bluuebunny/crossref_metadata_2025 huggingface dataset:
ThP4.1 - Benign biliary emergencies in the elderly: Does age influence the outcomes of index admission surgery and one session management of bile duct stones
Authors: Hayyawi Israa , Omran Asmaa , Al-Shaye Ahmad , Khan Khurram S , Nassar Ahmad H M
Published: September 2024

Aim

To study operative and postoperative outcomes of biliary emergencies in the elderly two age on a unit adopting index admission surgery and one session management of bile duct stones.

Methods

A prospective database of 6140 patients had 1089 (17.7%) over 60 years. Two age groups were analysed.

Results

Group I (60-69 years)N=530 (48.7%) Group II (over 70 years)N=559 (51.3%) Females 314 (59.2) 312 (55.8) Age Median 65 77 ASA 3 0r 4 174 (32.8) 236 (42.2) Presentations Acute cholecystitis 136 (25.6) 132 (23.7) Pancreatitis 96 (18.1) 97 (17.4) Jaundice/Cholangitis 218 (41.1) 323 (57.8) Ultrasound Bile duct dilatation 39 (7.4) 247 (44.2) Suspected CBD stones 388 (73.2) 461 (84.2) Preoperative ERCP 21 (3.9) 34 (6.1) Operative Acute/Empyema 147 (26.3) 160 (30.2) Difficulty Grading III 130 (24.5) 140 (25) IV 163 (30.7) 183 (32.7) V 29 (5.4) 46 (8.2) Difficult cystic pedicle 321 (6.5) 210 (37.5) Fundus first dissection 31 (5.8) 36 (6.4) Abnormal IOC 255 (48.1) 314 (56.2) Bile Duct Explorations 244 (46) 308 (55.1) Choledochotomy 74 (30.3) 153 (27.4) Choledochoscopy 186 (35.1) 261 (46.9) Biliary drains 98 (18.5) 167 (29.8) Operative time; median/range) 80 min/ 24-370 90 min/ 23-345 Open conversion 2 (0.37) 7 (1.25) Morbidity 63 (11.8) 40 (6.7) Readmissions 27 (5.1) 49 (8.7) Reoperations 3 (0.6) 4 (0.6) *Hospital stay; median 8 days 12 days Mortality 1 (0.2) 6 (1.1) *Resolved in one or two episodes 471 (88.8) 499 (90) *Including all previous and readmissions. BOLD : statistically significant

Conclusions

A policy of index admission surgery and one session management of bile duct stones is safe in the over 70s.
ThP4.5 - The challenges of the emergency laparoscopic cholecystectomy in the obese patient
Authors: Davies Sian , Bodla Salman , Roy Sornali , Pallister Santiago , Olaifa Fumi , Athwal Tejinderjit , Laing Richard
Published: September 2024

It’s well documented that obesity is a positive predictor of surgical morbidity and with increasing obesity rates it is becoming a challenge for patients presenting with obesity related surgical conditions such as acute cholecystitis. This study aims to assess the impact of the class of obesity on the outcomes following laparoscopic cholecystectomy for acute cholecystitis.

Methods

A retrospective observational study was performed on patients undergoing emergency laparoscopic cholecystectomy at UHNM from January 2022 to January 2023. These patients were then stratified by their class of obesity as defined by the WHO; Healthy weight (BMI <25), Overweight (BMI 25 – 30), ClassI Obesity (BMI 30-35), ClassII Obesity (BMI 35-40), and ClassIII Obesity (BMI >40). Primary outcomes included LOS, mortality, 30 day readmission rates and postoperative complications. Secondary outcomes included total operative time.

Results

A total of 643 patients were identified. The classes of obesity were on average a younger cohort (median age, Healthy Weight = 60 [32–82], Overweight = 62 (28-86), Class I = 56 (27-80) ClassII = 50 (22-83) and ClassIII = 47 (28-90); p < 0.001). Length of hospital stay, mortality and operative duration, were similar between groups. However readmission rates were higher for the obese groups (Healthy Weight 8% vs Overweight 8% vs ClassI = 7% vs ClassII = 14% vs ClassIII 16%; p < 0.001) and postoperative complications (p = 0.067).

Conclusions

Emergency laparoscopic cholecystectomy can be performed safely on patients with higher classes of obesity but an appreciation of the class of obesity needs to be taken into consideration and higher class of obesity is associated with increasing risk of post operative complications.
ThP4.12 - Impacted Bile Duct Stones Encountered during 1447 Laparoscopic Explorations; Incidence and Management
Authors: Hayyawi Israa , Attia Abdel Aziz , Omran Asmaa , Al-Shaye Ahmad R A , Nassar Ahmad H M
Published: September 2024

Aim

To study the incidence and management of impacted bile duct stones encountered during laparoscopic bile duct exploration (LCBDE).

Methods

A review of patients undergoing LCBDE for impacted stones. Preoperative imaging, operative difficulty grading, impaction location, dis-impaction methods, operative complications and postoperative outcomes were analysed.

