bluuebunny/crossref_metadata_2025 huggingface dataset:
SP4.1.1 An Audit of Negative Appendicectomy Rates at the Borders General Hospital
Authors: Brown Jasmine , Lennon Kirsty , Rae Richenda , Young Jamie
Published: November 2022

Aims

Appendicitis is the most common abdominal surgery emergency globally with 50,000 acute appendicectomies in the UK annually. Despite improvements in diagnostic techniques, negative appendicectomies still occur.

We aimed to audit local results of negative appendicectomy rates (NAR) against the 2012 National Appendicectomy Audit which recommends an NAR <20%.

Methods

Retrospective data of patients who underwent appendicectomy from January 2016-October 2021 was collected using electronic records. Patients who underwent elective appendicectomies, were not suspected appendicitis or did not have pathology results were excluded. Data was collected on patient demographics, surgical approach, pathology and radiological investigations prior to surgery.

Results

A total of 518 patients were included. 54.1% (280) were male and 45.9% (238) were female. The age range was 5–87 years with an average of 36.4 years.

48.9% (253) had CTs with 98.4% reporting appendicitis, 16.2% (84) had ultrasounds with 50% reporting appendicitis, 34.9% (181) had no imaging prior to surgery. Of those imaged the NAR was 12.8% (6.3% CT, 32.1% ultrasound) and no scan was 17.1% (p=0.188).

26.2% (135) of appendicectomies were open, 69.5% (358) laparoscopic and 4.3% (22) converted.

Pathology showed that 14.3% (74) appendixes were negative and 85.7% (444) positive. Males had a lower NAR of 11.1% vs females with 18.1% (p=<0.05).

Conclusions

Our result of a 14.3% NAR shows that we are working within the recommended national guidelines of a <20% NAR. The NAR was higher in females than males. The use of imaging in addition to clinical evaluation helps reduce the NAR, with CT being more effective than ultrasound.
SP5.2.1 Intra-muscular interposition of nerve endings to minimise neuropathic and residual pain in lower limb amputations
Authors: Lu Victor , Zhou Andrew , Krkovic Matija
Published: November 2022

Introduction

A major cause of morbidity in lower limb amputees is phantom limb pain (PLP) and residual limb pain (RLP). This study aimed to determine if surgical interposition of nerve endings into adjacent muscle bellies at the time of major lower limb amputation can decrease the incidence and severity of PLP and RLP.

Methods

Data was retrospectively collected from January 2015 to January 2021, including eight patients that underwent nerve interposition (NI) and 36 that received standard treatment. Primary outcomes included the 11-point Numerical Rating Scale (NRS) for pain severity, and Patient-Reported Outcomes Measurement Information System (PROMIS) pain intensity, behaviour, and interference. Secondary outcome included Neuro-QoL Lower Extremity Function assessing mobility. Cumulative scores were transformed to standardised t scores.

Results

Across all primary and secondary outcomes, NI patients had lower PLP and RLP. Mean ‘worst pain’ was 2 out of 10 for RLP in the NI group, compared to 3.58 in the control group (p=0.045). Mean PROMIS t scores were lower for NI cohort for both RLP (pain intensity [41.2 vs 48.1;p=0.035]; pain interference [44.9 vs 46.3;p=0.260]; pain behaviour [44.4 vs 50.8;p=0.039], and PLP (pain intensity [50.8 vs 58.5;p=0.029]; pain interference [49.1 vs 54.0;p=0.009]; pain behaviour [53.4 vs 55.6;p=0.061]). Mean Neuro-QoL t score was lower in NI cohort (45.4 vs 41.9;p=0.03).

Conclusion

Surgical interposition of nerve endings during lower limb amputation is a simple yet effective way of minimising PLP and RLP, improving patients’ subsequent quality of life. Additional comparisons with targeted muscle reinnervation should be performed to determine the optimal treatment option.
SP5.2.5 Optimising Communication during Damage Control Surgery- a survey of adult Major Trauma Centres in England
Authors: Patton Ethlinn , Lisagors Ilans , Smith Stella
Published: November 2022

Aims

Snap briefs (truncated WHO checklists) and Sit Reps (situational reporting), are long established practices within the military, developed from their vast experience in treating patients requiring Damage Control Surgery (DCS)[1,2].

Our aim was to establish if formal systems like these are in place in Major Trauma Centres (MTCs) in England, and gather staff's experiences of using these systems.

Methods

An online survey was devised and distributed to MTCs in England via the Major Trauma Network. It consisted of 14 questions, relating to use of modified WHO checklists and Sit Reps during DCS.

Results

Results were received from all 23 adult MTCs in England. Eight centres (34.8%) reported using a modified WHO checklist for DCS. Most commonly these were modified to include reference to blood products used and available, other specialties needed, and presence of surgical equipment prior to start (eg. thoracotomy.)

12 centres (52.2%) are using Sit Reps during DCS. Many respondents from centres without a formal policy in place stated that they personally endeavor to maintain communication when they are involved in DCS cases, and recognised that a formal system would be greatly beneficial.

Conclusion

Many MTCs are not using truncated WHO checklists and Sit Reps for DCS. From the centres who have adopted these methods, staff have reported they improve shared decision making. Wider implementation of these techniques could therefore lead to both improved patient care and staff experiences.
SP6.1.2 Endoscopic versus Laparoscopic Surgical Management of Achalasia: A Decision Analysis
Authors: Bradley Alison , Sayers Anna , Chin Mei Ying , Webb Hannah , Basu Sinjini , Buter Anton
Published: November 2022

Aims

To compare achalasia treatment outcomes at one and two years post intervention.

