bluuebunny/crossref_metadata_2025 huggingface dataset:
265 Group and Saves for Laparoscopic Cholecystectomies: An Unnecessary Expense?
Authors: Cole K , Jamnadass E , Ward J , Hou D
Published: November 2022

Aim

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.

Method

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 month, 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.
409 Evaluation of Advanced Bimanual Skills in Novices Using the Wrist-Like FlexDex™ Articulating Laparoscopic Needle Holder in 2D and 3D Vision: A Randomised Trial
Authors: Farzaneh SB , Motahariasl N , Motahariasl S , Kokotkin I , Sousi S , Zargaran A , Zargaran D , Patel B
Published: November 2022

Aim

The aim of this study was to evaluate the novice performance of advanced bimanual laparoscopic skills using the articulating FlexDex™ laparoscopic needle holder in two-dimensional (2D) and three-dimensional (3D) visual systems.

Method

In this prospective randomised trial, novices (n=40) without laparoscopic experience were recruited from a university cohort and randomised into two groups, which used the FlexDex™ and 2D or the FlexDex™ and 3D. Both groups performed 10 repetitions of a validated assessment task. Times taken and error rates were measured, and assessments were made based on completion times, error rates and learning curves.

Results

The intervention group that used FlexDex™ and 3D visual output completed 10 attempts of the standardised laparoscopic task quicker than the control group that used FlexDex™ with standard 2D visual output (268 seconds vs 415 seconds taken for the first three attempts and 176 seconds vs 283 seconds taken for the last three attempts, respectively). Moreover, each attempt was completed faster by the intervention group compared to the control group. The difference in average time for the first three and last three attempts reached statistical significance (P < 0.001).

Conclusion

Combination of 3D visual systems and the FlexDex™ laparoscopic needle holder resulted in superior task performance speed, leading to shorter completion times and quicker learning effect. Although the 3D group demonstrated lower mean error rates, it did not reach statistical significance.
916 The Use of Absorbable Suture Versus Staples Versus Tissue Glue in Laparoscopic Port Skin Closure. a Prospective, Randomised Control Trial. the STILS Trial
Authors: Ramjit SE , Donlon NE , Nugent T , Kelly M , Ravi N , Neary P , Donohoe C , Reynolds JV
Published: November 2022

Aim

The closure of surgical wounds following laparoscopic surgery is not currently standardised. The aim of this study was to compare the three main methods of closure – Stitches, Staples, and Tissue Glue to evaluate which of these produce optimum cosmetic outcomes, results in least wound complications and which is most cost-effective. This would enable the adoption of a standard protocol for closure of laparoscopic wound sites.

Method

This was a prospective, randomised controlled trial. Patients undergoing elective, laparoscopic surgeries were consented and randomised into one of the three treatment arms (Stitches–Subcuticular 4–0Monocryl;Skin Staples or Tissue Glue). Pre-defined, specific guidelines for each of the closure methods were followed. Data recorded at the time of surgery included: Number/Size of Port Sites, time taken and Quantity of closure material used. At an interval follow-up appointment, the wounds were evaluated using the ‘Patient and Observer Scar Assessment Scale’ (POSAS), wound complications recorded, and photographs taken to facilitate further evaluation by a third-party clinician.

Results

A total of 147 patients were recruited with 138 completing full follow-up. In the ‘Sutures’ arm the average Observer Scar Score(OSS) was 10.3;Patient Scar Score(PSS) was 12.6;Rate of wound closure(RWC) 4.3mm/min;Wound complication rate(WCR) 0.08%;Cost €4.22/patient. The ‘Staples’ arm demonstrated an average OSS-13.1;PSS-16.4;RWC-15.7mm/min;WCR-0.06%;Cost €21.97/patient(excluding labour for ROS). In the ‘Tissue Glue’ arm there was an average OSS-15.7;PSS-18.4;RWC-5.1mm/min;WCR-.19%; Cost €21.10/patient.

Conclusions

Laparoscopic port site closure with 4–0 Monocryl was most superior with regards to cosmetic outcome and cost-effectiveness. Staples was the fastest method of closure and lowest complication rate.
64 The Radial Forearm Free Flap Versus the Nasolabial Flap in Adults Having Reconstructive Surgery for Oral Cancer: A Comparison of Quality-of-Life Outcomes
Authors: White M
Published: November 2022

Background

The radial forearm free flap has classically been used in oral reconstructions, however, there has been research into an alternative option, the nasolabial flap. Surgical research is focussing more on quality-of-life outcomes to measure a successful recovery. Therefore, this review has a focus on QOL as well as functional outcomes.

Aim

To determine if there are better QOL outcomes between patients undergoing tongue reconstruction with the NLF or the RFFF. The quality and limitations of the included papers will be discussed.

Method

Four databases were searched using set search terms and inclusion/exclusion criteria. Fourteen final papers were assessed using a CASP checklist and a bias tool.

Results

Four papers lost patients to follow-up; one provided no information, and one excluded three patients from follow-up, leaving nine papers with complete follow-up data. Eight studies used subjective measurements for functional outcomes; two used objectives; three used both; and one study used objective measurements for speech, but no information was provided for swallowing. A variety of outcome measures were featured; despite this, all the papers found good functional and QOL results at follow-up. There were problems with bias throughout all the papers and several reoccurring limitations such as small sample size and the retrospective nature of all but one study.