Results

136 of 1447 (9.4%) LCBDEs had impacted stones; median age 53 years, 63.2% females. 88.2% were emergencies; 94 Jaundiced (69.1%). USS showed CBD dilatation in 30.1%. 16.9% had previous ERCP and 43% previous biliary admissions. CBD exploration was transcystic in 52 (38.2%) and via choledochotomy in 84 (61.8%). LCBDE difficulty grading was IV in 61 (44.9%) and V in 75 (55.1%). The number of stones ranged from 1-70 (mean 6, median 2) and stone size 4-30mm (median 12). All needed choledochoscopy. Impaction was at lower CBD in 83 (61%), Mid-CBD 29 (21.3%), Intra-hepatic 15 (11%), intra and extra hepatic in 6 (4.4%) and intramural in 3. Dis-impaction needed biopsy forceps/grasper fragmentation (45.6%) basket/Fogarty manipulation in 35.3%, laser in 8.8%, pushing stones using the choledocoscope in 6 cases (4.4%) and conversion or leaving stone for ERCP in 7 (5.8% 6 prior to1997). The median operative time was 150 minutes (60-630 minutes).

Complications occurred in 33 (24.2%) including15 biliary-related and 9 biliary drain-related. Readmissions occurred in 18 patients (11 biliary-related) and one death was caused by pneumonia. Hospital stay median was 10 days (3 to 54). On 80% follow up the presentation to resolution period median was 2 weeks (1- 30).

Conclusions

Apart from CBD stones shown on USS and failed ERCP this study identified no obvious risk factors.
ThP5.3 - A Clinical Audit on Assessing Severe Acute Pancreatitis: Improving the use of the Glasgow-Imrie Criteria and outcomes
Authors: Nazar Naadir , Read Phoebe , Bolton Hannah , Bailey Charles
Published: September 2024

Introduction

Severe acute pancreatitis (SAP) is defined by pancreatic and extra-pancreatic necrosis, ITU admission, multisystem organ failure and death. Severity should be predicted on admission using the Glasgow-Imrie Criteria (GIC) to stratify patients and scores ≥ 3 are indicative of SAP and requires review by a senior and/or HDU/ITU to determine possible transfer to HDU/ITU.

Methods

We performed a 2-cycle audit on the use of the GIC to score 140 patients with acute pancreatitis (AP) from November 2022 – October 2023. Initial interventions included a presentation, posters and an email. The second intervention was the insertion of a scoring tick box into the electronic clerking notes.

Results

At baseline 44% (22/50) of patients with AP were scored using the GIC. Post first intervention this was 66% (21/32), post second intervention it was 84% (49/58).

Post interventions the proportion of patients scoring ≥3 escalated to a senior and/or HDU/ITU increased from 17% to 100% and mean length of stay reduced from 14.5 to 11 days, also the completeness of documentation rose from 78% to 96%.

There were 18 Glasgow-Imrie scores ≥ 3 and 8 of these patients developed clinical SAP.

Conclusion

Our audit showed that simple interventions and incorporation of the scoring system into the electronic notes increased the percentage of patients being scored on admission and resulted in all patients with a score ≥ 3 being reviewed by a senior and/or HDU/ITU. Incorporating the scoring into the electronic clerking document was relatively straightforward and could be adopted by other Trusts.
ThP6.6 - Enhancing Management Strategies: Exploring the Expansion of Low-Risk Criteria in Glasgow-Blatchford Scoring for Acute Upper Gastrointestinal Bleeding – A Retrospective Cohort Study
Authors: Ng Shou Kee , Nemade Mitesh J , Adeoti Olayiwola M , Khan Khurram S
Published: September 2024

Aims

Glasgow-Blatchford Scoring (GBS) determines the need for further interventions in patients presenting with acute upper gastrointestinal bleeding (AUGIB). We aimed to study whether we can safely expand low-risk criteria to patients with GBS 2 and manage them as urgent outpatient.

Methods

A retrospective study of consecutive adult patients who had inpatient endoscopy for AUGIB in a single surgical unit from September 2021 to September 2022. Patient demographics, clinical and laboratory findings, GBS and endoscopic findings was analysed. Low-risk was defined as GBS 0-1 and high-risk as GBS ≥3.

Results

150 patients were identified; 79 (58.7%) were male and median age of 63 years (IQR 53-76). Median total length-of-stay was 3.7 days (IQR 1.9=7.8).

Similar to the low-risk group, patients with GBS 2 presented with lower range and frequency of symptoms as the high-risk group (p=0.0002). Severity correlated with admission haemoglobin (p=0.001) and urea count (p<0.0001) but not relevant comorbidities (p=0.560) and admission observations (p=0.456).

The frequency of benign endoscopic findings in patients with GBS 2 were similar to the low-risk group with no malignant findings noted. This group also had similar rates of past and re-attendances for AUGIB and 30-day mortality of 0% to the low-risk group.

Conclusion

While our study has a small sample size, it suggests promising prospect that patients with GBS 2 may not need inpatient endoscopy. Future multi-centre studies are crucial to validate and strengthen this proposition. The potential advantages include decreased inpatient admissions, reduced healthcare costs, and alleviating pressures on emergency endoscopy unit.
ThP6.18 - 2 week wait referrals for suspected colorectal cancer in patients more than 85 years old. How many actually end up on the operating table?
Authors: Elzanati Hisham , Adetoye Moyinoluwa , Oyefeso Samuel , Alemam Ahmed , Masood Saad , Sangal Sam
Published: September 2024

Aims

To assess the outcomes of 2 week wait referrals for patients > 85 years old for suspected colorectal cancer in a large university hospital

Methods

Retrospective review of records of patients >85years old referred on the pathway between September to November 2023. Outcomes assessed were the number of patients that underwent investigation, cancers detected and whether they ended up having surgery.