Methods

A decision-tree model was populated with data from 36 randomised controlled trials to compare: pneumatic dilation, botulinum toxin injection, Heller myotomy (+/- Dor or Toupet), Dor and peroral endoscopic myotomy (POEM).

Freeman-Tukey arcsine square root transformation under random effects model, to account for heterogeneity, was used to calculate weighted pooled model transition probabilities. Utility was 1, 0.5 and 0 for treatment success without significant complication, success with significant complications and treatment failure respectively. Deterministic sensitivity analysis and Monte Carlo Probabilistic Sensitivity Analysis (PSA) set to 10000 iterations tested model uncertainty.

Results

Laparoscopic Heller myotomy had marginally superior utility over POEM but only if the risk of significant complications remained less than 7.2% and 7.9% at one and two years respectively.

Conclusion

Superior treatment selection depends on individual risk of complications. Future research should therefore focus on personalised risk stratification and cost-effectiveness implications.
SP6.1.9 Long-term Impact of Mini-Gastric Bypass on Inflammatory Cytokinesin Cohort of Morbidly Obese Patients: a Prospective Study
Authors: Salman Mohamed , Noureldin Khaled , Issa Mohamed , Tourky Mohamed , Bisheet George
Published: November 2022

Bariatric surgery has become a wide world popular surgery. Evolution in its techniques is progressive to achieve best outcomes. Purpose One anastomosis gastric bypass (OAGB) is a promising bariatric procedure. We performed this study to evaluate the changes in a group of inflammatory cytokines 12 months after OAGB.

Methods

A single-arm prospective study was conducted on obese patients who underwent OAGB. Serum levels of the following adipocytokines were monitored pre- and 12 months postoperatively: adiponectin, leptin, interleukin 6 (IL-6), interleukin 8 (IL-8) levels, tumor necrosis factor-alpha (TNF-α), serum amyloid A (SAA), high-sensitivity C-reactive protein (hs-CRP), and monocyte chemotactic protein 1 (MCP-1).

Results

A total of 62 patients were included with a mean age of 43.9 ± 6.8 years old. Serum adiponectin increased significantly from7.64 ± 0.29 to 8.76 ± 0.42 μg/mL 12 months after the operation (p < 0.001). hs-CRP and IL-6 decreased significantly 12 months after the OAGB from 3323.35 ± 643.4 ng/mL and 3.72 ± 7.7 pg/mL to 1376.81 ± 609.4 ng/mL and 3.64 ± 6.9 pg/mL, respectively (p < 0.001). The MCP-1 showed significant increase in its level after OAGB as well (p = 0.014). In contrary, there were no significant changes in serum levels of IL-8 (p = 0.12) and TNF-α (p = 0.84) 12 months after the operation. The correlation analysis showed significant correlations between initial body mass index (BMI) with serum adiponectin, IL-8, and serum SAA.

Conclusion

OAGB can significantly impact the inflammatory cytokine profile in obese patients with possible subsequent protection from obesity-related comorbidities such as insulin resistance, cardiovascular diseases, and certain cancers.
SP7.5 Psychomotor assessments of fundamental ability are associated with the future operative performance of surgical trainees
Authors: Toale Conor , Ryan Donncha M , Doherty Eva , Traynor Oscar J , Morris Marie , Kavanagh Dara O
Published: November 2022

Introduction

Assessments of visuospatial, psychomotor and perceptual ability correlate with simulated operative performance. This study investigates the association between fundamental technical ability and future operative performance as measured through both in-theatre and simulation-based assessments.

Methods

Core surgical trainees in the Republic of Ireland recruited from 2016–2019 participated in validated assessments of fundamental technical ability; Pictorial Surface Orientation (PicSOr) testing of perceptual ability, ‘paper-based’ visuospatial aptitude assessments, and psychomotor testing using a grooved pegboard. Operative performance was assessed using the in-theatre Supervised Structured Assessment of Operative Performance (SSAOP) tool, and Operative Surgical Skill (OSS) assessments (multi-station simulation-based assessments) performed over a 2-year core training period. SSAOP assessments were scored using a 15-point checklist and a global 5-point Operative Performance score. Univariate (Pearson) correlations and multiple linear regression were used to explore the association between fundamental ability and operative performance, controlled for both operative experience and centile scores from the trainee's undergraduate medical degree.

Results

Aggregated fundamental ability scores strongly correlated with performance in all submitted SSAOP assessments using the Total Checklist score (B = 0.75, t(168) = 3.17, p = 0.002) and weakly correlated with Overall Performance scores (B = 0.04, t(168) = 3.16, p = 0.002), independent of operative experience and centile scores. Fundamental ability scores were also predictive of OSS assessment scores on multivariate analysis (B = 0.219, t(168) = 2.22, p = 0.03).

Conclusion

Fundamental technical ability is predictive of future performance in both in-theatre workplace-based assessments of operative skill and simulation-based assessments of operative performance.
SP8.1.1 Emergency Vs Elective Common Bile Duct Exploration, A District General Hospital Experience over 6 years
Authors: Al-Ardah Mahmoud , Barnett Rebecca E , Rottenburg Hannah , Clarke Michael , clark James , Finlay Ian
Published: November 2022

Introduction

Laparoscopic Common bile duct exploration (LCBDE) is a relatively new approach for clearing choledocholithiasis. The aim of this study is to assess the feasibility of this approach to clearing CBD stones in an emergency setting.

