bluuebunny/crossref_metadata_2025 huggingface dataset:
EP.TH.289Diagnosis of the aetiology of acute pancreatitis at a district Hospital: A retrospective audit
Authors: Ravindran Sharanya , Shaaban Hossam , Mohsin Muhamed
Published: October 2021

Introduction

The correct diagnosis of acute pancreatitis should be made in all patients within 48 hours of admission. According to recently published NICE (NG 147) guidelines for diagnosis of aetiology of acute pancreatitis should be determined in at least 80% of cases and no more than 20% should be classified as idiopathic. We aim to overview our current practice compared to guidelines. Early identification of aetiology is essential.

Materials and Methods

Patients diagnosed to have pancreatitis presenting to surgical assessment unit from March 1st 2019 to December 31st 2019. Sample size audited 291. The diagnosis of acute pancreatitis is made with a combination of history, physical examination and laboratory evaluation. Further investigations were done for the ethology. These patients were identified from their discharge information. They had raised amylase along with history suggestive of pancreatitis and were analysed retrospectively.

Results

Of all the pancreatitis patients admitted in SAU, 88 (30%) were due to biliary, 40 (16%) alcohol related, 20 (7%) other causes whereas 134 (46%) were classified as idiopathic. 3 patients self-discharged.

Conclusion

In our trust it seems that aetiology of acute pancreatitis is not adequately investigated. Most of other blood investigations were not performed in index admission and relevant drug history was not elicited. This failure of non-identification of gallstones could be attributed to operator dependant and they didn’t have second USS as advised. We formulated an action plan with detailed history with adequate step wise investigations which will benefit the patients.
EP.TH.299Is peritoneal lavage with water the optimal washout as a preventative method for peritoneal disease following colorectal cancer resection? A systematic review
Authors: Youssef Nadia , Beddingham James , Soliman Faris , Swarnkar Keshav
Published: October 2021

Aim

To study available data on the advantages of peritoneal lavage with distilled water following colorectal cancer resection in improving overall patient outcomes

Methods

PubMed, Google Scholar, and Cochrane databases were searched until October 2020. References from relevant articles were reviewed to widen the search.

Results

Overall, 3 experimental studies were identified. Water was found to be superior to other peritoneal lavage solutions in inducing tumorigenic cell lysis in vitro. Mice who underwent peritoneal lavage with water survived longer and had a significantly reduced peritoneal tumour burden compared to mice who did not undergo lavage or those treated with saline lavage solution. Peritoneal secretions were found to contaminate water lavage and reduce its cell-lytic effect. Nonetheless, complete cell lysis was achieved, in vivo, by prolonging the time of cell exposure to contaminated lavage solution by 20 min.

Conclusion

Single peritoneal lavage with water is probably safe and may have a positive influence on patient outcomes. Further evidence is required to regard sequential peritoneal lavages with water as beneficial and safe in humans.
EP.TH.305Savi Scout Radar versus Wire-Guided Localisation in Breast Cancer Surgery: A Systematic Review and Meta-Anaylsis of Surgical Outcomes
Authors: Latif Ahmed , Suliman Amna , Giono Ilaria , Doddi Sudeendra , Kasem Abdul , Uhercik Michal
Published: October 2021

Aims

Wire-guided localisation (WGL) has been the standard technique for localisation of non-palpable breast cancers (NPBC) for almost 40 years. However, WGL has disadvantages including peri-operative scheduling challenges and patient discomfort. Savi Scout localisation (SSL) is a novel alternative that utilises an implantable wireless non-radioactive reflector. A systematic review and meta-analysis was performed to compare outcomes of SSL versus WGL in NPBC surgery.

Methods

Embase, MEDLINE, PubMed and the Cochrane Library (1946 to December 2020) were searched using PRISMA guidelines for studies comparing SSL and WGL in NPBC surgery. Outcome measures analysed were operative duration, positive margins and re-excision. Results were pooled into meta-analyses using a Mantel-Haenszel Random-Effects model as Odds Ratios for dichotomous data and Mean Difference for continuous data.

Results

Four eligible peer-reviewed cohort studies involving 808 patients were identified comparing SSL (n = 462) and WGL (n = 346). There was no significant difference between SSL and WGL in operative duration (95% CI -0.27, -7.89 to 7.34, p = 0.94), positive margins (OR 0.73, 0.36 to 1.45, p = 0.36) and re-excision (OR 0.62, 0.33 to 1.16, p = 0.13). Inclusion of two non-peer-reviewed cohort studies (additional SSL n = 143, WGL n = 424) altered statistical significance for re-excision in favour of SSL (OR 0.55, 0.36 to 0.83, p = 0.004).

Conclusions

This study demonstrates that SSL is a safe and effective alternative to WGL. SSL uncouples pre-operative localisation from surgery, reducing scheduling challenges. This is particularly useful in the current COVID-19 climate, with pre-operative patient self-isolation requirements. SSL may decrease re-excision rates. Randomised controlled trials are required to investigate this further.
EP.TH.316Laparoscopic Cholecystectomy in KGH in 2019 - Comparing the Incidence of Complications and Patient Demographics to National Data
Authors: Islam A B Mohammad Monirul , Seddon Thomas
Published: October 2021

Aims

Bile Duct injury is one of the serious complications of Laparoscopic Cholecystectomy and should be avoided.

Several recent large studies that have examined Bile Duct Injuries (BDI) during cholecystectomy have found major BDI rates of 0.15-0.36% and an overall biliary complication rate of 1.5% if bile leaks are included.