Conclusions

Due to the significant amount of bias found, the low quality of literature available, and discrepancies between outcome measures, further research is needed in the form of a long-term prospective study with a larger cohort that includes some objective outcome measures.
390 Assessing Biocompatibility & Mechanical Testing of 3D-Printed PEEK Versus Milled PEEK in Maxillofacial Surgical Applications
Authors: Limaye N , Veschini L , Coward T
Published: November 2022

Aim

PEEK (poly-ether-ether-ketone) is an innovative thermoplastic polymeric biomaterial used in Maxillofacial Surgery. As opposed to metallic implants, PEEK implants can be 3D-printed specifically for patients and do not suffer stress shielding effects- a major cause of implant failure. This investigation aimed to compare mechanical integrity and biocompatibility of modern 3D-printed PEEK implants against traditionally produced Milled-PEEK implants and metallic biomaterials e.g., Titanium.

Method

Fused-deposition-modelling and non-CNC Milling were used to produce ASTM/ISO-designed PEEK samples. Samples were designed and produced using the Apium P155 FDM-3D-printer, Fusion 360 and Simplify3D software. Fracture Toughness KIc, Tensile Strength, Vickers micro-hardness and 3-point flexural strength tests were performed. Cell adhesion on sandblasted 3D-printed PEEK was evaluated by culturing primary human endothelial cells and osteoblasts (HUVEC, HOBS) and evaluating cell growth.

Results

Milled PEEK had higher tensile strength (p=0.022), higher flexural strength (p<0.0001) and higher fracture toughness (p=0.003) than FDM-printed PEEK. However, FDM-printed PEEK demonstrated higher microhardness than Milled PEEK (p=0.014). Both FDM and Milled PEEK showed mechanical strength values in normal ranges of cortical bone, and close to ranges of alternative bone-replacement biomaterials. Both HOBS and HUVEC demonstrated strong adhesion to PEEK with >95% viability.

Conclusions

3D-printing of PEEK is an emerging technology with advantages over milling and metallic biomaterials in implant production. Nonetheless, this manufacturing modality may produce 3D-printed PEEK devices with lower mechanical resistance parameters compared to milled PEEK, but with values compatible with natural bone. Sandblasting is a modality to create uniform micro-rough surfaces potentially enhancing osseointegration of PEEK implants with host tissue.
537 Oro-Nasal Fistula: A Very Rare Complication Following Routine Palatal Biopsy
Authors: Yasen Z , Smith M , Mani R , Chung A
Published: November 2022

Biopsies of the palate are generally well-tolerated with known complications of pain, bleeding, or infection, that can usually be well-controlled. We report a case of a 63-year-old male who developed a rare complication following a biopsy of an ulcer on the junction between hard and soft palate. Despite an uneventful routine biopsy, the patient presented with an oro-nasal fistula and complaints of nasal discharge. The cause of the fistula was unclear, and the histopathology results excluded malignancy. The possible hypotheses considered for this very rare and unusual complication were infection, vascularity, and underlying systemic co-morbidities. We believe in this case that the cause of wound breakdown was secondary to loss of vascularity of the mucosa from his CPAP device. The patient has since been referred to a tertiary unit for consideration of surgical repair. To the author's knowledge, there are no similar published reports of such complications following routine palatal biopsy.
565 Gorlin Syndrome: A Case of Recurrence of Odontogenic Keratocysts
Authors: Quek J , Al-Gholmy M
Published: November 2022

Gorlin Syndrome (GS) is a rare condition with multisystemic manifestations. Known features include basal cell carcinomas, odontogenic keratocysts (OKCs), and skeletal abnormalities. Multidisciplinary involvement is paramount with surgical intervention as a common treatment modality. Multiple OKCs with recurrence is common in GS. However, limited up-to-date guidelines are available on the appropriate radiographic monitoring of such lesions, in the form of orthopantomogram, in these patients.

This is a case of a 12-year-old girl with GS and multiple episodes of OKCs. She is monitored regularly with the Oral and Maxillofacial team since the age of 3, after her dentist referred her due to her condition and its association with OKCs. A multidisciplinary approach with Dermatology, Pediatrics, Ophthalmology, Ear Nose and Throat, and Orthodontics and Restorative Dentistry within the dental specialty is undertaken to manage her condition.

Yearly clinical reviews of her mouth and radiographs biannually were done, with her first episode of OKCs presenting at 10 years old. Orthopantomogram and magnetic resonance imaging revealed 6 OKCs – 2 in the maxilla, 4 in the mandible. These were surgically enucleated with liquid nitrogen cryotherapy adjunct, alongside extractions of associated deciduous teeth. Eighteen months following this, her OPG showed 2 new OKCs – 1 in the maxilla, 1 in the mandible. These were removed successfully in a similar fashion and active monitoring is ongoing.