Methods

Retrospective data collection and analysis was carried out for 207 consecutive cases of LCBDE performed over 6 years (2015–2020). The patients were divided into two groups according to the operation performed as an emergency or elective. We compared demographics, perioperative data, post-operative complications, and outcomes.

Results

207 cases of LCBDE were performed during the time period. 122 performed as an emergency, and 85 on an elective list. Of the emergency cases, 37 performed because of cholangitis either mild or moderate in severity according to Tokyo grading system.

Ninety-six percent of the emergency cases and 94.1% of the elective cases were completed laparoscopically. Length of stay post-operatively was 3.3 +6.3 days in the emergency and 3.5 +4.6 days after elective.

Successful clearance achieved at the end of the operation in 99% of the patients in the emergency group, clearance failed in one case. In the elective group 100% of the patients has a successful clearance at the end of the operation.

Twelve patients (emergency) and 8 patients of the elective cases required post-operative ERCP to manage retained stones, recurrent stones or bile leak (p=0.921). Three patient required re-operation for post operative complications in each group.

Conclusion

Common bile duct exploration in emergency settings is feasible, with high success rate if performed by surgeons with advanced laparoscopic biliary skills.
SP8.1.2 Group and Saves for Laparoscopic Cholecystectomies: An Unnecessary Expense?
Authors: Cole Kirsty , Jamnadass Enakshee , Ward James , Hou David
Published: November 2022

Aims

The aim of this study was to analyse the necessity of routine group and saves (G+S) in patients undergoing laparoscopic cholecystectomies and to establish whether it would be safe to cease this practice. In doing so, we aim to reduce financial burden and workload, whilst maintaining safe clinical outcomes.

Methods

This was a retrospective study into all consecutive patients that underwent an elective or emergency laparoscopic cholecystectomy in Royal Hampshire County Hospital (RHCH) from May 2019 - May 2021. IT systems and clinical notes were analysed to identify the quantity of pre-operative G+S samples sent, and the proportion of patients that required a postoperative blood transfusion.

Results

Over 24 months, 427 laparoscopic cholecystectomies were performed in RHCH, 70% of which were elective. In total, 682 G+S samples were processed (1.6/patient), resulting in a cost of £16504. Two patients received a postoperative blood transfusion (0.5%). One of these patients presented with an UGI bleed, whilst the other presented with a haemolytic crisis. They were therefore predictable, pre-operative conditions, for which a post-operative transfusion had been planned prior to surgery.

Conclusion

In conclusion, this study suggests that performing routine G+S for all laparoscopic cholecystectomy patients has created an unnecessary workload and financial burden on this small DGH. Furthermore, during this 24 months, this practice had no clinical advantage. We therefore advise that sending pre-operative G+S samples should be a clinical decision made on a case by case basis, rather than a default for all patients.
SP8.2.6 Risk Prediction in Emergency Giant Hiatus and Diaphragmatic Hernia Repairs
Authors: Alasmar Mohamed , Moore Eleanor , McKechnie Iona , Chaparala Ram
Published: November 2022

Aims

Emergency presentation of giant hiatus and diaphragmatic hernias are associated with significant morbidity and mortality. The preoperative risk prediction tools not only can help clinicians stratify risk, but they can also be valuable tools to outline surgical risks to patients and families. This study aimed to evaluate the suitability of different risk prediction models when predicting morbidity and mortality in emergency giant hiatus and diaphragmatic hernia repairs.

Methods

This was a retrospective cohort study of all emergency hiatus and diaphragmatic hernia repairs at a tertiary upper gastrointestinal centre from 2010 to 2021. We compared the outcomes to the predicted mortality and morbidity of different risk prediction models. The mortality models SORT, NELA and ACS-NSQIP were compared using the area under the curve (AUC). We evaluated morbidity by calculating the comprehensive complication index (CCI). Using Spearman correlation, CCI was compared to P-POSSUM and ACS-NSQIP predicted morbidity.

Results

108 patients were included in the analysis. The 30-day mortality rate was 6.93%. ACS-NSQIP had the highest predictive power for mortality (AUC ¼ 0.845) in comparison to NELA (AUC¼0.809) and SORT (AUC ¼ 0.740). Both ACS-NSQIP and P-POSSUM showed moderate correlation to CCI (rho ¼ 0.489, p < 0.001 and 0.446, p < 0.001 respectively).

Conclusions

ACS-NSQIP is a better predictor of both mortality and morbidity in emergency giant hiatus and diaphragmatic hernia repairs when compared to NELA, P-POSSUM and SORT. Multi-centre prospective studies could be used to validate these findings. ACS-NSQIP may have a role in pre-assessment and consenting emergency giant hiatus and diaphragmatic hernia repairs.
SP10.1.1 A retrospective study: Rectal foreign bodies, enter at your own risk…
Authors: Chowdhury Ashim , Havelka Eva , O’Farrell Eoin , Pangeni Anang , Shrestha Ashish Kiran
Published: November 2022

Aims

Entrapped rectal foreign bodies (FB) are being encountered by acute surgical teams with increasing frequency and can be a challenge to manage. This study aims to highlight typical patient demographics, risk factors for presentation and management options for these patients.

Methods

Between 2017 and 2021, 29 cases of rectal FB were diagnosed and managed at East Kent Hospital University Foundation trust. Retrospective data taken from theatre directory and electronic notes was used to audit patient demographics, co-morbidities, the type of foreign body and the extraction technique.

