrospective analysis of 97 patients who underwent oesophageal stenting, in a 5 year time period between 2018-2023 in the Dumfries Royal Infirmary, a large district general hospital. Patients electronic notes were retrospectively analysed for patient characteristics, indication for stenting, early complications, successful hospital discharge and mortality.

Conclusion

The retrospective study demonstrated oesophageal stenting is a relatively safe procedure with a low mortality and the majority of patients being discharged from hospital. However, complications are not uncommon and patients should be properly counselled; on the risks, benefits and also food habits to prevent bolus.