Results

211 patients were referred. 43 were not investigated (20.4%), 95 had CT-colons (45%), 37 had CT-abdomen, 25 had flexible-sigmoidoscopy, 15 had CT Chest-abdomen-pelvis, only 10 had a colonoscopy (4.7%). 13 colorectal cancers were diagnosed (6.2%). Out of these only 3 agreed and were fit to proceed with surgery, 7 refused surgery and 2 were undecided while 1 passed away 2 weeks after the diagnosis was made. 5 incidental extracolonic cancers were diagnosed (2 pancreatic, 2 renal and 1 lung, 2 of which were metastatic) All the diagnosed colorectal cancers were FIT positive (100% sensitivity). 7 had no FIT test done and 14 were FIT negative.

Conclusion

The incidence of colorectal cancers in this group of patients is relatively small and most end up being not fit for investigation or surgery or refusing it themselves even when cancer is diagnosed. These patients should still have the right to be investigated and treated if they wish to but a pragmatic discussion needs to be made with them by the referring clinician before a referral is made as well as making use of the very high sensitivity of FIT testing to ensure optimal use is made of the limited resources available in our already stretched system.
ThP6.19 - Surgical Management in Sacrococcygeal Pilonidal Sinus Disease Depending on The Suggested Staging System
Authors: Al-Maliki Doaa , Saud Jasim Dager , Naji Alsabbagh Humam Abdulsalam , Azir Elia
Published: September 2024

Background

The ideal management of the PNS has not been established yet. However; The optimal method should cover rapid recovery and return to normal daily activities, low recurrence rate, be technically applicable with reasonable cost.

Aim

to evaluate outcomes with the use of a stage-based treatment approach.

Method

A cohort prospective analytical study was conducted at Basrah Teaching Hospital-Iraq, a total of 71 patients were operated based on the proposed staging system in the period between December 2018 to April 2022, the staging system (Stage I–IV) was defined by using the morphological extent. the collected data includes demographic, perioperative data, short and long-term outcomes.

Results

Stage IV had the highest abscess drainage, drain insertion, and hospital stay. Concerning the short and long-term complications, the following frequencies were observed: Collection (9.85%), Infection (8.45%), and Dehiscence (4.22%), the collection and dehiscence were highest among stage R while the lowest rate of collection and infection was among stage III cases (6.67%, 6.67%) accordingly. Primary healing was recorded (91.5%) among the overall included patients with the higher rates of stage II-a (100.0%) with the lowest being among stage R (71.4%). Stage IV patients experienced the longest time for functional recovery and wound healing (14.25± 7.13, 13.25± 7.27) accordingly. The Recurrence rate was (2.81%) commonly observed among stage II-a (16.67%).

Conclusion

PNS is a recognizable condition in our locality and presents in different stages, thus this proposed staging system categorizes its extent and is a valuable tool in tailoring surgical approaches to each stage, Furthermore, it provides a common language for the surgeon to communicate about the disease.
ThP7.2 - Nonoperative versus Operative Management in Traumatic Liver Injuries: A Prospective LiPTA Multicentre Study
Authors: Lewis-Lloyd Christopher , Koh Amanda , Adiamah Alfred , Blackburn Lauren , Brooks Adam , Collaborative LiP TA
Published: September 2024

Aims

The liver is the most injured abdominal organ, with subsequent significant morbidity and mortality. Over the last 30-years liver trauma management has changed, with an increase in nonoperative versus operative approaches. However, contemporary UK data on how liver trauma is managed is limited.

Methods

This prospective, multicentre audit was conducted through the National Trauma Research and Innovation Collaborative at 18 participating major trauma centres and units across the UK between 01/01/2021-01/10/2021. Differences in demographics, physiology, injury mechanisms, complications, length of stay, and 30-day mortality were compared between patients undergoing definitive nonoperative, including interventional radiology, or operative management. Univariable tests were used to compare data where appropriate with adjusted odds ratios of 30-day mortality used to assess definitive management via a multivariable model.

Results

Of 266 patients, 76.69% underwent nonoperative management. Operative patients were significantly younger, median age 29 (IQR 20-41) vs. 34 (IQR 23-52) p=0.0146, sustained more penetrating compared to blunt injuries (62.90% vs. 9.80%, p<0.0001), had more active bleeding on CT (32.65% vs. 5.97%, p<0.0001), required massive transfusions (27.42% vs. 8.33%, p=0.0001), sustained more inpatient complications (29.03% vs. 1.96%, p<0.001) and more physiologically unstable on admission. Operative compared to nonoperative management resulted in a significant 20-fold increase in 30-day mortality, (aOR 20.21, 95%CI 3.28-124.43, p=0.001).

Conclusions

These findings highlight the current approach to UK liver trauma management. Patients undergoing operative management have significantly greater morbidity and mortality yet may represent the severest of liver injures. Where appropriate nonoperative management should be used following liver trauma to reduce this.
ThP7.3 - Time of admission has no impact on outcome in trauma laparotomy
Authors: Green James , Dick Lachlan
Published: September 2024

Introduction

Trauma laparotomy outcomes are influenced by both patient and system factors. Out of hours (OOH) is associated with reduced staffing and on-site seniority which may impact patient outcomes. We aimed to establish if OOH laparotomy is associated with poorer outcomes.

Methods

A retrospective analysis was performed on all patients that underwent a trauma laparotomy at a major trauma centre between 2019 and 2023. Groups were divided into in-hour admission (IH) (08:00 - 20:00) and OOH (20:00– 08:00). The primary outcome was mortality and secondary outcomes included intensive care and total length of stay. Statistical analysis was performed to determine differences between groups.