Results

The majority of patients were male (87%). The patient's age ranged from 15 to 78 years, with a median age of 48 years. In the majority of cases, the FB had become entrapped during sexual activity. Nineteen patients (65%) underwent examination under GA for removal, seven patients (24%) were manually evacuated and three required a laparotomy (10.3%). Nine patients (31%) had a history of known mental health problems. The most common FB removed was a roll-on deodorant (n=5).

Conclusion

Cases of rectal FB's needing surgical management typically involve male patients in their 40's. While a small proportion can have manual evacuation, the majority require examination under anesthetic and in some cases a laparotomy. While a larger study would be required for significance, it appears a history of mental health problems may predispose patients to presenting with this problem. Patients present with a wide range of foreign body type, typically items commonly found in the home, the most common being roll on deodorant.
SP10.1.10 Management of Acute Sigmoid Volvulus in a Single Scottish Health Board
Authors: May Victoria , Drever Sara Katherine , Ramsay George
Published: November 2022

Aim

The Emergency General Surgery guidelines from the ACPGBI were recently published and recommend that definitive management should be planned on index admission with sigmoid volvulus. However, the evidence base for these recommendations was low. We aim assess the current practice of Sigmoid Volvulus (SV) in a Single Scottish Health board.

Method

A retrospective review of patients with acute SV managed at two hospitals between 2011 and 2021 was conducted. Individuals were identified through inpatient coding and case notes reviewed electronically. Operative intervention, colonoscopic decompression and short and long term outcomes were noted.

Results

Of 105 patients treated, 41 were female. The mean age at presentation was 73.2 (range: 38–94 years). In total, 70 patients (66.7%) underwent decompression alone and 35 (33.3%) were treated with surgical intervention. There was no difference in mean age, number of co-morbidities and number of previous operations between the two groups. Of the decompression group, 35 (50%) presented on a single occasion. However, the mean number of re-presentations was 3.3 (range 2–29) and the mean time to re-presentation was 136.5 days (range 5–1224 days). There were no recorded inpatient deaths following surgical intervention.

Conclusion

The most common method of acute SV management has been decompression on its own. There were no differences observed in patient demographics between the intervention groups, suggesting that there are no set criteria to determine method of intervention. However, representation remains commonplace and operative intervention had few complications indicating a likely required increase in definitive surgical approaches.
TU1.5 Endoscopic electroporation for inoperable oesophagogastric cancer: Preliminary results from a phase II clinical trial (The VECTOR Trial)
Authors: Jackson Andrew , James Eleanor , Vohra Ravinder , Humes David , Parsons Simon
Published: November 2022

Aims

Electrochemotherapy (ECT) combines the use of low-dose chemotherapy with reversible electroporation to increase intracellular uptake of chemotherapeutic agents and improve tumoral cytotoxicity. Although a well-established treatment modality in primary skin and cutaneous metastases, the effects of ECT in the treatment of advanced oesophagogastric cancer are unknown. Development of the endoVE/ePORE system now allows endoscopic delivery of ECT.

We aim to recruit thirty patients to the VECTOR trial to assess the efficacy of endoscopic ECT in the local treatment of inoperable oesophagogastric cancer.

Methods

The study began recruitment in March 2020. Patients undergo a single treatment of endoscopic ECT alongside a dose of intravenous Bleomycin. Validated dysphagia and QoL scores (Ogilvie, EORTC QLQ-C30/ OES18) are used to assess symptomatic response to treatment. Local tumour response is assessed with interval gastroscopy and cross-sectional imaging.

Results

Six males and one female with a mean age of 71 years (41–88) have received endoscopic ECT.Four patients had received oncological therapy prior to enrolment. The mean procedural time was 22 minutes.All patients were discharged within 24 hours of treatment.Over 50% of patients reported significant improvements in their dysphagia score at 6-week follow-up with concomitant improvement in their QoL metrics.

Conclusions

Early experience of endoscopic ECT is safe, well tolerated and can be performed in the endoscopy suite with sedation and analgesia. Improvements in patients’ symptomatology are promising and may indicate this as an alternative to stenting.We are yet to demonstrate favourable tumour response on follow up imaging and endoscopy.Careful patient selection is key to negate post procedural complications.
TU1.7 The correlation between BITE score and weight outcomes in Mini/One Anastomosis Gastric Bypass patients – an update with 24-month post-operative results
Authors: Gurunath Tharun Muthu , Edwards Olivia , Sufi Pratik , Parmar Chetan
Published: November 2022

Background

The Bulimic Investigatory Test, Edinburgh (BITE) self-report questionnaire is used to assess the risk of bulimic and binge eating habits in bariatric patients preoperatively. This study aimed to investigate the correlation between preoperative BITE scores and weight loss at 3, 6, 12, 18 and 24 months follow up in patients with Mini-Gastric Bypass (MGB-OAGB).

Method

Consecutive patients who received MGB-OAGB between 2016–2018 completed the BITE questionnaire at initial assessment and were included in this prospective study. Baseline demographics were measured. Excess body weight loss (%EBWL) and total weight loss (%TWL) were calculated on the day of surgery and at 3, 6, 12, 18 and 24 months follow up.

