bluuebunny/crossref_metadata_2025 huggingface dataset:
1020 Pre-Operative Investigation of Symptomatic GORD Patients and Hiatus Hernia: Are We Doing Too Many?
Authors: Sivakaran A , Sufi P
Published: August 2023

Aim

To evaluate the clinical utility of diagnostic tests such as upper endoscopy, barium swallow, oesophageal manometry and pH studies that are commonly performed in patients prior to undergoing a hiatus hernia repair and determine whether one or more of these investigations can be omitted in our practice.

Method

A retrospective analysis was conducted on 215 patients from September 2012 to August 2022 with symptoms of gastro-oesophageal reflux disease (GORD) undergoing hiatus hernia repair. Endoscopy was used as the gold standard to evaluate the performance of oesophageal manometry and barium swallow findings in diagnosing hiatus hernia (HH).

Results

Endoscopy had the highest detection rate of HH (76.9%), followed by barium swallow which had a higher detection rate of HH (51.8%), specificity and positive predictive value compared to manometry studies (42.1%), however, this did not reach statistical significance (p = 0.07). There was no significant difference between endoscopy and barium swallow (p<0.05) and oesophageal manometry and endoscopy (p<0.00001) in the detection of HH.

Conclusions

All three investigations appear to be useful for the detection of GORD and hiatus hernia prior to treatment. However, the routine use of manometry pH studies may not be crucial and therefore could be performed selectively in patients. Further prospective analysis comparing preoperative and intraoperative findings could be carried out for each diagnostic test to assess whether the significance of our results is applicable to all populations and to determine whether one of these tests can be safely omitted or performed more selectively.
903 Operative Records at Emergency Inguinal Hernia Repair: Improvements Might Avoid Future Litigation
Authors: Mohamud M F
Published: August 2023

Background

Chronic groin pain (CGP) after inguinal hernia repair is a multi-factorial problem of variable incidence. The literature is concentrated on the management of CGP after elective repair where litigation for pain accounts for up to 40% of claims for negligence.

Method

Computerised surgeon-typed operative reports of all emergencies inguinal hernia repairs in a single DGH over two years were scrutinised. Specifically looking for the descriptions of the handling of the spermatic cord and the nerves of the canal.

Results

Forty-three repairs were performed by surgeons in training using an open approach. The majority were primary hernias (37/43; 86%) and the repair was usually augmented with prosthetic mesh (88%). Cord handling was described in 35 patients (81%) but identification of the ilio-inguinal nerve was documented in only three. No report mentioned ‘seeking but not finding’ the nerve(s).

Conclusions

Surgeons in training seem to disregard documenting the status of nerves at urgent/emergency repair. Lawyers can be forgiven for arguing negligence if operative records omit observations on vital structures prone to ‘inadvertent’ damage. This needs to be emphasised to all those concerned with the emergency repair of inguinal hernias.
755 Management of Perforated Peptic Ulcer in Laparoscopic Era
Authors: Albirnawi H , El-Bernawi H
Published: August 2023

Aim

We want to share our initial experience in treating Perforated Peptic ulcer by mini-invasive techniques.

Method

Retrospectively, data was collected by looking at surgical files for patients who were admitted with perforated peptic Ulcers under an experienced consultant surgeon between 2016 and 2021 at Benghazi Medical Centre in Libya. Only patients were managed laparoscopically were included and were managed by the same surgeon.

Results

In the period of 2016 until 2021, 18 patients with perforated peptic ulcers were treated laparoscopically in our hospital.All were men except three women, age ranged from 23 years to 56 years. Laparoscopy was attempted in all patients , none of the cases were converted to open , 14 patients of perforations were located in the first part of duodenum (80%) and 4 were pre-pyloric , simple closure with omental patch were enough to close the perforation, copious peritoneal lavage with normal saline access to all abdominal compartments is very easy and never can be reached in open surgery. Mean operative time was 90min (60-120 min). the hospital stay ranged from 3 to 7 days. with no morbidity, leak , and no mortality within 30 days.

