bluuebunny/crossref_metadata_2025 huggingface dataset:
TP6.1.4 Risk factors for post-cholecystectomy bile duct injuries: Systematic review and meta-analysis
Authors: Burns Rowan , Connor Katie , Sherif Ahmed , Wigmore Stephen
Published: October 2021

Aims

Bile duct injury (BDI) is a major complication of cholecystectomy resulting in long-term consequences. The relatively low incidence (0.23% – 1.5%) of BDI makes the identification of risk factors challenging. The aim of this study was to systematically analyse available literature on BDI post-cholecystectomy to provide an update on the incidence and determine current risk factors.

Methods

The study was pre-registered on PROSPERO (CRD42020177318). A search was conducted of MEDLINE, EMBASE, Scopus, Cochrane Central, Web of Science databases and the grey literature from inception to February 2020. 1583 unique papers were identified and screened for eligibility. English language, retrospective and prospective studies were included where the population age was > 16 and underwent cholecystectomy.

Results

Outcomes analysed were incidence of BDI and risk estimates for possible risk factors. 30 studies (6,420,667 patients) were included in the meta-analysis. Gender, BMI>30, acute cholecystitis (AC), emergent surgery, the operative approach, intraoperative cholangiography (IOC) and the impact of surgeon’s experience were analysed. Male gender and AC were determined to be statistically significant risk factors (OR 1.25 (1.13-1.39)) and 1.74 (1.27-2.39) respectively). Furthermore, IOC use was found to be significantly associated with BDI risk (OR 1.27 (1.17 – 1.37), while BMI>30, open surgical approach, emergent surgery and surgeon’s experience were not statistically significant; however, significant heterogeneity among included studies limited the interpretation of these factors.

Conclusion

Male gender and AC were found to be predictors of BDI, while better quality evidence is needed to show the effect of other factors.
TP6.1.5 The Importance of the Patient Voice in Metastatic Colorectal Cancer: A Qualitative Study
Authors: Chan Anthony , Ignatowicz Agnieszka , Mason James , Siriwardena Ajith
Published: October 2021

Aims

Colorectal cancer is the fourth commonest cancer in the UK with a third presenting with synchronous liver metastases. Although there is a large body of clinical cohort data, there is no research exploring patient perspectives of disease. This qualitative phenomenological study explores the lived experiences of patients following treatment for synchronous disease.

Methods

Qualitative interviews used pre-prepared prompts encouraging open dialogue and were transcribed for thematic analysis.

Results

Four major themes emerged.

(1) Experience of Cancer

The initial diagnosis was recalled in vivid detail, with delays perceived negatively particularly if clinicians were dismissive about their concerns. Caregiver participation was valued in consultations. Patients with recurrence perceived chemotherapy as a method of control.

(2) Patient Autonomy

Patients describe a paternalistic relationship with their clinician and were satisfied with their management despite any complications or recurrence. There was little perception of pathway equipoise with some questioning any real choice particularly those with a symptomatic bowel primary.

(3) Treatment Strategy

Patients preferred a bowel-first strategy as a method of control, perceiving the primary to continually seed the body with metastases. Chemotherapy offered little reassurance for disease control. Synchronous resection was preferred but the greater potential for complications was appreciated.

(4) Research

No patients expressed ethical concerns about potential studies randomising to different surgical strategies. However, patients would not want a liver-first strategy.

Conclusions

This is the first qualitative study exploring patient perceptions of metastatic colorectal cancer. The importance of the first consultation outlining management is emphasised as a simple but important message.
TP6.1.7 Systematic review and meta-analyses of cholecystectomy as a treatment of biliary hyperkinesia
Authors: Eltyeb Hazim A. , Al-Leswas Dhya , Abdalla Mutwakil O. , Wayman John
Published: October 2021

Aims

Biliary hyperkinesia is typically diagnosed in patients with biliary like pain and no evidence of gall stones on imaging modalities but who have had biliary scintigraphy scan (HIDA) that shows ejection fraction ≥80%. This study aims to identify whether the removal of the gall bladder can alleviate the symptoms associated with Biliary Hyperkinesia.

Methods

Systematic search following PRISMA guidelines was done from inception to January 2020 using PubMed/Medline, OVID, Embase, Cochrane database of systemic reviews, Cochrane central register of controlled trials, The Database of Abstracts of Reviews of Effects (DARE) and Cochrane library databases. Results were expressed as risk ratios (RR) for dichotomous outcomes together with 95% confidence intervals (CI) or mean differences (MD) or standardized MD (SMD) for continuous outcomes. A meta-analysis done using random-effect model in RevMan 5.4® software.

Results

Thirteen studies met the inclusion criteria and were included in the review. A total of 332 patients diagnosed with biliary hyperkinesia underwent cholecystectomy, of whom 303 (91.3%) reported symptomatic improvement RR 8.67 [95% CI 4.95, 15.16] P = 0.01. Six studies described abnormal histological features in 163/181 (90.05%) with high GB EF. RR 7.88 [95% CI 3.94, 15.75] P = 0.08. Chronic cholecystitis n = 155 (95%), cholesterolosis n = 7 (4.3%), and one showed features of acute cholecystitis.