Results

120 patients were eligible with an average age of 43 (± 10.84) years. 21.67% (n=26) had high BITE scores (≥20), 44.17% (n=53) had medium BITE scores (10–19), and 34.17% (n=41) had low BITE scores (≤9). Low and Medium BITE groups had similar outcomes at each follow up. The low BITE group had greater %EBWL and %TWL compared to high BITE group across all the follow ups, however this difference was not significant. There were no reoperations or mortality.

Conclusion

MGB-OAGB results in good weight loss at 3, 6 and 12 months post-operatively independent of BITE scores. There was no significant difference between pre-operative binge eating behaviours on post-operative weight outcomes. To extend the study, further research between the effect of pre-operative psychological input on weight outcomes could be investigated. Going forward, comparative study in patients with RYGB and sleeve gastrectomy would be recommended.
TU1.10 Oesophageal/ Oesophagogastric Junction Cancer: EUS Role Revisited
Authors: Viswanath Nakul Gokhare , Bohra Ashok
Published: November 2022

Introduction

Oesophageal and Oesophago-gastric junctional (OGJ) cancer remains a challenge both from the perspective of early diagnosis, prompt staging and subsequent treatment. The prognosis of these cancers is directly related to the stage of the disease at diagnosis. CT scan followed by Endoscopic ultrasound (EUS) are investigations which help with the T and N staging. In conjunction with staging tools like PET and laparoscopy there is a resultant delay with frequent breaching of treatment targets. Reducing the number of investigations potentially avoids delays in the management pathway.

Methods

We conducted a retrospective audit on patients who have had oesophageal cancer resections from 2017 to 2021. We compared the accuracy of the CT scan in comparison to EUS staging preoperatively with final histopathological staging. Patients who had neo-adjuvant therapy were excluded from the final histological comparisons.

Results

CT is routinely performed in all patients with oesophageal cancer. All oesophageal cancers going for treatment had EUS staging. EUS staging was found most useful for Tx and T1 stages. We did not find EUS additionally useful for T2 and T3 stages. EUS is useful for T4 stages to help exclude inoperability.

Conclusion

Modern multi-slice CT scans provide a comparable accuracy to EUS for T2 and T3. This suggests that EUS staging can be avoided for CT stage T2 and T3 cancers of the oesophagus and GOJ. This is in keeping with current NICE guidance. EUS has a role in TX, T1 and T4 cancers and can be selectively used as per other specific indications.
TU2.4 Synthesis review with meta-analysis on risk of incisional hernia following transverse versus vertical midline incision for specimen extraction in patients undergoing laparoscopic colorectal resections
Authors: Ahsan Amiya , Nour Hussameldin M , Baig Mirza K , Sains Parv , Sajid Muhammad S
Published: November 2022

Objective

The objective of this article is to explore the risk of incisional hernia (IH) occurrence at the site of specimen extraction following laparoscopic colorectal resection (LCR), highlighting the comparison between transverse incision versus midline vertical abdominal incision.

Method

Analysis was conducted according to PRISMA guidelines. Systematic search of medical databases like MEBASE, MEDLINE and pubmed was performed to find all types of comparative studies reporting the incidence of IH at the specimen extraction site of transverse or vertical midline incision following LCR. The analysis of the pooled data was done using the RevMan statistical software.

Result

Twenty-five comparative studies (including 2 RCTs) on 10362 patients fulfilled the inclusion criteria. There were 4944 patIents in the transverse incision group and 5418 patients in the vertical midline incision group. In the random effects model analysis, the use of transverse incision for specimen extraction following LCR reduced the risk of IH development [odds ratio 0.30, 95% CI (0.19–0.49), z= 4.88, p=0.00001]. However, there was significant heterogeneity (Tau2 = 0.97; Chi2= 109.98, df = 24(p=0.00004; I2 = 78%) among included studies.

Conclusion

Transverse incision used for specimen extraction following LCR seems to reduce the risk of postoperative IH incidence compared to vertical midline abdominal incisions.
TU3.3 Impelling Factors for Contracting COVID-19 Among Surgical Professionals During the Pandemic: a Multinational Cohort Study
Authors: Yang Wah , Bangash Ali Haider , Abouelazayem Mohamed , Parmar Chetan , Cheruvu Chandra , Viswanath Yirupaiahgari , Konjengbam Alakh
Published: November 2022

Background

Medical workers, including surgical professionals working in COVID-19 treating hospitals, were under enormous stress during the pandemic. This global study investigated factors endowing COVID amongst surgical professionals and students.

Methods

This global cross-sectional survey was made live on the 18th of February, 2021, and closed for analysis on the 13th of March, 2021. It was freely shared on social and scientific media platforms. It was also sent via email groups and circulated through a personal network of authors. Chi-square test for independence, binary logistic regression analysis was carried on determining predictors of surgical professionals contracting COVID-19.

Results

This survey captured the response of 520 respondents from 66 countries. 92.29% (503/545) were working in a hospital receiving patients with COVID-19. More than one-fourth (25.5%) caught COVID-19, which was more frequent in participants working in public sector hospitals (P=0.001). 75.7% of those who did not contract Covid (283/376) were vaccinated (P<0.001). Surgical professionals undergoing practice in the private sector (OR: 0.33; 95% CI: 0.14–0.77; p=0.011) and getting two doses of vaccines (OR: 0.55; 95% CI: 0.32–0.95; p=0.031) had decreased odds of contracting COVID-19. Only 6.9% of those who reported not contracting COVID-19 (26/376) were calculated to have the highest Level of Harm score (LH4) (P<0.001).