Results

176 patients were included. The majority (62.5%) were OOH and penetrating the commonest mechanism of injury in both OOH (63.6%) and IH (57.5%). Comparing those admitted OOH and IH there was no difference inactivation of code red protocols (42.7% vs 39.4% p=0.663). ITU admissions (36.3% vs 43.9% p=0.318), length of ITU stay (mean days 9.1 ± 11.1 vs 15.7 ±17.4 p=0.068), total hospital stay (mean days 14.4 ± 25.3 vs 19 ± 25.4 p=0.204) or mortality (7.3% vs 4.5% p=0.469).

Conclusion

Although a larger proportion of trauma laparotomies occur in the OOH period, no statistical difference was found in any patient outcomes. This is likely due to established processes in our mature trauma model.
ThP7.13 - A systematic review of the perioperative outcomes of surgical fixation versus conservative approach for severe rib fractures
Authors: Singh Anurag , Khan Nida , Swaminathan Christie , Janakan Gnananandan , Sajid Muhammad
Published: September 2024

Objective

The objective of this meta-analysis is to compare the patient outcomes for severe rib fractures being managed by operative or non-operative treatment.

Methods

Studies reporting patient outcomes in patients undergoing surgical fixation or conservative approach were selected from medical electronic databases and meta-analysis was conducted by following the guidelines of the Cochrane Collaboration using statistical software RevMan version 5.

Results

Three studies on 258 patients reporting patient outcomes were included. In the random effect model analysis, the total hospital stay [mean difference -1.44, 95%, CI (-2.88, 0.00), Z = 1.96, p = 0.05] was comparable between the two groups with no heterogeneity among included studies. The intensive care stay [mean difference -2.36, 95%, CI (-5.92, 1.21), Z = 1.30, p = 0.20] and mortality [odds ratio 1.08, 95%, CI (0.11, 10.31), Z = 0.07, p = 0.94] was comparable between the two groups but with moderate heterogeneity among included studies. Pneumonia was more common in patients of the non-operative group [odds ratio 0.35, 95%, CI (0.15, 0.82), Z = 2.41, p = 0.02] with no heterogeneity among included studies.

Conclusion

Pneumonia was more common in patients in the patients managed with the conservative approach. Other patient outcomes were comparable between the two groups. Due to the paucity of data, multiple other crucial variables could not be assessed and a major multi-centre randomised control trial is needed to confirm the findings of this meta-analysis.
ThP7.14 - CSF Leak or Ear Wax? Logical Thinking in Emergency Management of a Collapsed Patient With Heat stroke
Authors: Hern Daniel
Published: September 2024

A man in his 60s presented to RESUS by ambulance on the hottest day of the year with suspected STEMI and collapse at home.

The patient was intubated and unresponsive (GCS 5), with global rigors. Hospital ECG showed sinus tachycardia. Body temperature was in excess of 41°C, confirmed on central temperature monitoring. Bilateral clear fluid was noted to be discharging from both ear canals.

Query CSF leak was indication for CT head, which was unremarkable. Considering this, efforts were focused on optimising body temperature. This was done with the use of ice packs and fans as well as continuous misting of cool water over the exposed patient. Improvement was shown with temperatures decreasing to 38°C.

In questioning the cause of the “clear fluid,” a swab of it placed on an icepack swiftly returned the fluid to its natural consistency of ear wax. As a result of the extraordinarily high body temperatures, ear wax had melted in both ear canals and started to leak out, giving the impression of a CSF leak.

This was simply identified at the bedside to refute the idea of a CSF leak. As CSF leak was the indication for a CT head, this could have been avoided with rapid cooling initiated earlier.

Unfortunately, this patient later died due to heat stroke.

Whilst avoiding the delay of a CT head most likely would not have changed the prognosis for this patient, it is useful to note the importance of logical thinking in an emergency setting.
ThP7.15 - An audit to assess the usefulness of investigations for patients with acute appendicitis
Authors: Sultana Emiko , Kausar Maria , Amin Amina , Kumar Harish
Published: September 2024

Introduction

The NICE guidelines recommend that acute appendicitis should be diagnosed clinically. In our hospital, many patients initially have an ultrasound or a CT scan before being taken to theatre. We aimed to assess the usefulness of investigations in diagnosing acute appendicitis. The objective will be to look at the clinical, radiological, operative, and histological diagnosis and identify if these are coherent.

Methods

A single centre retrospective study was carried out on all patients who underwent an appendicectomy between December 2022 and May 2023. Data was collected about the patient demographics, their presenting symptoms, clinical examination findings, blood test results, and whether they had radiological investigations and the respective results. This was then compared to the operative diagnosis and histological diagnosis.

Results

169 patients were taken to theatre for an appendicectomy with a median age of 24 (IQR 15-43) and 51.5% were male. Blood tests were done in all patients and imaging was done in 50.9% patients. Amongst the investigations, CT scans were the most accurate in diagnosing appendicitis (91.5% accurate), followed by bloods (65.5% accurate). US scans were the least reliable as it only accurately picked up 57.1% of the histologically proven appendicitis and reported 52% of appendicitis on histology as normal.

Conclusions

History, clinical examination, blood tests, and CT scans are reliable tools for diagnosing appendicitis pre-operatively. Investigations such as US Abdomen are not suggested for diagnosing appendicitis. Patients with clinically suspected appendicitis with raised inflammatory markers should be taken to theatre regardless of normal US Abdomen results.
ThP8.2 - Degree of Lymphatic dysfunction in severe obesity
Authors: Maharjan Surina , Sivakanthan Mathumie , Peters Adrien , Odiase Ruth , Gambhir Raghvinder Pal Singh
Published: September 2024

Aim

Obesity can affect the lymphatic system through a multitude of ways with patients presenting to lymphoedema clinics. The aim of this present study is to assess the degree of lymphatic dysfunction through Lymphoscinigraphy (LSG) scans in severely obese patients.

