bluuebunny/crossref_metadata_2025 huggingface dataset:
1582 Radiolucent Foreign Bodies Presenting As IBD- The Case of An Ingested Plastic Straw Disguising as Crohn’s Disease
Authors: Wadham B , Connolly T , Satchidanand R
Published: October 2021

Ingested foreign bodies (FBs) occur most commonly in children or adults with impaired neurological function. Overall, 80% are thought to pass spontaneously in the faeces, with around 20% requiring endoscopy and less than 1% requiring surgical intervention. ‘Missed’ gastro-intestinal FBs are rare and often due to the lack of an obtainable history in patients with communication difficulties.

We present the unusual case of a 27-year-old female with severe learning difficulties and a complex surgical history who presented with a 2-year history of increasing abdominal discomfort due to a ‘missed’ FB. Four CT scans had misdiagnosed Crohn’s disease and the patient was due to commence immunosuppression when she developed a small bowel perforation. This was managed conservatively and follow-up imaging with a CT with oral contrast detected the FB in the ileum. The patient underwent a laparotomy with resection of a 26cm segment of ileum containing a plastic straw. Post-operatively she recovered uneventfully and is now symptom free with no evidence of IBD on histology.

This case highlights the value of oral contrast enhancement imaging in patients who don’t fit a ‘classical’ inflammatory bowel disease presentation.
1588 A Rare Case of Arteriovenous Malformation Following TMJ Arthroscopy: A Case Report and Review of The Literature
Authors: Farooq S , Sarai R , McMillan K
Published: October 2021

Patients undergo temporo-mandibular joint (TMJ) arthroscopy as part of the diagnosis and management of chronic pain in the TMJ. Known complications of the procedure include bleeding within the joint spaces, lacerations of the external auditory canal and local nerve damage. We present the case of a 25-year-old woman who developed an arteriovenous fistula in the right pre-auricular region secondary to TMJ arthroscopic examination. She had presented with ongoing TMJ pain necessitating further investigation with arthroscopy. Following her procedure her TMJ symptoms improved, however she developed right pre-auricular swelling of gradual onset, right-sided headaches, and pulsatile tinnitus. Due to her pregnancy of around 16 weeks this was originally linked to expansion in plasma volume and hyperdynamic circulation; however, this was later diagnosed as an extremely rare, post-operative complication of TMJ arthroscopy. Her examination revealed a pre-auricular pulsatile swelling measuring approximately 1.5 cm. Blood tests including ESR and CRP were within normal limits excluding temporal arteritis. An ultrasound scan revealed an AV fistula of the right superficial temporal artery; Her MRI confirmed single vessel supply. Following discussion in the vascular anomalies MDT, she underwent embolisation with PHIL and surgical excision via a preauricular approach. The procedure was successful, and the patient made a full recovery. The literature reports very few cases of iatrogenic arterio-venous fistulas resulting from TMJ arthroscopic surgery. Our case emphasises the importance of a multidisciplinary approach in combining embolisation with surgical excision resulting in the successful management of a rare post-operative complication.
1610 Haemangiomas of the Small Intestine: Poorly Known Cause of Abdominal Pain
Authors: Mohamed B , Soric I
Published: October 2021

Background

Haemangioma of the small intestine is a rare disease in adult patients and is usually located in the jejunum. The usual clinical features include abdominal pain, bleeding, and obstruction. Acute intestinal bleeding leading to anaemia is the most common presentation in most patients. Intussusception and even perforation caused by cavernous haemangioma are extremely rare

Case Summary

we report a 31-year-old male with a right upper quadrant pain, nausea, elevated CRP. ultrasound abdomen suggestive of hepatic haemgioma whereas the CT abdomen showed left upper quadrant mass. He had laparoscopy converted the laparotomy showed5*5cm small intestine mass. small bowel resection and anastomosis was done. Histology has confirmed haemangioma.

Discussion

Small bowel haemangioma accounts for 5 to 10 % of all benign neoplasms of the small intestine. It is thought to be one of the congenital benign vascular lesions. Haemangiomas are classified as cavernous, capillary, or mixed type, and the cavernous type is the most common Malignant change is quite unusual. Multiple lesions are often associated with similar neoplasms in other organs, such as the liver and skin.

Conclusions

Small intestine haemangioma are often very difficult to diagnose. Early diagnosis and appropriate intervention could provide good outcomes. Diagnostic and therapeutic measures should be taken to avoid further complications.
1613 A Case Study Implementing A Strength Training Programme with The Aim to Reduce the Risk of Osteosarcopenia And Bone Fractures
Authors: Said Noor M , Chawla M
Published: October 2021

Aim

Strength training induces a mechanical load, both increasing muscle mass and enhancing osteoblast activity. This results in increased muscle and bone strength, reducing the risk of osteosarcopenia. Osteosarcopenia can start after the age of 30, putting patients at increased risk of bone fractures, with an untrained individual losing 0.23kg of muscle mass per year. In this case study, we illustrate a training programme, implemented over a period of 4 weeks on an untrained individual. The aim is to set an exemplar strengthening regimen for patients to reduce their risk of developing osteosarcopenia and bone fractures.

