bluuebunny/crossref_metadata_2025 huggingface dataset:
O026 Post-operative mortality following planned versus on-demand relaparotomy for secondary bacterial peritonitis: a literature review
Authors: Hinchcliffe Z , Hargest R
Published: November 2022

Introduction

Post-operative peritonitis is a life-threatening complication of surgical care, whereby early relaparotomy is paramount in diagnosing and controlling the infective source. Currently, there are no clear guidelines on surgical strategies for re-laparotomy. This study aimed to evaluate the current evidence on the mortality rates and length of hospital admission associated with planned (PR) versus on-demand re-laparotomy (ODR) in patients with secondary peritonitis.

Methods

Literature review was conducted using Ovid MEDLINE and PubMed to identify English-language papers directly comparing ODR and PR in adults over 18 years. Case reports, reviews and papers including individuals with peritonitis post-pancreatitis or abdominothoracic surgery were excluded. Eight of the 154 studies identified met inclusion criteria following abstract screening.

Results

No significant difference was found between post-operative mortality in PR and ODR for patients with secondary peritonitis (mean mortality rates 30.0% and 31.7% respectively). ODR was shown to have better overall outcomes in avoiding unnecessary surgeries, reducing infection-related complications and length of ITU admissions. ODR is favoured provided there is no operation delay. However, in patients with extensive peritonitis and high APACHE-II scores, PR is preferred to effectively control infection source.

Conclusion

Literature analysis shows there is still much debate regarding whether PR or ODR is favoured for post-operative peritonitis. Further randomised control-trials across multiple international centres are required to improve the evidence base for future surgical practice.

Take-home message

Mortality and complication rates are comparable following planned and on-demand re-laparotomy in patients with post-operative peritonitis. Further international research is required to construct evidence-based guidelines for re-laparotomy and improve our future care for critically unwell surgical patients.
O029 Long term outcomes of renal transplants in kidneys with multiple arteries
Authors: Seet C , Clementoni L , Mohamed IH , Khurram M
Published: November 2022

Introduction

Variations in kidney arterial anatomy may affect decisions regarding implantation, and in some cases require multiple anastomoses or reconstruction. We aimed to assess the effect of multiple arteries on transplant outcomes.

Methods

We performed a registry analysis of UK kidney transplants from 2000–2018. Univariate and

Multi-variate analyses were performed to assess the effect of multiple arteries on graft outcomes including graft function and the incidence of DGF and vascular thrombosis.

Results

13240 living donor (LD) and 28095 deceased donor (DD) transplants were analysed. Warm ischaemic times in single artery kidneys was lower than kidneys with multiple arteries (LD 42 vs 45mins, p=0.025, DD 40 vs 43mins, p<0.001). Donor characteristics were similar between both groups. When adjusted for age, sex, diabetes, cold and warm ischaemic time, there was no difference in mean creatinine at 3, 12 or 60 months in LD and DD with single or multiple arteries. There was an increased incidence in vascular thrombosis seen in LDs with multiple arteries (2.2% vs 4.5%, p=0.008), but not in DDs (3.7% vs 4.0%, p=0.584). There was no difference in DGF or PNF. In LDs, multiple arteries had no effect on transplant survival time (p=0.473), but DDs with multiple arteries had poorer survival (5493 vs 5649 days, p=0.007).

Conclusion

While multiple arteries may pose technical challenges and are associated with longer warm ischaemic times, the clinical implications of this are minimal. The increased risk of graft thrombosis in LDs is clinically relevant but long-term graft survival and graft outcomes remain excellent.

Take-home message

Kidneys with multiple arteries can make transplantation more technically challenging, but this has minimal effects on long term graft outcomes.
O030 Image-analysis algorithm to determine quality of cold perfusion in kidney transplantation
Authors: Tingle SJ , Thompson ER , Bates L , Connelly C , Colenutt S , Turner M , Ugail H , Hodgetts R , Thomson BM , Sheerin N , Wilson C
Published: November 2022

Introduction

Surgeon assessment of visual ‘quality of perfusion’ (QOP) influences kidney discard and predicts transplant outcome. However, this assessment is subjective and bias-prone.

We aimed to design an application utilising a smartphone camera to make this assessment objective and enhance decision making.

Methods

The QOP in photographs of backbench kidneys was graded from 1 (ideal) to 5 (very poor) by three independent surgeons. A training cohort was used to develop an image-analysis algorithm, which was validated in a separate cohort.

Results

Analysing surgeon scores of 174 kidney images revealed that inter-rater agreement was good for kidneys displaying the best (rated 1) and worst (rated 4 or 5) QOP. However, for intermediate scores inter-rater agreement was poor. Inter-rater agreement between surgeons decreased as they graded more images; as surgeons fatigued, their ability to classify images worsened. A training cohort (n=174 kidneys) was used for algorithm development. First, small regions within each image were mapped within the CEILAB colour-space, where well-perfused and poorly perfused areas show clear separation. To generate a score for each kidney these regions are compared with ideally flushed kidney tissue. Testing our algorithm (validation cohort - n=29 kidneys) revealed strong correlation between image-analysis QOP score and surgeon assessment, r=0.789 (0.587–0.899), P<0.001.

Conclusion

Surgeon inter-rater agreement on kidney QOP is low for kidneys with borderline QOP and worsens with fatigue. We provide a QOP score utilising an image-analysis algorithm, which correlates with surgeon scoring. With additional images and training this could provide an objective, numerical, point-of-care assessment of organ quality.

