bluuebunny/crossref_metadata_2025 huggingface dataset:
EP.TH.652Use of the Proceed Ventral Patch (PVP) Mesh for Small to Medium sized defects in Ventral Hernia Repair over 10 years – Simple, Safe and Secure
Authors: Krishnamoorthy Ashwin , Tan LamChin
Published: October 2021

Aims

The Proceed Ventral Patch (PVP) has been in use since the late 2000s and is a self-expanding lightweight mesh patch comprised of multiple layers of absorbable and non-absorbable materials including polypropylene and polydioxanone. It is intended for use in all ventral hernias. We report our single-centre experience of using the mesh with primary outcomes being recurrence and reoperation for recurrence, readmission within 21 days for post-operative complications and discharge as day-case.

Methods

Retrospective review of case notes from 54 patients who were operated between October 2010 and November 2020 was undertaken. Patient characteristics were of a 2.1: 1 Male:Female ratio with a median age of 56 years old. 3 epigastric hernias and 51 paraumbilical hernias were repaired using either a 4.3cm or 6.4cm Proceed Ventral Patch. The size of the hernia defect ranged from 0.5cm to 4cm with a median defect size of 2cm for the 54 patients.

Results

There were no intraoperative complications. Two patients (0.04%) underwent laparoscopic reoperation for recurrence. Only one (0.02%) patient was readmitted within 21 days for a wound abscess which was drained and treated with a VAC dressing with satisfactory healing. The operations were split between nine different surgeons of varying expertise from ST5 level to Consultant level.

Conclusions

Ventral hernia repair with PVP is intuitive to learn and has low recurrence/complication rates.
EP.TH.717Triple tumour: A myriad of serial incidental findings in a patient presenting with Gallstone pancreatitis
Authors: Boyle Cameron , Lowe Katherine , Dhaif Ahmed , Hassan Adeeb , Shalli Kawan , Gumber Ashutosh
Published: October 2021

Aim

To present a rare incidental synchronous triple tumours - colonic adenocarcinoma, endometroid ovarian adenocarcinoma and benign Brenner tumour in a patient admitted with acute gallstone pancreatitis.

Methods

A 75-year-old female presented with epigastric pain. Blood-tests and USS abdomen confirmed gallstones and pancreatitis. She was treated conservatively. USS also showed incidental pelvic mass which was further characterised by CT and MR scans. These scans confirmed heterogeneous lobulated mass in the left adnexa. CT scan also picked-up incidental mass in transverse colon, which was confirmed as cancer by colonoscopy. She was offered therapeutic resection after discussion in Colorectal and Gynaecology MDT. Intra-operatively, transverse colonic tumour was invading into the proximal ileum. Laprascopic surgery concluded with extended right hemicolectomy, small bowel resection-anastomosis, omentectomy, total abdominal hysterectomy and bilateral salpingo-oophorectomy.

Results

The patient had gradual recovery without any complications. Histopathology showed T4N2 poorly differentiated adenocarcinoma of colonic mass, FIGO grade 1 stage 1c endometrioid adenocarcinoma of left ovary and benign brenner tumour of right ovary. Post-operative MDT did not offer adjuvant-therapy due to slow recovery and fraility. So far, two-years of follow-up did not show any recurrence.

Conclusion

This report adds to the limited literature of triple synchronous tumours, including rare Brenner accounting for 5% of benign ovarian tumours and endometrioid ovarian tumour with an incidence of 4 -7%. Multi-disciplinary approach and combined surgery can achieve a desirable outcome in such complex cases. It is crucial to identify the primary status of the tumours as it will guide the adjuvant treatment.
EP.TH.772Meta-analysis of laparoscopic mesh rectopexy versus posterior sutured rectopexy for management of complete rectal prolapse
Authors: Hajibandeh Shahin , Hajibandeh Shahab
Published: October 2021

Objectives

To evaluate comparative outcomes of laparoscopic mesh rectopexy (LMR) and laparoscopic posterior sutured rectopexy (LPSR) in patients with rectal prolapse

Methods

We conducted a systematic search of electronic databases and bibliographic reference lists with application of a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits. Recurrence, Cleveland Clinic Incontinence Score (CCIS), Cleveland Clinic Constipation Score (CCCS), surgical site infections, procedure time, and length of hospital stay were the evaluated outcome measures.

Results

We identified 5 comparative studies reporting a total of 307 patients evaluating outcomes of LMR (n = 160) or LPSR (n = 147) in patients with rectal prolapse. LMR was associated with significantly lower recurrence rate (OR:0.28, P = 0.009) but longer procedure time (MD:23.93, P < 0.0001) compared to LPSR. However, there was no significant difference in CCIS (MD:-1.02, P = 0.50), CCCS (MD:-1.54, P = 0.47), surgical site infection (OR:1.48, P = 0.71), and length of hospital stay (MD:-1.54, P = 0.47) between two groups. No mesh erosion was reported in any of the included studies at maximum follow-up point. Sub-group analyses with respect to ventral mesh rectopexy, posterior mesh rectopexy, randomised studies and adult patients were consistent with the main analysis.