Conclusions

We shared our experience for management of perforated Peptic ulcer at Benghazi Medical Centre, by managing 18 patients with perforated viscus Laparoscopically. Laparoscopy is safe and permits successful primary suture closure of perforated duodenal and gastric ulcer and provides excellent access to different regions of the abdomen for better lavage. Furthermore, it confers benefits on patients in the form of reduced postoperative pain, and early recovery.
172 Embryological and Developmental Understanding in Improving Outcomes of Canine Exposure
Authors: Gupta A , Ganesan K
Published: August 2023

Aim

85% cases of canine impaction are palatal. This presentation reviews the surgical factors to consider in predicting outcomes for canine exposure.

Age - Apexogenesis of the canine root completes by 16 years. Exposures should be considered before root completion. Where the patient is over 16y, a bracket & chain should be considered.

Vertical level of impaction - Mcsherry’s rule of thirds suggests the Orthopantomogram can be used to grade the vertical level of impaction. Grade 2 and 3 impactions will most likely require a closed approach.

Role of the follicle – The follicle is a source of RANK, CSF-1 and progenitor cells involved in bone remodelling and formation of root-bone surface. Therefore, during surgical exposure, the follicle should not be stripped. Ankylosis may occur from radical removal of dental follicle as bone deposition occurs in the created space. Orthodontic mobilisation should be considered within 4-6 weeks of exposure whilst the woven bone is to mineralise.

Method

Surgical outcomes were reviewed to assess these theories. Data was collected for the canine exposures done in the department over a 7-year period. The re-exposure rates is compared to the National re-exposure rate reported by Spencer et al.

Results

Over 500 palatal canines were exposed. 90% were successfully aligned. 0.6% cases required re-exposure. Spencer et al. reported a re-exposure rate of 3% for open exposures.

Conclusions

By applying the follicle preservation theory and considering age and level of impaction in surgical decision making, our service demonstrates that canine exposure can be carried out with predictable outcomes.
386 Fibrous Histiocytoma of the Hard Palate – Clinico-Pathological Description of a Rare Tumour with Literature Review
Authors: Sawhney S , Zhou Z M , Amin A , Mumtaz S , Lee J , Proctor I
Published: August 2023

Introduction

Fibrous histiocytoma (FH) is a commonly reported soft tissue tumour which can occur ubiquitously in the body. However, its presence is incredibly rare in the oral cavity. When they do occur, they usually present as painless nodular growths with sessile base in the buccal mucosa. Diagnosis is confirmed through clinical, histopathological and immunohistochemistry analysis.

Method

The description of this condition is undertaken by presentation of a clinical case & findings, histopathological and immunohistochemical features, literature review and relevance to the oral and maxillofacial surgeons and pathologists.

Results

A 66-year-old man presented with an exophytic smooth mass of the hard palate affecting his ability to eat. The lesion was excised with a 2 mm margin and sent for histopathological evaluation. This was reported to have contained mixed population of histiocytes, foamy macrophages/xanthoma cells and plump spindle shaped cells arranged in storiform pattern confirming benign FH. Only 59 cases of the oral variant of this lesion have been published in literature and only 7 of these cases were found on the palate. There is a slight male predilection and occurrence between 3rd and 4th decade of life. The risk of recurrence after excision can be between 5-10% cases mainly due to incomplete excisions. Malignant transformation is rare.

Conclusions

Oral FH is an uncommon diagnosis for a soft tissue palatal lesion. Clinicians should have sufficient awareness of these rare lesions and consider them in the surgical sieve when dealing with soft tissues lumps of the oral cavity.
995 Cavernous Sinus Thrombosis Secondary to Dental Neglect
Authors: Falls D , McEvoy C , Mentias Y , Wilson A
Published: August 2023

Background

Cavernous sinus thrombosis is a rare, potentially life-threatening condition often caused by a cervicofacial bacterial infection. Prompt diagnosis and management improve prognosis and help prevent permanent complications.