Take-home message

Current visual assessment of transplant organ quality is subjective and bias-prone. This body of work attempts to create a point-of-care image-analysis application to provide an objective numeric organ quality score.
O036 Does Cxbladder accurately exclude bladder urothelial cell malignancy on diagnostic and surveillance cystoscopy? a prospective multi-centre study
Authors: Narroway H , Kovacic J
Published: November 2022

Introduction and Objectives

Health systems incur significant costs from bladder cancer. Diagnostic and surveillance protocols are intensive. Urine cytology and Computed tomography (CT) have low sensitivity as screening and surveillance tools. Cxbladder is a non-invasive urinary biomarker approved for use in Australia, with high reported sensitivity in bladder cancer detection. The purpose of this study was to determine the accuracy of Cxbladder as a screening and surveillance tool in patients with suspected and established bladder cancer, respectively.

Methods

A prospective trial (88 participants) was performed at Gosford and North Gosford Hospitals (New South Wales, Australia). Inclusion criteria were: patients undergoing investigation for macroscopic haematuria or bladder cancer surveillance. Patients were asked to perform a Cxbladder test prior to either flexible or rigid cystoscopy. Exclusion criteria were: patients aged < 18 years, or patients that had undergone transurethral resection of the bladder within five months. Testing kits were supplied at no cost by Pacific Edge Ltd. Cxbladder results were then compared with cystoscopic findings, the prevailing gold-standard for bladder cancer diagnosis.

Results

Sensitivity and specificity of Cxbladder for detection of bladder cancer were 76.5% and 45.1% respectively. Positive and negative predictive values (PPV/NPV) were 31.7% and 85% respectively. False negative cases comprised low-grade papillary tumours only. Cxbladder had 100% NPV in detection of high-risk bladder cancer.

Conclusion

There is evidence to support Cxbladder as a screening tool in the detection of high-risk bladder cancer. Further studies involving larger populations are required to validate its accuracy.

Take-home message

The purpose of this study was to determine the accuracy of Cxbladder as a screening and surveillance tool in patients with suspected and established bladder cancer, respectively. Sensitivity and specificity of Cxbladder for detection of bladder cancer were 76.5% and 45.1% respectively, whilst a 100% negative predictive value was obtained in detection of high-risk bladder cancer.
O050 A ten-year review of methodological trends and outcomes in riskreducing mastectomy and associated reconstruction at a tertiary referral centre
Authors: Aslam A , Arshad Z , Ahmed A , Kazzazi F , Benson JR , Forouhi P , Agrawal A , Benyon SL , Irwin M , Malata CM
Published: November 2022

Introduction

Risk-reducing mastectomy (RRM) is the removal of breast tissue to substantially decrease the risk of developing breast cancer in individuals with higher breast cancer susceptibility due to strong family history or genetic mutations. This retrospective study evaluates cases of RRM, and subsequent reconstruction performed at a tertiary referral centre over the last decade, with emphasis on mastectomy and reconstructive trends.

Methods

A retrospective review of all cases of RRM performed between January 2010 and January 2020, divided into two groups corresponding to the first half (group 1) and second half (group 2) of the decade was conducted. Data collected included demographics, genetic test results, family and personal history of breast cancer, co-morbidities, mastectomy type, reconstruction type, surgical histopathology findings and complications.

Results

A total of 167 patients (group 1=76, group 2=91) underwent RRM, with a significant increase in cases of RRM despite negative genetic test results (p=0.047). The proportion of nipple sparing techniques for RRM compared to more traditional skin-sparing techniques. Concomitantly, post-RRM reconstruction has progressively become solely implant-based, to coincide with a rise in ADM usage. This is consistent with national trends towards fewer complex autologous procedures.

Take-home message

Emergent trends in risk-reducing mastectomy and reconstructive techniques are occurring against a background of broadened indications for RRM and more frequent patient requests for RRM in the absence of any documented pathogenic gene mutation. As breast surgery continues to evolve, it is important to evaluate specific trends such as more conservative forms of mastectomy and novel techniques/devices for breast reconstruction to ensure optimal patient care and levels of satisfaction.
O058 Characteristics and prognosis of cerebrovascular fibromuscular dysplasia (FMD) - a retrospective cohort study
Authors: Weerakkody RA , Kythreotou A. , Marzouqa N. , Baker DM
Published: November 2022

Introduction

Fibromuscular dysplasia (FMD) is a rare, non-atherosclerotic, non-inflammatory vascular disorder that primarily affects renal and cerebrovascular vessels. Limited data are available on the clinical characteristics of cerebrovascular FMD, particularly from the UK/Europe.

Methods

We performed a retrospective cohort analysis of all cases of carotid/cerebrovascular FMD presenting to our regional vascular service, by case-note review, and searching all relevant clinical databases.

Results

Eighty-six patients were identified between 1998–2020. Stroke or TIA was the most common mode of presentation. The most frequent vascular pattern was bilateral extracranial internal carotid artery FMD. Concomitant cerebrovascular complications - dissection, aneurysm or occlusive disease of the carotid, vertebral and cerebral vessels was common (41%) and included two cases of carotid cavernous fistula. FMD was also observed in the renal/visceral vessels and aorta in 13(15%) of the cohort (60% of those who had extracranial imaging), with 5% having aneurysm or dissection of other vessels. 19(22%) of patients required carotid/cerebrovascular intervention (mainly for intracranial aneurysm), with 10% requiring intervention for other vascular complications. Recurrent cerebrovascular events (stroke/TIAs and aneurysmal disease requiring intervention) was seen in 23% of cases. Overall mortality was 7% over a median follow-up period of 47 months.