This case underscores the importance of regular clinical and radiographic follow-ups due to the frequency of multiple OKCs with recurrence in GS. Long-term multidisciplinary approach in this multisystemic syndrome is also paramount.
868 External Carotid Artery Pseudoaneurysm Following Penetrating Trauma Presenting as an Atypical Parotid Mass
Authors: Cairns M , Fernando S , Balasundaram I
Published: November 2022

Pseudoaneurysm (PSA) of the external carotid artery (ECA) is a rare but potentially lethal clinical entity, with mortality as high as 30%. PSA of the external carotid artery branch vasculature are found consequent to penetrating trauma; infection; vasculitis; iatrogenic injury; radiation therapy and idiopathic causes. Adequate clinical intervention is warranted to prevent rupture and the subsequent neurologic sequelae or death. Management strategies for head and neck PSA have included open vessel ligation, open direct vessel repair, endovascular embolization of the parent vessel or the pseudoaneurysm itself. While surgery was once the standard treatment for PSA, later endovascular approaches have become effective alternatives with minimal morbidity and high success rates.

Here we present a complex case of 37yo man who presented with an atypical parotid mass to the emergency department. History revealed several attendances to the primary care, and the emergency department, due to painful enlargements of the mass. Imaging later identified the mass as a PSA secondary to historical penetrating trauma of the left neck. The clinical presentation and diagnosis of this condition is explored. We discuss the initial unsuccessful endovascular embolization and stenting of the ECA, and the subsequent multi-disciplinary decision for surgical excision months later. This case highlights the importance of obtaining an appropriate history; clinical exam; special investigations to consider the differential diagnoses of parotid mass and specifically the management of PSA in the Head & Neck.
932 The Use of Medical & Dental Clinical Healthcare Apps by Dental Core Trainee Groups in Scotland
Authors: Cairns M
Published: November 2022

Introduction

The development of healthcare applications and their use has increased significantly in clinical practice. A variety of different applications are available covering clinical guidelines, prescribing advice and productivity. These applications may aid clinical decision making and improve patient care

Aim

This survey aimed to determine the use of the medical & dental healthcare applications within the Dental Core Trainee group (DCT) and describe the demographics of the population using them.

Method

An electronic questionnaire was distributed to DCT groups in Scotland between May and July 2018. The questionnaire collected demographic data and type of application used. Trainees also provided comments on their experiences.

Results

49 responses were received with 14 different apps described. SDCEP(89%) and BNF(63%) apps were used most commonly. 22% of respondents describe using apps daily with 73% reporting at least monthly. The average app use was 2 per person. SDCEP(89%) and BNF(63%) apps were most common. DCTs in OMFS (36%) use more apps (4) and do so more frequently. This may reflect the nature of the work undertaken. 66% were using Apple i0S devices. 51 comments were obtained about the perceived advantages and disadvantages of apps. Respondents praised the benefits of app updates, but report concerns about the reliability and quality assurance. The use of mobile phones in clinical settings also generated contrasting responses. App use does not appear age or sex linked.

Conclusion

Applications are used regularly within the DCT group but questions about their quality and appropriateness in the clinical setting remain.
337 Comparison of Outcomes, Signs, and Symptoms of Traumatic Posterior Fossa Epidural Hematoma (PFEDH) Patients Who Managed Surgically Versus Conservatively: A Systematic Review and Meta-Analysis
Authors: Aljabali A , Altal M , Jbarah O
Published: November 2022

Aim

To compare patients with PFEDH who managed surgically versus conservatively in terms of signs and symptoms at admission and outcomes at follow-up.

Method

This systematic review was performed according to PRISMA guidelines on four databases: PubMed, Scopus, EBSCO, and Cochrane central up to December 20th, 2021.

Result

Eighteen observational studies including 713 patients were assessed quantitatively. The proportion of patients achieved a Glasgow Outcome Scale (GOS) score of 5 was higher in the conservative group (Odds Ratio [OR] = 3.588, p < 0.001) and odds of mortality were lower in the same group (OR = 0.210, P = 0.010). Surgical groups were more likely to have vomiting (OR = 3.316, P = 0.049), loss of consciousness (LOC) (OR = 4.584, P = 0.039), and bone fractures (cranial or facial) (OR = 3.223, P = 0.045), but less likely to have headache (OR = 0.342, P =0.032) at the admission time. There was higher proportion of males in the surgical group (proportion in surgical = 71%, p < 0.001 versus proportion in conservative = 54%, p < 0.001).

Conclusion

The initial presentation and overall outcomes of PFEDH patients who managed conservatively usually are better than those who managed surgically. This doesn't indicate that conservative management is used all time, as the treatment option should be in accordance with Brain Trauma Foundation's Guidelines in 2006, that surgical intervention is still the mainstay treatment and conservative management is used upon neurosurgeon's discretion depending on admission neurological status and other many criteria.
637 Choroid Plexus Tumours in the Paediatric Population - a Five Year Review
Authors: O'Kane R
Published: November 2022

Aim

A systematic, qualitative review of the literature available on choroid plexus tumours (CPTs) in the paediatric population, published within the last 5 years.

Method

Medline and Embase databases were used to identify suitable papers, and 70 papers were eligible for inclusion. Inclusion criteria: (1) Paediatric population, (2) Choroid plexus lesions of any grade, (3) Human subjects, (4) Abstract available, (5) Author name available, (6) Abstract in English.