We wished to identify our current complication rate and compare to national data.

Methods

Retrospective study

Data time frame from:

01/01/2019 to 31/10/2019

Type of patients:

All patients who underwent elective or emergency laparoscopic cholecystectomy between the above dates

Results

312 patients identified and analyzed over the study period.

227 female (72.76%) and 85 male (27.24%)

268 Elective operations (85.9%). 44 Emergency operations (14.10%)

Primary outcome

Secondary outcomes

Conclusions

KGH performed 312 cholecystectomy operations between Jan - Oct 2019, putting it in the upper 1/3 of hospitals regarding the number of operations performed per year. (1)

The complication rate for the study period was 0.32%. This was one out of the 312 operations. Our incidence of complications is lower than published data reporting complication rates, including bile leaks, of up to 1.5%. There were no bile duct injuries during the study period.

The majority (>85%) of cases were performed as elective operations.
EP.TH.328Present status of cancer burden in Sri Lanka based on GLOBOCAN estimates
Authors: Jayasinghe Ravindri , Sriskantharajah Varothayan , Jayarajah Umesh , Seneviratne Sanjeewa
Published: October 2021

Aims

We aimed to provide an overview of cancer burden in Sri Lanka including incidence, prevalence and mortality rates in 2018 by age groups.

Methods

We used the data from GLOBOCAN 2018 which provided worldwide estimates of cancer incidence, prevalence and mortality for each country and regions.

Results

Highest prevalence in both sexes (total = 56,054) in Sri Lanka included cancers of the breast (n = 9,534, 87.5/100,000 population), lip and oral cavity (n = 5,904, 28.2/100,000), thyroid (n = 4,387, 20.9/100,000), colorectum (n = 3,634, 17.3/100,000) and leukaemia (n = 3,234, 15.4/100,000), respectively. In males, the highest incidence was reported for lip and oral cavity, lung and oesophageal cancers and in females, breast, uterine cervix, thyroid and ovarian cancers. Cancers causing highest mortality among Sri Lankan males included lung, lip and oral cavity, oesophagus and leukaemia and in females, breast, uterine cervix, leukaemia and ovary.

Conclusions

The burden of cancer is increasing in Sri Lanka which is probably related to changing cancer risk factor profiles and rapidly aging population. New innovative strategies for prevention, early detection and improving the quality cancer treatment is essential to deal with this effectively.
EP.TH.375Inguinal hernia repair: A systematic analysis of online patient information using the modified Ensuring Quality Information for Patients tool
Authors: Chien Siobhan , Cunningham Danielle , Khan Khurram
Published: October 2021

Aims

Online resources are a fundamental source of healthcare information due to the increasing popularity of the Internet, therefore ensuring accuracy and reliability of websites is crucial to improving patient education and enhancing patient outcomes. Inguinal hernia repair is the most commonly performed general surgical procedure worldwide. This study aims to analyse the quality of online patient information on inguinal hernia repair using the modified Ensuring Quality Information for Patents (EQIP) tool.

Method

A systematic review of online information on inguinal hernia repair was conducted using 4 search terms: “inguinal hernia”, “groin hernia”, “inguinal hernia repair” and “inguinoscrotal hernia”. The top 100 websites for each term identified using Google were assessed using the modified EQIP tool (score 0-36). Websites for the paediatric population or intended for medical professional use were excluded from analysis.

Results

142 websites were eligible for analysis. 52.8% of websites originated from the UK. The median EQIP score for all websites was 17/36 (IQR 14-21). The median EQIP scores for Content, Identification and Structure were 8/18, 2/8, and 8/12, respectively. Complications of inguinal hernia repair were included in 46.5% of websites, with 9.2% providing complication rates and 14.1% providing information on how complications are handled.

Conclusions

This study highlights that the current quality of online patient information on inguinal hernia repair is poor, with minimal information available on complications, hindering patients’ ability to make informed decisions regarding their healthcare. To improve patient education, there is an immediate need for improved quality online resources to meet international standards.
EP.TH.462Elective colorectal procedures: postoperative stay & outcomes
Authors: Kalaskar Shrinivas , Hanek Petr
Published: October 2021

Aim

This was a re-audit of (ACPGBI) Association of Coloproctology of Great Britain and Ireland guidelines for the management of colorectal cancers 3 rd Edition 2007.

“Surgeons should expect to achieve an overall anastomotic leak rate below 8% for anterior resections and below 4% for other types of resection. Surgeons should expect to achieve operative mortality of less than 7% for elective colorectal cancer surgery.”

To ensure that our Anastomotic Leak rates & Mortality rates are below the recommended standards.

Method

All elective colorectal surgeries from 01/01/2011 to 31/06/2012 from a busy colorectal the firm were included in study.

A thorough analysis & review of Discharge Summaries was done including type & number of elective colorectal surgeries, anastomotic Leak rate, 30 day mortality and readmission rate, average(Mean & median) postoperative stay and common postoperative complications were identified.

The reasons for delayed discharge identified.

Results

The anastomotic leak rate was 3.0% (2/65). Thirty-day mortality was 1.53%(1/65). The mean postoperative stay was 9.1days (Median 7 days).

Twenty postoperative complications were identified: 6 patients had ileus; 6 patients had minor wound infection; 2 patients had an anastomotic leak; 2 patients had stoma related complications; 2 post-op collections; 1 C-Diff infection & 1 Hospital-acquired Pneumonia.

The common reasons for delayed discharges were Social reasons, ileus, reoperations, inability to cope with a stoma and Hospital-Acquired Pneumonia.