Conclusions

LMR seems to be associated with lower recurrence but longer procedure time compared to LPSR. Although no mesh related complications have been reported by the included studies, no definitive conclusions can be made considering that the included studies were inadequately powered for such outcome. Future high quality randomised studies with adequate sample size are required.
EP.TH.803VAE for Breast Lesions of Uncertain Potential (B3) -A Quality Improvement Project
Authors: Sandhya Anu , Dent Helen , Oyewole Bankole , Pogson Caroline , Silva Tania De , Waheed Shamaela , Perera Iroshini
Published: October 2021

Aims

Breast lesions of uncertain malignant potential (B3) account for 7% breast lesions biopsied. Management has been controversial and challenging for the MDT. Aim of the study was to compare current NHS BSP guidelines with our trust’s practice and the secondary outcome was a shorter patient pathway and cost effectiveness.

Methods

As per NHS BSP guidelines VAE should be performed for all B3 lesions diagnosed on 14g or vacuum assisted biopsy. We were referring them to other NHS trusts as there were no in-house facilities or doing an excisional biopsy if no resources for VAE available.

From September 2019 VAEs started to be done by in-house consultant breast radiologist after getting the appropriate training and instruments. Data was collected from September 2019 to August 2020 for all patients.

Results

22 VAEs were performed in one year. Out of those 6 (27.2%) were upgraded to malignancy and needed further surgery, 2 (9%) with atypia had 5 years mammographic surveillance and 14 (63%) were discharged including sclerosing lesions, radial scars, fibrosis and chronic inflammation.

The cost of VAE in our hospital is £1330 vs. £2439 for Wire Guided wide local excision. This makes it cost effective.

Conclusion

We were following the VAE protocol as per NHS BSP guidelines. Despite added workload to radiology VAE is minimally invasive, safe and cost effective alternative to surgery providing thorough MDT discussion has taken place.

Greater benefit was provided to patient as all VAEs were performed in radiology department avoiding general Anaesthesia and surgical trauma.
EP.TH.861Compliance with guidelines for inguinal hernia repair in a large teaching hospital
Authors: Nassar Ahmed , Ward Stephen
Published: October 2021

Background

The Royal College of Surgeons of England guidelines recommends laparoscopic repair for bilateral inguinal hernias, recurrent hernia after an initial open approach and Groin hernias in women.

Aim

This study assessed the surgical management of inguinal hernia over 6 years to see how well we adhered to national guidelines and investigated reasons for non-adherence.

Methods

A retrospective study from January 2013 to December 2018 of all patients undergoing inguinal hernia repair. Data collected were patient identifiers, gender, date of birth, date of admission and discharge, type of inguinal hernia, type of repair and the operating consultant. If the type of repair performed was outside of national guidance, patients’ case-notes were reviewed.

Results

2593 patients were included, 93.4% male and median age of 63 (interquartile range 49-74 years). 403 patients underwent laparoscopic repair (15.5%). For unilateral primary inguinal herniae, 221 out of 2222 patients underwent laparoscopic repair (9.9%). 29 of 170 (17%) of female patients underwent laparoscopic repair. 118 out of 160 patients with bilateral hernia underwent laparoscopic repair (73.8%) - no explanation was identified for selecting open repair in 25 out of 42. Regarding recurrent hernia, 64 out of 211 patients underwent laparoscopic repair (30.3%). No explanation for selection of open approach was identified for 61 of the 147.

Conclusion

National guidelines recommending laparoscopic inguinal hernia repair for females, bilateral and recurrent herniae are not well followed. A likely contributing factor is the overall low rate of laparoscopic repair. Changes to practice are underway and repeat audit is planned.
EP.TH.879Does ‘fast -track’ axillary node clearance following positive core biopsy lead to overtreatment of axilla?
Authors: Abdullah Muhammad , Voynov Velin , Stonelake Paul
Published: October 2021

Aims

Axillary node clearance (ANC) can cause lifelong disability and conservative axillary dissection is increasingly preferred. However, direct (fast-track) ANC after preoperative axillary biopsy is still performed, which may be overtreating the patients with low axillary burden. This study aims to identify if direct (fast- track) ANC leads to overtreatment of axilla.

Methods

Retrospective data for all breast cancer patients who underwent surgery between 1 January 2017 and 31 December 2018 were included in this study. The histopathology results of ANC were correlated with axillary ultrasound findings, axillary biopsy or SLNB results and effect of neoadjuvant treatment. These were analysed against the available guidelines to evaluate the current practice.

Results

82 patients out of 520 had ANC (15.7%). Four groups were identified. 35.5% of patients diagnosed with nodal infiltration on preoperative biopsy (Group A) had only 1- 2 positive nodes following ANC. Complete pathological response was observed in 37.5% patients with nodal infiltration who had ANC following neoadjuvant chemotherapy (NACT) (Group B). No further nodes were subsequently found in 63.6% of patients who underwent ANC following positive SLNB (Group C). Group D included 2 patients with axillary recurrence.

Conclusions

15.7% of breast cancer patients required ANC. The practice of direct (fast-track) ANC after axillary biopsy leads to overtreatment of the axilla, which needs re-evaluation. Targeted axillary dissection could avoid unnecessary axillary dissection in patients with abnormal nodes. This is now recommended in patients who have received NACT but has not been evaluated yet in patients with up front surgery.
EP.TH.916Managing Gallstone Pancreatitis: Are We Doing Enough?
Authors: Malik Salim , Evans Thomas , Zaman Shafquat , Budhoo Misra
Published: October 2021

Background

Acute pancreatitis carries significant morbidity and has an estimated annual incidence of 30-50/100,000 in the U.K. 50% of these cases are related to gallstone disease. NICE/BSG guidelines recommend definitive management of gallstone pancreatitis during the index admission or within 14 days of hospital discharge. We audited our compliance against these national guidelines.