Conclusion

The co-existence of intracranial aneurysm and other cerebrovascular complications in patients with carotid FMD is high and requires careful surveillance. Vascular complications in other vascular beds are also frequent and probably under-estimated. We would recommend a low threshold for routine imaging of all vascular beds in patients presenting with carotid/cerebrovascular FMD.

Take-home message

Fibromuscular dysplasia is rare but when presenting as a stroke, other vascular beds may be involved,
O080 A double-blind, placebo-controlled, randomised trial of extracorporeal shockwave therapy as a novel treatment for intermittent claudication.
Authors: Cai PL , Pymer S , Raza A , Ibeggazene S , Hitchman LH , Carradice D , Chetter IC , Smith GE
Published: November 2022

Introduction

Intermittent claudication (IC) is a prevalent manifestation of peripheral arterial disease and affects about 3% of the UK population. Current guidance for the management of nonlife limiting IC is supervised exercise and best medical therapy. Supervised exercise however is not readily available across the nation and has poor recruitment and retention rates. Pilot data has demonstrated that Extracorporeal ShockWave Therapy (ESWT) is effective for improving walking distance in patients with IC. This study aims to consider its effectiveness for improving quality of life (QoL).

Methods

In a double-blind, sham-controlled, randomised trial, patients with IC were randomised in a 1:1 ratio to ESWT or sham treatment. The primary endpoint was change in physical functioning at 12-week follow-up, as measured by the SF-36. Secondary endpoints included changes in walking distances and ABPI.

Results

138 patients were randomised. The ESWT group had a significantly higher physical functioning score at 12 weeks (Mdn 41 vs 34, z=-2.1, p=0.033). They also had significantly longer claudication (Mdn 125 vs 88, z=-2.9, p=0.004) and maximum (Mdn 179 vs 129, z=-2.4, p=0.013) walking distances. The change from baseline to 12-weeks was also significantly greater in the ESWT group for claudication (Mdn 51 vs 24, z=-2.8, p<0.01) and maximum (Mdn 63 vs 17, z=-4 p<0.01) walking distance. No difference observed in ABPI.

Conclusion

This study demonstrates that ESWT is safe, well tolerated and clinically effective for improving QoL and walking distances in patients with IC.

Take-home message

Extracorporeal shockwave therapy improves quality of life and walking distances, and could potentially be used as a non-invasive adjunct to supervised exercise or in institutions were supervised exercise is not available.
O081 Investigating the FLYWCH1/ β-catenin signalling in pancreatic cancer
Authors: Sharmin N , Zaitoun AM , Babaei-Jadidi R , Lobo DN , Nateri AS
Published: November 2022

Introduction

β-catenin is a protein molecule of the E-cadherin/catenin adhesion complex that maintains epithelial cell-cell adhesion and intracellular signalling. The mutation and overexpression of β-catenin leads to cancer, including pancreatic ductal adenocarcinoma (PDAC). FLYWCH1 is a newly identified protein with zinc-finger type DNA-binding domain that interacts with nuclear β-catenin, leading to increased cell-cell and cell-matrix adhesion in cancer and stem cells. This study aimed to explore the roles of crosstalk between FLYWCH1 and Wnt/β-catenin signalling for the first time in pancreatic cancer cells.

Methods

We performed Western Blot analysis for the extraction of FLYWCH1/β-catenin, E-cadherin and GSK3-b in AsPc-1, PANC-1, and MIA PaCa-2 pancreatic cancer cell lines.

Recommended concentrations of antibodies were used for the detection of proteins of interest. Tubulin was used as a loading control. Fluorescent detection was used, and the density of detected proteins were measured.

Results

Our results demonstrate evidence of differential expression of FLYWCH1 in pancreatic cancer cells. PANC-1 had less expression of FLYWCH1, but expression was moderate in AsPC-1. E-cadherin, β catenin, and GSK3-b were also expressed. These data suggest that FLYWCH1 levels correlated with unphosphorylated β-catenin to suppress the transcriptional product via controlling the aberrant Wnt/β-catenin pathway while E-cadherin promoted the cell-cell attachment.

Conclusion

These results suggest that Wnt1/β-catenin activity is negatively correlated with FLYWCH1 expression in pancreatic cancer cells. Thus, FLYWCH1 could have tumour suppressive activities. Future studies are required to elucidate their therapeutic and biomarkers efficacy.

Take-home message

FLYWCH1 is a newly identified protein could control B-catenin expression which leads tumour suppression. Thus, FLYWCH1 would be a therapeutic target for pancreatic cancer treatment in the future.
O085 CD10 expression in carcinomas of the pancreas, bile duct and ampulla
Authors: Arora A , Storr SJ , Reddy H , Lobo DN , Madhusudan S , Zaitoun AM
Published: November 2022

Introduction

Pancreatic cancer and cholangiocarcinoma including, cancer of ampulla of Vater, are very aggressive and have a dismal prognosis; hence improved methods of patient stratification are required.