Conclusions

Our anastomotic leak rates (3.0%) & 30-day mortality (1.53%) are well below recommended standards by ACPGBI.

Our median postoperative stay was below to National average (7days Vs 8days colonic cancer &10days rectal cancer).
EP.TH.589Comparison of Surgeon Gaze Behaviour Against Objective Skill Assessment in Open Inguinal Hernia Repair – A Pilot Study
Authors: Salazar Oliver , Erridge Simon , Beatty Jasmine Winter , Darzi Ara , Purkayastha Sanjay , Sodergren Mikael H
Published: October 2021

Aims

Technical skill is associated with improved postoperative outcomes. Adoption of a formalised high-stakes assessment of surgical skill is technically challenging and limited by the financial and human resources available. We aimed to assess the ability to adopt gaze behaviour analysis as an assessment of surgical skill within live open inguinal herniorrhaphy.

Methods

Surgeons’ gaze was measured with Tobii Pro eye-tracking Glasses 2 (Tobii AB). All grades of surgeons were included. Primary outcomes were dwell time (%) and fixation frequency (count/s), as markers of cognition, on areas of interest correlated to mean Objective Skill Assessment of Technical Skill score. Secondary outcomes assessed effort and concentration levels through maximum pupil diameter (mm) and rate of pupil change (mm/s) correlated to perceived workload (SURG-TLX). Three operative segments underwent analysis: mesh preparation, fixation and muscle closure. Spearman’s and Pearson’s correlation were performed with significance set at p < 0.05.

Results

5 cases were analysed, totalling 270 minutes of video footage. All participants were senior surgical trainees and right-hand-dominant. The median number of hernia operations performed was 160 (range:100-500). The median ASA score of each patient participant was 2 (range:1-2). The median operation length was 45 mins (range:40-90 mins). There were no statistically significant primary outcomes from this pilot data (p > 0.05).

Conclusions

This pilot study demonstrated the feasibility of recording gaze behaviours for comparison against formal skills assessment to determine the role of eye tracking in live high stakes technical skills assessment. A full study will now commence based on formal power calculation.
EP.TH.603Hypofractionated radiotherapy for resectable pancreatic ductal adenocarcinoma: a world first in response to COVID19
Authors: Spiers Harry VM , Thankamma Ajithkumar , Davies Susan , Duckworth Adam , Jah Asif , Liau Siong-Seng
Published: October 2021

Introduction

COVID-19 has challenged healthcare systems across the world, restricting resources for major hepato-pancreato-biliary resections. We report the experience of a unique temporising measure to overcome unavailability of upfront surgery, for select patients with resectable pancreatic ductal adenocarcinoma (rPDAC) during the pandemic.

Methods

Select patients with rPDAC who were assessed to be unsuitable for, or declined, upfront systemic chemotherapy, were considered for hypofractionated radiotherapy (hypoRT) as bridging therapy to Whipple’s pancreaticoduodenectomy.

Results

Three patients with EUS-biopsy confirmed rPDAC with no vascular involvement received 5 fractions of hypoRT followed by Whipple’s resection. Median patient age was 68 (range 63-77). All patients successfully completed hypoRT, with one case of transient grade 2 anorexia. Median interval from hypoRT to resection was 75 days (range 41-95 days), with median operative time including anaesthesia of 573 minutes (range 496-661 minutes). R0 resection was achieved in two cases, including one requiring portal vein resection. R1 resection was seen in one patient who required superior mesenteric vein resection. One patient experienced complication in the form of delayed gastric emptying. Median length of stay was 11 days (range 11-58 days). No patient experienced post-operative pancreatic fistula, and no patient has evidence of recurrence on 30-day follow up imaging.

Conclusion

This report provides initial experience for hypoRT in select patients with rPDAC prior to resection. Further work is required to quantify outcomes and long-term safety profile of this novel approach. The hypoRT programme allowed select patients to obtain treatment whilst awaiting availability of surgical resources.
Ep.Th.654Home Based Pre-Rehabilitation in Hepatic & Pancreatic Oncological Surgery- A Way Forward for Improved Patient Outcome
Authors: Ahmed Nauman , Obeidallah Rami , Subar Daren
Published: October 2021

Aims

To ascertain the impact of ‘’Cost effective home-based pre-rehabilitation’’ on post-operative outcomes in patients undergoing major hepatic and pancreatic oncological surgery.

Methods

In this non-randomized comparative study (2019-2021), we included 36 patients having pancreatic or hepatic malignancy. In group I, patients were signed up for home-based pre-rehabilitation program and dietary modification. Group II; included patients who did not have rehabilitation. The two groups were compared for post-operative outcomes (post-operative complications, length of ITU and hospital stay)

Results

Mean age was 69.05±9.68 years in group I and 67.50±8.75 years in group II (p-value 0.61). Open approach was used in 02 (11.0%) patients in group I and in 09 (50%) patients in group II (p-value 0.01). More patients in group II needed admission in intensive care unit (ICU); 18 (100%) versus 11 (61.1%) in group II (p-value 0.0003). The group I had shorter length of hospital stay as compared to Group II (p-value 0.0001). There was no significant difference in post-operative complications between the groups.

Conclusion

Home based pre-rehabilitation, has shown beneficial outcomes in terms of less requirement for ITU admission post operatively, shorter length of hospital stay and cost effective method of pre rehabilitation.
EP.TH.675Snapshot Audit of post ERCP surgical complications over three years at District General Hospital
Authors: Sarodaya Varun , Garg Arti
Published: October 2021

Aims

To determine the rates of Post ERCP (Endoscopic retrograde cholangiopancreatography) complications at District general hospital compared to standard derived from guidance issued by the European Society of Gastrointestinal Endoscopy (ESGE).