Methods

Retrospective data was collected for patients admitted with acute gallstone pancreatitis over a 12-month period. Patient demographics, admission details, length of stay, previous/future admissions, timing of cholecystectomy and ERCP were recorded.

Results

47 patients were included (mean age: 50.7 years) with a mean length of stay of 6.2 days. Only 6% had a cholecystectomy during the index admission or within 14 days of hospital discharge. 12 (26%) patients had an ERCP performed with a mean time of 45 days. The mean time to surgery after initial discharge was 97 days.

Conclusion

There is poor compliance with national guidelines in the management of gallstone related pancreatitis in our cohort of patients. Definitive management reduces readmissions, resulting in financial savings and improved patient care. This audit demonstrates the need to develop a robust ‘hot gallbladder’ pathway to improve the management of patients with acute pancreatitis secondary to gallstones.
EP.TH.917An Audit of Compliance with NICE guidelines for Acute Cholecystitis
Authors: Malik Salim , Evans Thomas , Zaman Shafquat , Budhoo Misra
Published: October 2021

Background

Gallstone disease is common and affects approximately 10-15% of adults. Laparoscopic Cholecystectomy (LC) is the definitive management of cholecystitis. NICE and RCS guidance recommend that in patients diagnosed with acute cholecystitis a LC should be performed during the same admission or within 7 days. We audited our compliance against these national guidelines.

Methods

Retrospective audit of all patients admitted with uncomplicated acute cholecystitis over a 4 month period. Patient demographics, admission details, timing of cholecystectomy, complications, follow-up, and re-admission data were collected.

Results

50 patients (60% female, 40% male; mean age: 60.7 years) with acute cholecystitis were included. Mean length of stay was 4.8 days. Only 10% had a cholecystectomy within 1 week of diagnosis. Of those discharged without a LC on the index admission, 14% were readmitted with further gallstone related complications (cholangitis, pancreatitis) within 48.6 days from initial discharge. The mean time to surgery after initial discharge was 125.8 days.

Conclusion

There is poor compliance with NICE guidelines to perform an early LC in our cohort of patients, primarily because of the lack of Trust based guidelines. This audit demonstrates the need to develop a robust ‘hot gallbladder’ pathway within our hospital to improve current practice.
EP.TH.930Contemporary trends in the management of micrometastatic axillary disease in the setting of mastectomy – a 5 year single institution experience
Authors: Earley Helen , Denis Evoy , Geraghty James , McDermott Enda , Prichard Ruth , McCartan Damian
Published: October 2021

Background

Since the ACOSOG Z0011 trial, rates of axillary node clearance (ANC) for micrometastatic axillary disease have declined among women undergoing breast conservation surgery (BCS). However, for women undergoing mastectomy, it remains unclear whether omission of ANC is a safe and feasible option.

Aims

Identify current practice relating to management of the axilla in women with early stage, clinically node negative breast cancer, found to have micrometastatic disease on SNB, who undergo mastectomy

Methods

From 2013 to 2017 patients with clinical T1-T2Nmi breast cancer undergoing upfront surgery were identified from a prospective institutional database. Receipt of adjuvant radiotherapy or subsequent ANC were assessed. Patients who received neoadjuvant chemotherapy or BCS were excluded.

Results

47 patients undergoing mastectomy for ESBC had micrometastasis identified on SNB. The majority of tumours had invasive ductal histology. 16/27 women underwent completion ANC (34%). Six patients had further nodal disease identified in the ANC specimen. 2 had >5 nodes positive. During the study period 31 patients (65%) received adjuvant radiotherapy. Of the patients who did not undergo ANC, 21 (67.7%) received adjuvant radiotherapy.

Conclusion

At this institution the majority of patients requiring mastectomy with micrometastatic disease on SNB do not undergo subsequent ANC (>60%). Although this is a small patient cohort, these data indicate the rate of residual axillary disease is low, and are in keeping with trends in the literature, and may help inform management decisions in this patient group.
EP.TH.939Is routine CTU necessary in the investigation of haematuria?
Authors: Miller Alexandra , Rake Grace , Bright Elizabeth
Published: October 2021

Aims

Upper tract urothelial cancer’s (UTUC) are rare of which 17% have concurrent BT’s. Whilst CTU is the gold standard imaging for UTUC, its routine use is questionable due to low diagnostic yield.1

There is no consensus in our department regarding the use of CTU in screening haematuria patients, regardless of whether a BT is identified. We therefore sought to investigate the diagnostic yield of CTU.

Method

Retrospective case-note review of haematuria patients (May-October 2018), screening tests utilised and their diagnostic yield.

Results

764 patients (mean age=68) presented with VH (n = 448) or NVH (n = 316). All underwent flexible cystoscopy (FC) and upper tract imaging, (346 = USS; 126=CTU; 257= USS and CTU).