Methods

We assessed the expression of CD10 in stromal and epithelial cells of two patient cohorts using immunohistochemistry on tissue microarrays. The first cohort was composed of 68 pancreatic adenocarcinomas and the second cohort was composed of 120 cancers of the bile duct and ampulla.

Results

In bile duct and ampullary carcinomas an association was observed between CD10 stromal expression and patient age (p =0.009). The CD10 stromal expression was associated with poor disease specific survival (DSS) (p =0.05). In multivariate Cox model for DSS, stromal CD10 expression (p = 0.037) was independently associated with poor outcome. In multivariate Cox model for disease free survival (DFS), CD10 stromal expression (p = 0.012), and nodal status (p = 0.025) were independently associated with poor outcome. In pancreatic cancer, no statistically significant association was observed between CD 10 stromal expression and clinicopathological variables such as tumour size (p = 0.099), T stage (p = 0.393), N stage (p = 0.860), Vascular invasion (p = 0.904), perineural invasion (p = 0.532) and grade (0.168). In multivariate Cox model for DSS, T stage (p = 0.042) was independently associated with poor outcome.

Conclusion

The results suggest that CD10 stromal expression may have prognostic significance in cholangiocarcinoma. The findings of this study warrant a larger follow-up study.

Take-home message

The results suggest that CD10 stromal expression may have prognostic significance in cholangiocarcinoma. The findings of this study warrant a larger follow-up study.
O086 Genomic analysis of response to neoadjuvant chemotherapy in oesophageal adenocarcinoma
Authors: Breininger SP , Izadi F , Sharpe B , Secrier M , Gibson J , Walker R , Rahman S , Devonshire G , Lloyd M , Walters Z , Fitzgerald R , Rose-Zerilli M , Underwood T
Published: November 2022

Introduction

Oesophageal adenocarcinoma (OAC) is the ninth most common cancer worldwide with a mortality of over 500,000 deaths yearly. Neoadjuvant chemotherapy (NAC) followed by surgery is the standard of care (SOC) for locally advanced OAC. Although almost all patients receive chemotherapy as SOC, fewer than 20% obtain a clinically meaningful response and benefit before surgery. The OAC genome is complex and heterogeneous between patients, and it is not yet understood whether specific mutational patterns result in chemotherapy sensitivity or resistance.

Methods

To identify associations between genomic events and response to NAC in OAC, a comparative genomic analysis was performed in 65 patients using whole-genome sequencing. We defined response to NAC using Mandard Tumour Regression Grade TRG), with responders classified as TRG1-2 (n=27) and non-responders classified as TRG4- 5 (n=38).

Results

We report a higher non-synonymous mutation burden in responders (median 2.08/Mb vs 1.70/Mb, P=0.036) and elevated copy number variation (CNV) in non-responders (282 vs 136/patient, P<0.001). We identified CNVs unique to each group, with cell cycle (CDKN2A, CCND1), c-Myc (MYC), RTK/PIK3 (KRAS, EGFR) and gastrointestinal differentiation (GATA6) pathway genes being specifically altered in non-responders. Of particular interest was the identification of the Neuron Navigator-3 (NAV3), a known tumour suppressor downstream of EGFR, which was mutated exclusively in 22% of non-responders.

Conclusion

We characterise genetic features and mutations that are uniquely associated with response to NAC. We envision a treatment pipeline that incorporates driver mutation profiling in OAC, combining response prediction with targeted therapies enhancing response to NAC and improving survival outcomes.

Take-home message

Developing a method of determining an OAC patient's response to neoadjuvant chemotherapy before treatment is administered is desperately needed and will improve patient outcome and quality of life. We identified a number of aberrations in the genome that were unique to non-responders to chemotherapy compared to responders, particularly a known tumour suppressor gene namely Neuron Navigator-3, suggesting that these events may contribute to chemoresistance in these patients. Our work characterises pre-existing genomic alterations that have potential as biomarkers for resistance or sensitivity to NAC.
O092 Fibrin-based haemostatic agents for reducing blood loss in adult liver resection: a meta-analysis
Authors: Malik AK , Amer AO , White SA , Manas DM , Wilson CH
Published: November 2022

Introduction

Liver resection can be associated with significant perioperative bleeding. Fibrin based haemostatic agents (FBHAs) are bioabsorbable topical haemostatic agents used to enhance haemostasis and reduce blood loss. We performed a systematic review and meta-analysis, comparing FBHAs with the standard of care and no topical application (SoC), and comparing FBHAs with non-fibrin-based haemostatic agents (NFHAs) to evaluate their efficacy in reducing blood loss and improving perioperative outcomes.

Method

The Cochrane Hepato-Biliary Specialised Register was searched to identify (quasi-) RCTs to include in our meta-analysis. Two authors independently reviewed each study. Primary outcomes were haemostatic efficacy (defined as haemostasis within 4 or 5 minutes post application), adverse events and perioperative mortality (within 30-days of surgery). Statistical analyses were performed using the random effects model and results expressed as odds ratio (OR) with 95% confidence intervals.

Result

Twenty-seven RCTs (3736 participants) were included in our analysis. FBHAs were found to have superior haemostatic efficacy compared to NFHAs (OR 4.03; 1.73–9.36, p=0.001), and were superior to SoC (OR 13.59; 4.06–45.47, p<0.0001). Incidence of adverse events and perioperative mortality was no different when comparing FBHAs with SoC or NFHAs. No differences were detected when testing for post-operative bile leakage, intra-abdominal collections, volume of abdominal drain output, post-operative transfusion requirements, reoperation rates and length of stay (all p>0.05).