Methods

All obese patients who presented with leg swelling and underwent LSG scans were included in the study. Based on NICE guidelines they were graded as class 1 (BMI of 30-34.9 kg/m2), class 2 (35-39.9 kg/m2) and class 3 (40 kg/m2 or more). Severity of their Lymphoedema were categorised as mild (uptake 5-8%), moderate (uptake 2-5%), and severe (Uptake <2%) in accordance with the worst affected leg. These two variables were then compared.

Results

Of the 133 patients with BMI provided, the average BMI was 37.18Kg/m2. 54.89% of patients with BMI provided were classed as Obese.19 (26.03%) of these patients were classed as class 1 obesity and of these 68% had severe Lymphoedema. 14 (19.18%) were classed as class 2 obesity and 28% had severe Lymphoedema. 40 (54.79%) were classed as class 3 obesity and 28% had severe Lymphoedema.

Conclusion

Majority (75%) of obese patients had lymphatic dysfunction on LSG scans. Majority (62%) had mild to moderate Lymphatic dysfunction. Only 38% of patients with severe Obesity (40 kg/m2 or more) had severe Lymphatic dysfunction. Lymphoedema in Obesity is often not constitutional lymphoedema.
ThP8.4 - Initial Results of CAC (Cyanoacrylate Closure) of lower limb truncal venous incompetence
Authors: Naseer Afifa , Elkorety Mohamed , Belbase Sushen , Jayawardena Panduka , Jamil Sanober , Bhatti Tahir
Published: September 2024

Aims

We have tried CAC in our unit, as an emerging new treatment. We present our initial experience on efficacy and safety of the technique.

Methods

Venous trunks were treated with n-butyl Cyanoacrylate (Variclose® by biolas) as per IFU. Clinical and doppler US follow-up at three months was carried out. Data was captured prospectively.

Results

Eighty-six venous trunks (79 GSV, 5 SSV, 2 ATV) in 82 limbs of 65 patients were treated. Median length/ diameter of LSV treated was 32 /0.7 cms; 15/5 cms for SSV. Median volume of glue used was 1.83 mls.

Eighty-two out of eighty-six (96%) trunks were successfully treated with complete primary occlusion. Four(4.5%) trunks did not demonstrate total occlusion at primary treatment. There was no extension of thrombus into deep veins and no immediate adverse reactions.

On doppler US at 3 months, 58(70.7%) trunks demonstrated total occlusion. Twenty-four (29.3%) trunks were only partially occluded. which were deemed not suitable for thermal endovenous treatment.

Nine (11%) patients had adverse events. One had pulmonary embolism two days after treatment. Five limbs developed erythema and swelling in the thigh which took few weeks to settle. Two patients had exaggerated thrombophlebitis of the treated GSV requiring hospital admission.

Conclusion

There is a high rate of primary occlusion of the treated trunk which does not appear to be maintained at short term follow up. There is glue associated adverse reactions and potential serious complications. It may limit the options of subsequent treatment where the glue treatment has not been successful.
FP1.1 - The relationship between tumour necrosis, the tumour microenvironment, systemic inflammation, body composition and survival in patients with operable colon cancer. Does tumour necrosis drive systemic inflammation and cachexia?
Authors: Dolan Ross , Pennel Kathryn , Thompson Joshua , McKenzie Molly , McMillan Donald , Edwards Joanne
Published: September 2024

Introduction

The prognostic value of the systemic inflammatory response and its incorporation into the definition of cancer cachexia (GLIM) is now established. However, the basis of the relationship between the tumour, its environment and the systemic inflammatory response is not clear. The aim of the present study is to examine this hypothesis in greater detail.

Methods

A total of 473 patients were included. Host and tumour characteristics were assessed including tumour cell signaling pathways, CT derived body composition and systemic inflammation (as assessed by SIG). Categorical variables were analysed using χ2 test for linear-by-linear association, or χ2 test for 2 by 2 tables. Survival analysis was carried out using univariate Cox regression.

Results

Tumour necrosis was associated with age (p<0.01), tumour location (p<0.01), T-stage (p<0.001), margin involvement (p<0.05), SIG (p<0.001), SMI (Martin, p<0.01), SMI (Dolan, p<0.01), SMD (Dolan, p<0.05) and 5-year survival (p<0.001). No association was found between tumour necrosis and signalling markers of the IL-6/JAK/ STAT and NF-KB pathways. On univariate survival analysis age (p<0.001), ASA (p<0.001), T-stage (p<0.001), N-stage (p<0.001), tumour budding (p<0.05), venous invasion (p<0.01), adjuvant therapy (p<0.01), margin involvement (p<0.001), necrosis (p<0.01), SIG (p<0.001), MUST (p<0.001), BMI (p<0.05), sub cutaneous obesity (p<0.001), visceral obesity (p<0.05), Sarcopenia (Martin, p<0.05), Sarcopenia (Dolan, p<0.01), Myosteatosis (Dolan, p<0.05) GMS (p<0.001), Ki67 (p<0.01) and TSP (p<0.01) were independently associated with overall survival.