BT and UTUC were diagnosed in 69 (9%) and 5 patients (0.7%), respectively. Of the 5 patients with UTUC (VH = 4, NVH=1) 2 had synchronous bladder tumours, both were low grade. All 5 underwent CTU but only 3 had a prior USS, of which USS detected UTUC in 2 of these 3.

CTU was performed in 384 patients (VH n = 323, NVH n = 61) yielding only one UTUC diagnosis when other investigations were negative. This patient presented with VH. CTU provided no additional cancer detection in all patients with BT.

Conclusions

Due to the small sample of synchronous tumours, location or grade of BT is not a predictor of UTUC2. In all patients screened with FC and USS, CTU only detected one additional UTUC. On the basis of these results, CTU screening is not indicated for patients presenting with NVH.
EP.TH.959Meta-analysis of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer surgery: An ongoing dilemma
Authors: Hajibandeh Shahin , Hajibandeh Shahab , Bhattacharya Pratik , Zakaria Reza , Thompson Christopher , Peravali Rajeev
Published: October 2021

Aims

To evaluate comparative outcomes of temporary loop ileostomy closure during or after adjuvant chemotherapy following rectal cancer resection.

Methods

We systematic searched MEDLINE; EMBASE; CINAHL; CENTRAL; the World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; ISRCTN Register, and bibliographic reference lists. Overall perioperative complications, anastomotic leak, surgical site infection, ileus and length of hospital stay were the evaluated outcome parameters. Combined overall effect sizes were calculated using fixed-effect or random-effects models.

Results

We identified 4 studies reporting a total of 436 patients comparing outcomes of temporary loop ileostomy closure during (n = 185) or after (n = 251) adjuvant chemotherapy following colorectal cancer resection. There was no significant difference in overall perioperative complications (OR 1.39; 95% CI 0.82-2.36, p = 0.22), anastomotic leak (OR 2.80; 95% CI 0.47-16.56, p = 0.26), surgical site infection (OR 1.97; 95% CI 0.80-4.90, p = 0.14), ileus (OR 1.22; 95% CI 0.50-2.96, p = 0.66) or length of hospital stay (MD 0.02; 95% CI -0.85-0.89, p = 0.97) between two groups. Between-study heterogeneity was low in all analyses.

Conclusions

The meta-analysis of best, albeit limited, available evidence suggests that temporary loop ileostomy closure during adjuvant chemotherapy following rectal cancer resection may be associated with comparable outcomes to closure of ileostomy after adjuvant chemotherapy. We encourage future research to concentrate on completeness of chemotherapy and quality of life which can determine appropriateness of either approach.
EP.TH.965Use of Oral Antibiotics as Adjunct to Systemic Antibiotics and Mechanical Bowel Preparation for Left Sided Colorectal Surgery. It is the time to trust the best available evidence and change the practice
Authors: Hajibandeh Shahin , Hajibandeh Shahab , Thompson Christopher , Thumbe Vijay , Torrance Andrew , Peravali Rajeev
Published: October 2021

Aims

To prospectively evaluate the clinical efficacy of oral antibiotics as an adjunct to intravenous antibiotics and mechanical bowel preparation (MBP) in patients undergoing left sided colorectal surgery.

Methods

All participants aged 18 years or older and of any gender undergoing an elective open or laparoscopic left sided colorectal resection for benign or malignant colorectal pathologies were considered. The intervention of interest was oral neomycin 1g every 4 hours combined with oral metronidazole 400mg every 8 hours from 24 hours before the proposed surgery. Surgical site infections (SSIs), anastomotic leak, paralytic ileus, need for intervention, and mortality were the evaluated outcome parameters.

Results

Forty-two consecutive patients received oral antibiotics as an adjunct to intravenous antibiotics and MBP before left sided colorectal surgery. The mean age was 58.8 ± 11.5. There were 23 males (54.8%) and 19 females (45.2%). Use of oral antibiotics was associated with SSI infection rate of 2.4% (1 patient). The rates of clinically significant and non-significant anastomotic leak were 0% and 2.9%, respectively. Moreover, postoperative ileus happened in 11.9% of patients. Furthermore, there was no mortality or need for re-intervention.

Conclusions

Use of oral antibiotics as an adjunct to intravenous antibiotics and MBP in patients undergoing left-sided colorectal surgery was associated with a surprisingly low rate of SSIs and no significant anastomotic leak. It is time to trust the best available evidence and incorporate the use of oral antibiotics as an adjunct to intravenous antibiotics and MBP in colorectal surgery protocols in the UK hospitals.
EP.TH.1025The necessity of pre-operative investigations for elective surgical patients
Authors: Barman S , McGeehan M , Joseph E , Perakath B
Published: October 2021

Introduction

Patients admitted for elective surgeries tend to get quite a few investigations at pre assessment. Are these strictly necessary? Are there significant cost implications? National Institute for health and Care Excellence first issued guidance on routine preoperative tests for elective surgery in 2003.

Aims

To carry out an audit of pre-operative investigations of elective surgical patients at pre-admission. To determine level of unnecessary tests.

Results

Regarding correlation between ASA grades and over testing, grade 4 is the highest and grade 2 is the lowest in meeting standard guideline per ASA grade. Only 20% intermediate surgical cases meet the guideline whereas 30% of minor and 85% of major cases meet guideline per surgery grade respectively. Majority of unnecessary tests are carried out in minor and intermediate cases. Very few cases of missing tests. Only four tests that should have been taken as per the guideline weren’t done in the whole cohort. For all cases,57.4% of FBC,38.2% of U&Es, 48.5% ECG and 5.9% lung function tests carried out unnecessarily.