Results

Choroid plexus tumours are rare neuroepithelial tumours. It was found that 74% of CPTs present within the first decade of life. They have a slight male predilection, with a male to female ratio of 1.2:1. The most frequent symptoms found in this study included headache, vomiting, and motor weakness. Both CT and MRI images of CPTs usually demonstrate densely enhancing, multilobulated, intraventricular masses. Choroid plexus tumours can be divided into three histological grades and have been subdivided into 3 methylation groups, which is proposed to be a more accurate classification than histological information alone. The review found that management is one of the most controversial aspects of CPT's. Treatment options include surgical resection, traditional chemotherapy, marrow ablative chemotherapy, and radiotherapy, depending on the case.

Conclusions

Larger cohorts are necessary for prospective, randomised studies are needed to develop a standardised treatment for paediatric patients with CPTs and improve outcomes. As with many low incidence conditions, there appears to be a vicious cycle of low incidences and poor outcomes, which perpetuate limited research into the area alongside a clinical need for better management.
930 Cauda Equina Syndrome Referrals: A Single Centre Experience
Authors: Parwez R , Baig A , Giakoumettis D , Sadek AR
Published: November 2022

Aim

Cauda Equina Syndrome (CES)is a neurosurgical emergency that requires prompt surgical intervention. History and examination performed by referring departments play an imperative role in the triaging of these patients for onward radiological investigation. We aimed to compare radiologically confirmed cauda equina syndrome to the CES referrals to our tertiary unit to elucidate the true regional incidence of CES.

Method

All CES referrals over a 4 year period (2018–2021) made using the electronic patient referral portal, referapatient.orgtm, were collated. The incidence of radiological confirmed CES was identified.

Results

2018: 231 CES referrals of which 26 were radiological CES and accepted (14 female and 12 male).

2019: 151 referrals of which 20 were radiological CES and accepted (14 female and 6 male).

2020: 257 referrals of which 28 were radiological CES accepted (16 female and 12 male).

2021 (first 6 months): 89 referrals of which 16 were radiological CES and accepted (7 female and 9 male).

Conclusions

In 2018–2021 we received 728 CES referrals of which 90 were radiologically CES and required surgical management. There were 51 female and 39 male patients.

211 referrals were from our own Hospital (Hub) while 517 referrals were from 6 other (Spoke) Hospitals. 12.36% had radiological CES.

This represents just over 1 in 10 referrals from secondary care facilities. A greater understanding of the condition via the utilisation of large electronic datasets may facilitate the formulation of novel scoring systems to more accurately appraise cases of putative CES to avoid unnecessary transfers to tertiary centres.
1040 Metabolite Quantification and Entity and Grade Characterisation of Gliomas via Single-Voxel Spectroscopy for Pre-Operative Radiological Diagnosis
Authors: Crispi V , Sanders K , Kenning L , Spink G
Published: November 2022

Aim

Brain tumours pose a diagnostic challenge, but single-voxel spectroscopy (SVS) provides a non-invasive tool to quantify brain metabolite variations reflective of neoplasia, such as NAA, choline (Cho), creatinine (Cr), lipids (Lip) and lactate (Lac). Inconsistency in spectroscopic research and time-patient pressures emphasises the need for reviewing SVS characterisation of gliomas for peri-operative decision-making.

Method

A single-centre, retrospective, observational study, including 93 SVS meaningfully interpretable examinations between 2012 and 2018 (PRESS, TE=35ms, 144ms). Spectroscopic diagnoses were compared to histopathologic reports for overall, entity and grade accuracy analysis. Metabolite ratios to Cr were recorded or obtained from peak area integrals.

Results

High accuracy of lesions discrimination was observed (83–98%). Significant metabolite variation for Cho/Cr (p=0.021) and Cho/NAA (p=0.013) was observed across grades (WHO Grade I-IV). Spectra of astrocytomas and oligodendrogliomas (grade II) were similarly characterised by high Cho, decreased NAA and Cr, and small-to-moderate Lac-Lip and mIns. In contrast, grade III anaplastic oligodendrogliomas (AO) were distinguished from anaplastic astrocytomas (AA) thanks to smaller Lac-Lip and mIns/Cr. Finally, glioblastoma multiforme (GBM, grade IV) displayed high Cho, decreased Cr, the lowest or virtually absent NAA, and the highest Lac-Lip. High-grade spectroscopy, such as enhanced Lac or Lac-Lip, may be an early indicator of grade transformation prior to reflection in histopathology in tumours, which were follow up prospectively.

Conclusion

This study enhanced spectral characterisation of gliomas and discrimination amongst low- and high-grade gliomas. Whilst these aid pre-operative radiological diagnoses, further research is required to investigate spectroscopy predictive of tumour genetics, now necessary for diagnosis.
38 Laparoscopic Surgery Versus Endoscopy in the Management Common Bile Duct Stones: Systematic Review and Meta-Analysis
Authors: Elhag HE , Eltayab O
Published: November 2022

Introduction

The objective of this study is to assess whether a 1 stage Laparoscopic Common Bile Duct Exploration (LCBDE) followed by Laparoscopic Cholecystectomy (LC) should be the gold standard in managing CBD stones by comparing the clearance rate of common bile duct stones, morbidity, mortality, and the duration of hospital stay with ERCP+LC.