Method

One untrained novice subject was recruited. Two physical profile measurements were taken, prior to the start of the programme and at its conclusion. These included height, weight, BMI, lean body mass, muscle circumference and 1 repetition max (1RM) for upper body strength (bench press) and lower body strength (deadlift and squat).

Results

The subject had increased strength performance with increased 1RM, or equivalent, in the deadlift (+2.9kg), squat (+3kg) and bench press (+2.5kg) He also had a small increase in lean body mass of 0.1kg and increased body circumference in all muscle groups.

Conclusions

Our study shows that a simple strength training programme performed independently can lead to improved muscle strength and increased lean body mass. We illustrated that the programme can be performed inexpensively. Forthcoming, we would like to perform a prospective cohort study with the aim to implement a standardised programme within national guidelines for fracture risk-reduction.
1630 Laparoscopic Repair of Linea Arcuata Hernia Presenting as Generalised Abdominal Pain - a Case Report
Authors: Sayers A , Ain Q , Thomas R , Laliotis A
Published: October 2021

Background

Arcuate line hernia (LAH) is an abnormal ascending herniation of intraperitoneal structures over the linea arcuate, between the rectus abdominus muscle and the posterior layer of its sheath. It is a rare clinical entity often associated with non-specific abdominal pain, posing a significant diagnostic challenge. The true prevalence is unknown, and diagnosis is almost always radiological.

Case Report

We report the case of a 57-year-old lady investigated extensively for frequent episodes of generalised abdominal pain. No palpable hernial defect or other pathology was identified on clinical examination. Subsequent computed tomography(CT) of the abdomen and pelvis revealed a 95 x 74 mm arcuate line hernia(LAH) anterior to the transversalis fascia, containing small bowel loops. She underwent an elective laparoscopic repair involving closure of the hernial defect with 2-0 knotless barbed sutures and reinforcement with a 20 x 15 cm underlay mesh. Postoperative recovery was uneventful, with complete resolution of her symptoms. One year after the repair there were no signs of recurrence.

Discussion

To our knowledge, only eleven prior cases of symptomatic LAH have been reported in the literature. There is no conclusive evidence regarding most appropriate diagnostic imaging, treatment approach and follow up regimen. Clinical diagnosis is difficult. Existing literature suggests use of CT scan as the primary imaging modality for diagnosis. The laparoscopic approach is safe, feasible and has certain advantages. This includes confirmation of diagnosis, excludes the presence of concomitant hernias and enables inspection of herniated viscera. Prosthetic mesh reinforcement is considered to minimise recurrence. Long term follow-up of these patients is required
1664 A rare case of Stenotrophomas maltophilia affecting an ACL Endobutton: A Case Report and Review of the literature
Authors: Adewusi M , Roy K , Joshi Y
Published: October 2021

Background

Stenotrophomas maltophilia (SM) is a ubiquitous opportunistic gram-negative bacillus known to cause hospital acquired infections, commonly in immunosuppressed individuals. However, occurrence of this microorganism is rarely reported in the musculoskeletal system. We report a case of a young healthy man with recurrent knee swelling caused by SM. This organism has been reported to form biofilms over orthopaedic implants, with increased resistance to antibiotic therapy, making it difficult to eradicate once established.

Case Report

A 34-year-old man with psoriasis and asthma presented with right knee swelling and pain, and no history of preceding trauma or fever. He has a past surgical history of anterior cruciate ligament tear and underwent reconstruction with an endobutton two years prior, and a lateral meniscal repair treated in the previous year. At presentation, he was apyrexial and was noted to have a moderate right knee effusion. Initial radiographic imaging identified a large joint effusion with no obvious evidence of bone destruction, laboratory studies also showed a raised white cell count of 11.4 *10^9/L, C-reactive protein of 54mg/L and aspiration cultures were negative. He subsequently underwent numerous washouts, and removal of endobutton with open synovial biopsy which showed SM. The organism was sensitive to cotrimoxazole. The patient had appropriate antibiotics with resolution of symptoms, however he still presented with recurrence.

Conclusions

The persistence of SM despite intervention makes it difficult to treat. Although a rare organism, surgeons should consider it as a differential in recurring knee effusion with orthopaedic implants, and institute early and appropriate management for best outcomes.
1669 Ureterosciatic Hernia: A Case Report and Review of the Literature
Authors: Woo C A , Quraishi M K
Published: October 2021

Aim

Ureterosciatic hernia (USH) is an extremely unusual condition, with presentations ranging from asymptomatic, to flank pain, renal failure, septic shock and even obstructive uropathy. Due to its rarity, there are no recommendations on the treatment of USH. We therefore carried out a systemic review of published literature on its management.

Method

The systemic review was completed using three search terms: “uretero sciatic hernia”, “ureterosciatic hernia” and “ureteric sciatic hernia” on Healthcare Databases Advanced Search, producing 224 potential papers. This was narrowed down to 42 papers after using the PRISMA guidelines. All selected papers included a case report of USH, as well as the investigation and management in English only.

Result

We report a case of an 85-year-old female who was investigated for weight lost with Computed Tomography(CT), which showed an incidental finding of USH. She was managed conservatively after she denied any symptoms and had no hydronephrosis. Abdominal pain was the most common presentation of USH(64%), whilst only 9.5% were found incidentally. 79% of all patients had a CT scan which showed the pathognomonic “curlicue” sign. 55% of all patients had hydronephrosis. Half of all patients had surgical intervention, from open repair to laparoscopic to robotic(9.5% of all management)with no known mortality. Conservatively management(16.6%) was reserved for asymptomatic/poor surgical candidates, and were more likely to be followed up compared to surgical patients(55.5%vs47.6%).