Conclusion

Generally we are over-testing patients at pre-assessment. This seems to be an issue with minor and intermediate cases, with majors generally doing better in fulfilling the guidelines. This may not be deliberate but coincidence as major surgeries call for more tests. Over-testing is more of an issue in lower (1-2) ASA grades in minor and intermediate surgeries. Under-testing is very rare. Using NICE’s estimated costs for each test, approximately £965.78 was spent in 1.5 months for tests which were not needed.
NELA.03Laparoscopy in Emergency Surgery is Associated with Lower Risk-Adjusted Mortality
Authors: Darbyshire Alexander , Kostakis Ina , Pucher Phil , Prytherch David , Toh Simon , Mercer Stuart
Published: October 2021

Aims

To compare risk-adjusted outcomes after emergency intestinal surgery by operative approach.

Methods

Data from December 2013-November 2018 was retrieved from the NELA national database. Complete data on 102,154 patients with P-POSSUM was available, and 47,667 had NELA score. AUROC curves were calculated to assess model discrimination (c-statistic), and calibration plots to visualise agreement between predicted and observed mortality.  Standardised Mortality Ratio's (SMR) were calculated for the total cohort and by operative approach. Operative approach was divided into: laparotomy, completed laparoscopically, converted to open and lap assisted.

Results

Both P-POSSUM and NELA score displayed good discrimination for total cohort and by operative approach (P-POSSUM c-statistic=0.801-0.815; NELA score c-statistic=0.851-0.880).  Calibration plots demonstrated that P-POSSUM was highly accurate up to 20% mortality, after which it substantially over-predicted mortality.  NELA score was highly accurate up to 25% mortality after which it slightly under-predicted.

Overall SMR of observed vs expected deaths was 0.77 using P-POSSUM, 0.8 for laparotomy and 0.46 for laparoscopy.  Restricting cases to < 10% predicted mortality (n = 65,000), overall SMR improved (0.9) and was considerably lower for cases completed laparoscopically (0.41) compared to open (0.97).  Using NELA scores of < 10% predicted mortality (n = 27,000) had similar overall SMR (0.96), with cases completed laparoscopically displaying much lower SMR (0.61) compared to laparotomy (1.0).

Conclusions

SMR's calculated using P-POSSUM and NELA score have demonstrated that laparoscopy has significantly lower observed vs expected mortality rate compared to laparotomy. This raises the question of why laparoscopy is associated with reduced mortality and should operative approach be included in risk models?
SPOD.01A double-blind, placebo-controlled, randomised trial of extracorporeal shockwave therapy as a novel treatment for intermittent claudication
Authors: Cai Paris , Pymer Sean , Raza Ali , Ibeggazene Said , Chetter Ian , Smith George
Published: October 2021

Aims

Intermittent claudication (IC) is a prevalent manifestation of peripheral arterial disease. Pilot data has shown Extracorporeal ShockWave Therapy (ESWT) as a novel, non-invasive treatment for IC. We aim to compare the effects of ESWT on quality of life (QoL) and walking distances of patients with lower limb IC through a randomised trial.

Methods

A double-blind, placebo-controlled, randomised trial, where patients with lower limb IC were randomised at a 1:1 ratio to ESWT or placebo. Primary outcome was the physical functioning domain of the SF-36 QoL questionnaire at 12-week follow up. Secondary outcomes included claudication and maximum walking distances, and Ankle Brachial Pressure Index (ABPI).

Results

Full study power achieved with 138 patients randomised. The ESWT group had a significantly higher physical function score at 12 weeks (Mdn 41 vs 34, z=-2.1, p = 0.033). At 12 weeks the ESWT group had significantly longer claudication and maximum walking distances (Claudication Mdn 125 vs 88, z=-2.9, p = 0.004) (Maximum Mdn 179 vs 129, z=-2.4, p = 0.013). The increase in claudication and maximum walking distance at 12 weeks from baseline was also significantly higher in the ESWT group (Mdn 51 vs 24, z=-2.8, p < 0.01) (Mdn 63 vs 17, z=-4 p < 0.01).

Conclusion

This study demonstrates ESWT is clinically effective in improving QoL and walking distances in patients with lower limb IC.
EP.TU.142Impact of PC-CRC on curative intent and survival of patients
Authors: Elsayeh Karim , Brown Alexander , Chintapatla Srinivas , Lim Michael
Published: October 2021

Introduction

PC-CRC is an important benchmark of endoscopy performance and results in a delayed diagnosis of cancer for patients. Little is known of the impact of PC-CRC on survival; we chose to study this in a cohort of patient at our institution.

Methods

A retrospective analysis was performed on all PC-CRC from 2015 to 2020. Electronic endoscopic records and case-note review were performed to identify cases. Suitable patients underwent surgery in the absence of widespread metastatic disease after MDT discussion. Survival data were recorded, Kaplan-Meier curves were constructed; the log rank test was used to compare groups, a p-value of < 0.05 was deemed significant.