Conclusion

Patients with typical biliary colic symptoms without gallstones and markedly high ejection fraction might benefit from having cholecystectomy to alleviate their symptoms.
TP6.1.9 Prolonged post-operative stay following emergency and elective laparoscopic cholecystectomies and its contributing factors
Authors: Lucocq James , Radhakishnan Ganesh , Scollay John , Patil Pradeep
Published: October 2021

Aims

Patients who undergo laparoscopic cholecystectomy (LC) for gallstone disease are a heterogenous population with many variables involved in their management. The aim was to identify the proportion of patients who have a prolonged post-operative stay (PPS; >3days) following elective and emergency LC and the variables that most contribute to PPS.

Methods

We retrospectively collected data for all patients who underwent an elective and emergency LC across three surgical units from 2015 to 2020. Rates of PPS were compared between elective and emergency groups and variables associated with PPS were identified using multivariate logistic regression models.

Results

2769 patients were included in the study (median age, 53years(range, 13-92); M:F,1:2.7; emergency:elective,1:3.6) The rate of PPS was higher in the emergency versus elective group (25.1% versus 6.6%; p<0.0001). Pain was one of the major causes in both groups. In the elective group, factors associated with PPS included cholecystitis (OR,1.96; p=0.008), previous gallstone related admissions (OR,1.48; p=0.008), pre-operative ERCP (OR,3.58;p<0.0001), ASA (OR,1.82; p=0.001) and age (years) (OR,1.03;p=0.001). In the emergency group, factors associated with PPS include cholecystitis (OR,5.3;p<0.0001), ASA (OR,1.96; p = 0.01) and pre-operative ERCP (OR,4.44;p=0.001).

Conclusions

The rate of PPS following laparoscopic cholecystectomy is significant, particularly in the emergency group. Although the possibility of PPS cannot be avoided, patient information regarding the possibility of PPS is important, particularly for those at risk. The risk factors for PPS should be used to guide surgical decision making and should be followed by targeted management of these patients including optimised pain relief.
TP6.2.4 Emergency colorectal resections: do colorectal surgeons achieve better outcomes than non-colorectal surgeons?
Authors: Wu Diana , Gartner Isabel , Henderson Nikola
Published: October 2021

Aim

Patients requiring emergency colorectal surgery in Tayside are managed by general surgeons who may or may not have subspecialist training in colorectal surgery. We investigated whether surgeon subspecialisation influences outcomes after emergency colorectal resections.

Methods

All patients undergoing emergency colorectal resections between 01/01/14 and 31/10/20 were included. Demographic, clinical, operative and outcome data were collected from hospital electronic records. Outcomes were compared for patients treated by colorectal versus non-colorectal surgeons. The primary outcome was 30-day post-operative mortality. Adjusted mortality was calculated using logistic regression. Secondary outcomes included rates of laparoscopic surgery, stomas, complications, readmissions and length of hospital stay. Categorical data were compared by chi-squared tests and non-parametric data by Wilcoxon tests.

Results

Of the 177 operations performed, 104 (58.8%) were performed by colorectal surgeons. Overall 30 day mortality was 5.1%, which was significantly lower for colorectal versus non-colorectal surgeons (1.0% vs 11.0%, p = 0.003), this remained significant after multivariate adjustment (Odds ratio 0.10, 95% confidence interval 0.01-0.86, p = 0.036). The proportion of laparoscopic cases was significantly higher for colorectal compared with non-colorectal surgeons (54.8% vs 4.1%, p < 0.0001). There were no significant differences in stoma rates (76.0% vs 63.0%, p = 0.063), further procedures (5.8% vs 8.2%, p = 0.523), anastomotic leaks (1.9% vs 4.1%, p = 0.387), readmission within 30 days (12.5% vs 13.7%, p = 0.815) or median length of hospital stay (16 vs 18 days, p = 0.375).

Conclusion

Mortality rates at 30 days after emergency colorectal surgery are significantly lower for patients treated by subspecialist colorectal surgeons. This provides a strong argument for a subspecialist on-call rota.
TP6.2.5 Post-operative recovery following emergency laparoscopic cholecystectomy: a need to redefine the consent for emergency cholecystectomy
Authors: Lucocq James , Radhakishnan Ganesh , Scollay John , Patil Pradeep
Published: October 2021

Aims

Understanding the risks of emergency LC is necessary before patients can make an informed decision regarding operative management. Our primary aim was to provide a comprehensive analysis of the post-operative course of these patients.

Methods

Emergency LC performed for all biliary pathology across three surgical units between January 2015 and January 2020 were included. We followed each patient up for 100 days postoperatively and data was collected retrospectively. Data collected included demographic data, operative data, post-operative recovery, imaging, additional interventions and re-admissions.

Results

A total of 605 patients were identified (median age, 53 years (range 13-92); M:F, 1:2.7). 36.9% of patients had a complicated postoperative period, either suffering a significant complication, requiring prolonged post-operative stay (>3 days), further imaging, additional interventions or re-admission. The rate of complication was 13.5% (including retained stones 3.5%; collections 3.8%; bile leaks 3.3%). The rate of prolonged post-operative stay was 25.1%. 16.2% required postoperative imaging and 6.1% required post-operative intervention.12.9% were re-admitted for assessment related to the LC. The rate of bile duct injury was 0% (0/605).