Method

This systematic review with a meta-analysis included RCTs of patients who were treated by the LCBDE/LC versus ERCP+LC. RCTs were collected using PRISMA guidelines by 2 authors Independently from Cochrane central register of controlled trials, Medline and Embase. Review Manager was used for Statistical analysis using the Mantel–Haenszel method. The results were plotted on a Forest Plot diagram and then compared.

Results

849 patients from 7 RCTs were included in the study, 426 patients in the ERCP+LC arm and 423 in the LCBDE/LC arm. According to the Meta-analysis, Laparoscopic Common Bile Duct Exploration with Cholecystectomy was significantly superior to ERCP + LC in terms of successful Clearance of CBD stone, mortality rate and Acute Pancreatitis. but had significantly higher rates in biliary leakages. There were no significant differences in Surgical Site Infections, Haemorrhages, Acute Cholangitis, Perforations, or duration of hospital stay.

Conclusion

LCBDE/LC is superior in successful CBD stone clearance, mortality, and acute pancreatitis. Further RCTs will be needed to assess overall Morbidity, surgical site infections, Haemorrhages, Acute Cholangitis, perforations, or duration of hospital stay. Therefore, LCBDE/LC should be considered as the gold standard in clearing CBD stones.
355 Comparison of Outcomes in Surgical and Endoscopic Transgastric Cystgastrostomy for Severe Acute Pancreatitis
Authors: Mountjoy P , Latif J , Bandlamudi N , Austin A , Bhatti I , Awan A
Published: November 2022

Aim

The heterogeneous nature of severe acute pancreatitis (SAP) renders decisions related to complications challenging. A select group of patients may be suitable for surgical (S-CG), which can be performed open or laparoscopic, or endoscopic (E-CG) transgastric cystgastrostomy (TCG) of symptomatic or infected retrogastric pancreatic collections (walled-off pancreatic necrosis (WOPN) or pseudocyst). There is limited data comparing outcomes between these approaches.

Method

Retrospective analysis of all patients that underwent S-CG or E-CG was performed from a single, high-volume benign pancreatic centre between 2012 – 2021 inclusive. Patient demographics, clinical characteristics, and outcomes of these 3 groups was compared. One-way analysis of variance tests was used to compare categorical data.

Results

47 patients underwent TCG: 20 S-CG (12 open and 8 laparoscopic), and 27 E-CG. There was no statistical difference between S-CG and E-CG for age, body mass index (BMI), aetiology, organ failure and type or position of collection. S-CG patients had less burden of pre-existing co-morbidities (APACHE-II and Charlson-Co-morbidity-Index (CCI)) (p<0.05). S-CG patients had shorter length of stay, emergency readmission and reintervention (p<0.05). Those who underwent E-CG had higher burden of intervention due to persistent/recurrent pancreatic collections, with 33% mortality rate (p <0.05).

Conclusions

S-CG, in a select group of patients, provides a single-staged intervention for drainage of transgastric pancreatic collections, especially when they predominantly contain solid necrosis and patient is suitable for general anaesthetic. Outcomes are favourable for S-CG, but multidisciplinary approach is critical to delineate the most appropriate approach for each individual patient.
442 A Comparison of Short-Term Outcomes in Robotic and Laparoscopic Distal Pancreatectomy
Authors: Ding H , Kwaka M , Gall T , Hand F , Jiao L
Published: November 2022

Aim

Technical limitations of laparoscopic distal pancreatectomy (LDP) may translate to high conversion postoperative complications rates. Robotic distal pancreatectomy (RDP) can potentially allow for better visualisation and greater freedom of movement, improving surgical outcomes. The aim of this retrospective observational study is to compare short term outcomes between RDP and LDP.

Method

We retrospectively analysed all RDP and LDP procedures performed at our centre by a single surgeon between December 2009 and July 2021. We recorded demographic data for 62 consecutive LDP cases and 27 RDP cases and compared the perioperative outcomes, 90-day morbidity and mortality.

Results

Both groups were comparable with respect to baseline characteristics. The conversion to open rate was significantly higher in the laparoscopic group (21.0% vs. 3.7%, p = 0.04). Operative time (176.5 min RDP vs. 156.8 min LDP, p = 0.503) and number of operations with clinically significant estimated blood loss (> 500ml) (1 RDP vs. 3 LDP, p = 0.998) was comparable in both groups. For the benign conditions, the spleen preservation rate showed no significant difference between the two groups (14.8 vs. 11.3%, p = 0.729). In both groups, three patients were readmitted within 90 days. There was no 90-day mortality in either group.