Results

There were 32 (24 male) patients with a PC-CRC out of 1207 patients during this interval. The 5-year PC-CRC rate was 2.6%. Median age was 72 (IQR 63-79) years. 10 patients had metastatic disease, 9 with large volume disease that was not resectable. All 9 were palliated with a median survival of 3 (IQR 2-23) months. Twenty-three had potentially curative disease and all underwent surgery. On follow-up a further seven patients died with recurrent disease at a median of 19 (IQR 13-35) months. Sixteen are alive with a median survival of 38 (IQR 27-52) months. The survival curves for the 3 groups are significantly divergent, p-value <0.001.

Conclusion

The impact of PC-CRC on individual patients is significant as a quarter die within 3 months of diagnosis. A further quarter die within 24 months despite a potentially curative operation due to metastatic disease.
EP.TU.157Can Twitter Attention Predict Citation Metrics? A Machine Learning Aided Analysis
Authors: Lumley Emma , Perin Giordano , Baker Megan , Hanton Alice , Mahendran Ashuvini , Saha Arin
Published: October 2021

Aims

Surgical journals have developed social media profiles to increase engagement though it remains unclear as to whether social media attention indices for publications act as a surrogate or predictor of traditional citation metrics. This study used machine learning to determine if there is a relationship between Twitter mentions and number of citations for surgical publications.

Methods

We identified all original research and review papers published in Annals of Surgery, BJS and JAMA Surgery in 2019. Citations data and Twitter mentions were retrieved and the Spearman rank coefficient was used to determine degree of correlation between the two variables. An unsupervised machine-learning hierarchical clustering algorithm was used to define clusters of outlying papers. Quantitative and qualitative analysis of the clusters was completed.

Results

413 papers were selected. Median number of citations was 7 (IQR 3-14), median number of Twitter mentions was 40 (IQR 15-79). No correlation between Twitter mentions and number of citations was observed (Spearman’s rho 0.076 p-value 0.124). Cluster analysis identified one large (cluster 2, 367/413 papers) and six small clusters. Analysis of cluster 2 revealed a weak but significant correlation between citations and Twitter mentions (Spearman’s rho 0.107 p-value 0.041). The remaining six clusters were characterised by an out of proportion number of Twitter mentions compared to citations or vice versa.

Conclusions

Twitter mentions should not be used as a surrogate or predictor of traditional citation metrics. In our database the relationship between social media attention and citations was skewed by a small number of outlying papers.
EP.TU.192Phlegmasia cerulea dolens associated with lung abscess
Authors: Ibrahim Ban , Kattimani Raviprasad
Published: October 2021

Introduction

Phelgmasia cerulea dolens (PCD) is a rare limb and life-threatening condition caused by extensive of deep veins thrombosis of the extremities and it is classically associated with extensive oedema, severe pain and skin mottling which may lead to compartment syndrome, venous gangrene, and death.

Case presentation

We present a rare case of phlegmasia cerulea dolens associated with lung abscess. A 40-year-old male with background history of right femoral vein thrombosis, cardiomyopathy with ejection fraction of only 10% presented with three days history of progressive swelling, pain and purple discoloration of right leg to the accident and emergency department at a district general hospital. He was treated with therapeutic low molecular weight heparin. He was found to have lung abscess 2 weeks after admission for which he was treated with broad spectrum intra venous antibiotics. In view of his poor ejection fraction, he was treated without any surgical intervention for PCD.

Patient succumbed after 3 months of presentation. PCD is a rare vascular emergency condition if not recognized early and treated aggressively may lead to high morbidity and mortality.

Conclusion

Phlegmasia cerulea dolens is an acute limb and life-threatening condition. Early diagnosis and aggressive intervention with thrombolysis and thrombectomy is necessary to prevent morbidity and mortality.
EP.TU.207Maintaining High Quality Surgical Teaching during the COVID-19 Pandemic
Authors: Boardman Charlotte , Moschidis Thomas , Saunders Michael
Published: October 2021

Aims

The COVID-19 pandemic has resulted in many changes to the delivery of undergraduate surgical education. Formal teaching is now online and exposure to the many different aspects of General Surgery is greatly reduced.

We explored how the changes made to the 4-week General Surgery rotation at a district general hospital have impacted on students and their learning.

Methods

Online survey was used to collect feedback from the students and was compared to data collected prior to the pandemic.

Results

A total of 10 survey responses were received. Despite the timetable changes, 80% of students rated the placement as Good-Excellent. The students received more registrar/consultant level teaching than previously and rated the teaching to be of a good standard. They logged more clinical procedures and clerked more patients than previously, but clinic attendance remained poor and operating theatre sessions static.

Conclusion

Despite the added pressures of the pandemic, undergraduate surgical education has been maintained to a high standard. The struggles experienced with the decrease in elective operating lists and fewer surgical clinics does not appear to have impacted significantly when compared to pre-pandemic data. However, this is certainly an area that needs to be improved upon to ensure adequate exposure to surgery. The increase in procedural and clerking experience is perhaps a reflection of greater time spent on the wards. This is certainly of benefit in preparation for foundation training and any missed opportunities for exposure to surgical pathologies have been alleviated by the increase in formal senior-level teaching.
EP.TU.216Golden Patient Protocol: A Closed Loop Audit
Authors: Mactier Mhairi , Bramhall Russell
Published: October 2021

Introduction

Identifying a ‘Golden Patient’ the proceeding day improves emergency theatre efficiency and overall operating capacity.