Conclusion

There is a clear association between tumour necrosis, the SIR and body composition in patients with colon cancer. These results are consistent with the hypothesis that tumour necrosis and the subsequent inflammatory response results in profound changes in body composition.
FP1.2 - Exploring Risk Factors and Incidence Patterns of Incisional Hernia following Colorectal Surgery: A Retrospective Cohort Study
Authors: Kishore Swetha , On Jason
Published: September 2024

Aims

This study aimed to determine the incidence rate of incisional hernias (IH) following colorectal resections and identify risk factors associated with their development.

Methods

A retrospective cohort of 942 patients undergoing colorectal surgical resection between January 2020 and March 2023 were analysed. Data collected encompassed patient demographics, medical history, operative details, and complications. Comparative statistical tests and logistic regression were employed.

Results

The incidence of IH was 10.2% during a median follow-up of 11 months (4,12). Multivariate analysis revealed significant risk factors, including increased BMI (OR 1.063; 95% CI 1.029 – 1.097, p < 0.001), neoadjuvant chemotherapy (OR 2.098; 95% CI 1.021 – 4.314, p = 0.044) and midline extraction site (OR 15.465; 95% CI 3.292 – 31.591, p < 0.001).

Conclusions

With an IH incidence of 10.2%, this study identifies high BMI, neoadjuvant chemotherapy, midline extraction site, and laparotomy procedures as significant risk factors. Data also indicated a pfannenstiel incision is the preferred incision site during robotic surgery thereby minimising the risk of developing an incisional hernia and improving patient outcomes.
FP1.8 - Optimizing Rectal Cancer Treatment: Comprehensive response to Neoadjuvant therapy
Authors: Anwar Kehkashan , Talal Muhammad Nasir , O' Connor Adam , Kamposioras Konstantinos , Arthur Claire , Ullah Sana
Published: September 2024

Aims

This study aimed to assess the outcomes and feasibility of a watch-and-wait strategy in patients with rectal cancer showing a complete response to neoadjuvant chemoradiotherapy (CRT). The primary objectives included evaluating the oncological results, disease-free interval, and survival rates in patients who underwent the watch-and-wait approach after a complete clinical response.

Methods

The study involved a retrospective analysis of last 10 years of rectal cancer patients enrolled in a complete responder surveillance program in an acute general hospital. Cohort characteristics, including age, performance status, tumor histology, distance from the anal verge, and treatment modalities, were documented.

Results

The median age was 74 (57-90), and the median performance status was 1, with the age at diagnosis being 69. All cohort members had a histologically confirmed rectal adenocarcinoma. The median tumor-to-anal-verge distance was 5 cm (1-10 cm). Neoadjuvant chemotherapy was administered to 55% of patients. All patients underwent long-course radiotherapy, and 35% received papillon contact brachytherapy. Total neoadjuvant therapy was received by 10%. The median follow-up involved approximately 9 colonoscopies. During follow-up, 25% of patients experienced recurrence, with a median disease-free interval of 3.5 years.

Conclusion

The findings of this study, in addition to ongoing prospective clinical trials and insights from databases such as EURECCA and OnCore, indicate that a watch-and-wait approach can be safe and effective for selected rectal cancer patients who have achieved a complete response to neoadjuvant CRT. This study highlights the significance of additional research to identify appropriate patients for this approach and to refine its implementation in rectal cancer management.
FP1.14 - A Re-audit of the prevalence of faecal incontinence in hospital inpatients
Authors: Saraee Danial , Khadka Subodh , Kaur Geetinder
Published: September 2024

Introduction

Faecal incontinence (FI) is a common and under-reported problem, with many patients too embarrassed to seek help. Patients often do not receive optimal care due to lack of identification. In-hospital identification when they are admitted for other reasons may be one method of improving the care of such patients.

Aims & Methods

We had assessed the identification of continence problems in our hospital inpatients via a simple ‘spot check’ audit of the different wards in 2015; we used the case notes for checking the documentation by both nursing and medical staff. We looked at care plans, stool charts, follow up plans etc. We repeated this audit in 2023 to check for any improvement.

Results

Overall,132 (163 in 2015) patient case notes were examined. 94%(previously 90) had nursing documentation about bowels documented in comparison to 47% (48) for medical documentation. 5.3% (10.8) were found to have FI. Only 28% (31) of these patients would have been identified by medical documentation. Most of the patients identified with FI were elderly, as expected; surprisingly, 28.57% were on general surgical wards. All patients (100%) in 2015 were then referred appropriately for further management. In 2023, though some action for FI was taken in 71.42 % patients, no referral was apparently arranged in any.

Conclusion

It is important to identify patients with FI, establish cause and initiate appropriate management. The impact on the individual patient’s QOL needs assessment prior to planning management/specialist referral etc. We found that our nursing documentation was still better than medical documentation which needs to be improved; however, onward referral/management needs improving significantly.
FP5.7 - Why I don’t want a career in surgery? - Uncovering obstacles and investigating barriers among year 3 UK medical students: A thematic analysis
Authors: ELsherbiney Saged , Alakus Conor , Kaur Harneet , Khera Goldie
Published: September 2024

Aims

Surgical training and placements can be stereotyped negatively by medical students. Our study aimed to identify barriers to pursuing a surgical career amongst UK year 3 medical students, to improve surgical educational policies.

Methods

An optional, anonymous, single-question, open-text survey was administered to 190, year 3 UK medical student, after they had completed an 11 week surgical clinical placement, comprising Breast, Emergency Department, Interventional Radiology, Orthopaedics, Peri-op anaesthetics, Plastics, Vascular, Upper/Lower GI and Urology.