Conclusions

Our case is of an incidental USH managed conservatively, with a literature review emphasising similarities to our case and the different management options.
188 Right Hemicolectomy with End-To-Side Circular Stapled Ileo-Colic Anastomosis: Evaluation of Outcomes in A Series Of 55 Consecutive Patients
Authors: Angamuthu N , Froghi F , Shah S , Mirnezami R , Knowles J
Published: October 2021

Background

Stapled ileo-colic anastomosis is a well-established alternative to hand-sewn anastomosis after right hemicolectomy. A side-to-side configuration (SSA) is the option commonly practiced. This study describes our experience using a less well described technique, using an end-to-side circular stapled ileo-colic anastomosis (ESSA).

Method

Consecutive adult patients undergoing a right or extended- right hemicolectomy with ESSA for colonic cancer between July 2013 and March 2020 were included. Perioperative outcomes including anastomotic leak and anastomotic bleeding were extracted from a prospectively maintained institutional database. The Clavien-Dindo classification was used to stratify post-operative complications. Data are presented in medians and IQR.

Results

Right hemicolectomy with circular stapled ESSA ileo-colic anastomosis was performed in 55 consecutive patients (M:F 26:29) by a single surgeon at a tertiary referral centre. Over half of patients (54.5%, 30/55) were in the 8th and 9th decades of age with a median BMI of 26.5 (IQR:24-30.7). Median postoperative length of stay was 6 days (IQR:4-8) and the overall morbidity rate was 34.5% (19/55). Anastomotic leak and anastomotic bleeding were seen in 5.45% (3/55) and 3.64% (2/55), respectively. None of the patients with leak or bleeding needed a re-operation.

Conclusions

In comparison to the widely used SSA type of ileo-colic anastomosis, the ESSA configuration using a circular stapling device is a viable option for restoring bowel continuity after right colonic resections with comparable results. Potential advantages of this approach include avoidance of cross stapling and improved ileo-colic anatomical fidelity.
269 Outcomes of Modified Karydakis Flap in The Surgical Management of Sacrococcygeal Pilonidal Disease: A Single Surgeon’s Experience
Authors: Alam F , Farooq D , Theofilis A , Wooler H , Payne R
Published: October 2021

Aim

To determine the incidence of post-operative complications of patients with sacrococcygeal pilonidal disease who were treated with the Modified Karydakis flap with a specific management bundle. Primary outcomes assessed included the post-operative incidence of seroma, haematoma, SSI, deep SSI, wound dehiscence, re-admissions, return to theatre and flap necrosis. Secondary outcome evaluated was recurrence at 6 months follow up.

Method

It was a retrospective analysis of a single surgeon’s (FA’s) practice results of Modified Karydakis flaps on patients with sacrococcygeal pilonidal disease who were managed according to a specific protocol (fig. 1). Data was collected between June 2017 and June 2020. 96 patients were analysed, of which 9 were excluded as they only had excision without closure. Pre, per and post-operative management of the remaining 87 patients was according to a standardised protocol (fig. 1). Data was collected from patient’s notes and from prospectively and retrospectively maintained patient data bases (Theatre System, Medway).

Results

Primary outcomes:

Secondary outcome:

Conclusions

Good surgical results can be obtained with Modified Karadakis flap, provided meticulous surgical technique is applied. Placement of a suction drain for a minimum of 72 hours reduces incidence of post-operative haematoma and seroma formation. Three post-operative doses of broad-spectrum intravenous antibiotics followed by 5 days of oral antibiotics helps reduce post-operative infections.
386 Is the Routine Histopathology of Haemorrhoidectomy Specimens Cost Effective?
Authors: Ng G S
Published: October 2021

Introduction

The necessity for routine histopathologic evaluation of hemorrhoidectomy specimens has been controversial, yet it is commonplace in many hospitals. The cost effectiveness was analysed in a regional hospital in Queensland. Our secondary aim was to also determine the incidence of unexpected abnormality in haemorrhoidectomy specimens.

Method

This is a retrospective study between March 21st 2012 – April 30th 2020 in a regional hospital in Queensland, and approved by the Health Service Human Research Ethics Committee as a low risk research project. We used Operating Room Management Information System (ORMIS) to obtain a total number of 122 haemorrhoidectomies. The cost of histopathological analysis of a haemorrhoidectomy specimen is AUD$174.65.

Results

We found that 122 haemorrhoidectomies were performed over the study period. Of these, 66.39% (n = 81) haemorrhoidectomy specimens were sent for routine histopathology. 84.4% (n = 103) were done via the Milligan-Morgan technique. There was intra-operative suspicion of abnormality in 2 cases; histology showed no dysplasia. In total, no specimens had any evidence of dysplasia or neoplasia.