Conclusions

High prevalence of respondents caught COVID-19, which was more frequent in participants working in public sector hospitals. Self-isolation or shield, getting two doses of vaccines decreases the odds of contracting COVID-19. Those who reported contracting COVID-19 were calculated to have the highest Level of Harm score.
TU4.1 Single-center experience in robotic-assisted colorectal surgery during COVID pandemic: First 72 cases
Authors: Mansuri Ahmer , Butnari Valentin , Kaul Sandeep , Huang Joseph , Rajendran Nirooshun
Published: November 2022

Aim

To present an analysis of the first 2-years’ experience of robotic-assisted colorectal procedures (RACP) using the DaVinci Xi platform.

Methods

This data were prospectively collected and include 72 RACP between February 2020 and December 2021.Indications were: malignancy in 74.3%, diverticular disease 10%, inflammatory bowel disease 8.6%, rectal prolapse 4.3%, intussusception 1.4% and recurrent volvulus 1.4%.

Results

Over the 13-month study period, 72 RACP were performed including elective 57 cases and 15 semi-elective cases. These comprised: 25 right hemicolectomies, 25 high anterior resections, 6 extended right hemicolectomies,4 low anterior resections, 4 subtotal colectomies 2 restorative proctectomies, 3 abdominoperineal excisions of the rectum, 3 rectopexies that were performed. 51.2% were female and 48.6% were male with a median age of 45 years (22–85 years) and the median body mass index was 31 (18–46) kg/m2. Preoperative American Society of Anaesthesiology scores were reported as 1–2 in 72.9% (n=51) of patients and 27.1%(n=19) as 3. The median length of stay was 5 days (1–35), with readmission rate within 30 days of 8.6% (n=6) that were resolved conservatively. The mean operating time was 268 minutes and the mean console operative time was 158 minutes, with only 3 (4.3%) reported cases of conversion to open. The incidence of postoperative complications was 24.3% (Clavien–Dindo (CD) I/II- 12.9%, CD III- 10%, and CD V-1 case with superimposed COVID 19 within 30 days.

Conclusion

RACP is a safe and viable modality in the treatment of colorectal conditions and can be introduced safely with appropriate guidance and proctorship.
TU5.9 Do Surgical In-patients prefer to use first names or titles when greeting and being greeted by Surgical Doctors?
Authors: Dunlop Lucia , Steele Kathryn , Minford Eunice
Published: November 2022

Aims

Using first names between staff and patients could potentially help in reducing medical paternalism and encourage a shift to an equal partnership relationship. A survey was performed to determine surgical patients preference for greeting and being greeted by Surgical Doctors.

Methods

100 surveys were distributed around three surgical wards over two time periods and collected anonymously.

Results

67 surveys were returned and analysed, 21 males, 45 females, 1 unspecified with age range 20 to >80 years.

The majority of surgical in-patients prefer junior (85%) and senior doctors (87%) to greet them by their first names. Yet only 27% wished to greet Senior surgical doctors by their first name, compared to 57% for Juniors. In contrast 51% preferred to address seniors by title, but only 22% for juniors. Remaining patients preferred to address doctors by their full name or role only. 50% surveyed believed first names could improve patient-doctor relationships, making it easier to raise concerns but 12% felt tradition restricted them, with 27% believing it would devalue the medical profession.

Conclusions

Majority of surgical in-patients prefer to be addressed by their first name. However, many are reluctant to address Senior surgical doctors by their first name and are more comfortable doing so for juniors. Although half realise it could improve doctor-patient relationships and ease voicing concerns, some recognise that they are curtailed from doing so by tradition. The shift to equal partnership doctor-patient relationship may be curtailed by the persistence of power differential that occurs through using titles.
TU6.3 Limited geriatrician input is better than none: Geriatrician led team meetings improve understanding of frailty and medical management of older general surgical patients, meeting NELA standards of care
Authors: Hudson Murray , Luo Rong , Reese George , Koizia Louis , Fertleman Michael , Sritharan Ganan
Published: November 2022

Aims

General surgical teams are treating an increasing number of frail, older patients.1 Geriatrician involvement has shown improvement in length of stay.2

We sought to demonstrate that even with limited geriatrician involvement we could meet NELA targets of completing frailty scores, increasing frequency of geriatrician reviews and improving team education.

Methods

We introduced twice-weekly geriatrician-led team meetings followed by selected patient reviews to best optimise the care of older patients. Surgical trainees, nurses and allied health staff attended each meeting. The team was educated by the geriatrician about geriatric medicine and the importance of recognising frailty. They were also supported in performing independent frailty assessments.

We measured frequency of frailty score recorded and geriatrician involvement pre- and post-set up of this limited service. We also conducted semi structured interviews of staff pre- and post-intervention related to educational impact.

Results

94% (29/31) of patients aged over 65 had a clinical frailty score recorded post intervention compared to 9% (3/35) originally. All 31 had geriatrician involvement. Comments from the surgical team included: ‘pro-active approach to identifying frailty’, ‘early identification of barriers to discharging complex patients' and ‘improvement in understanding of geriatric giants’.