Conclusions

Although LC has the reputation of largely an uncomplicated procedure, our data illustrates the substantive morbidity associated with emergency LC. Patients should be counselled about the high morbidity rates. This involves patient education and will improve consent which should help decrease litigation. Surgeons should take a more selective and pragmatic approach when offering the procedure.
TP6.2.7 Routine examination of gallbladder specimens after cholecystectomy: a single-centre analysis of the incidence, clinical and histopathological aspects of incidental gallbladder carcinoma
Authors: Mauro David Di , Orabi Amira , Myintmo Aye , Reece-Smith Alex , Wajed Shahjehan , Manzelli Antonio
Published: October 2021

Aims

Gallbladder carcinoma is often found incidentally on histopathologic examination after cholecystectomy – this is referred as incidental gallbladder carcinoma (IGC). Routine vs selective histopathological assessment of gallbladders is under debate, this study evaluates the role of regular specimens’ examination, based on a single-centre analysis of incidence, clinical and histopathological aspects of IGC.

Methods

Patients who underwent cholecystectomy, between July 2010 and January 2020, were considered. Exclusion criteria were age under 18 and preoperative diagnosis of GB carcinoma. Demographic, clinical and histopathological data were retrospectively collected, continuous variables with a normal distribution were evaluated with Student’s t-Test and ANOVA.

Results

Some 5779 patients were included. The female/male ratio was 2.5:1. Chronic cholecystitis (CC) was the most common finding on specimens (99.3%), IGC was found in 6 cases (0.1%). In the latter group, there were 5 women and patients were older than those with benign disease – 73.7 ± 5.38 years vs 55.8 ± 0.79 years (p < 0.05). In all the cases, the GB was abnormal on intraoperative inspection and beside cancer, histopathology showed associated CC and/or dysplasia. Upon diagnosis, disease was at advanced stage – one stage II, one stage IIIA, one stage IIIB, three stage IVA. Two patients are alive, three died of disease progression – median survival was 7 months (range 2-14).

Conclusions

In this series, ICG was rare, occurred most commonly in old adult women and was diagnosed at an advanced stage. In all the cases, the GB was abnormal intraoperatively, therefore macroscopic GB anomalies demand histopathological assessment of the specimen.
TP6.2.9 1224 Surgical Endoscopic Retrograde Cholangio-Pancreatography over three years. A single unit’s experience of service provision and delivery of clinical excellence
Authors: Smith Eleanor , Bowyer Eleanor , Nagendram Sathyan , Zeindler Jasmin , Singh Sukhpal , Veeramootoo Darmarajah
Published: October 2021

Aims

Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is traditionally the domain of medical gastro-enterology. Our practice is exclusively surgeon delivered and therefore represents an alternative paradigm. The British society of Gastro-enterology (BSG) proposed key performance indicators in 2014 to evaluate standards of ERCP practice with focus on performance and safety against which we evaluated our practice.

Methods

The study period covers 3 years from September 2016 to August 2019. An analysis of prospectively collected data was performed. Performance of the individual surgeons and collective was collated and retrospectively analysed.

Results

The unit’s caseload for the 3 years period was 1224 procedures. Each surgeon’s share was similar, i.e. 454, 430 and 340 cases respectively (BCG 75 per annum). Most procedures were performed electively, some on emergency basis or within two weeks. Biliary duct stones were the most common indications for the procedure, followed by malignancy. Overall bile duct cannulation rate was 95.3%; and 91.8% for first ERCP (BSG > 85%). CBD clearance was achieved in 80.6% cases, and stone clearance at first ERCP was 78.6% (BSG > 75%). Successful stenting of extra-hepatic biliary stricture was achieved in 89.4% cases at first ERCP (BSG > 80%). Overall complications rate was 6.2% and for level 1 & 2 cases 5.3% (BSG less than 6% is accepted standard).

Conclusions

We performed a high volume of safe and effective ERCPs with low risk of complications in line with national standards. ERCP has become an exclusive therapeutic tool in surgical management of gall stones disease and biliary malignancy.
TP6.2.18 Initial experience with routine postoperative nasal high-flow oxygen as part of enhanced recovery following oesophagectomy for cancer
Authors: Nnaji Martin , Koshy Renol , Priest Oliver , Beardsmore Duncan , Jagadesham Vamshi , Bouras George
Published: October 2021

Introduction

Pulmonary complications occur in up to 38% of patients undergoing oesophagectomy and are associated with significant risk of mortality. Nasal high-flow oxygen (NHFO) has previously been shown to reduce respiratory complications following major abdominal surgery, however, its use in oesophagectomy has not previously been assessed. We report our results using NHFO routinely as part of our enhanced recovery protocol (ERP) in consecutive patients undergoing oesophagectomy for cancer at a single tertiary referral centre.

Methods

We recently incorporated routine postoperative NHFO following oesophagectomy as part of our ERP at Royal Stoke University Hospital. We conducted a prospective study of patients undergoing surgery between November 2019 and September 2020. The primary outcome measure was complications related to delivery of NHFO. Secondary endpoints included rates of pulmonary complications and mortality within 30 days of surgery.

Results

Fifty patients underwent oesophagectomy during the study period. The median age was 66 years (range 43-78 years) and male to female ratio was 4:1.Majority (49/50) of patients underwent 2-stage oesophagectomy while one underwent 3-stage oesophagectomy. All patients received postoperative NHFO. There were no complications related to NHFO. The 30-day overall pulmonary complication rate was 30%.Of these, 28% developed pneumonia,4% pulmonary embolism,and 2% pleural effusions requiring drainage. There were no deaths within 30 days of surgery.