Conclusions

Routine pathological evaluation of hemorrhoidectomy specimens is not useful and is expensive, as unsuspected anal carcinoma is a rare occurrence and was not demonstrable in the study period. However, a careful pre-operative examination should be performed as unsuspected carcinoma of the anus diagnosed solely by microscopic analysis has been described in the literature. Any suspicious areas should be sent for microscopic evaluation. At a cost of AUD$174.65 per specimen, approximately AUD$1,768.33 could have been saved per annum, or AUD$14,146.65 in 8 years.
429 Preoperative Risk Assessment In Elective Colorectal Patients
Authors: Cernei C , Grossman R , Bodger O , Williams J , Pritchard C , Goede A
Published: October 2021

Introduction

Cardiopulmonary Exercise Testing (CPET) and the Colorectal Physiology and Operative Severity Score (CR-POSSUM) are increasingly used in colorectal surgical practice to risk-stratify patients preoperatively and for planning level 2 HDU or ITU admission. This study aims to generate a simple, objective pre-operative risk assessment model to complement clinical judgement, and to determine objectively for whom CPET is necessary in colorectal pre-assessment.

Method

A retrospective cohort study was conducted. Demographic and perioperative data were gathered, and CR-POSSUM score was determined retrospectively. Mortality at 12 months was considered the primary outcome with readmissions up to 12 months as secondary outcomes. Statistical analysis used Binary Logistic Regression, and odds ratios were reported with confidence intervals. A new combined pre-operative risk assessment model with the most significant individual predictors was constructed.

Results

Some 167 elective patients were included in the final analysis. Half of patients had planned HDU admissions. The all-cause mortality at 90 days was 3.5% and at 12 months was 11%. Readmission rate at 30 days was 10%, with a further 11.3% at 90 days postoperatively. The ASA, Physiology Score and Operative Severity Scores correlated with mortality rates (p < 0.05). Current diagnostic performance using CPET vs. the combined model identified 48% and 35% ‘high risk’ patients with 83.3% and 56.5% vs 94.4% and 76.1% sensitivity and specificity, respectively. The model draws its predictive power mainly from the CR-POSSUM.

Conclusions

Current practice at the study centre produces outcomes above the national average. The process can be improved whilst focusing resources further using the combined model.
533 Diverticular Disease and Diet: Are We Doing Enough?
Authors: Jamshad F , Al-Zubaidy R , Ahmed R , Singhal T
Published: October 2021

Introduction

Diverticular disease (DD) is a major burden on healthcare systems globally, especially in the western world. DD accounts for the second most common indication for elective colorectal resections, with each resection costing the NHS a minimum of £5000. Since dietary advice is an integral part of the management of DD, we aim to investigate the proportion of patients that receive documented dietary advice or guidance on their stay in hospital.

Method

A list of all admissions related to DD from June to November 2019 was obtained from the HIPE Department in Princess Royal University Hospital. Our Electronic patient record system was used to extract information regarding patient demographics, length of stay in hospital and the presence of documented evidence that dietary advice was given to patients.

Results

A total of 57 patients were admitted due to DD over a six-month period in 2019. 41 were female and 16 were male. They had a mean age of 67.1 and an average length of stay of 6.3 days. 12 of the 57 (21%) had some form of surgery either as an emergency or electively after discharge. Only 15 (26%) received dietary advice of which only 9 were referred to a dietician.

Conclusions

DD is a major contributor to surgical admissions requiring both elective and emergency surgery. It is largely a preventable disease; hence health care staff should take more initiative to highlight the importance of lifestyle modification to patients whenever the opportunity arises, with the target to benefit public health and free healthcare resources.
804 The Role of Kono-S Anastomosis and Mesenteric Resection in Reducing Recurrence After Surgery for Crohn’s Disease: A Systematic Review
Authors: Alshantti A
Published: October 2021

Aim

Recurrence after surgery for Crohn’s disease is common. Anastomotic configuration may influence recurrence and the mesentery may be key.The Kono-S anastomosis and radical mesenteric excision have been proposed as methods of reducing recurrence. We analysed the literature pertaining to these novel techniques.

Method

We searched MEDLINE, Embase and the Cochrane Library for, studies evaluating Kono-S anastomosis and/or radical mesenteric excision in Crohn’s disease. We assessed methodological quality and risk of bias using the Cochrane tool for randomized controlled trials and the JBI tool for nonrandomized trials. A narrative synthesis was used to summarize the findings.

Results

Nine studies (896 patients) were identified. Apart from one randomized controlled trial with a low risk of bias the overall level of evidence was poor (Grade IV). The Kono-S anastomosis was associated with a lower incidence of endoscopic and surgical recurrence (0%–3.4% vs 15%–24.4% respectively). Complications, particularly anastomotic leak rate, were also lower (1.8% vs 9.3% respectively). Evidence from a single poor-quality study suggested that mesenteric excision may reduce surgical recurrence rates compared with mesentery preservation.

Conclusions

The existing literature suggests that the Kono-S anastomosis is safe and may reduce endoscopic and surgical recurrence, but level of evidence is mainly poor. One element of the Kono-S technique, preservation of the mesentery, may be detrimental to recurrence. Further, higher quality, studies are required to investigate these techniques. Such studies should consider the impact of the degree of mesenteric resection in addition to the anastomosis on disease recurrence.
869 Colorectal Cancer Referral Pathways: Impact of First Months of COVID-19
Authors: Spyropoulou L E , Li M , Curley D , Martin E , Wynn G , Doulias T
Published: October 2021

Introduction

Whilst daily living has adapted to the “new normal” during Covid-19, colorectal cancer pathways are yet to be revised to reflect this transformation. Government advice to stay at home, hospital avoidance and reduced healthcare access, may be masking a significant proportion of population at risk. We aim to identify changes in colorectal cancer target pathways.