Conclusion

FBHAs appear superior to SoC and NFHAs in achieving haemostasis within 4–5 minutes post-application, however this does not translate into improved post-operative outcomes. FBHAs are not justified for routine use based on the available evidence.
O099 Position and number of anchors in hip arthroscopy labrum repair: a systematic review
Authors: Samoutis A , Lee MH , Patel A , Jaiswal P
Published: November 2022

Introduction

Hip labral tears are reported in 22–55% of patients with hip or groin pain. Operative treatment is necessary for most cases, via hip arthroscopy with the use of suture anchors. This systematic review aims to determine the optimal number and position of anchors in hip labral repair.

Methods

Pubmed, Ovid & Embase were searched, and 2 researchers independently screened the 1,304 results. Outcome measures such as procedures performed, number & (clockface) position of anchors, failure & articular involvement of anchors were extracted.

Results

5 studies were included in the analysis: 1 Cross-Sectional Study (1645 Hips, mean age (MA):33.7 years), 3 Retrospective case studies (491 hips, MA:31.0) and 1 Controlled Cadaveric study (32 cadaveric hips, MA:62.7). Chi-squared statistical analysis of 323 hips found a significant difference (X2 (2, N = 323) = 17.88, p < .001) in the risk of articular involvement with the position of anchors at 11°-12° o’clock, 1°-2° and 3°-4°. There is an absolute risk reduction (ARR) of 19% with anchors positioned at 11°-12° compared to anchors positioned at 3°-4° (X2 (1, N=178) =15.79, p < .001) and an ARR of 12% with anchors at 1°-2° compared to anchors positioned at 3°-4° (X2 (1, N = 237) = 15.79, p < .0109). Additionally, by assessing 1645 operations it was found that for tears spanning >2 hours, a minimum of 2 anchors was placed.

Conclusion

Placement of anchors in the 3°-4° o’clock position carries the highest risk for articular involvement. Small diameter anchors and careful placement can be used to minimize articular injury. Preferable positions of anchors are 11°-12°, furthermore, for tears spanning over 2 hours, a minimum of 2 anchors was placed.

Take-home message

In Hip Arthroscopy labral repair, placement of anchors in the 3°-4° o’clock position carries the highest risk for articular involvement. Small diameter anchors and 2 hours. flexible anchor instrumentation can be used to minimize articular injury, furthermore, for tears spanning over 2 hours, a minimum of 2 anchors was placed.
O106 Maximising the benefits of bariatric surgery through targeting ghrelin: a randomised, double-blind, placebo-controlled crossover study in people with suboptimal weight loss after bariatric surgery
Authors: Zakeri R , Carnemolla A , Marvasti P , Mok J , Jassil F , Chaiyasoot K , Lichfield J , Alves M , Mansoor R , Omar R , Batterham R
Published: November 2022

Introduction

One in 5 people have a suboptimal weight-loss (WL) response to bariatric surgery. The causes are unclear, but patients report resumed hunger and increased food intake, eating behaviours driven by the orexigenic hormone, ghrelin. This proof-of-concept study aimed to evaluate the impact of reducing circulating acyl-ghrelin, the biologically active isoform, on appetite and energy intake in people with suboptimal WL and aberrant ghrelin profile after bariatric surgery.

Methods

Thirty-five patients with <20%WL from 12 months after Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) and aberrant circulating ghrelin profile underwent 10 days of treatment with a novel, highly-selective ghrelin o-acyltransferase inhibitor, GLWL-01, and placebo. The primary endpoint was within-person change in ad libitum energy intake during a test meal on day 10. Secondary endpoints assessed subjective appetite, food cravings, macronutrient intake, gut hormones, cardiometabolic profile and body composition. Ethical approval was obtained.

Results

Thirty-one participants (26 RYGB, 9 SG) completed both cycles. GLWL-01 produced a 58.9±27.2% decrease in fasting plasma acyl-ghrelin and 29.3±27.1% increase in desacyl-ghrelin after 10 days. Marked reduction in subjective hunger, food cravings and hedonic influence on appetite was observed with GLWL-01, however objective appetite measures – ad libitum and free-living energy intake – did not change. Circulating levels of cardiovascular risk-conferring lipoproteins significantly improved and no adverse impact on glycaemic control was observed.

Conclusion

Pharmacological modulation of the ghrelin system may be used as part of a personalised therapeutic approach to optimise clinical outcomes in patients with suboptimal WL after bariatric surgery.

Take-home message

This first-in-human mechanistic study shows that pharmacological modulation of the ghrelin system is a promising therapeutic strategy for maximising weight loss response to bariatric surgery.
EP-87 Use of Harmonic Focus Shears in Plastic Surgery. Literature review and future recommendations
Authors: Bahadori Darab , Eiben Inez , Eiben Paola , Hever PennyLouise
Published: November 2022

Introduction

Harmonic Focus Shears (HFS) (Ethicon Endo-Surgery, USA) is an ultrasonic device specifically designed through its curved clips and hand activated trigger system to be precise and minimise the impact on tissues. Initially designed for head and neck dissection and proved to be effective without increasing risk of complications in thyroidectomy procedure it is surprisingly rarely mentioned in the field of plastic surgery.