Method

We performed a retrospective data collection of all the patient who underwent ERCP between 01/01/2018 and 31/12/2020. Parameters like patient demographics, date of procedure, immediate post-procedure complications, A&E presentation within 7 days and 30-day mortality were considered.

Results

One hundred and fifty-three ERCPs were performed at our institution over this three year period. Eleven patients undergoing ERCP in this time interval developed surgical complications. Out of the 11 patients, 8 were females and 3 were males. The median age at ERCP was 63 Years. Of the 11 patients, 6 underwent MRCP and 5 had an Ultrasound scan before the procedure. Three patients had perforation (1.9%) out of which 1 required surgical intervention in theatre and 2 were managed conservatively. Out of the remaining, 4 (2.6%) developed acute cholecystitis and 2 (1.3%) were admitted with acute pancreatitis.

Conclusion

The incidence of complications post ERCP is roughly 10%, with a reported mortality of around 1%. Incidence of post ERCP complication at the UK district hospital was marginally higher than the standard set by ESGE guidelines. Determining incidence is difficult and the study had various shortcoming like small sample size, patient variation in selection for ERCP, inherent bias. Despite limitations, we aim to take various measures to improve our practise and meet the national standards set by ESGE.
EP.TH.697The great mimic of mesenteric cyst - an interesting case report of mucinous adenocarcinoma of the ovary
Authors: Lowe Katherine , Dhaif Ahmed , Gumber Ashutosh , Pareek Raju , Allam Mohammed , Elsapagh Khaled
Published: October 2021

Aims

A mesenteric cyst, rare intra-abdominal pathology, poses a clinical challenge due to lack of pathognomonic symptoms, variability in presentation and location. We present an interesting case with a significant diagnostic dilemma; a suspected benign ovarian cyst invading the mesentery on repeat imaging and laparoscopy is questioned for mesenteric in origin.

Methods

A 77-year-old female presented with a 6-year history of abdominal mass. She had multiple radiological scans which reported it as a simple cyst, but the origin could not be defined. She had repeated aspirations with benign cytology. They cyst developed septations, filled-up rapidly, became an abdominal cyst from the pelvis. A careful decision was taken for surgery. The procedure undertook with general surgeons and gynaecologists with a possibility of the mesenteric cyst. During laparotomy, the cyst was found extending from pelvis and base of mesentery up to the diaphragm densely adhered to sigmoid colon. The cyst was completely excised with hysterectomy and oophorectomy.

Results

The patient recovered well from surgery. Post-operatively, histopathology confirmed Figo IC2 Grade 2 mucinous adenocarcinoma of the ovary with an expansive growth pattern. She is awaiting further treatment with chemotherapy after discussion in the Gynaecology MDT.

Conclusion

This case emphasises the importance of having an insight into the question of established diagnosis in the face of a changing clinical picture. Also, it highlights the need for understanding the mesenteric cyst. Early exploration can prevent diagnostic delays and further treatment.
EP.TH.714Adult Spontaneous Choledochal Cyst Rupture: A Case Report of a Rare Presentation
Authors: AlSaleh Khaled , Wani Mahmood , Almudawah Yasmin , Alotaibi Ahad
Published: October 2021

Background

Choledochal cysts are uncommon congenital biliary duct dilatation involving either intra-hepatic, extra-hepatic ducts or both. The presentation varies among pediatric age groups compared to adults, in which pediatrics present mostly with jaundice whereas adults present with abdominal pain. It carries high-risk complications and related malignancy depending on the type of cyst. There were few reported cases of spontaneous rupture of choledochal cyst in adults.

Case Description

A 35-year-old female, medically and surgically free. Presented to Emergency Department with recurrent episodes of non-bilious vomiting for three weeks, managed conservatively. One day later, she presented with generalized abdominal pain with persistent vomiting. The patient mentioned a history of chronic abdominal pain for 6 years. On examination, the abdomen was tender all over with signs of peritonitis. A Computed Tomography scan revealed a septated intra-hepatic duct cyst measuring 9 x 11 cm. Therefore, she was taken to the operating room for exploratory laparoscopy, washout was done and drains were inserted. Afterward, Endoscopic Retrograde Cholangio-Pancreatography with sphincterotomy and stenting performed. Six weeks later, she underwent elective left hepatectomy and histopathology confirmed the choledochal cyst. She had an uneventful postoperative course with two weeks follow up with no complications.

Conclusion

Ruptured choledochal cyst is a rare presentation and high clinical suspicion is warranted in adult patients who present with a surgical abdomen along with a history of chronic abdominal pain. This case report represents the importance of conservative treatment before the definitive operation, to allow resolution of the peritonitis and lower the consequences.
EP.TH.770Upgrading the level of evidence regarding Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy: Meta-analysis of randomised controlled trials
Authors: Hajibandeh Shahin , Hajibandeh Shahab , Mankotia Rajnish , Peravali Rajeev
Published: October 2021

Objectives

To evaluate comparative outcomes of intracorporeal (ICA) and extracorporeal (ECA) anastomosis in laparoscopic right hemicolectomy.

Methods

We conducted a systematic search of electronic databases and bibliographic reference lists. We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases. Overall perioperative morbidity, anastomotic leak, surgical site infection (SSI), paralytic ileus, bleeding, postoperative pain within 5 days, conversion to an open procedure, length of incision and procedure time were the evaluated outcome parameters.