Method

All cancer referrals during the initial Covid-19 period were retrospectively analysed, recording type and date of first clinic and investigation, MDT discussion and decision to treat dates. A comparison was made with referral and treatment data from the same referral period in 2019.

Results

338 referrals were received during March-April 2020, compared to 542 in 2019, indicating a 37.6% decrease. A high proportion of patients were reviewed by telephone clinic (63.4%) rather than face-to-face (23.8%), representing a significant shift in practice. An increasing number of patients were initially investigated by CT(40.2%) instead of endoscopy (37.8%). 51(15.5%) patients were not investigated, with COVID-19 being the commonest reason. 25 patients were diagnosed with colorectal cancer, of which 8(32.0%) breached the investigation and 13(52.0%) the treatment date, both usually postponed due to the pandemic. There was a 66.7% reduction in surgical management compared to 2019.

Conclusions

Two-week wait pathways are strained in the era of Covid-19. As the fight against the global pandemic continues, patients are mostly seen virtually and receive non-gold standard investigation. With fewer patient presentations and elective surgeries, it is important to continue colorectal cancer surveillance and timely treatment, considering possible alternative pathways.
1029 Evaluation of Significant Polyp and Early Colorectal Cancer (SPECC) MDT In A District General Hospital
Authors: Pereira I , Kulkarni N , Dalton M , Azhar A
Published: October 2021

Aim

There is an increase in the number of complex SPECC cases presented at colorectal MDT meetings with a wide variation in the treatments offered to patients, many of whom undergo high-risk and life-changing surgical resection. This study aimed to evaluate the detection, diagnosis and treatment of early colorectal cancer since the introduction of a SPECC MDT.

Method

This was a retrospective audit of 108 patients, from the SPECC MDT database from January 2014 to December 2019. Primary outcome assessed the recognition of lesions using endoscopy and radiological evaluation to assess depth of invasion and lymph node involvement. Secondary outcomes included definite treatment, pathological reporting and recurrence.

Results

Overall, mean age of 72, 79% had one or more significant co-morbidity. Clinical presentation; 61 asymptomatic, 46 symptomatic and 31 referred from the national bowel cancer-screening programme. All patients (n = 108) had endoscopic assessment the lesions were, 53% sessile and 47% pedunculated; 78% of the lesions were found in the rectum. We observed surgical management in 31 cases, endoscopic in 28, chemo-radiotherapy in 12 and 3 cases were palliative. However, 17 (n = 108) underwent failed endoscopic resection and required surgical intervention. Recurrence was observed in 17.6% of cases and mortality in 4%.

Conclusions

Pathological reports provide a definitive answer to questions of malignancy but SPECC can be challenging in all areas. A specialist MDT allows for appropriate assessment and treatment of lesions and leads to better patient outcomes.
1057 Outcome Reporting Following Rectopexy Requires Standardisation for Reproducibility and Transparent Outcome Analysis
Authors: Wa Katolo H , Fleming C , Wilkinson G , Brannigan A
Published: October 2021

Aim

Rectopexy is a surgical procedure commonly used to correct rectal prolapse. Several studies have investigated different approaches (abdominal, perineal) and techniques (open, laparoscopic, robotic) in this field however reporting outcomes vary significantly among studies impeding comparison of techniques. We aimed to comprehensively analyse primary outcome reporting methods following rectopexy in published literature.

Method

A systematic search was performed in keeping with PRISMA guidelines and search protocol registered with PROSPERO. Published databases were searched using the following terms: “rectopexy”, “abdominal rectopexy” and “rectopexy outcomes”. Randomised controlled trials, comparative and non-comparative prospective and retrospective studies published between 1992 and 2019 were included for analysis. Review articles, letters, editorials, abstracts, and non-English language studies were excluded. A narrative description of outcomes was reported.

Results

A total of 1089 articles were screened, and 32 articles were identified as suitable for inclusion, reporting on 1780 patients who underwent rectopexy surgery. Over 30 unique methods of reporting outcomes were recorded, with the most common being the rate of recurrence (n = 15), Cleveland Clinic Faecal Incontinence score (CCIS) (n = 11), and customised symptom questionnaires (n = 10). Many studies recognised the impact of symptoms of rectal prolapse on patients’ quality of life (QoL) however, few utilised standardised quality of life scores to evaluate the outcome of the procedures.

Conclusions

As surgical technique evolves in rectopexy, incorporating minimally invasive surgery and robotic surgery, it is important that outcome reporting is standardised to facilitate transparent comparison. Improving patient QoL is the mainstay of surgical intervention and it is important that QoL outcome measures are incorporated.
1123 An Audit of Pick-Up Rate of Random Colonic Biopsies
Authors: Zulfiqar S , Baig H , Buksh M
Published: October 2021

Aim

We aimed to evaluate optimal random biopsy criteria are being followed in our institution to increase the diagnostic yield of a subsequent histopathological examination and to reduce the number of unnecessary biopsies in which histopathology is unlikely to deliver clinically useful information and causing a burden on health resources in terms of cost and manpower.