Conclusions

The Emergency Laparotomy and Frailty (ELF) study recognised that frailer individuals were vulnerable to adverse outcomes and longer hospital stays.3 Our limited geriatrician-led service supported surgical doctors and the MDT in understanding frailty and considering its impact. Within a short space of time we aligned with NELA recommendations, improved patient outcomes and improved MDT understanding of geriatric medicine.
TU6.8 An Audit of Day case surgery for cholecystectomy
Authors: Gulnaz Nadia , Akram Farhan , Dixon Michael , Siddique Khurram
Published: November 2022

Aims

To compare the trust-wide performance with the standard by the British Association of Day Surgery in the management of cholecystectomy

Methods

4 months of Electronic data of patients undergoing elective laparoscopic cholecystectomy in 2020 was analyzed. Those who had emergency cholecystectomy were excluded.

Results

112 of 145 total patients were female and 33 were male. The age range was 18–82 Around 65% of patients were sent home the same day. 51 Patients ended up being admitted. 33 of these were Pre-booked as inpatients' intent. 39% (13/33) had no specific reason for being booked as an inpatient. The rest Majority had medical issues quoted as the reason for booking.35% (18) of the 51 admitted patients were actually brought in as day-case lap-chole. 6 of these were admitted for perioperative surgical issues and 8 had no documented reason. The Mean length of stay was 2.56 days(0–13). Our Performance was noted to be 10% lower than the BADS standard.

Conclusion

Relatively more patients are being treated as inpatients than the recommended standard. About 1/4th of those who were inpatient had no specific/genuine grounds to be kept in. There is a need for improvement in pre and perioperative documentation to explain the reason for inpatient management. Development of inpatient surgery booking criteria and adherence to set criteria.
TU8.10 Should patients with a predicted NELA mortality of 5–10% be managed on ICU? An audit of the management of high-risk laparotomies as per NELA Guidelines
Authors: Banks Jessica , Macadam Robert
Published: November 2022

Aims

The National Emergency Laparotomy Audit (NELA) has been pivotal in improving the care of patients undergoing emergency laparotomy. One key recommendation is ‘high-risk’ patients are managed on ICU post-operatively. We aimed to identify if there was a difference in outcomes between ‘high-risk patients’ (predicated NELA mortality >5%) managed on ICU or a surgical ward post-operatively.

Methods

We retrospectively analysed all patients registered to our hospitals NELA database from January 2019-September 2021, assessing if ‘high-risk’ patients were managed on ICU or general surgery wards post-operatively and the difference in outcomes between these two groups.

Results

249 patients were included (138 Female). Over 80% of ‘high-risk’ patients were admitted to a ICU bed over the three-year period, as per NELA guidelines. 46 high-risk patients were managed on the ward post-operatively. Although there was no difference in age between the two groups, those admitted to ICU had a significantly higher predicated NELA mortality and higher mortality rate.

Conclusions

NELA predicted mortality helps to guide which patients may need a higher level of post-operative care. However, this study indicates that for some patients with a predicted mortality of 5–10%, ward-based care may be appropriate. In the context of increasingly stretched ICU resources, we believe further research is needed to identify whether some patients with a NELA mortality over 5% would be appropriate for ward management.
WE1.4 Laser haemorrhoidoplasty (LHP) is an efficacious alternative to excisional treatment of haemorrhoidal disease: Results from a single centre retrospective study
Authors: Essiet Edidiong , Kalaskar Shrinivas , Wu Fiona , Atif Qurrat
Published: November 2022

Purpose

LASER haemorrhoidoplasty (LHP) is a novel procedure in the management of the symptomatic haemorrhoidal disease. LHP is a non-excisional procedure to treat haemorrhoids in which hemorrhoidal arterial flow feeding the hemorrhoidal plexus is abrupted by laser coagulation.

Methods

We conducted a retrospective review on 121 consecutive patients treated with LHP over 2018 to 2020 at a District General Hospital. A diode laser device is used to seal the terminal branches of the hemorrhoidal plexuses. Routine follow-up was at 12 weeks. Our aim was to investigate the efficacy and safety profile of LHP. Efficacy was associated with symptom resolution, the degree of patients’ perception of improvement, and the number of procedures required to treat recurrence. Safety was determined by more than one hospital follow-ups and complications necessitating treatment.

Results

Follow-up was achieved in 100 patients. 21 patients with incomplete data were excluded. The mean age was 45 years old. LHP was utilised in 2% of patients with grade I haemorrhoids, 24% with grade II, 67% with grade III and 7% with grade IV. At follow-up, 57% reported complete symptom resolution and 94% reported symptom improvement. Residual symptoms were observed in 29% of patients. Only 9% underwent a re-operation. 38% attended hospital for more than one outpatient visits and 5% of those required antibiotics to treat local infections.

Conclusion

LHP is a safe and efficacious non-excisional surgical alternative to the management of the haemorrhoidal disease. Our patients reported a high degree of symptom resolution and satisfaction.

Key words

haemorrhoids, benign anorectal conditions, bleeding, laser haemorrhoidoplasty
WE1.8 Is colon capsule effective at reducing the requirement for colonoscopy in symptomatic patients with a faecal immunochemical test (FIT) <100? Do patients find this an acceptable investigation?
Authors: Lord Ian , Fajardo Winona , Owen Ruth , Durango Nichole , Basavaraju Krishna , Wells Antonia
Published: November 2022

Aim

To assess the effectiveness of colon capsule in reducing the need for colonoscopy and to review patient satisfaction for this investigation.

Method

Potentially suitable patients for colon capsule were identified from 2 week wait referrals and patients referred to colorectal clinic. Inclusion criteria for consideration were; FIT <100, performance status 0–1 and aged 18–75. Data was collected for our first 20 patients for age, gender, FIT result, quality of the bowel preparation, pathology and the follow up outcome. Following completion of the investigation patients were invited to complete a feedback questionnaire.