Results

We identified 4 randomised controlled trials reporting a total of 399 patients evaluating outcomes of ICA (n = 199) and ECA (n = 200) in laparoscopic right hemicolectomy. The ICA was associated with significantly shorter length of incision (MD:-1.82, P < 0.00001), lower postoperative pain score on day 2 (MD:-0.69, P = 0.0007), day 3 (MD:-0.80, P = 0.02), day 4 (MD:-0.83, P = 0.01) and day 5 (MD:-0.49, P < 0.00001) when compared to ECA. Moreover, it was associated with significantly shorter length of hospital stay (MD:-0.27, p = 0.03). However, there was no significant difference in overall perioperative morbidity (RR:0.79, P = 0.47), anastomotic leak (RR:1.29, P = 0.65), SSI (RR:0.61, P = 0.42), bleeding (RR:0.70, P = 0.71), ileus (RR:0.60, P = 0.45), conversion to open (RD:-0.02, P = 0.45), number of harvested lymph nodes (MD:0.82, p = 0.06), and procedure time (MD:16.04, p = 0.06) between two groups.

Conclusions

The meta-analysis of level 1 evidence demonstrated that ICA and ECA have comparable perioperative outcomes in laparoscopic right colectomy although the former may be associated with less postoperative pain probably due to shorter incision length. Future research may provide stronger evidence in favour of an intervention.
EP.TH.893Virtual Clinic follow-up in Laparoscopic Fundoplication Surgery
Authors: Ji Chenchen , Mitchell Benjamin , Tan Christine , Toh Simon
Published: October 2021

Aims

There are clinical and financial incentives to reduce follow-up NHS clinics after elective surgery. 55% of our laparoscopic anti-reflux procedures are day-cases procedures. To reduce consultant clinic workload and unnecessary face-to-face patient reviews, we introduced a laparoscopic surgical care practitioner (LSCP) based Virtual Clinic.

Methods

Patients were telephoned on day 1 and 5 to ensure they were managing their diet without significant post-operative symptoms.

This was followed by a Virtual Clinic follow-up at 6-8 weeks, using a universal list of questions and template, and an electronic letter with outcomes recorded.

149 patients underwent laparoscopic fundoplication surgery from September 2016 – May 2018. All follow-up clinics, both virtual and face-to-face, were recorded electronically. These were reviewed, data collected and analysed.

Results

Between September 2016 – May 2018, 149 patients had laparoscopic fundoplication surgery at our trust with the following clinic outcomes:

Conclusions

Our LSCP Virtual Clinics discharged 50 out of 149 (33%) patients with no need for face-to-face clinic time, and no detriment to patient care. Those requiring further follow-up were patients who had difficulty managing dietary changes, or experiencing symptoms like dysphagia, often needing physical review and further investigations. Furthermore, patients have expressed high satisfaction with this service. Virtual clinic follow-up is safe, patient-friendly, and reduces both clinical and financial load on NHS outpatient clinics.
EP.TH.961Meta-analysis of Spinal Anaesthesia Versus General Anaesthesia During Laparoscopic Total Extraperitoneal Repair of Inguinal Hernia
Authors: Hajibandeh Shahin , Hajibandeh Shahab , Mobarak Shahd , Mobarak Dham , Satyadas Thomas
Published: October 2021

Objectives

To evaluate comparative outcomes of spinal anaesthesia (SA) and general anaesthesia (GA) during laparoscopic total extraperitoneal (TEP) repair of inguinal hernia.

Methods

We systematically searched MEDLINE; EMBASE; CINAHL; CENTRAL, and bibliographic reference lists. Post-operative pain assessed by visual analogue scale (VAS), individual and overall perioperative morbidity, procedure time and time taken to normal activities, were the outcome parameters. Combined overall effect sizes were calculated using fixed-effect or random-effects models.

Results

We identified 5 studies enrolling 1,518 patients (2,134 hernia) evaluating outcomes of laparoscopic TEP repair under SA (n = 1,277 patients, 1,877 hernia) or GA (n = 241 patients, 257 hernia). SA was associated with significantly lower post-operative pain assessed by VAS at 12 hours (MD: - 0.32, P < 0.0001) and shorter time to normal activities (MD: -0.30, P = 0.002) compared to GA. However, it significantly increased risk of urinary retention (OR:4.02, P = 0.01), hypotension (OR:3.97, P = 0.004), headache (OR:7.65, P = 0.003), and procedure time (MD: 3.82, P = 0.004) There was no significant difference in VAS at 24 hours (MD:0.06, P = 0.34), seroma (OR:1.54, P = 0.26), wound infection (OR:1.03, P = 0.94), and vomiting (OR:0.84, P = 0.66) between two groups. There was a non-significant decrease in overall morbidity in favour GA (OR:1.84, P = 0.17) which became significant following sensitivity analysis (OR:2.59, P = 0.01).

Conclusions

Although TEP inguinal hernia repair under SA may reduce pain in early postoperative period, it seems to be associated with increased postoperative morbidity and longer procedure time. It may be an appropriate anaesthetic modality in selected patients who are considered high risk for GA. Higher level of evidence is needed.
EP.TH.1029Surgery for retained gallstones: A single centre experience
Authors: Gok M A , Ftaieh F , Shams O , Ward S J , Khan U A
Published: October 2021

Aims

Lost spilled gallstones during laparoscopic cholecystectomy is a rare inadvertent complication results in recurrent delayed sepsis. Diagnosis is made via retrospective review of operative notes. 2 cases of retained gallstones were removed surgically, following several years after the initial laparoscopic cholecystectomy.