Conclusion

Routine postoperative NHFO in consecutive patients undergoing oesophagectomy is safe and feasible with lower pulmonary complication rates than previously reported, leading to better overall outcomes. The value of NHFO in oesophagectomy requires further evaluation in a randomized clinical trial.
TP7.2.5 Surgeon measured radiological pelvic measurements as a patient selection tool for laparoscopic rectal resection – an aide in early learning curve
Authors: Gavrila A D , Deans A J , Dhruva Rao P K
Published: October 2021

Introduction

Rectal resections are considered one of the most technically demanding laparoscopic procedures. This study reviews one unit’s rectal cancer resections to determine whether pelvic dimensions measured by the surgeon could aide patient selection for laparoscopic resections.

Methods

A prospectively maintained database was used to identify rectal cancer resections between April 2015 to March 2018 and patient demographics, BMI, height of tumour and operative details were in extracted. Anteroposterior (Coccygio-pubic) and transverse (interspinous) distance were measured retrospectively on linked Axial & Saggital views on staging CT scans. Tumour dimensions in the respective planes were recorded and relative proportions of tumour to pelvic dimensions calculated. These were correlated to operative approach.

Results

Our cohort comprised of 70 patients (42 men) with a median BMI of 27 and mean age of 71. While 6 operations were planned as open procedures, 64 were attempted laparoscopically. Of these, 55 were completed laparoscopically and 9 were converted (16%). There was no correlation between gender and operative approach (p = 0.2). Mean BMI for laparoscopic group 28.7 and converted group 30.0 which was not statistically significant (p = 0.32). Conversion was more likely for low tumours (89%). Median tumour to pelvic area proportion was 0.14 laparoscopic compared to 0.03 for open and 0.03 for converted suggesting that bulkier tumours are more likely to need conversion.

Discussion

None of previously identified factors such as gender and BMI predicted conversion in our cohort individually. Tumour size relative to pelvic dimensions is a simple measure a surgeon could use to guide patient selection.
TP7.2.13 Clinical characteristics and outcomes of acute pancreatitis following spinal surgery: a systematic review
Authors: Jayasinghe Ravindri , Ranasinghe Sonali , Jayarajah Umesh , Seneviratne Sanjeewa
Published: October 2021

Aims

Acute pancreatitis (AP) is a rare post-operative complication of spinal surgery. This study reviews the current evidence on clinical characteristics and outcome of AP following spinal surgery.

Methods

A systematic search was performed on English articles published up to May 2020 using PubMed, Scopus, EMBASE, LILACS and Cochrane databases. Data on clinical characteristics, risk factors and outcomes were extracted and analysed.

Results

Eleven papers meeting the inclusion criteria which included a total of 306 (23.02%) patients developing AP out of 1,329 patients undergoing spinal surgery were included (mean age= 14.17 years). Of the 11 studies that specified symptoms (n = 55 patients) abdominal pain (43.6%), nausea and vomiting (32.7%) and abdominal distension (7.27%) were the commonest symptoms. The mean duration from surgery to onset of symptoms was 6.15 days (range:1-7). Almost all (n = 10, 90.9%) were treated non-operatively. Of the complications mentioned (n = 306 patients), glucose intolerance (25%), peritonitis (2%), pseudocyst (2%), and fluid collection (2%) were the commonest. Of the studies mentioning associated factors (n = 22 patients) prolonged fasting time (13.6%), intra-operative blood loss (9.09%), gastroesophageal reflux disease (9.09%), age >14 years (9.09 %), low BMI (9.09 %), and anterior/combined approach (9.09%) were the commonest associated factors for AP. A total of 2 deaths (n = 2/306, 0.65%) were reported.

Conclusion

Although uncommon, AP remains an important post-operative complication of spinal surgery due to its associated morbidity and mortality. Avoiding major risk factors including prolong fasting and minimizing intra-operative blood loss may help reduce the incidence of AP in patients undergoing spinal surgery.
TP7.2.14 Long Term Outcome of Patients with Minimally Symptomatic Diverticular Stricture
Authors: Jayawardena P A , Hany T S , Peris M R
Published: October 2021

Aims

Minimally symptomatic diverticular stricture poses diagnostic and management dilemma for the Colorectal Surgeon. Long term outcome, risk of missing a cancer and complications are not well documented in the literature. This study aims at assessment of outcomes of patients with minimally symptomatic diverticular stricture who were treated conservatively.

Methods

Retrospective chart review of all patients with confirmed diverticular stricture on endoscopy and imaging scans who had minimal or mild symptoms over a 6-year period from January,2014 to June,2020 in a large tertiary referral hospital. Search methods included diverticular disease with stricture using ICD10 code K57 and K56.6. Outcome measures included complications while on conservative treatment including missed cancer, any subsequent surgery and complications including stomas.

Results

29 patients fitted the inclusion criteria, 18 females with median age 75(43-92). Median follow up was 32.5 months (8-93). All had endoscopic and CT imaging confirmation of diverticular stricture. Repeat investigations were recorded as 16 endoscopies in 9 patients and 30 CT scans in 14 patients during follow up. Four patients had at least one episode of diverticulitis; only one underwent emergency surgery at 5 years from diagnosis. 2/29 (6.9%) patients presented with diverticular perforation requiring Hartmann’s procedure. One patient (3%) had elective sigmoid resection with average duration of follow up 29 months (11.5-59) months. There were no missed diagnosis of cancer and no mortality due to diverticular disease.