Method

Our study was a retrospective on 419 random colonoscopy biopsies performed over 6 months. Data collection included variables such as age, gender, indications, request of urgency, and histology findings. Data analysis was done descriptively.

Results

Out of 419 random biopsies, only 10.02% had positive findings. The total number of histology results with microscopic colitis was 10. The main indication of the random colonic biopsy was a change in bowel habits (328 cases) followed by significant diarrhea greater than 50 years in 20 cases. In patients with a change in bowel habits, 2.44% of histopathology specimens revealed microscopic colitis. The percentage of random colonic biopsy histology in patients greater than 50 years with significant diarrhea showed microscopic colitis was 10%.

Conclusions

Our study revealed random biopsy during colonoscopy should only be done in selected patients otherwise it has low diagnostic yields biopsy and should only be reserved for patients with risk factors for optimum utilization of health resources and to reduce the cost burden. A scoring system may be helpful to risk-stratify patients in low and high risk for MC to determine which patients qualify for RCB.
1252 A Systematic Review of International Colorectal Multidisciplinary Team Meetings: The Development of Best Practice Through Inter-Regional Learning
Authors: Fadel M , Hamrang-Yousefi S , Mills S , Warren O , Tekkis P , Kontovounisios C
Published: October 2021

Aim

Colorectal multi-disciplinary teams (CR MDTs) were introduced to enhance the cancer care pathway and allow for early investigation and treatment of colorectal cancer. However, there are no gold standards set for this process. The aim of this study is to establish recommendations on the principles, organisation, structure and output of CR MDTs internationally.

Method

The available literature on the role of CR MDTs from January 1999 and March 2020 in the United Kingdom (UK), United States of America (USA) and continental Europe was evaluated. Historical background, structure, core members, education, frequency, patient selection criteria, quality assurance, output and outcomes were extracted from data from the UK, USA, and continental Europe.

Results

Fifty studies were identified that specifically met the inclusion criteria. CR MDTs should occur at least once a month with established key members. Generally, all colorectal cancer patients should be discussed and there should be a focus on education. There are noted differences in the lead member of the CR MDT, the use of information technology and storage of MDT information in databases and quality assurance internationally.

Conclusions

The most common issues facing MDTs internationally include a lack of staffing and resources as well as limited information on the patient’s fitness and preference for surgery. These factors are important and urgent improvements are required in these areas in CR MDTs. Quality assurance should be a mandatory component of every CR MDT.
1288 Colorectal Cancer Surgery Service Provision During The COVID-19 Pandemic: An Assessment of a Single Trust
Authors: Hanna J , Khoory C , Manu N , Clifford R , Fowler H , Fok M , Vimalachandran D
Published: October 2021

Aim

Post-operative pulmonary complications in perioperative SARS-CoV-2 infection are associated with significant morbidity and mortality. To maintain a safe cancer service, the Countess of Chester Hospital adopted “Cold-site” operating and maintained ERAS principles for patients undergoing elective colorectal cancer surgery during the pandemic. A comparative assessment of service was undertaken for benchmarking purposes.

Method

A comparative retrospective audit was undertaken of consecutive patients undergoing elective colorectal cancer surgery from June to November 2019 and compared to June to November 2020. The Somerset Cancer Registry and electronic medical case records were used to obtain the dataset. Outcomes measured were approach to surgery; stoma rate; length of stay; level of care required; post-operative complications (>Clavien-Dindo 2) and survival at 30 days. Mann-Whitney U test and Chi-squared were used for analysis.

Results

There were 33 and 24 elective colorectal cancer operations in 2019 and 2020 respectively. There was no difference in the median age (64:69; p = 0.3) or ASA grade (p = 0.9). The median length of stay was 5 and 4 days respectively (p = 0.3). There was a 32.2% reduction in laparoscopic approach to surgery in 2020 (69.7% vs 37.5%; p = 0.02). There was no difference in the stoma rate (p = 0.9), post-operative complication rate (p = 0.7), ITU admission rate (p = 0.3), length of ITU stay (p = 0.6) and 30-day mortality rates (p = 0.4).

Conclusions

“Cold-site” operating allows robust ERAS care to be adopted to ensure comparative outcomes for patients undergoing colorectal cancer surgery and was associated with a non-significant trend to shorter hospital stay during the COVID-19 pandemic.
308 The Effect Of COVID-19 On Hand Trauma Management: A Single-Centre Correlation Study, Inter-Rater Agreement and Functional Outcomes
Authors: Rojoa D , Raheman F , Irvine E , Sharma V , Macdonald C , Cutler L
Published: October 2021

Introduction

Management of hand trauma has evolved to incorporate assessment, treatment and rehabilitation of patients in a ‘one-stop’ clinic on initial presentation. Our aim was to evaluate the effect of COVID-19 on hand trauma management using inter-rater agreement between hand surgeons.

Method

Patients with hand fractures were consecutively assessed from March to May 2020, with atleast 6-month follow-up outcomes. Two experienced hand surgeons blinded to management and outcomes independently reviewed radiographic images and clinical history to provide their opinion on optimal treatment. Weighted-kappa analysis was performed for concordance and inter-rater agreement between the two surgeons and actual management.