Conclusion

2 cases presented with delayed symptoms of abdominal pain, sepsis with intra-abdominal collections. Intra-abdominal abscesses treated with percutaneous USS guided drainage & antibiotics. Abscesses arise in right subphrenic space, right anterior abdominal wall & iliacus as a result of gallstone migration. Diagnosis of “spilled lost gallstones” was delayed until confirmation of retained gallstones on radiological imaging. Combination of USS, CT and MRI scan enabled to detect retained gallstones (radiolucent or radio-opaque) within an abscess cavity.

Multi-disciplinary approach allowed a more concerted management i.e. diagnosis of retained gallstones & planning surgical exploration for retained gallstones.

Ultimately, abscesses should be drained (percutaneously or surgically), and retained stones should be removed. Ideally this is done via minimally invasive techniques, but open surgery is often required. Use of laparoscopy enables exploration of the peritoneal cavity and any abscess cavity. This exploration will extract any fragment of gallstone that could be a nidus for continuous infection.
EP.TH.1043Outcomes of liver resections by trainee surgeons versus consultant surgeon – a single centre experience
Authors: Thiyagarajan Umasankar Mathuram , Al-Mohammad Alaa , Goh Stephanie , Liau Siong-Seng , Huguet Emmanuel , Jah Asif
Published: October 2021

Introduction

Liver resection is a most effective treatment for patients with operable primary or secondary cancer deposits. The role of trainee as a lead surgeon versus consultant surgeon performing liver resections and its impact on surgical outcomes had never been reported.

Methods and Materials

This study was aimed to assess the liver resection outcomes including operative time, acute kidney injury (AKI), bile leak, sepsis, mortality and hospital readmission within 3 months. A total of 320 liver resections from Addenbookes Hospital at Cambridge between 2015 to 2017 were included in this study.

All liver resections were performed under supervision of the consultant surgeon who is either scrubbed or unscrubbed in theatre. Trainee surgeons have performed 116 of 320 as lead surgeon and the consultant surgeons performed the remaining 204.

Results

The mean operative time was 413±129 versus 383±118 (P = 0.41) minutes in trainee surgeons and consultant surgeons respectively. The incidence of postoperative AKI were similar in between the groups (5/116 versus 11/204;P=0.79). Although the bile leak was numerically high in the trainee group, did not reach statistical difference (13/116 versus 12/204;P=0.12); similar results noted in the incidence of sepsis too (3/116 versus 4/204;P=070). Mortality, hospital readmission at 3 months were (1/204 versus 1/116;P=1) and (2/116 versus 4/204;P=1) respectively. No significant difference was observed.

Conclusion

Liver resections performed by the trainee surgeons under supervision appeared to be safe without increasing the operative time, morbidity, mortality and hospital readmission at 90 days. Further multicentre prospective study with long-term follow up is recommended.
EP.TH.1063Independent Risk Factors influencing healing times in pilonidal sinus excision surgery
Authors: Bhome-Dhaliwal Shona , James Rhodri , Arun Chokkalingam
Published: October 2021

Aims

Pilonidal Sinus excision surgery is commonly accompanied by a complex healing process. This study assesses the risk factors associated with poor wound healing from pilonidal excision surgery, and which patient demographics would benefit from assisted healing interventions, such as vacuum assisted closure, to enhance recovery times in a cost effective manner.

Methods

OMIS Theatre databases were used to identify primary pilonidal sinus excision procedures between January 2016 and January 2018 with a 32-patient cohort. Clinical workstation highlighted the time of wound healing based on date of clinic discharge. Risk factors for poor healing including smoking status, BMI, Diabetes, Vascular disease, gender, immunocompromised status, Chronic Renal impairment and ASA classification were identified.

Results

Of the 32: 16% have not healed at present and require further surgical intervention and 10% had not been followed up. The median duration for wounds healed was 105.5 days. The risk factors highlighted for complicated wound healing was gender, smoking status and diabetes. Median time for current smokers (30%) was 187 as opposed to 96.5 within the non-smoking population. Males (65%) had a longer healing time of 111 in comparison with females (75 days). Diabetic patients (9%) had a median time of 196.5 in comparison with non-diabetes patients with 96 days.

Conclusion

The highest risk factors for a prolonged healing process are the male gender, presence of diabetes and current smoking status. Therefore consideration of assisted healing interventions should be taken for patients with these demographics, implementing a cost effective approach to complex wound healing procedures.
Moy.01HOXB9: an emerging novel prognostic marker and potential target for gene-therapy in colorectal liver metastases
Authors: Martinou Eirini , Moller-Levet Carla , Angelidi Angeliki , Bagwan Izhar , Karanjia Nariman
Published: October 2021

Aims

Homeobox (HOX) proteins are emerging as promising biomarkers and targets for gene-therapy in cancer; however, their role in colorectal liver metastases (CRLM) is unknown. This study aims to investigate the role of HOXB9 as prognostic marker and potential therapeutic target in CRLM.

Methods

Two patient-cohorts were included: a) Patients with colorectal cancer (CRC) from the National Cancer Institute, Tissue Cancer Genome Atlas (TCGA) database (n = 614) and b) Institutional patient cohort who underwent liver resection for CRLM (n = 110) between 2007-2014. Primary outcome was 10-year overall survival (OS). COX regression and Kaplan-Meier survival analyses were performed including HOXB9 expression, demographics, clinicopathological and treatment-related variables. HOXB9 gene expression was modulated to assess its impact on CRC cell growth in vitro. Therefore, we conducted experimental studies using plasmid-vector and siRNA-interference to overexpress and knockdown HOXB9 respectively.