We performed a literature search to established current uses of ultrasonic devices in plastic surgery and determine its effectiveness, and future uses.

Methods

Literature search was performed in accordance to guidelines for Preferred Reporting Items for Systemic Reviews and Metanalysis.

Discussion

Use of ultrasonic devices as harmonic prove to be a useful tool in precise large tissue dissection surgery including pedicled flap and free flap dissection. Described benefits embrace upgraded operative time, blood loss, tissue discharge and morbidity.

Initially described to be superior to traditional electrocauthery in facelift procedure, ultrasonic devices then evolved to be advantageous when considering outcomes in breast reduction surgery, implant based breast reconstruction and capsulectomy.

HFS as a novel and improved ultrasonic device allows for focused forceps dissection, haemostasis and tissue coagulation without the need to swap instruments that is safe to the surrounding tissues. Learning curve is expected and pitfalls include additional staff training, multiple wire device setup, single use and possible overheating. On balance however improved timings and therefore operative efficiency, low risks of complications and optimal patient outcomes make this method of tissue handling a favourable tool to introduce to common plastic surgical practice.
EP-90 Bouveret Syndrome: A challenging case of impacted gallstone within the fourth part of the duodenum
Authors: Smith Emma , Zhao Sarah , El-Boghdady Michael , Sabato-Ceraldi Serena
Published: November 2022

Aims

Bouveret syndrome is a rare condition characterised by gastric outlet obstruction secondary to a gallstone fistulating into the proximal duodenum or pylorus. We present a case of a 68-year-old with recurrent small bowel obstruction secondary to a large gallstone impacted in the fourth part of the duodenum and cholecysto-duodenal fistula. We describe our atypical approach to surgical retrieval.

Methods

The patient presented acutely with abdominal pain and vomiting, on a background of recent admission for gallstone ileus managed conservatively. Initially, due to high anaesthetic risk (P POSSUM score = 14% mortality, 60% morbidity), the patient was managed conservatively with nasogastric drainage and total parenteral nutrition. On day 6 of admission, emergency laparotomy was performed after identifying radiological signs of impending perforation and clinical deterioration. Endoscopic management was not available locally. The stone could not be milked proximally for retrieval via pyloroplasty. Subsequently, high-pressure water flushes delivered via the gastrostomy expelled the stone distally. The stone was then retrieved via a jejunotomy at the DJ flexure.

Results

The patient required a 2-day high dependency unit admission and she was discharged 3 weeks post-operatively at her functional baseline. She was clinically well and asymptomatic when reviewed at the four-month post-operative surgical follow-up appointment.

Conclusions

This is the first report to our knowledge to describe successful surgical management of a gallstone impacted in the fourth part of the duodenum. Enterolithotomy can be considered safe option in patients with large, impacted stone and multiple co-morbidities.
EP-95 Full Cycle Audit on Prescription and Cost Effective Analysis of Metronidazole in Acute Surgical Unit
Authors: Wong Li Siang , Chin Mei Ying , Mcgee Caroline , Mccubbin Kay
Published: November 2022

Aims

Oral Metronidazole has very high bioavailability, similar to that of intravenous(IV) metronidazole. Prescribing oral Metronidazole has many advantages such as saving drug preparation time, reducing risk of line infection and also being more cost effective. We aim to study the incidence of prescription or oral Metronidazole and its cost impact in or acute surgical unit.

Methods

Retrospective analysis on the prescription and cost effectiveness of Metronidazole usage in acute surgical setting. Inclusion criteria for this study was acute surgical patients with viable oral route and who were prescribed oral or IV Metronidazole. Cost assessment was carried out using British National Formulary (BNF). Education and awareness campaigns were held to encourage the prescription of oral Metronidazole. A second cycle audit was done to measure outcome of education.

Results

First audit done in 2020 found only 12.5% of patients were prescribed oral instead of IV Metronidazole. This has improved to 61% during second cycle audit done in 6 months time after the awareness campaigns. Prescribing oral instead of IV Metronidazole would save approximately £64.77 per dose resulting in reducing total cost by £971.55 per standard course of 5 days treatment.

Conclusion

There is clear improvement in the rate of prescribing of oral Metronidazole following equation campaigns. Further improvement can be achieved through continued education of various members of surgical team which will ultimately result in reduced costs, lessen drug preparation time for nursing staff and lower risk of line infection for patients.
EP-124 Local Recurrence after Breast Cancer Surgery – 5 year follow up. Breast Cancer Unit University Hospital North Tees
Authors: Allen Neill , Jain Yogesh , Dordea Matei
Published: November 2022

Introduction

Breast conserving surgery in the form of wide local excision with sentinel node biopsy is a common treatment option for patients with early breast cancer.

The National Institute for Health can Care Excellence recommends that each Breast Unit should audit their local recurrence rates.

Aim

Audit our unit's 5 year local recurrence rate as recommend by national guidelines

National Standard

Early and locally advanced breast cancer: diagnosis and management NICE guideline [NG101] Published: 18 July 2018

Method

Patients who had a breast cancer operation in 2014 were included. Histology records were checked to confirm diagnosis and check for any histological recurrence in the following 5 years.

Data collected were Age at diagnosis, the disease free interval in months and the site of recurrence.

Results

531 patients were included in the study of these 22 patients had local recurrence defined as recurrence in the ipsilateral breast, chest wall or local axillary nodes.

The local recurrence rate was 4.14% for this cohort of patients. This is below the recommended <5%.