Conclusions

According to our results, RDP was equivalent to LDP in nearly all short-term operative outcomes and safety but significantly reduced the risk of conversion to open resection. However, the evidence is limited, and larger multi-centre randomised trials are needed to investigate the long-term outcomes.
525 A Review of Literature on Anatomical Variation of the Extrahepatic Biliary Tree Using Cadaveric Dissection and Imaging Modalities
Authors: Kettyle G , Abdel Meguid E
Published: November 2022

Aim

The aim of this project was to examine world literature to establish the various types and frequencies of anatomical variants within the extrahepatic biliary tree, thereby contributing to the body of information available to anatomists, surgeons, and radiologists. Knowledge of the notoriously variable anatomy of the extrahepatic biliary tree is of greater importance than ever, given the increased occurrence and complexity of hepatobiliary and laparoscopic surgeries.

Method

A database search of MEDLINE, EMBASE and PubMed was conducted in June 2021 and returned 3440 articles, of which 29 were deemed eligible for inclusion.

Results

A rare malposition, the left-sided gallbladder, was observed in 0.04–0.60% across five studies. A normal cystic artery origin, that is, from the right hepatic artery was observed in 73.3–92% with variations being seen from the left hepatic artery (1–1.9%), gastroduodenal artery (1–7.5%) and the aberrant right hepatic artery (3–12.1%). It was also noted that in 3.6–32% of subjects the course of the cystic artery lay extraneous to Calot's triangle. Michels’ and Hiatt's classification systems were used to define the anatomical variations of the hepatic arteries: studies using Michels’ Type III reported a prevalence from 6.4–15%, Michels’ Type VI from 0.6–7% and Hiatt's Type III recorded an incidence ranging from 9.7–14.8%.

Conclusion

The most obvious finding to emerge from this project was the widely variable anatomy of the extrahepatic biliary tract and the contrasting reported data. Surgeons should therefore anticipate such complexities and adapt techniques to avoid biliary and arterial injuries and associated intra- and postoperative complications.
729 Endoluminal Vacuum Therapy in the Management of Boerhaave Syndrome: A Case Series
Authors: Soussi D , Helmi Ahmad Alharahsheh B , Stevens S , Boshier P , Karim S , Hoare J , Direkze N , Ekpe J , Peters C
Published: November 2022

Background

Boerhaave syndrome is a rare condition associated with poor prognosis: high morbidity and mortality. Prompt intervention greatly improves outcomes, with surgery being the mainstay of management. Recent advances in therapeutic endoscopy have led to increasing interest in endoluminal vacuum therapy (EVT). EVT is a minimally invasive technique, allowing wound debridement and drainage, and granulation tissue formation. EVT has been associated with excellent clinical outcomes, including lower mortality rates when compared to surgery and stenting. EVT has been adopted into practice across Europe, however, only two cases have been reported in the UK. We report three cases of Boerhaave syndrome, successfully managed with EVT, using the EsoSPONGE ® (B.Braun, Medical Ltd, Sheffield, UK).

Method

EVT involves the placement of a polyurethane sponge into the wound cavity. The cavity is initially assessed endoscopically before an overtube is introduced. The sponge is pushed into the cavity through the overtube, and the overtube is removed. Sponge position is confirmed and adjusted if necessary. The sponge is connected via a trans-nasal drain to continuous negative pressure suction and is changed every 3–5 days.

Results

Having been deemed surgically unfit, all three patients were referred for EVT, using the EsoSPONGE. All patients made excellent recovery and were discharged home.

Conclusions

EVT is an effective management strategy for surgically unfit Boerhaave syndrome patients. EsoSPONGE use aided drainage of the septic focus and closure of the defect, leading to complete recovery. Our findings support the existing evidence that EVT is a promising solution for Boerhaave syndrome.
398 Acute Paediatric Appendicitis (AA)- Decreasing the Negative Rate of Appendicectomy in a District General Hospital
Authors: Karagiannidis G , Youssef F
Published: November 2022

Aim

Globally Acute appendicitis (AA) is the most common general surgical emergency. A recent consensus study has proposed a negative appendicectomy rate of 10%. Our aim is to monitor and reduce the negative rate of paediatric appendicectomy and optimise the acute paediatric management following the newly introduced workflow.

Method

Retrospective patient data collection via electronic sources (Evolve discharge summary, Operation notes) for all paediatric patients (0–16 years old) admitted with AA between March 23rd and October 31st, 2020.

Results

We separated our audit in three different periods of time. In the first period, 5 out 20 (25%) who underwent an appendicectomy had a normal appendix on histological analysis. In the second period (from June to August) we introduced a paediatric assessment workflow and managed to decrease the negative rate of appendicectomy from 25% to 19%. During the third period (from September to October 2020) the negative rate of appendicectomy decreased to 11%, 14% less than our initial result. More patients underwent an US prior CT as part of routine screening in order to avoid a negative appendicectomy. The initial percentage of US scanning was 72% and was increased to 90% after the end of the third period. Additionally, conservative management was 20% and was increased to 24% after the end of the third period.