Conclusions

In this patient population, diverticular stricture runs a relatively benign course with few complications or surgical intervention during follow up.
TP7.2.15 Superior Mesenteric Artery Syndrome Managed with Laparoscopic Duodenojejunostomy: Case Series and Review of the Literature
Authors: Saber Hatem , Shaalan Ramy , Kahlin Carl , Elhoofy Ahmed
Published: October 2021

Aims

Superior Mesenteric Artery (SMA) Syndrome is a rare disorder which may be managed surgically when conservative management fails. We present a case series of six patients who underwent laparoscopic duodenojejunostomy in our tertiary centre for treatment of SMA Syndrome. The aim of our case series is to assess and present our outcomes in comparison to the limited available literature on the topic.

Methods

Retrospectively, we identified all patients who underwent laparoscopic duodenojejunostomy for SMA Syndrome in our tertiary university centre’s surgical database between December 2016 and July 2019. Data collected included demographics, presenting symptoms, co-morbidities, pre and post-operative Body Mass Index (BMI), operative approach, operative blood loss, operative duration, length of hospital stay, clinical and radiological results, in hospital/30 day complications, mortality and post operative follow up outcomes.

Results

We identified six patients, 1:5 male to female ratio, with a median age 18 years of age (range 17-31 years). All patients had refractory symptoms after a minimum of two months (range 2-5 months) of conservative management and subsequently underwent laparoscopic duodenojejunostomy. Median hospital stay was 7 days and no in hospital/30 day post operative mortality or complications were identified. Follow up data showed no recurrence of symptoms and a BMI median increase of 10.2 (range 8-13.6) at a median follow-up of 18 months (range 12-30 months)

Conclusions

Laparoscopic duodenojejunostomy is a safe treatment option for SMA syndrome and should be considered when patients do not respond to conservative management.
TP7.2.16 Systematic review and meta analysis of pre operative antibiotics and bowel preparation on ileus following colorectal resection
Authors: Kelly Michael , McKnight Gerard , Scott Alisdair J.
Published: October 2021

Aims

Pre-operative oral antibiotics (OAB) and mechanical bowel preparation (MBP) may reduce rates of post-operative infectious complications following colorectal surgery but their effects on post-operative ileus (POI) are not well-established. We conducted a systematic review and meta-analysis to address this question.

Methods

Medline and Embase databases were searched to identify randomised controlled trials and cohort studies comparing pre-operative MBP or OAB to control in patients undergoing elective colorectal resection and reporting the rate of POI as an outcome. Risk ratios were pooled using a random-effects model to generate a summary risk ratio and 95% confidence interval.

Results

Five randomised trials and three cohort studies were included which reported the effect of pre-operative MBP on POI. Some 29056 patients received MBP compared to 13077 who did not. The rates of POI were 10.0% vs 12.0% respectively. Meta-analysis gave a risk ratio of 0.85 (0.80-0.91, p < 0.0001) for the development of POI with MBP versus control. Four randomised trials and four cohort studies were included which reported the effect of pre-operative OAB on POI. Some 9.5% of 19,903 patients receiving OAB developed POI compared to 11.8% of 23,884 control patients. The pooled risk ratio for the development of POI with OAB compared to control was 0.86 (0.81-0.91, p < 0.0001). However, when limiting analyses to randomised trials alone, neither MBP (RR 1.13, 0.67-1.90) nor OAB 1.01, 0.75-1.35) had a significant effect on the rate of POI.

Conclusions

Pre-operative MBP or OAB may reduce POI following colorectal resection but this has not been confirmed in randomised trials.
TP7.2.19 Review of bascom cleft lift and flap-procedures versus excision for pilonidal disease in a single centre (2017-2019)
Authors: Stonelake Stephen , Bhattacharya Pratik , Thompson Christopher
Published: October 2021

Introduction

Pilonidal disease continues to be managed with varying surgical techniques. We review results with Bascom cleft lift comparing to other practices at our institution.

Methods

All elective procedures for pilonidal disease reviewed from December 2017 to December 2019. Patient demographics, previous emergency and elective procedures for pilonidal disease, follow-up, dehiscence and recurrence rates, and all-cause morbidity were examined retrospectively.

Results

In the study period there were 106 procedures. Average age was 27 years (range 15-64). Male to female ratio was 83:23. Procedures were excision and primary closure (48), excision and packing (19), rhomboid flap (2), Bascom cleft lift flap (31), other rotational/perforator or V to Y flaps (6). Rates of previous elective procedures in the flap procedures versus excision group were 31% and 10% respectively (P = 0.01). Rates of previous emergency procedures in the flap-procedures versus excision group were 41% and 31% respectively (P = 0.40). In 50 procedures there was a documented follow up encounter at a mean time of 55 days (median 34 days, range 2-239). Dehiscence (partial and full) in flap procedures versus excision and closure was 33% and 27% respectively (P = 0.64). Recurrence rates in flap procedures versus excision +/- closure or packing were 0% and 8% respectively (P = 0.16).