Results

Univariable TCGA analysis showed that HOXB9 did not predispose to poor OS (HR = 1, 95%CI:0.92-1.1, p = 0.620). On the contrary, univariable analysis in the CRLM patient cohort showed that high HOXB9 levels, right sided CRC, CRLM number≥4, CRLM diameter≥5cm, and intrahepatic recurrence were associated with significantly increased risk for worse OS. On multivariable models, only high HOXB9 expression (HR = 3.82, 95%CI:1.59-9.2, p = 0.003) and intrahepatic recurrence (HR = 4.28, 95%CI:1.88-9.72, p = 0.001) retained significance as independent prognostic factors after liver resection. Experimental studies showed that HOXB9 overexpression increased cell proliferation (p < 0.001) whereas HOXB9 inhibition markedly supressed CRC cell growth (p < 0.001) in vitro.

Conclusions

HOXB9  demonstrates oncogenic properties and may serve as novel prognostic marker and potential target for gene-directed therapy in CRC/CRLM.
BJS.04PreciSSIon: A collaborative initiative to reduce incidence of SSI after elective colorectal surgery
Authors: Clayphan Benjamin , Biggs Sarah , Dixon Lauren , Jordan Lesley , Dalton Stephen , Pullyblank Anne
Published: October 2021

Aims

Surgical Site Infection (SSI) is common after colorectal surgery where rates are reported as high as 30%. The aim of this project was to assess whether a collaborative approach to implement a 4-point care bundle could reduce SSI rates across a group of hospitals.

Methods

PreciSSIon is a Quality Improvement Project (QIP) involving 7 NHS hospitals, with a design based on the Institute for Healthcare Improvement’s Breakthrough Series collaborative model. The Public Health England SSI surveillance questionnaire was used to measure patient-reported SSI at 30 days post-op. An evidence based bundle of care was introduced including: 2% chlorhexidine skin preparation; dual ring wound protectors; triclosan-coated sutures for wound closure; and a second dose of antibiotics after 4 hours.

Results

All hospitals had implemented the care bundle by February 2020.  By December 2020 6/7 hospitals had reduced SSI. Mean patient questionnaire response rate = 84.8%. Mean compliance with each of the above bundle components are as follows: 91%; 72%; 85%; and 92% respectively.

Conclusions

Implementing an evidence based care bundle, using a collaborative approach to QIP, was effective in reducing the rates of patient-reported SSI following colorectal surgery. The success of this project in the West of England suggests that similar methodology could be used to improve patient outcomes in other regions.
EP.TU.2Standards in Operation notes
Authors: Alfred Joshua , McClean Simon , Nita George , McNicol Frances , Ugur Suha
Published: October 2021

Guidelines exist for operation notes from the Royal College of Surgeons of England but compliance has been shown to be variable.

Aim

The authors performed an audit of compliance with RCS standards in a colorectal department.

Methods

Thirty random operation notes were selected from a conserved pool. Their compliance was recorded against RCS good surgical practise record keeping and also looked particularly at fistula surgery and there documentation.

Result

Compliance was found to be poor and recommendations were put in place and the following was re audited.

Conclusion

As some specialities are developing operation note standards specific to individual procedures, the findings are compared with previous similar published work.
EP.TU.4Performance at Medical School predicts success in the Intercollegiate Membership of the Royal College of Surgery (MRCS) examination
Authors: Ellis Ricky , Scrimgeour Duncan , Cleland Jennifer , Lee Amanda , Brennan Peter
Published: October 2021

Aims

Identifying predictors of success in post-graduate examinations can help guide the career choices of medical students and may aid early identification of trainees requiring extra support to progress in specialty training. We assessed whether performance at medical school as quantified by the Educational Performance Measurement (EPM) and scores from the Situational Judgement Test (SJT) used for selection into Foundation Training predicted success at the Membership of the Royal College of Surgeons (MRCS) examination.

Methods

We analysed data from the UKMED Database for UK graduates who had attempted MRCS Part A (n = 1,975) and Part B n = 630) between 2013-2017. Univariate analysis examined the relationship between performance and the likelihood of passing MRCS at first-attempt. Logistic regression identified independent predictors of MRCS success.

Results

For every additional EPM decile point gained the chances of passing MRCS at first attempt increased by 52% for Part A (odds ratio 1.52 [95% confidence interval (CI) 1.46-1.60]) and 27% for Part B (1.27 [1.18-1.38]). For every point awarded for additional degrees in the EPM, candidates were 29% more likely to pass MRCS Part A first time (1.29 [1.12-1.48]). SJT score was not a statistically significant independent predictor of MRCS Part A or Part B success after adjusting for sociodemographic factors (P = 0.182 and P = 0.125 respectively).

Conclusions

This, the first study to investigate the relationship between medical school and success at a high stakes UK postgraduate surgical examination found that medical school performance deciles are the most significant measure of predicting later success in the MRCS.
EP.TU.7A cross-sectional study examining the association between MRCS performance and surgeons receiving Fitness to Practice sanctions
Authors: Ellis Ricky , Scrimgeour Duncan , Cleland Jennifer , Lee Amanda , Brennan Peter
Published: October 2021

Aims

Fitness to practice (FtP) investigations by the General Medical Council (GMC) can be one of the most stressful experiences in a surgeon’s career. Demographic factors are known to alter the likelihood of GMC investigation. Despite this there are no studies assessing risk factors in surgeons for FtP sanctions. Thus, we used the newly created Intercollegiate Membership of Royal College of Surgeons (MRCS) examination database to identify risk factors for and the prevalence of GMC sanctions in early-career surgeons.