Results

268 patients were identified, 82 had fractures involving tubular bones of the hand. 62 were male and 20, female. Mean age was 40.3 (SD 19.7). Mechanism of injury was secondary to home-related injuries (34%) and falls (28%). Fractures involving the metacarpals (n = 24) and distal phalanx (n = 20) were most commonly seen. 35 patients underwent surgery whereas 47 were managed conservatively. Overall agreement between actual management and both consultant-1 and consultant-2 was moderate (κ = 0.55, p < 0.0001 and κ = 0.63, p < 0.0001, respectively). Subgroup analysis showed a weak agreement between actual management of metacarpal fractures and both consultant-1 and consultant-2 (κ = 0.22, p = 0.29 and κ = 0.47, p = 0.02, respectively). Inter-rater agreement was substantial for management of metacarpal fractures (κ = 0.73, p < 0.0001) whilst functional outcomes were comparable as reported by patients.

Conclusions

Our study has shown that overall management of hand fractures remained optimized throughout the pandemic. However, lack of concordance was observed in the management of metacarpals through substantial inter-rater agreement but overall poor agreement.
320 The Initial Impact Of COVID-19 On Paediatric Spinal Services Across Scotland
Authors: Newman M , Garrido E , Tsirikos A
Published: October 2021

Background

The COVID-19 pandemic has meant a significant decline in the activities of the paediatric spinal services in Scotland.

Method

All referrals to the Scottish paediatrics spinal service from 1st January 2020 to 30th June 2020 were analysed. Comparison was made to the same period in 2019. All orthotist initial consultations and all paediatrics spinal theatre activity in Scotland from 1st March 2020 to 30th June 2020 was analysed and compared to the previous year.

Results

There was a 64.3% decline in referrals during the first wave of the pandemic in Scotland to the paediatric spinal service. The mean wait time to be seen in 1st clinic for a new referral was 6.56 weeks in 2020 compared to 10.94 in 2019. There were however 60 patients still waiting to be seen. The number of paediatric spinal operations declined by 34% during March to June 2020 when compared to the same months in 2019 There was a reduction of 50% of new paediatric patients seen by orthotists from March – June 2020 when compared to 2019

Conclusions

COVID-19 has had a significant effect on paediatric spinal services in Scotland. This is likely due to a combination of service delivery factors and patient factors. This is likely to result in delays to children getting the care they require for their spinal condition. There will also be a back-log of patients requiring to be seen when services start to re-establish themselves. There are several options available to department to optimise efficiency, such as video consultants and streamlining referral systems.
331 COVID-19 Mortality After Vascular Procedures During the Initial UK Surge: Moving Forward with Elective Vascular Work
Authors: Liu P , Cheema S , Adeoye I , Theivacumar S , Hussain T , Malina M
Published: October 2021

Aim

Following the initial COVID-19 surge in the United Kingdom, there was a national incentive for elective vascular surgery to be restricted to clean sites in order to reduce perioperative cross infection and subsequent mortality. We assessed the risk of dying from perioperatively acquired COVID-19 during the peak of the London outbreak.

Method

43 consecutive patients who had vascular (n = 48) procedures in March and April 2020 at a regional hub serving five London hospitals were analysed. The patients were screened for COVID-19 in the 30-day postoperative period and the main outcome measure was mortality from COVID-19. A comparison was then made with patients who underwent minimally invasive procedures from our integrated interventional radiology department. Median follow-up was 41 days (IQR 8- 58 days).

Results

Three patients (7%) in the vascular group (median age 61 years, all diabetic, two male) died from COVID-19, all of whom tested positive postoperatively. Two others became positive but recovered. In comparison, two patients (2%) in the interventional radiology group died from COVID-19, however one was positive prior to their procedure.

Conclusions

Only urgent vascular cases should be performed during a COVID-19 surge, with elective work delayed or continued at clean sites. However, with growing waiting lists for elective surgery currently, further restrictions may not be a viable long-term solution. Resumption of care at hot sites should be considered, if resources allow for it and if safety measures can be implemented. The advantages of minimally invasive surgery may inherently reduce risk as well.
380 To Change or Not to Change? Has COVID-19 Altered Our Adherence to BOAST Guidelines on Management of Ankle Fractures?
Authors: Yeoh T , Dhillon G , Johal K
Published: October 2021

Aim

The COVID-19 pandemic impacted the orthopaedic surgical ethos drastically. There was a lower threshold to manage fractures conservatively, in an attempt to curtail COVID-19 transmission rates amongst inpatients. This retrospective study evaluated our Orthopaedic department’s adherence to BOAST guidelines on ankle fractures, during COVID-19 and pre-COVID-19.

Method

Data on patient’s who presented with ankle fractures during the initial national lockdown in 2020 were compared against similar ankle fracture patterns one-year prior (pre-COVID) over a similar time frame. Patient clerking notes, operative notes, radiographical images and clinic letters were retrieved and compared against BOAST guidelines on ankle fractures. Management plans and time to surgery was extrapolated from these resources.

Result

Ankle fracture incidence rates increased by 79.8% during the COVID pandemic when compared with data from 2019. 28% of ankle fractures in 2020 were managed operatively when compared with 80% in 2019. Average time to surgery during the pandemic improved by 1.64. Adequate documentation for neurovascular status, as per BOAST guidelines, was 30.5% in 2019 and 27% in 2020. Pre- and post-reduction views were available in 87% of cases in 2019 and 83% in 2020.