Clinical case

A 54-year-old man with a background of alcohol excess attended the emergency department following a collapse at home. He presented with a potassium of 1.5 and a firm right parotid swelling with associated facial nerve weakness and was admitted to ICU for management of severe sepsis and electrolyte disturbance.

CT imaging out of hours showed swelling of right parotid and submandibular areas and generalised oedema parapharyngeally.

Further clinical examination by the maxillofacial team noted a right sided 6th nerve palsy, raising concern about intracranial spreading infection from a dental source and MRI was requested. The patent continued to deteriorate and developed bilateral chemosis and proptosis. MRI scan confirmed bilateral cavernous sinus thrombosis and right cerebral hemisphere subdural collection and the patent was transferred to a neurosurgical unit for a craniotomy, temporal lobe washout and dental clearance.

Upon further review of imaging by a specialist head and neck radiologist the cavernous sinus thrombosis was noted on the initial scans.

Conclusions

Raise awareness of this condition and its management – much rarer more now due to antibiotics in developed world.

Importance of thorough clinical examination to pick up subtle signs such as cranial nerve palsies.

Vital to have multidisciplinary involvement in diagnosis and management; both radiology to help with diagnosis and neurosurgery, ENT and maxillofacial to carry out surgery as required.
1123 Incidence of Electrolyte Abnormalities in Patients Recovering Form Maxillofacial Resection and Free Flap Reconstruction
Authors: Ridley S , Uthayakumaran M
Published: August 2023

Aim

Recovery from resection of head and neck malignancy is fraught with potential complications. Among these are electrolyte disturbances. The majority of junior trainees in Oral & Maxillofacial surgery have qualified in dentistry and will have had little exposure to this topic. We aim to examine the incidence of disturbances in Serum Sodium, Potassium, Calcium, Magnesium and Phosphate. This information will aid in prioritising information for robust induction and educational programmes in Maxillofacial oncology centres.

Method

Patients were identified in a single centre from January to November 2022 from theatre records. All patients were adults who underwent resection for Head and Neck malignancy with free flap reconstruction. A total of 65 patients were included. The electronic pathology system was integrated for results.

Results

The most common abnormal result was hypophosphatemia (<0.8 mmol/L) present in 53 patients (81%). The next most common was hypocalcaemia (<2.2 mmol/L) which was present in on 46 patients (71%) Potassium imbalances were seen in fewer patients, with 10 being high (>5.3 mmol/L and 17 low (<3.5mmol/L). Least common were issues with Sodium, being high (>145mmol/L) for 9 patients (14%) and low (<135 mmol/L) for 14 patients (21%).

Conclusions

Electrolyte abnormalities are commonly encountered when caring for Maxillofacial Head & Neck cancer patients. Prior to surgery many patients have undergone a period of malnutrition due the pain. This makes them high risk of re-feeding syndrome once nutrition is started. Induction programmes should familiarise dental core trainees with the trust’s Re-feeding guidelines and when to escalate more severe problems.
192 Preserving Glenoid Subchondral Bone in aTSR
Authors: Giannas E , Zhang J , Haar R , Tancak M , Hansen U , Sankey A , Emery R
Published: August 2023

Aim

Glenoid loosening remains a major concern in anatomical Total Shoulder Replacement (aTSR). Preoperative planning software and patient specific guides allow implantation optimization in aTSR. This study aims to examine and compare the amount of bone resected with prescribed adjusted angles to respecting the subchondral plate with minimal resection, using a freehand technique.

Method

Two groups of shoulder CT scans were assessed, normal and osteoarthritic of patients who had undergone aTSR. Preoperative planning software was used to place the glenoid component in prescribed adjusted angles, with neutral (0o,0o), retroverted (-10o,0o) and inclined alignment (0o,10o). This was then compared to positioning the component using a freehand technique, whereby the component was placed in a position to maintain the subchondral plate with minimal bone loss and respecting the integrity of the vault.