The specific question asked was, 'Would you contemplate pursuing a career in surgery?'

Responses from students NOT considering a surgical career were analysed qualitatively using a thematic approach to identify perceived barriers to a surgical career.

Results

102 responses were received of which 35 were not suitable for analysis. Of the remaining 67 students, 30 (44.8%) demonstrated a negative view towards a surgical career. Following thematic analysis four main themes were identified:Pre-existing interest in another specialty.Nature of surgical training (long duration, competitive, poor work-life balance).Stressful clinical workload, high emotional pressure and burnout.Negative, masculine culture within surgical teams.

Positively, despite not planning to pursue surgery - some students reported surgery was not as intimidating as they had expected it to be and surgeons did not meet stereotypes they were expecting.

Conclusions

Medical students continue to comment on negative surgical working environment experiences. Our study highlights areas that high pressure surgical training placements, need to actively improve in order to ensure a positive working and teaching surgical environment for our future medical workforce.
FP6.9 - Improving Compliance & Implementation of the STAR Score at a tertiary level hospital in India: A continuous process
Authors: Sinha Akatya , Kadam Sameer
Published: September 2024

Aim

To perform an audit to check the Quality and compliance of Surgical documentation using STAR Score at a tertiary hospital in India.

Method

A total of 90 case files were studied and assessed in detail from all surgical departments. The “STAR: Surgical tool for auditing records” tool was used to collect data accordingly. The results were compared with standard guidelines and further analyzed. A series of departmental training and implementation meetings were carried out. Three cycles were carried out and a re-audit was performed at the end of every cycle.

Result

The overall compliance score of the hospital was found to be 74%. While the departments of General surgery and orthopaedics showed a higher rate of compliance, each constituting 82%, Neurosurgery showed the least compliance at 62%. It was also seen that the maximum percentage of missing information constituted anaesthetic records and subsequent entries. At the end of 3 cycles, a considerable improvement was observed, with the compliance rate improving to 98% in all departments.

Conclusion

We believe that compliance and implementation of the STAR Score is mandatory, as it can significantly improve the quality of documentation and can be implemented universally.
FP8.5 - QR Coded Patient Leaflets – Transforming the Sustainability of Patient Information Delivery in the Surgical Outpatient Department
Authors: Kumar Sidharth , Yeung Antoinette , Issa Mohammed Talaat , Farrugia Alexia , Sarma Diwakar
Published: September 2024

Introduction

Quick Response (QR) codes are becoming ubiquitous in all aspects of life, including healthcare. In outpatient clinics, the benefits of convenience, cost effectiveness and environmental sustainability of QR codes has great potential. We identified that our trust was lacking in both electronic and hardcopy patient information leaflets for Bascom’s Procedure and Endoscopic Pilonidal Sinus Treatment (EPSIT). Our aim was to create information leaflets on our trust website and link them via a QR code for easy access.

Methods

We audited our hardcopy information leaflets for both procedures for quality and satisfaction of information and patients were given a feedback questionnaire which specifically included a response for their preference for electronic QR code access.

Results

The initial feedback from 20 patients showed 85% support for QR codes. 90% found the information clear, informative and easy to understand. There was a suggestion to include diagrams in our leaflets.

Conclusion

We had positive feedback regarding the following: quality of information, clarity of the leaflet, and accessibility (particularly the use of QR codes). The latter reflects the younger age demographic of patients that were surveyed. We plan to prospectively audit QR coded leaflets in our outpatients. We will evaluate success through both patient and clinician feedback forms. QR coded leaflets could be implemented trust wide and even nationally, to increase sustainability in outpatients and the wider NHS, without compromising patient understanding or satisfaction.
FP8.9 - Surgical Synergy: Rethinking waste for a greener tomorrow in General Surgery
Authors: Kabir Tahmid , Lingam Gita , Sivarajah Vernon , Hussein Adam
Published: September 2024

Aims

Every year in the UK, the NHS sends approximately 156,000 tonnes of clinical waste for processing via high temperature incineration or other treatments, and then to landfill sites. Majority of the waste produced by hospitals comes from the operating theatres (OTs). In this study, we aim to assess the current implementation of waste management strategies at an NHS district general hospital (DGH) in general surgery. We have investigated a variety of cases and have surveyed the volume of waste produced.

Methods

We observed elective and emergency general surgery cases across 2 weeks. For each case, we weighed the waste produced- both recyclable and non-recyclable (clinical).

Results

This study included four umbilical hernia repairs, two right hemicolectomies, one examination of rectum under anaesthesia with seton insertion and three laparoscopic cholecystectomies. Across the operations, the average total waste produced was 5.9kg. The average clinical waste and recyclable waste was 4.7kg and 1.2kg, respectively. Additionally, a significant proportion of non-infectious recyclable waste was incorrectly placed into the clinical waste bin.

Conclusion

On average 5.9kg of waste is produced after a general surgery operation. Most of this waste is clinical and not recycled. However, the clinical waste can be cut down by appropriate waste segregation, thus reducing the impact on the environment as well as reducing the cost of incineration.
EP160 - A comparison of pre-rotation confidence levels over a year of surgical foundation year one doctors in a busy district general hospital
Authors: George Jayan , Savage Daniella , Brown Denise , Yeluri Sashidhar
Published: September 2024

Aims

Assess the confidence levels of foundation year one (FY1) doctors in managing surgical patients pre-rotation. Identify areas where further support could be given to improve confidence levels.