Conclusion

Flap procedures have a lower rate of recurrence and comparable dehiscence rates despite being performed in patients with higher rates of prior procedures for pilonidal disease. Bascom cleft lift was the simplest flap procedure most commonly performed and matches the results of more complex flaps.
TP7.2.20 Systematic Review and meta-analysis of Interventions for Benign Large Non-Pedunculated Colonic Polyps (BLNPCP)
Authors: Wheldon L , Spence O , Lee MJ , Riley S , Brown SR , Wyld L
Published: October 2021

Aim

To examine the efficacy of treatment options for benign large non-pedunculated colonic polyps (BLNPCP).

Background

BLNPCP may harbour covert malignancy and opinions differ about the optimal treatment modality, be it endoscopic mucosal resection (EMR), endoscopic submucosal resection (ESD), combined endoscopic laparoscopic surgery (CELS) or surgical resection (SR). Despite the widespread availability of endoscopic resection (ER) techniques, rates of surgery in the UK remain high.

Methods

This review is reported in line with PRISMA guidelines (PROSPERO registration: CRD42021148944). EMBASE, CENTRAL, and MEDLINE databases were searched from January 2000 to January 2020 to evaluate interventions for treating BLNPCP in adults. The primary outcome was recurrence, adverse events were secondary outcomes. Meta-analysis was performed using a random effects model expressed as a percentage with 95% confidence interval. Quality assessment was performed using ROBINS-I.

Results

Ten studies (2499 polyps in 2327patients) were included (five assessed EMR, four SR, two CELS, two ESD). All studies were at moderate risk of bias. SR, ESD and CELS had the lowest recurrence rates 0% CI:0-1, 1% CI:0-2 and 2% CI:0-12 respectively. EMR had the highest (15% CI:9-22). SR complication rate was 12% CI:7-19, ESD 12% CI:9-15, CELS and EMR 11% CI:0-45 and 7% CI:5-9 respectively. Rescue surgery for complication or finding of invasive cancer was 17% CI:5-35 for ESD, CELS 14% CI:3-30, EMR 11% CI:7-15, SR 4% CI:2-6.

Conclusion

These data provide information that should be taken into account when considering the choice of intervention. It will allow a more robust shared decision-making process to occur.
TP8.1.4 Can volume replacement with local perforator flaps reduce the trauma to patients caused by mastectomies and cost of reconstructions in breast cancer treatment?
Authors: Karagiannidis Georgios , Mortimer Caroline , Tuffaha Hussein , Peerlinck Inga , Mallidis Evangelos
Published: October 2021

Aims

Improved screening and raised breast awareness raises the demand for breast cancer treatment. 25% - 45% of breast cancer treatment will be mastectomies, some of them followed by reconstruction. Mastectomy +/-reconstruction is a traumatic procedure which affects quality of life of patients plus extra cost for NHS for reconstruction. Can the “relative new” technique of local perforator flaps, reduce the volume of mastectomies (and subsequently reconstructions) in a District General Hospital?

Methods

Retrospective review of yearly breast cancer treatment operations from 2017 to 2020 in Ipswich Hospital.

Results

1094 surgical operations performed for breast cancer. In 2017, 85/292 (29,1%) had mastectomy and 13/292 (4,4%) had local perforator flap surgery. In 2018, the number of mastectomies was 74/299 (24.7%), while 4/299 (1.3%) patients underwent local perforator flap surgery. In 2019, the amount of perforator flaps increased to 24/305(7.8%) while the mastectomies remained in equivalent percentages [72/305 (23.6%)]. Finally, in 2020, despite the presence of COVID19 and the decrease in surgical management of cancer, 16/198(8.5%) had local perforator flaps surgery and only 34/198 (18%) had mastectomy.0/57 (0,00%) of the local perforator flaps failed.

Conclusions

Local perforator flaps have resulted in 11.1% reduction in mastectomy rate (also reducing reconstructions). The exchange of mastectomy and reconstruction with breast conserving surgery and local perforator flap reduces the operating time and cost of cancer treatment without compromising oncological outcome or patient satisfaction.
TP8.1.9 Effect of Covid 19 on breast referrals from GP
Authors: Sandhya Anu , Narayan Prabhat , Pogson Caroline , Waheed Shamaela , Singh Jagdeep , Suleiman Usama , Silva Tania De
Published: October 2021

Aim

Coronavirus disease 2019 (COVID-19) has put a strain on regular healthcare worldwide. This study shares a DGH experience of effect of covid 19 on breast referrals from GP.

Methods

It is a single centre retrospective comparative study to analyze the effect of Covid 19 on breast referrals during the pandemic.

Patients referred under TWR from 15th march to 15th July 2020 were included and a comparison was made with March to July 2019. The primary outcome was number of referrals and number of cancer diagnosis.

Secondary outcomes were breach in 62 day pathway.

Results

In Covid pandemic, 1231 symptomatic patient were referred under TWR, of which 91 (7.4%) were diagnosed with breast cancer. There were 22 (24%) 62 days breaches.

Comparing this with similar 4 months in 2019 there were 1826 symptomatic patients referred under TWR of which 131 (7.1%) diagnosed with cancer. There were 34 screen detected cancers as well. There were 28 (21%)62 day breaches.

The reduction in GP referral was 32%.

Conclusion

There was an overall decrease in number of patients referred from GP but cancer diagnosis remained almost same for symptomatic patients since TWR pathway carried on with telephonic clinics & assessments at nearby closed screening centres.
TP8.2.3 Horses for Courses – the Impact of Covid-19 on Surgical Training Courses
Authors: Ali Roshneen , Baker Alexander , Lewis Christopher
Published: October 2021

Aims

Surgical training has been disrupted by the Covid-19 pandemic. Educational courses may be mandatory for training progression, complementing critical skills for surgical trainees. Previous work collated a first comprehensive database of available courses. The aim of this project was to determine the extent of disruption caused to courses by the current pandemic.