Results

The number of CT scans was 68, 34 normal and 34 osteoarthritic. The freehand technique resulted in statistically superior cortical bone seating in the osteoarthritic group with a mean (standard deviation) of 53.27% (14.32), while neutral alignment resulted in 36.68% (10.81), retroversion 40.40% (13.06), and inclination 39.34% (13.52), p<0.001. Similarly in the normal scans, cortical bone seating in the freehand scenario was 46.71% (15.96), neutral 25.65% (12.27), retroverted 26.73% (15.03), and inclined 32.93% (12.12), p<0.001.

Conclusions

The freehand method for positioning the guidewire resulted in significantly superior cortical bone seating, when compared to prescribed adjusted angles. Applying this technique in the clinical setting may achieve superior glenoid component seating and hence reduce the risk of aseptic loosening in aTSR.
427 Systemic Imaging for Early Laryngeal Cancer; a Single Centre Review of Guideline Application in Contemporary Clinical Practice
Authors: Tagdiwala P , Stimpson P
Published: August 2023

Aim

Early-stage laryngeal cancer (T1 and T2) has low rate of locoregional and distant metastasis. Therefore, National Institute for Health and Care Excellence (NICE) guidelines were updated in 2016 and recommended to no longer offer systemic staging for early laryngeal cancer because systemic imaging was not deemed to be cost effective. Our study aims to evaluate (1) if NICE guidance on the role of systemic imaging in the assessment and management of early laryngeal cancer is being followed in our centre (2) assess the impact of this practice on our patients (3) perform a cost analysis relevant to our institution.

Method

We retrospectively reviewed all laryngeal cases at a major H&N cancer centre between 01/01/2020 and 01/01/2022. The following information was collected for all the patients: neck/systemic imaging modalities performed on patients, demographics, site of original laryngeal tumour and any metastatic disease detected by systemic imaging. Next, we performed a cost analysis based on the cost analysis method undertaken by NICE.

Results

Our results showed n = 83 patients had laryngeal cancer between 01/01/2020 and 01/01/2022. Of which n = 30 had T1N0 and T2N0 disease. Systemic imaging found no metastatic disease, however n = 2 primary lung tumours and n = 1 lung infection was detected. The total cost for systemic imaging was £4,207.12 and total cost for neck imaging investigations it was £12,335.07.

Conclusions

Our study concludes NICE guidance is not being followed at our centre. Systemic imaging provides little benefit to patients and is an expensive practice.
453 The Optimal Timing of Colectomy for Acute Severe Ulcerative Colitis
Authors: Ryan E , Tyrrell-Price J , Phillips J
Published: August 2023

Aim

Acute severe ulcerative colitis (ASUC) is a medical emergency which, if left untreated, can be fatal. Some cases require colectomy. The timing of this operation is important to reduce post-operative morbidity. The primary study aim is to assess whether the timing of this operation impacts upon post-operative outcome. The secondary aim of this study is to determine whether pre-operative blood albumin level may be able to predict post-operative complication rates.

Method

All patients who underwent colectomy and ileostomy formation for ASUC at Bristol Royal Infirmary between 2010-2020 were identified. Patient demographic information, duration of pre-operative hospital stays, blood results and post-operative complications up until the most recent follow up were recorded. Patients undergoing elective colectomy for ulcerative colitis were analysed separately.

Results

Twenty-one ASUC admissions were identified who were all treated with intravenous steroids for a median of 9 (range 1-18) days before colectomy. 16 patients (76%) received either ciclosporin or infliximab rescue therapies. Median admission CRP was 41 (range 4-231). Median admission blood albumin was 29 (range 16-38). <30-day and >30-day post-operative complication rates were 52% (11/21) and 25% (5/20) respectively.