Results

The median age of patients was 58 (IQR 50–64) with 12 (60%) female patients. The median FIT result was <7 (IQR <7 to 33). The bowel preparation was excellent to good for 18 (90%) patients. Colon capsule was able to avoid colonoscopy for 14 (70%) patients. 6 (30%) patients required flexible sigmoidoscopy to complete the investigation or assess identified pathology. 15 (75%) patients completed patient satisfaction questionnaires, with all patients reporting little to no pain and little to no embarrassment. 9 of 13 (69%) respondents would choose to have a colon capsule again if further investigation was required. Overall patient experience was positive with a median satisfaction score 8/10 (IQR 5–10) with 10 being very satisfied.

Conclusions

Our units initial experience supports the findings of other pilot studies, that the majority of symptomatic patients with a FIT <100 do not require a colonoscopy following colon capsule. Patients appear to find this an acceptable method to investigate their symptoms.
WE1.9 The learning curve for stoma care; can it be shortened by Stoma CNS input at weekends or affected by day of surgery?
Authors: Shah Priya , Hill Michelle , McDonald Rosie , Miller Andrew
Published: November 2022

Aims

Length of hospital stay for colorectal patients can be prolonged by stoma training. This study explores the impact of 2 variables on time to stoma competency; day of the week that surgery is performed and whether stoma education was available at the weekends.

Methods

Retrospective review of a prospectively maintained stoma database identified all patients who had a GI tract stoma formed between 1st January and 31st December 2020. Demographics, operative details and time to stoma competence data was collated.

Results

158 patients had a stoma formed. Mean age was 59 years (range 13 – 94).

Conclusions

Time to stoma competence was shorter when stoma education was available at the weekends, despite similar numbers of reviews being provided. This suggests that length of hospital stay could be reduced for this cohort by providing stoma education 7 days a week. The day that surgery was performed did not have a clear impact on time to stoma competence.
WE2.4 Optimal timing of Laparoscopic Cholecystectomy for symptomatic gallstone disease: the importance of symptom duration
Authors: Dey Abhishek , Lal Nikhil , Otunla Afolarin , Singh Sandeep , Gilmour Jeffrey
Published: November 2022

Aims

This study aims to assess outcomes of laparoscopic cholecystectomy (LC) performed in patients presenting with acute cholecystitis or symptomatic gallstone disease within 7 days of onset of symptoms compared to 7 days of diagnosis.

Methods

A prospective case note analysis was conducted for all patients undergoing laparoscopic cholecystectomy in a tertiary center between February and April, 2018. Outcome measures were compared between 2 patient cohorts: A- those undergoing laparoscopic cholecystectomy within 7 days of diagnosis and B-within 7 days of onset of symptoms.

Results

86 patients met inclusion criteria. The mean duration between LC and diagnosis was 5 days, and 16 patients (18%) had surgery over a week after diagnosis. The mean duration between LC and symptom onset was 9 days, and 44 patients (51%) underwent LC over 7 days after symptom-onset.

There was a statistically significant reduction in the number of pre-operative ERCPs(p-0.08) and MRCPs(p<0.01) in patients of group B compared to A. A similar decline was noted in surgery length(p<0.01) and incidence of complicated gallbladder disease (characterised by adhesions, empyema, retrograde dissection, perforation, necrosis, pancreatitis) (p<0.01) in the former group when measured against the latter. We further observed significantly better post-operative outcome in group A with reduced rates of complications(p<0.01) (urinary retention, bile leak and hepatic artery pseudoaneurysm) and readmission(p-0.03).

Conclusions

This is the first study to demonstrate the advantages of using symptom onset to guide practice, and whilst higher power studies are needed to confirm our findings, could represent the beginning of an important shift.
WE2.8 Improving Management for Acute Cholecystitis and Biliary Pancreatitis – the ‘Hot Gallbladder Pathway’
Authors: Kam Cheuk Tung , Abdelsaid Kirolos , Jayasankar Balaji , Balasubramaniam Dinesh , Abdulaal Yasser
Published: November 2022

Aim

There is a wide variation between National Health Service (NHS) hospitals in the management of patients with acute cholecystitis and biliary pancreatitis. 20–33% of patients will make repeat visits to hospital with gallstone-related symptoms before any surgical intervention performed. We established a ‘Hot Gallbladder Pathway’ with the aim for improving outcome and decreasing complications of these patients. The aim of this quality improvement project was to assess if a district general hospital (DGH) could provide a safe and effective ‘hot gallbladder’ service with a clear pathway.

Method

Quality improvement methods were used to integrate the ‘hot gallbladder pathway’ to manage patients with acute calculous cholecystitis and biliary pancreatitis. A prospective observational study with strict inclusion/ exclusion criteria and secure online data was conducted during a 13-month period. The data were then compared against existing National Institute for Health and Clinical Excellence (NICE) guidelines and further changes were recommended.

Results

We achieved almost 70% of the patients undergoing emergency laparoscopic cholecystectomy in both group of patients who met the pathway criteria within the expected time frame, compared with the pre-implementation result of 23% and national average of only 16% in England. None of the patients suffered from intraoperative complications or 30-day mortality.

Conclusion

A clear ‘hot gall bladder pathway’ is effective at improving care for patients requiring emergency laparoscopic cholecystectomy and potentially useful for other acute Trusts which their standard is below the NICE guideline.