Methods

A snowballing approach was used to systematically search all online resources for courses available in 2021. This included websites of the Royal Colleges, sub-speciality societies, trainee organisations, regional centres, deaneries and surgical technology companies. Course target grade, price, provider and dates were collated and compared to matching data from 2020.

Results

35 sources yielded 127 courses. Since 2020, 78 courses had been cancelled and 37 new courses had been introduced. Courses price ranged between £90-1260 (median £495), with 12 courses increasing in cost overall and 4 reducing in cost due to online delivery. Only 13/127 courses were delivered online, 9 of which were newly available in 2021. Technical, clinical and revision courses constituted the majority (115/127), with only 3 courses dedicated to leadership or research.

Conclusions

Educational courses supplement aspects of deanery-led teaching which are perceived to be lacking. However, course providers must respond to the need of trainees and adapt to the training restrictions necessitated by the Covid-19 pandemic by improving the availability of online courses. Whilst technical skills are often the primary focus of surgical training, the importance of non-technical, leadership and research skills is arguably greater than ever and should be recognised.
TP8.2.7 The Post Graduate Virtual Learning Environment: an effective platform for the delivery of a surgical teaching programme in the West Midlands
Authors: El-Sayed Charlotte , Ahmed Usman , Farquharson Adam
Published: October 2021

Aim

The Postgraduate Virtual Learning Environment (PGVLE) is a digital platform developed by HEEWM in response to the COVID-19 pandemic to deliver a virtual teaching programme to surgical trainees. The programme is delivered through the BigBlueButton; an integrated virtual classroom. All teaching sessions are recorded and archived to allow trainees to review content at their convenience. We performed a contemporaneous study to review the effectiveness and quality of the platform in delivering teaching and suggest its future role in the surgical curriculum.

Method

Anonymised feedback was gathered of trainee’s perspective of the platform experience, the quality of teaching and the archived content. All trainees were General Surgery higher trainees (HST) (ST3-ST8). The data from sequential teaching days was analysed.

Results

Of 90 HST, on average 40 attended each monthly training day (consistent with pre-COVID attendance). 122 trainee responses were completed. 68% of respondents were between ST3-ST5. 91% rated the administration and delivery of the teaching sessions as excellent or very good. 16% of trainees watched the archived sessions after the teaching day of which 46% felt it met their educational expectations.

Conclusions

The PGVLE is an effective platform for the delivery of a virtual surgical teaching programme. It met with high levels of trainee satisfaction in the context of the pandemic. The archived content provides advantages to consolidation of learning. It is thought that the PGVLE platform will become a key feature of the surgical training programme in a hybrid learning model, related to relevant curricula, in the future.
TP8.2.8 Medical School Selection scores correlate with MRCS Part A performance
Authors: Ellis Ricky , Brennan Peter , Cleland Jennifer , Lee Amanda , Scrimgeour Duncan
Published: October 2021

Aims

Selection into UK medical school involves a combination of three measures: prior academic attainment, selection tests (e.g. the University Clinical Aptitude Test (UCAT), Biomedical Admissions Test (BMAT), or Graduate Medical School Admissions Test (GAMSAT)) followed by interview. We investigated the predictive power of current UK medical selection tests and measures of prior attainment on success in the Membership of the Royal College of Surgeons (MRCS) examination.

Methods

The UKMED database was used to analyse A-Levels and medical school selection data for all UK graduates who attempted the MRCS Part A written examination (n = 9729) and Part B clinical examination (n = 4644) between 2007 and 2017. Univariate analysis and Pearson correlation coefficients examined the relationship between selection scores and first attempt MRCS success.

Results

Successful MRCS Part A candidates scored higher in A-Levels, UCAT, BMAT and GAMSAT examinations (p < 0.05) than their unsuccessful peers, but no differences were observed for MRCS Part B. Statistically significant positive correlation was found between MRCS Part A, BMAT (r = 0.32, p < 0.001) and GAMSAT scores (r = 0.35, p = <0.001). While a weaker statistically significant correlation was found between Part A, A-Level (r = 0.14, p < 0.001) and UCAT scores (r = 0.25, p < 0.001).

Conclusions

This, the first study to investigate the relationship between all UK medical school selection tests and success in a postgraduate examination found statistically significant correlations between selection test scores and performance on Part A of the MRCS. The strength of correlations found in this study are similar to those of other validated selection tests used in the United States.
TP8.2.15 Higher General Surgical Trainee preferences for Annual Review of Competency Progression during COVID-19 Pandemic
Authors: Khan Khurram , Torpiano Giuliana , Galbraith Norman , McLellan Morag , Lannigan Alison
Published: October 2021

Aims

The COVID-19 pandemic has caused significant disruption in surgical training. We aim to explore the preferences of higher general surgical trainees for Annual Review of Competency Progression (ARCP) also compare the responses across different training grades.

Methods

All higher general surgical trainee in a single deanery were invited to participate in an online voluntary anonymous survey. The respondents were divided in two groups: junior (ST3-ST5) and senior higher surgical trainees (ST6-ST8) and responses compared.