Methods

Ten questions used Likert scales (1 to 5: not at all confident to very confident) to assess general surgical patient management. One question focused on education methods and one open question. Cohort One (August 2022) were asked to reflect in December 2022. Cohort Two (December 2022) and Cohort 3 (April 2023) were surveyed at the start of their general surgical rotation. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results

100% (10/10) cohort one, 75% (6/8) cohort two and 100% (10/10) cohort three completed the survey.

Pre-rotation confidence levels mostly improved between the first cohort and last cohort.

Areas where modal scores were below three in the last cohort were in managing the acutely unwell general surgical patient, managing biliary disease and managing non-specific abdominal pain.

Common concerns of FY1 doctors were not being able to contact a senior in theatre and the busyness of the specialty.

Most FY1 doctors felt that group teaching would be the preferred method to increase understanding of general surgery.

Conclusions

Confidence levels were higher in the final cohort. This suggests core skills are picked up in different specialties which are transferrable to aspects of general surgery. Further work needs to be done to target improvement in areas of lower confidence.
EP181 - The role of abdominal X-rays in the acute abdomen: a retrospective audit
Authors: Alkaissy Riem , Manimaran Natarajan
Published: September 2024

Introduction

Abdominal x-rays (AXR) are commonly performed as part of the diagnostic work up for acute abdomen despite wide availability of CT. Several studies dispute the role of AXR in acute abdomen, due to low accuracy, uncertain role in diagnosis & management and superiority of CT (1). There are calls to replace AXRs with CT altogether where possible, as patients often end up having CT scans, thereby receiving larger doses of radiation (2). The Royal College of Radiologists (RCR) have produced guidelines to reduce the use of AXR in the acute setting (3). The aim of this audit was to clarify if we adhere to the RCR Guidelines at our DGH.

Methods

62 consecutive adult surgical patients admitted to our surgical admissions unit as emergency, between September and November 2023 were included in this retrospective audit. Data was collected regarding patient demographics, reason for request, AXR report, whether patient underwent CT, CT report and time between AXR and CT.

Results

97% of AXR requests were compliant with RCR guidelines. 30/62 patients also had a CT scan following initial AXR. Of these, 13 had normal AXR and CT. 9 had normal AXR but abnormal CT. 8 had abnormal AXR which was confirmed on subsequent CT.

Discussion

We identified that our surgical unit has good compliance with RCR guidelines. However, nearly half of our patients also had a CT scan, in addition to AXR. Although the AXR has lower radiation dose, it may be prudent to restrict the addition of AXR, if a CT is required to assess acute abdomen. We now aim to discuss and propose change in our practice for the future.
EP474 - Recycling Theatre Waste: A Quality Improvement Project
Authors: Wong Zhen Yu , Herrod Philip
Published: September 2024

Background

Theatre waste recycling is a crucial aspect of sustainable theatre production. Staff are usually under time pressure to empty and clean the theatre. This quality improvement project (QIP) aims to assess and reduce waste-related cost and carbon footprint by improving the proportion of waste recycled.

Methods

A retrospective review of the waste data and related cost for main theatres in Nottingham City Hospital (NCH) in 2022 was audited. A quick guide for waste disposal and recycling was made with the help of environmental department and was disseminated to the theatre staff electronically and physically. Data was reaudited for February to March 2023 post intervention.

Results

86.6 tons of waste was generated from the main theatres in NCH in 2022 and 18.4% of the waste was recycled. Monthly proportion of waste recycled ranged from 9.3% (January 2022) to 35.0% (December 2022). The proportion of waste recycled for February and March was 36.7% and 26.4% respectively.

Conclusion

The findings of this QIP demonstrate the potential for significant improvements in theatre waste recycling rates, which can lead to reduced cost and carbon footprint. The use of a quick guide for waste disposal and recycling proved to be an effective intervention in improving recycling rates among theatre staff. This QIP highlights the importance of promoting sustainable practices in the theatre industry, and the necessity to sustain the effort to maintain the impact.
EP496 - Metastatic Invasive Lobular Carcinoma of the Breast mimicking healed Gastric Ulcer: A Case Report
Authors: Hobeita Wesam , Curry Heather , Mahmud Sajid , Lannigan Alison , Khan Khurram S
Published: September 2024

Introduction

Breast cancer metastasizing to the stomach as a new presentation is highly unusual. We report a 77-year-old female with such presentation.

Case Presentation

A 77-year-old female investigated for significant weight loss. She denied any upper or lower gastrointestinal symptoms. She had bidirectional scopes. Colonoscopy showed only diverticulosis. Two gastroscopies revealed non-specific stellar shaped areas in the anterior antrum wall mimicking a healed gastric ulcer. Biopsies confirmed metastatic lobular carcinoma of the breast, ER+ve, HER2 negative.

On further clinical examination she had large mass upper outer quadrant with palpable enlarged nodes. Staging CT scan showed couple of hyper enhancing foci in the right breast which may be potential candidates for primary tumour and enlarged right axillary nodes. Subsequently she had an ultrasound guided biopsy of the breast lesion confirmed invasive lobular cancer.

Patient has been referred to the breast MDT for breast and lymph node biopsy.

Discussion

The incidence of GI metastatic disease from a primary breast cancer is less than 1%. It is more common to diagnose in patients with prior history and treatment for primary breast malignancy. However, occasionally it can be encountered prior to the diagnosis of the primary tumour. Hence, index of high suspicion is required as the endoscopic findings are non-specific.