The mean age at diagnosis was 62. The mean disease free interval was 39 months.

Recommendation

Our unit are meeting the national local recurrence rate for early and locally advanced breast cancer.

Plan for re-audit

Re-audit annually to ensure maintaining quality clinical care. To review method of admission (breast screening vs symptomatic clinic) and the method of detection for the recurrence.
EP-138 Pseudomyxoma peritoni induced by appendiceal mucinous adenocarcinoma- a case report
Authors: Rauf Fatima , Sial Fakhar Munir , Hanif Muhammad , Malik Muhammad Naveed , Khan Huma Sabir , Butt Adam Umair Ashraf
Published: November 2022

Introduction

Appendiceal tumours are rare and mucinous tumours account for 58% of the malignant tumours of appendix according to SEER data base, with remaining being carcinoid tumors. Mucinous tumours of appendix have a potential of peritoneal spread in the form of gelatinous material, resulting in pseudomyxoma peritoni (PMP). We report a case of mucinous adenocarcinoma of appendix inducing pseudomyxoma peritoni in a 37 year old male.

Case summary

A 37 year old male presented with generalised abdominal pain for 2 months and gradually increasing abdominal distension over a period of one month. On examination, abdomen was tense, distended and mildly tender. Rest of systemic examination was unremarkable. Biochemical investigations revealed normal blood complete picture. AST was mildly raised. ALP was 330 (normal upto 130 U/L. Bilirubin, total proteins and renal function tests were within normal limits. CECT abdomen and pelvis showed omental caking and moderate ascites with no overt bowel mass lesion. Diagnostic laparoscopy was done which showed extensive mucinous deposits over peritoneum. Biopsy was taken which revealed metastatic mucinous adenocarcinoma with appendix as primary organ of origin on immunohistochemistry (CK 7 -/CK 20 +, CDX 2 positive). CEA levels were done which were 220 ng/ml (normal upto 10 ng/ml). Patient was referred to oncology centre for further management.

Discussion

PMP occurs in 7th decade of life and more common in females with a M: F ratio of 1:4 and is almost always of appendiceal in origin.

Conclusion

PMP is rare tumour with negligible incidence in younger population.
EP-145 Prescription of antimicrobials…according to the guidelines?!
Authors: Rai Anil , Mahmood Ahsan , Singh Rhea , Kudchadkar Shantata , Mehana Omar , Sagar Jayesh
Published: November 2022

Aim

The trust guidelines do not recommend prescription of Co-amoxiclav and Metronidazole concurrently in the mentioned group of patients. This study aims to discern and improve the adherence to trust guidelines of antibiotics prescription in general surgery and urology patients.

Methods

A retrospective review over a period of three months was analyzed, wherein record sampling was done on two occasions with 584 and 490 patients respectively, with majority (280 and 254) admitted electively. The study comprised patients admitted to general surgery and urology departments. Data was assembled on patient demographics and use of antibiotics.

Results

51 patients (8.73% of 584) were prescribed both Co-Amoxiclav and Metronidazole during the first cycle. This number fell to 34 (6.9% of 490) during the second cycle. Prescription of antibiotics was observed to be maximum in emergency patients admitted in A&E. Furthermore, one patient in the first cycle was prescribed Metronidazole despite being allergic to it. Patients reported to be penicillin allergic were 48 and 26 in the two cycles respectively. It was found out that majority of the patients were discharged on the same day of admission.

Conclusion

Although, a minimal improvement (1.8%) in antibiotic (Co-Amoxiclav & Metronidazole) prescription was observed over the duration of the study, the trust guidelines on antimicrobials usage was not adhered to satisfactorily. Therefore, there is a need to create awareness among clinicians regarding the guidelines of appropriate antibiotic prescription.
EP-186 Recurrent Boerhaave's Syndrome
Authors: Loganathan Santhosh , Gul Rahman , Whittaker Laura
Published: November 2022

Boerhaave's syndrome is a rare clinical entity. It is caused by severe straining, vomiting or prolonged severe coughing, affecting the distal intrathoracic part of oesophagus. The clinical presentation is varied and associated with high mortality if there is a delayed diagnosis. Therefore, the mainstay of treatment is early diagnosis, drainage of intrathoracic collection if indicated and restoration of the oesophagal integrity. The recurrent Boerhaave's syndrome is rare, and only a few cases have been reported in the literature.

We present a 27-year-old female diagnosed to have Boerhaave's a year back which was managed conservatively, presented to hospital with sudden onset of epigastric pain radiating to left shoulder and chest associated with multiple episodes of vomiting. Abdominal examination revealed a tender epigastric region with elevated white cells and C-reactive protein. CTTAP showed a recurrent para-oesophageal collection of fluid and gas adjacent to the distal oesophagus at the same site, with no pneumoperitoneum. She was managed conservatively for a week with peripheral nutrition. The CTTAP was repeated with oral contrast, which showed partially improved left para-oesophageal collection, and surrounding inflammatory changes had also partly improved with no leak of contrast. She was hemodynamically stable, clinically well, and tolerated oral feeds, so she was discharged from the hospital.