Results

Sixty-four of 88 trainees responded. Thirty-three (51.6%) were ST3–ST5, 24 (37.5%) were ST6–ST8 and 7 (10.9%) were out-of-training. More trainees in ST3–ST5 group preferred to defer the next rotation for 12 months (18.2% vs 0%, p = 0.034), repeat current sub-specialty (33.3% vs 4.2%, p = 0.009), or add 12 months to training and delay predicted CCT date by 12 months (18.2% vs 0%, p = 0.034). Most trainees in both groups preferred the option of prolonging training should be offered to all trainees with an option to decline extension if ARCP competencies met (66.7% vs 50.0%, p = 0.276).

Conclusions

The preference for ARCP and length of training was different between two training groups, hence the need of trainees should be considered by training committees when addressing the impact of COVID-19.
TP8.2.18 Every little helps. A trainee led cost saving initiative
Authors: Lunt Adam , Bleakley Cait , Marshall Douglas , Rees-Lee Jacqui
Published: October 2021

Aim

The NHS is under pressure to deliver the best quality care within a confined budget. The cost of spending on medications is growing by 12% per annum. The five year forward plan for the NHS called for £22 Billion in efficiency savings. All NHS staff are being asked to help deliver better outcomes at lower costs. We aimed to review costs in the surgical department, identify savings, implement changes and evaluate the outcome.

Method

Pharmacy orders from 2016-17 were reviewed. Prices of branded and generic medications were compared. Levobupivicaine was identified as a product with cost savings between branded and generic forms. Procurement officers were advised to switch to generic alternatives and the pharmacy system was adjusted to highlight that generic forms should be ordered. Orders for 2018-19 were reviewed and savings calculated.

Results

29,280 units of levobupivicaine were ordered in 2016-17. 100% of these orders were of the branded product. Projected savings of switching to a generic product was £12,846 per annum. 31,355 units of levobupivicaine were purchased during the 2018-19 period. 83% of orders were for the generic product. £11,805 was saved over this period. £1,703 of further savings have been highlighted.

Conclusion

We have shown that simple changes can result in modest savings. All NHS staff, including trainees, can lead cost reducing initiatives. Multiple small savings will summate to larger savings, resulting in resources being better utilised to improve patient outcomes.
TP8.2.24 Returning to Surgical Training - a survey of surgical trainees' experiences in Yorkshire and the Humber Deanery
Authors: Richards Eleanor , Renwick Paul
Published: October 2021

Aims

To assess the support given to this deanery's surgical trainees returning after time out of programme.

Methods

An online survey was circulated to surgical trainees within the deanery. The survey included questions about their return, on calls, their experience of support and to evaluate interest in a return to work course.

Results

Of 35 respondents, 33 had had time out of training. Reasons were health (2), leadership fellow (3), research (11), research and parental leave (6) and parental leave alone (11). Twenty-three trainees reported feeling well supported, 4 were neutral and 6 reported negative experiences. Many returned to a new trust. Twenty were on-call within the first few days and 5 felt unprepared for this. Confidence and operative skills were commonly affected. Whilst trainees out for research or leadership deemed a return to work course unnecessary, those returning from parental leave expressed interest. This could enable trainees to network and gain information and support from peers and senior colleagues. Respondents came from a wide mix of surgical specialties indicating bespoke cadaveric courses might be appropriate. Childcare friendly hours were a priority.

Conclusions

There is scope for significantly improving the return to work experience through the SuppoRRT (Supported Return to Training) programme. Returning to an on-call shift or being prevented from attending induction is unacceptable. This deanery is developing a surgical return to work course combining cadaveric and animal model technical skills training with clinical scenarios for non technical skills. This is hoped to help improve returning trainees' confidence and operative skills, both commonly affected by time out of training.
TP8.2.28 Can surgical advanced care practitioners provide a cost effective local anaesthetic minor procedures service? Results from a 5-year retrospective study
Authors: Taib Adnan , Hammill Christa , Abraham Aleyamma , Garstang Paula , Fakim Bilal , Subar Daren
Published: October 2021

Aims

Surgical Advanced Clinical Practitioners (SACP) form part of the extended surgical workforce and are drawn from allied health care backgrounds. The primary aim of this study was to determine if there is a financial benefit performing minor surgical procedures on dedicated SACP lists compared to consultant surgeon lists.

Methods

This was a retrospective cohort study including all patients who had a minor ‘lumps and bumps’ procedure undertaken between April 2014 and August 2019 at Anonymous Hospitals NHS Trust (AHT) under local anaesthetic by the general surgery team. Data such as lesion type, theatre staffing levels and operating time was collected.

The cost of the procedure was calculated by operating time multiplied by cost of staff of per minute according to local banding.

Results

A total of 1399 patients had a lesion excised; the majority were carried out by a doctor n = 907, the rest independently by a SACP. The majority of lesions excised were lipomas and cysts. There was no difference in the median surgical time (20 minutes, IQR 14) taken to operate on each patient by SACPs and doctors. Minor procedures carried out on consultant surgeon lists cost 62.4% (£21.72) more on average than those on SACP lists (£56.55 vs £34.83 median respectively, p < 0.001) due to excess staff for these cases.

Conclusion

A dedicated and independent SACP ‘lumps and bumps’ list has shown to be a financially beneficial service. Operative times are similar to doctors. These lists free staff for consultant lists, potentially permitting more major cases.