Aim

Use this strategy to improve theatre efficiency in our Regional Plastic Surgery Department.

Methods

Cycle one:

Interventions:

Cycle two:

Cycle three:

Results

Cycle one:

Cycle two:

Cycle three:

Conclusions

Use of the ‘Golden Patient’ protocol improves emergency theatre efficiency with subsequent effect on overall operating capacity.
EP.TU.373What We Do In The Shadows: Night Surgical Registrars and Abdominal Pain
Authors: Quah Samantha , Cheah Hock Ping , Wong Kenneth
Published: October 2021

Aim

Surgical cover at night differ according to hospitals and are often performed by junior registrars. This can be challenging as a certain amount of independence is required in decision making. Abdominal pain remains one of the most common surgical presentations in the Emergency Department. This study analyses the type of abdominal pain presentations that were reviewed overnight in a regional Australian hospital.

Method

All patient presentations requiring surgical review from 9.00pm to 7.00am over a period of 4 months are prospectively collected and analysed. Patient details collected comprised of gender, date of review, blood tests, imaging results, histopathology, and intra-operative findings.

Results

Of the 114 patients who presented with abdominal pain, the majority of them were undifferentiated abdominal pain (n = 20, 17.1%). This is then followed by appendicitis (n = 17, 14.5%), diverticulitis (n = 13, 11.1%), pancreatitis (n = 8, 6.8%) and cholecystitis (n = 6, 5.1%). Among the others, a total of 8 presentations required urgent surgical review which resulted in three emergency surgeries being performed overnight, a laparotomy for closed loop small bowel obstruction, a Hartmann's procedure and a laparoscopic appendicectomy on a septic patient.

Conclusion

Common presentations for abdominal pain overnight include undifferentiated abdominal pain, appendicitis, diverticulitis, cholecystitis and pancreatitis. Hence education for night surgical registrars should be focused on management of these common conditions and also on surgical emergencies such as closed loop bowel obstructions, septic patients and perforated viscus to ensure optimal patient outcome without the need for close supervision.
EP.TU.425Visceroptosis - obsolete condition or missed opportunity to intervene early?
Authors: Matias Mariana , Kronberga Madara
Published: October 2021

Visceroptosis is defined as displacement or prolapse of abdominal organs below their natural position, most commonly stomach – gastroptosis – or bowel - enteroptosis. It is also known as Glénard’s disease, first described in 1885, when there is evidence of generalised visceroptosis. The aetiology of visceroptosis remains unknown, however some authors have suggested this condition to result from weakness of the ligaments that hold the abdominal organs in their anatomical place. Although patients with visceroptosis are often asymptomatic, this condition can also present with various gastrointestinal symptoms depending on its severity. The most common symptoms reported include anorexia, severe constipation or diarrhoea, abdominal distention, gastroparesia, nausea, intractable abdominal pain.

The aim of this study is to review the most updated literature reporting cases of visceroptosis, the diagnostic approach and its subsequent management, encouraging all surgeons to be more attentive towards and accurately identify visceroptotic habitus.

Method

Literature review using PubMed, Web of science and other reliable sources using the possible combinations of the following key words: visceroptosis, gastroptosis, enteroptosis, gastrointestinal complications, surgery.

Results

Current literature is scant regarding this unusual presentation and it is often referred as a rare complication of Ehlers-Danlos Syndrome. Due to its rarity, it often remains underdiagnosed potentially leading to sub-optimal treatment of patients, and ultimately significant morbidity and mortality.

Conclusion

We believe this condition should be repopularised as serious complications such as visceral torsion might arise from it which may require immediate surgical treatment, affecting quality of life and a high rate of relapses after surgical procedures.
EP.TU.439Falciform ligament torsion – a rare cause of the acute abdomen
Authors: Sabri Shariq , O'Connor Adam , Solkar Maseera , Ramzan Amalia , Solkar Mamoon
Published: October 2021

The falciform ligament attaches the liver to the anterior abdominal wall and diaphragm. Acute falciform ligament related pathology is rare. In this case report we present a case of acute fat necrosis related to the falciform ligament. A 53 year old women presented with acute upper abdominal pain localised to the right hypochondrium. He was tender to palpation in the same region with a positive Murphy’s sign. A provisional diagnosis of acute cholecystitis was made. Blood work revealed raised inflammatory markers but normal liver function tests. Abdominal ultrasound revealed no gallbladder pathology nor gallstones. Thus computed tomogram (CT) scan of the abdomen was performed, showing hyper-attenuation rim signal present within the inferior aspect of the falciform ligament consistent with local vascular occlusion. The patient was managed with intravenous antibiotics with liberal analgesia and went on to make a successful recovery. Only 10 cases have been reported in the literature related to falciform ligament necrosis. We present this unusual pathology encountered on our acute surgical take, to alert surgeons to this rare diagnosis and provide a review of the literature and provide detail of how such a pathology manifests on CT scan.
EP.TU.443Improving the Skills and Safety at Workplace: Training on the Use of the AirSeal Insufflation System in Laparoscopic Surgery
Authors: Win Myat , Ng Oliver , Bharathan Balamurali
Published: October 2021

Aims

According to Good Surgical Practice set by the RCS England, surgeons need to keep themselves up to date and maintain the competence in all areas of their practice. Literature and guidelines recommended the use of AirSeal insufflation in laparoscopic surgery for the safety during the first surge of Covid-19. Our objectives were to measure the level of knowledge and confidence of surgical trainees in using the AirSeal insufflation system in laparoscopic surgery at our institution and to help trainees achieve competence.