As the recurrent presentation is rare, the treatment should be customised for individuals as per their clinical condition. We emphasis on recognising this condition in both acute and chronic condition, which could be vital in preventing the mortality from this condition.
EP-190 Comparative Study of Single Clip Laparoscopic Cholecystectomy (SCLC), Two Clips Laparoscopic Cholecystectomy (TCLC) and Clipless Laparoscopic Cholecystectomy (CLLC) Vs Conventional Laparoscopic Cholecystectomy (CLC)
Authors: Devkaran Bhavesh , Attri Anshu , Chandel Upender Kumar
Published: November 2022

Introduction

Laparoscopic cholecystectomy has been accepted as the “gold standard” for the treatment of symptomatic gallstone disease. Conventionally 6 titanium clips are used for laparoscopic cholecystectomy (LC). Cost of 6 titanium clips are high and have been associated with complications in form of migration.

Material and Methods

200 patients of proven gallstones were randomly divided into four groups of 50 patients each, undergoing dissection of gall bladder by harmonic scalpel with application of one titanium clip, two titanium clips and absorbable Vikyl suture on cystic duct in Group 1 (SCLC), 2(TCLC) and 3(CLLC) respectively before division of duct and artery with harmonic ace. Group 4(CLC) patients underwent conventional LC with electrocautery and application of 6 clips.

Results

Mean operative time was statistically significant when CLC was compared with SCLC, TCLC and CLLC (CLC 43.10 ± 9.68 min vs 26.80 ± 8.44 in SCLC, 28.76 ± 8.23 IN TCLC, 37.30 ± 8.22min in CLLC group). Approximate blood loss in the CLC group was 28.90 ± 11.71ml as compared to 7.8 ± 3.06 in SCLC, 8.10 ± 3.18 ml in TCLC and 8.40 ± 3.70 ml in the CLLC group. Pain score was significantly better in the SCLC, TCLC and CLLC group. Conversion to open cholecystectomy was comparable in all the groups. Post operative hematoma formation and overall cost was significantly high in the CLC group.

Conclusion

SCLC, TCLC and CLLC are comparable to standard 6 clip laparoscopic cholecystectomy in all aspects. SCLC and TCLC have a clear advantage of decreased operative time, blood loss and low cost.
EP-241 Surgical virtual clinic (VC) practice: an audit of practice in the University Hospitals Sussex NHS Trust
Authors: Saleem Mohamed , Tahir Irtesam , Mohamed Mazin , Swaminathan Christie , Uheba Mokthar , Sajid Muhammad
Published: November 2022

Aims

The aim of the study was to assess the appropriateness of surgical virtual clinic practice (VC) in the University of Sussex hospitals.

Methods

A retrospective assessment of Six consecutive clinics of three consultants, a total of 216 patients, was audited according to guidelines of the Royal College of Surgeons (1). Additionally, feedback forms were obtained from ten Consultants and matched against RCS guidelines. Ethical approval was obtained from the quality improvement department.

Results

The study cohort mean age was 67 (20–94) years with 1: 1.2 female to male ratio. VC site was 68% from home. The VC attendance rate was 97.5% (2.5% DNA rate) and 93% patients were suitable for VC appointment because 2.8% needed physical examination and remaining percentage was not suitable due to hearing impairment and language barrier. Telephone was the mode of virtual consultation in addition to 100% documentation and 100 conclusion documentations. Four blocks of RCS guidelines compliance based upon the opinion of the consultant surgeon was reported from 65% to 97.5%.

Conclusion

The attendance of VC clinics was 97.7% with suitability for VC up to 93%. There was a good compliance with RCS guidelines reaching up to 97.5%. However, few areas which needs improvement are obtaining consent (documentation if consent was taken), confirmation of alternative contact details, length and details of VC and reassurance that VC is equivalent to face to face clinic in terms of service provision.
EP-270 A meta-analysis of the randomized controlled trials exploring the effectiveness of oral versus topical use of metronidazole following excisional haemorrhoidectomy
Authors: Imsirovic Anja , Baig Mirza K , Sains Parv , Sajid Muhammad S
Published: November 2022

Objective

Metronidazole has been proven an effective proctological analgesic and antimicrobial agent in patients undergoing excisional haemorrhoidectomy. The aim of this article is to evaluate the efficacy of topical versus oral administration of metronidazole to in controlling the post-operative pain following excisional haemorrhoidectomy.

Method

A comprehensive systematic search was undertaken with the help of local librarian and relevant published randomized controlled trials (RCT) were shortlisted according to the inclusion criteria. Summated outcomes of the poste-operative pain on day one and day seven were analyzed using the principles of meta-analysis on RevMan 5 statistical software.

Result

Two RCTs on 286 patients undergoing excisional haemorrhoidectomy were included in this review. There were 143 patients in topical metronidazole group and same number of patients were in oral metronidazole group. the antibiotics group (AG) and 877 patients in the no-antibiotics group (NAG). In the random effects model analysis, day 1 [standardized mean difference -0.06, 95% CI (-0.30–0.17), z = 0.55, p = 0.59] and day 7 [standardized mean difference 0.09, 95% CI (-1.29–1.47), z = 0.12, p = 0.90] post-operative pain score was statistically similar in both groups. There was significant heterogeneity [Tau2 = 0.96, chi2 = 32.49, df = 1; p = 0.00001, I2= 97%] between included trials.

Conclusion

Both topical and oral administration of metronidazole as post-haemorrhoidectomy proctological analgesic is an effective modality. However, this evidence is based upon the findings of two RCTs on 286 patients and should be taken cautiously. A major, high quality RCT is mandatory to validate these findings.