Methods

FtP sanction data contained in the GMC list of registered medical practitioners (LRMP) was linked at person-level to all UK graduates who had attempted MRCS Part A or Part B between September 2007 and January 2020. Data were anonymised by the Royal College of Surgeons of England prior to analysis.

Results

Of 11,660 candidates who had attempted the MRCS within the study period only 31 (0.3%) candidates had GMC FtP sanctions within the last two years. Of these, 12 had active conditions on their registration, 7 had active undertakings and 14 had warnings. Candidate demographics were similar between cohorts and there were no considerable differences between MRCS performance identified.

Conclusion

In this, the largest study of MRCS candidates to date, the prevalence of active FtP sanctions in early-career surgeons was 0.3%, significantly lower than the prevalence of sanctions across more experienced UK surgeons (0.9%). These data highlight early-career surgeons as a low-risk group for disciplinary action and should reassure patients and medical professionals of the rarity of FtP sanctions.
EP.TU.40Tendon Repair Training: An Alternative Approach
Authors: Moori Parisa , Rahman Shafiq
Published: October 2021

Aims

The COVID-19 pandemic has seen reduced training opportunities for surgical trainees. Tendon repair is an important surgical skill for all core surgical trainees. It is particularly essential for those training within Plastic and Orthopaedic surgery. Tendon repair simulation often involves the use of expensive materials or animal tissues, posing ethical predicament. Here we aimed to devise a simple and reproducible method for tendon repair simulation.

Methods

Our tendon simulation model is an inexpensive and easily set up arrangement consisting of edible strawberry laces.

Results

The tendon simulator gives reasonable replication of a tendon, with the laces depicting an inner and outer core of a severed tendon. In addition the materials are easy to acquire, handle, dispose of and are free from ethical limitations.

Conclusions

Surgical trainees will be able to practice varying tendon repair techniques on this model, applying basic surgical principles such as instrument and tissue handling and develop their expertise.
EP.TU.44Improving Access to Surgery: The F1 ‘Theatre Day’ Programme
Authors: Nunn Rebecca , Jeyarajah Santhini
Published: October 2021

Aims

To identify barriers in theatre attendance, facilitate access and maximise learning opportunities for surgical F1s (Foundation Year 1 Doctors) at a DGH (District General Hospital).

Methods

Between December 2019- December 2020, each F1 doctor was offered a day to spend in elective theatre during their General Surgery rotation (excluding emergency COVID rota periods). This was following feedback from the August- December 2019 cohort. Each ‘Theatre Day’ was scheduled during normal working hours when there was sufficient staff. Post-participation questionnaires were completed.

Results

Prior to implementation of the Programme, 3/8 F1s surveyed had not attended any elective surgery lists (1 had not attended theatre at all). All indicated that they would have been interested in attending a timetabled elective theatre day; 88% highlighted a ‘lack of staff’ and 63% indicated that ‘feeling guilty’ were barriers in attending theatre.

21 F1s were offered a ‘Theatre Day’: 17 agreed to participate and 16 completed post-participation questionnaires. Only 47% confirmed that they were considering a career in surgery prior to participation: all agreed that spending time in theatre was a useful learning opportunity and 94% agreed that the Programme should be continued.

Conclusions

Spending time in theatre appears to be valued as a useful learning opportunity for F1s, whether or not they are aspiring surgeons. Common barriers to self-organised theatre attendance appear to be an anticipated ‘lack of staff’ or feelings of ‘guilt’. A senior-led scheduling of one day in theatre should circumnavigate these barriers and ensure that access is available to all.
EP.TU.70The Conservative Management of Perforated Diverticulitis Based on Abscess Size and Presence of Distant Air
Authors: Isswiasi Sanad , El-Zahab Sarah , Drye Elisabeth
Published: October 2021

Aims

To determine the effectiveness of conservative management in perforated diverticulitis (PD) in a single District Hospital based on the size of the abscess and the presence of distant air (DA).

Methods

Data on 112 Patients who were admitted between 2013-2018 with PD was collected retrospectively. CT scan reports were used to document the size of abscess and presence of DA. Failed conservative management with antibiotics (ABx) was defined as the need for another therapeutic option after 48 hours of admission or readmission within 90 days.

Results

Overall, 40 patients (36%) needed operative management, 12 patients (11%) required washout, 6 patients (5%) underwent radiological drainage and 8 patients (7%) were offered best supportive care. In total, 46 patients (41%) were successfully managed with ABx only. ABx were tried on 45 patients who had <4cm abscess and no DA. This was successful in 30 of them (66%). However, 6 out of 17 patients (35%) with >4cm abscess and no DA were treated with ABx only. Despite presence of DA, 8 out of 17 (47%) cases with <4cm abscess were successfully treated with Abx only. Only 2 patients out of 19 (10%) with >4cm and DA were successfully treated with ABx only.

Conclusion

Abscess size and presence of DA in PD should be considered in predicting the outcome of the management. Even in presence of DA, nearly half of patients with small abscesses (<4cm) diverticular abscesses were successfully managed conservatively. The majority of patients with larger abscesses with DA failed ABx treatment.