Method

Multiple small group training sessions were delivered to 14 surgical doctors adhering to safety protocols. The concept of the AirSeal insufflation system, its benefits, limitations, set up and troubleshooting were delivered using lectures, videos and hands-on training. The change in level of knowledge and confidence in practical skills were assessed by analyzing the responses to the questionnaire completed before and after the course.

Results

Conclusion

The dramatic improvement in self-perceived confidence of practical skills and knowledge of the AirSeal system was achieved among surgical doctors. Adaptation to the situation and introduction of this advanced technology to the trainees in elective and emergency settings helped promote the skills and safety at workplace during this pandemic especially with the support of flexible training sessions.
EP.TU.566Virtual Interactive surgical skills classroom – An Ongoing Randomized Controlled Trial
Authors: Nathan Arjun , Fricker Monty , Asif Aqua , Patel Sonam , Georgi Maria , Hang Kien , Monks Massimo
Published: October 2021

Introduction

High costs and inaccessibility are significant barriers to face-to-face basic surgical skills (BSS) training. Virtual classrooms enable the combination of computer-based learning with interactive expert instruction. They may optimise resources and increase accessibility, facilitating larger-scale training with a similar educational benefit. We aim to evaluate the efficacy of virtual BSS classroom training compared to both non-interactive video and face-to-face teaching.

Method

72 medical students will be randomly assigned to three equal intervention groups based on year group and surgical skill confidence. Interventions will be implemented following an instructional video. Group A will practice independently, Group B will receive face-to-face training, and Group C will attend a virtual classroom. Participants will be recorded placing three interrupted sutures with hand tied knots pre- and post-intervention, and Objective Structured Assessment of Technical Skills (OSATS) will be blind marked by two experts. Change in confidence, time to completion and a granular performance score will also be measured. Each intervention’s feasibility and accessibility will be assessed.

Results

Data collection will be completed in February 2021. Significant improvement in OSATS within groups will be indicative of intervention quality. Difference in improvement between groups will determine the relative performance of the interventions.

Conclusion

To our knowledge, this will be the largest randomised control trial investigating virtual BSS classroom training. It will serve as a comprehensive appraisal of the virtual classroom’s suitability as an alternative to face-to-face training. The findings will assist the development of further resource-efficient training programs during the COVID-19 pandemic and afterwards.
EP.TU.569Improving Confidence and Technique When Preparing Nipple Smears for Cytology
Authors: Gandhewar Rishikesh , Jiwa Natasha , Leff Daniel
Published: October 2021

Aims

To create a sustainable means of educating breast surgeons on how to prepare nipple smears for cytology when investigating nipple discharge.

Methods

A nation-wide questionnaire of 51 doctors conducted in 2020 identified low confidence and competency in preparing a nipple smear slide. A 3-minute training video was subsequently created and published to the Association of Breast Surgery (ABS) website for universal access. Doctors were prompted to complete a questionnaire after watching the video to assess understanding, confidence, and obtain video feedback. Results were collected and analysed using Qualtrics software.

Results

31 doctors completed the survey (10% foundation doctors, 77% specialist trainees, 13% consultants). The mean±StD nipple smears prepared per year was 1.74±0.95. The percentage of doctors who felt confident in their technique increased from 44% to 100%. Ninety-seven per cent correctly identified how to store and label the sample, previously 45%. The percentage of doctors aware of where to place the sample on the slide increased from 37% to 100%. Eighty-seven per cent were aware of the optimal fluid volume in comparison to 10% previously. All respondents felt the video was valuable and 71% of respondents indicated they would also benefit from a written list of instructions.

Conclusions

The preparation of nipple smear slides has historically been an area of clinical uncertainty. An educational video was successfully created to educate all grades of doctors and made universally accessible through the ABS website.
EP.TU.571Is the pen mightier than the scalpel? Improving the quality and efficiency of Major Trauma ward rounds
Authors: Patton Ethlinn , Olaleye Dapo , Smith Stella
Published: October 2021

Aims

Methods

Data was collected retrospectively between October to December 2020. Patient paper notes were reviewed on three dates before and after implementation of the ward round sticker, gathering data from 26 and 27 patients respectively. Data was collected across a series of weeks to ensure a variety of clinicians present on ward round, in order to accurately reflect current practice.

Results

An improvement in rate of documentation was seen in 10 out of 12 key clinical variables. Some of the largest increases were seen in consideration of VTE status; 96.3% (n = 26) from 7.69% (n = 2), and recording oral intake; 85.2% (n = 23) from 23.1% (n = 6.)

Conclusions

We know that poor quality documentation is associated with increased rates of adverse events for patients,[1] so it is imperative to address both what is being covered, and how it is being recorded. Staff reported that the use of ward round stickers improved legibility of documentation and made it easier to locate important information. This simple, cost effective intervention has improved the consistency of daily reviews, and streamlined communication within the multidisciplinary team.