Conclusions

Due to the results of this study, the paediatric appendicitis workflow in daily practice has resulted in more patients being treated conservatively.
628 A Rare Case of Bilateral Abdominoscrotal Hydrocoele in a 10-Month-Old Infant
Authors: Shkoukani ZW , Al-Taher RN , Naser S
Published: November 2022

Abdominoscrotal hydrocoeles (ASH) are an increasingly rare form of hydrocoeles. Reported incidence rates are currently estimated between 0.18–3% of all hydrocoele cases. They can present in any age group, however they are more commonly reported amongst the paediatric population. Although not yet confirmed, the aetiology of ASH has been under scrutiny for the past two centuries, and scarcity of reported cases hinders this process. Clinical examination is oftentimes sufficient to make the diagnosis, however confirmatory ultrasonography is recommended. Although old reports favoured a more conservative approach with watchful waiting, the risk of serious secondary complications is high, and surgical intervention is hence considered standard of care. Different approaches have been described, each with their own benefits, with minimally invasive surgery becoming more prevalent as of late. In this case report a 10-month-old boy with bilateral abdominoscrotal hydrocoeles is presented. Overall, the surgical procedure is considered to be a difficult one, due to the fact that in many cases the hydrocoele attaches itself to the cord structures along with a thickened tunica vaginalis which can be difficult to access regardless of technique. Aspiration of the fluid prior to dissection of the membrane can thus help facilitate easier access. The use of laparoscopy in the treatment of ASH is becoming commonplace, with the added benefit of a confirmatory as well as a therapeutic role. Laparoscopic approach was employed in our case and had satisfactory results with no signs of recurrence on follow-up.
764 Paediatric Emergency Appendicectomy in a District General Hospital: A Review of Current Practice
Authors: Armstrong L , Ali T
Published: November 2022

Aim

Appendicitis is one of the most common surgical pathologies amongst children, with approximately 80% in the UK admitted and managed in district general hospitals. The Royal college of Surgeons paediatric emergency appendicectomy commissioning guidelines state a negative appendicectomy rate should be <15% and <1% should be admitted following a prior discharge with no intervention. We aimed to review current practice and adherence to guidelines.

Method

A retrospective review was carried out of all paediatric patients admitted with suspected appendicitis, in a single centre over a 1-year period. Demographics, pre-operative investigations, technique, histology, length of stay, readmissions, complications, and transfers to tertiary centres were recorded.

Results

Total of 101 patients admitted within audit window with a median age of 9.5 years, 50.5% male. Average length of stay was 2 days. Total of 30 appendicectomies performed (63.3% laparoscopic). Negative appendicectomy rate 23.3% (n=7). Seventeen underwent a pre-operative ultrasound, 2 of which confirmed appendicitis and proceeded to an appendicectomy. The remaining 15 were successfully discharged. 28-day readmission rate returned at 5.94%. 1 (0.99%) patient was readmitted following a prior discharge with no intervention and subsequently underwent an appendicectomy, revealing acute appendicitis. No patients were transferred to a tertiary centre.

Conclusions

Overall, favourable comparison to published guidelines, however higher than optimal negative appendicectomy rate. Utilisation of preoperative ultrasound may aid towards the reduction of this figure. Guideline also states patients should be taken to theatre within 12 hours of decision to operate. Further review of patient's notes should be performed to determine this.
788 Caecal Duplication Cyst: An Unexpected Cause of Bowel Obstruction in a 12-Year-Old
Authors: Dale J , Mclean E , Gupta T , Healy C
Published: November 2022

We report the case of a rare cause of bowel obstruction in a 12-year-old girl who presented with a short history of abdominal distension and vomiting after a month of unexplained urinary frequency and weight loss. Abdominal radiographs demonstrated small bowel obstruction with an unknown pelvic mass. A raised CA125 suggested a possible ovarian lesion and a magnetic resonance scan was interpreted as supportive of this pathology. Intra-operatively a 120x90x70mm cystic mass was found attached to the caecal serosa, immediately adjacent to the ileocaecal valve. There was an associated 180-degree twist of the terminal ileum and ascending colon. A limited right hemicolectomy was performed, and histopathology confirmed the diagnosis of a caecal intestinal duplication cyst. Post-operatively she has recovered well, with resolution of her obstructive and urinary symptoms. Given the unusual age of presentation, uncommon location of the cyst and the diagnostic challenges incurred, the authors wish to share their experience of managing an atypical duplication cyst.
240 Flexor Digitorum Profundus Tendon Segment Length Estimation via Measurement of Adjacent Landmarks in the Secondary Repair of Jersey Finger
Authors: Sehmbi A , Syed M , Shah S , Parry D
Published: November 2022

Aim

Jersey finger describes injury involving the rupture of a Flexor Digitorum Profundus (FDP) tendon. The rupture occurs at its point of insertion, at the base of the distal phalanx. Cause of injury is forced hyperextension of FDP. Correct tendon tensioning correlates with tendon length during repair and is vital to optimise restoration of function. No evidence-based approach to tendon tensioning exists hitherto. We used cadaveric dissection to measure anatomical landmarks associated with the FDP tendon and assess whether these can be used to estimate the length of the adjacent tendon segments.

Method

Eight cadaveric hands were dissected (four fresh-frozen and four formalin-fixed). Lumbrical muscles, A1 pulley and distal FDP insertion for digits II-IV were identified. Lengths between the most distal point of the lumbrical origin; proximal and distal ends of the A1 pulley and FDP insertion were recorded.

Results

Measurements involving the A1 pulley showed a great degree of variation and no clear trend across the digits studied. Conversely, lumbrical origin to FDP insertion lengths were consistent relative to the adjacent digit measurements across all cadavers for digits II, II and IV. This was confirmed by a linear regression analysis (R2 >0.97).