Conclusions

As a third national lockdown is upon us, evaluation of BOAST guidelines on ankle fractures would be worth revising. Teaching and posters were distributed throughout the department as a strategy to improve adherence to BOAST guidelines on ankle fractures. Furthermore, regular follow up clinics at specific times and post-management follow up clinics would be worth analysing to identify changes in patient satisfaction and clinical outcome.
406 Audit of Current COVID-19 Consent Process
Authors: Goldmann N , Brown C
Published: October 2021

Aim

Contracting COVID-19 increases the risk of serious peri-operative morbidity and mortality. The current best practice for informed consent is to make patients aware of the risk of contracting COVID-19. We aimed to determine if our local orthopaedic unit was meeting this standard of practice.

Method

We performed a single centre, retrospective, closed loop audit. Data was collected using Bluespeir© and Clinical Portal© software. We first audited all emergency and elective consent forms (n = 51) between September-October 2020; mean age 58 years old (range 17-87). Results were circulated to all orthopaedic departmental staff in poster format and given 2 weeks of educational awareness before re-audit of all consent forms (n = 59) in November 2020; mean age 54 years old (range 17-80). Any patient with an Adults With Incapacity (AWI) form in place was excluded.

Results

Initially, COVID-19 was included as a risk in 21/51 (41.2%) of all consent forms; elective procedures 10/24 (41.7%) and emergency procedures 11/27 (40.7%). On re-audit this increased to 32/59 (54.2%) of all consent forms; elective procedures 23/47 (48.9%) and emergency procedures 9/12 (75%). During the audit period, 1 patient tested positive for COVID-19 pre-operatively and 1 patient post-operatively.

Conclusions

This audit improved local adherence to COVID-19 consent guidelines. There remains significant room for improvement, especially in elective practice. Further research is required to determine the true impact of COVID-19 on morbidity and mortality.
426 An Evaluation of The Service of Endoscopic Trans-Sphenoidal Surgery for Excision of Pituitary Lesion During The SARS-Cov-19 Pandemic
Authors: Cernei C , Sinha S
Published: October 2021

Introduction

Since the start of SARS-CoV-2 pandemic many branches of medicine and surgery have undergone changes shifting the focus to prepare for an increase of COVID-19 related admissions. Halting all pituitary surgery services was not feasible particularly if patients present with acute or progressive visual loss due to the mass effect of the pituitary lesion, pituitary apoplexy, or lesions with aggressive features.

Method

An 11-point telephone questionnaire was used to evaluate the service provided between March and September 2020. On a 1-10 scale, patients scored their feelings about remote clinics, the support offered, the clarity of explanations, quality of interaction with their surgeon, and an overall assessment of remote clinics.

Results

20 of the 21 patients who underwent transsphenoidal pituitary lesion resection between the 02/03/2020 and 14/09/2020 participated in the survey. They unanimously felt the introduction of remote consultations was necessary and felt safer. Their surgeon’s communication skills helped their experience the most. It allowed for easier attendances as they did not rely on family or long travelling times. Drawbacks involved the lack of face-to-face interaction particularly pre-operatively, as patients felt they missed the human factor, seeing their scans, and meeting their surgeon in person.

Conclusions

The pandemic has affected people from a biopsychosocial perspective leaving long-lasting effects on the economy and healthcare systems of the world. This service evaluation highlights a positive outcome in terms of patient experience. Moving forward, incorporating remote services as an option for follow-up cases would be welcomed by most patients in the survey.
441 Management of Intracapsular Hip Fractures During Unprecedented COVID Times In A DGH
Authors: Zafar A , Galloway E
Published: October 2021

Aim

NICE published eligibility criteria for Total Hip Replacement (THR) vs Hemiarthroplasty for intracapsular hip fractures. COVID-19 resulted in the BOA publishing emergency guidelines regarding management of patients eligible for THR. If the available surgeon does not routinely perform hip arthroplasty, the patient should undergo a hemiarthroplasty to maximise theatre efficiency and minimise hospital stay. This project will compare Kings Mill Hospitals compliance with these new guidelines.

Method

Retrospective data was collected over a two-month period (24/03/20 – 22/05/20) from patients with intracapsular hip fractures. Notes and records allowed us to determine suitability for THR using NICE guidelines. National statistics were taken from the National Hip Fracture Database. The standards for this project consist of the NICE guidelines for Hip Fracture management and the BOA standards for Trauma and Orthopaedics - Management of patients with urgent orthopaedic conditions and trauma during the coronavirus pandemic’.

Results

51 patients were included in this audit. THR compliance dropped during the peak months of COVID 35% to 21.4%. Length of acute admissions stay decreased from 10 days to 8 days. Compared to the national averages, Kings Mills THR compliance rate was 27.3% vs 18.3%. 54.5% of eligible patients were operated on by THR performing consultants but received Hemiarthroplasty's

Conclusions

Some patients were eligible for THR according to the BOA guidelines (1) however received Hemiarthroplasty’s. Better identification may increase guideline compliance. Introduction of a new table in the clerking booklet will be implemented and Re-audited to evaluate effectiveness.