Conclusions

This study demonstrates how distal lumbrical origin to FDP tendon insertion measurements in digit III can be used to estimate the length of the tendon graft required in digit II or IV, during repair. This injury manifests most commonly in digit IV. Therefore, our finding furthers surgical knowledge and is likely to improve patient outcomes.
294 Stem Cell Enriched Fat Grafts Versus Autologous Fat Grafts for Facial Reconstruction: A Systematic Review and Meta-Analysis
Authors: Karam M , Abul A , Kahlar N , Naik A , Tay J , Rahman S , Matteucci P
Published: November 2022

Aim

To compare the results of stem cell-enhanced fat grafting to autologous fat grafting for face reconstruction.

Method

A systematic review and meta-analysis were carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines, and an electronic search was carried out to identify all Randomised Controlled Trials (RCTs), case control studies, and cohort studies comparing the outcomes of stem cell-enrichment fat grafting versus routine fat grafting for facial reconstruction. The primary outcome measures were volume retention and infection rate. Secondary outcome measures included post-surgery patient satisfaction, redness and swelling, fat necrosis, cysts, and operation time. For the analysis, fixed and random effects modelling were utilised.

Results

Eight studies with a total of 275 participants were assessed. In terms of mean volume retention, there was a significant difference between the stem cell-enrichment fat grafting and routine grafting groups (standardised Mean Difference [MD] = 2.49, P 0.00001). However, there was no significant difference in infection rates between the two groups (OR = 0.36, P = 0.30). Except for the operation duration, which was shorter in the latter, the intervention group had similar results to the control group for all secondary outcomes.

Conclusions

When compared to conventional fat grafting, stem cell-enriched fat grafting is a better alternative for facial reconstruction surgery since it enhances mean volume retention and does not worsen patient satisfaction or surgical complications.
305 Improving Clinic DNA Rates with a Patient Initiated Follow Up Pathway: A Cohort Study
Authors: Katsura C , Tomouk T , Gathura E , Miranda BH , Zweifel CJ
Published: November 2022

Introduction

A Patient Initiated Follow-Up (PIFU) pathway was implemented in 2019; this enabled patients with specific plastic surgery trauma diagnoses to request a consultant clinic review within 3 months, without a routine follow-up appointment being made. PIFU aims to reduce ‘did not attend' (DNA) rates in line with the Royal College of Surgeons of England Outpatient Clinics Guide.

Aim

To assess the impact of PIFU on DNA rates of plastic surgery trauma clinics.

Method

A prospective cohort study of plastic surgery PIFU outpatient clinic DNA rates was undertaken (1st January–31st October 2021) and compared to data held for pre-PIFU pathway DNA rates (1st January–30th June 2018); inclusion dates for 2021 were extended to achieve comparable sample sizes for patient numbers routinely booked into clinics. DNA rates were collected from the hospital clinic database. Data were analysed using IBM®SPSS®. The Kolmogorov-Smirnov test was performed to assess sample population distribution, and the Chi2 test was used to compare categorical data.

Results

A total of 1702 patients were included in the study. Pre-PIFU, there was an 18% (149/823) DNA rate for patients (31.4 years ± 18.45 years) (mean age ± SD) booked into routine Consultant clinic follow-up. Post-PIFU, there was a 9% (77/879) DNA rate for patients (31.1 years ± 20.77 years) booked into routine Consultant clinic follow-up. This represents a significant reduction in DNA rates by 9% (Chi2=7.49, p<0.01); non-operatively managed hand fracture patients were the most frequent non-attenders.

Conclusions

The PIFU pathway has significantly reduced trauma clinic DNA rates.
378 Comparison of Outcomes Between Early and Delayed Weight Bearing Following Lower Limb Free Flaps
Authors: Roman M , Al-Khalil M , Emam A , Marsden N
Published: November 2022

Aim

Post-operative protocols following lower limb free flap surgery are not well defined with a lack of consensus in the literature around limb dependency and weight bearing. The aim was to compare the complication rate for lower limb free flaps before and after the introduction of an enhanced lower limb free flap protocol with earlier dangling (day 3 vs day 4) and weight bearing (day 5 vs day 14) post lower limb free flap surgery.

Method

All lower limb free flaps between June 2020-October 2021 were identified from a departmental flap database. Patient data was collected retrospectively from the comprehensive lower limb free flap database, medical notes and electronic records. Exclusion criteria was any patient prescribed non-weight bearing due to the method of bone fixation.

Results

A total of 30 patients, 14 pre- and 16 post-enhanced protocol were identified for comparison. Mean age was 43 (17–72) with a M:F of 2:1 and RTC as the most common mechanism of injury. There was no difference in the type of flap reconstruction between groups, with the anterolateral thigh flap the most common in both groups. No differences were identified in the number of complications related to dependency/weight bearing before and after the introduction of the enhanced protocol, with mean length of stay reduced from 12 to 11 days.

Conclusions

The new enhanced protocol remains the standard of care in our unit, as we demonstrated a reduction in length of stay with no difference in complication rates following lower limb free flap surgery.