Conclusions

Previous literature shows significant association between the length of pre-operative medical therapy and post-operative complications. Surgeons can learn from them, so far, negative findings of our study. A surgeon’s own clinical judgement is the most important factor in the decision of when to take an ASUC patient to theatre. Biomarkers can aid a decision but cannot be used as a solitary justifier for the timing of colectomy.
977 The Impact of Post-Mastectomy Radiotherapy on Immediate Free Flap Breast Reconstruction
Authors: Suhail D , Brennan C , Akali A
Published: August 2023

Aim

Radiotherapy following free flap breast reconstruction has historically been thought to increase complication rates, worsen patient reported outcomes (PROs) and lead to poorer cosmetic results. We aim to assess the impact post-mastectomy radiotherapy (PMRT) has on immediate free flap breast reconstruction using these variables, with patients acting as inherent controls.

Method

We conducted a retrospective cohort study on all patients receiving immediate bilateral free flap breast reconstruction followed by unilateral radiotherapy between 2008 and 2022. Complication rates were assessed by comparing prevalence of fat necrosis, volume depletion requiring lipofilling, and flap loss among irradiated vs non-irradiated breasts. PROs were assessed by comparing “Satisfaction with Breasts” and “Chest Physical Well-Being” (two sections of the Breast-Q survey) among irradiated vs non-irradiated breasts. Cosmetic outcomes were assessed by scoring postoperative pre-radiotherapy and postoperative post-radiotherapy patient images using “Objective Breast Cosmesis Scale” (OBCS) and “Harvard Breast Cosmesis Scale” (HBCS).

Results

9 patients underwent immediate bilateral free flap breast reconstruction followed by unilateral radiotherapy. Median age was 40 years (IQR 32-44). Complication rates did not vary significantly between irradiated and non-radiated breasts. “Satisfaction with Breasts” did not vary significantly between irradiated and non-radiated breasts; however, “Chest Physical Well-Being” did vary significantly between both breasts. Cosmetic outcomes did not vary significantly between pre-radiotherapy and post-radiotherapy images.

Conclusions

PMRT following immediate free flap breast reconstruction does not have significant deleterious effects on complication rates, patient satisfaction with breasts or cosmetic outcomes. However, radiotherapy has a significant effect on patient’s chest physical well-being, hence we aim to study this further.
980 The Impact of Anticoagulant, Antiplatelet, and Nonsteroidal Anti-Inflammatory Drug (Nsaid) Use on Faecal Immunochemical Testing Measurements in Fast Track Referral Patients
Authors: Suhail D , Elbeltagi A , Lim M
Published: August 2023

Aim

Faecal immunochemical testing (FIT) has been used as a prioritisation tool and diagnostic adjunct for detection of colorectal cancer (CRC) patients on the fast-track pathway. Many patients referred through the pathway are on medications associated with gastrointestinal bleeding. We chose to study the impact of such medications on FIT measurements.

Method

A retrospective review of patients between March 2020 and August 2022 was conducted. Data on patient demographics, medication use, FIT results and colonoscopy findings were gathered. Patients who did not undergo further investigations and patients diagnosed with CRC were excluded. Patients with a FIT measurement greater than 7μg of haemoglobin/gram of faeces were deemed positive. Chi squared test was used to compare the proportion of patients with a positive FIT in those who were and were not on the above medications. A p-value of <0.05 was deemed significant.

Results

There were 1668 (778 male) patients. Median age was 71 (IQR 62-78) years. CRC was detected in 92 patients. In the 1576 patients without cancer, 164 (10.4%) were on anticoagulants, 242 (15.4%) were on antiplatelets and 82 (5.2%) were on NSAIDs. A significantly greater proportion of patients had a positive FIT when on anticoagulants compared with those who were not (40% vs. 23%, p-value = 0.00). Use of antiplatelets or NSAIDs had no impact on FIT measurements (29% vs 24%, p-value = 0.32 and 18% vs 25%, p-value = 0.36).

Conclusions

Anticoagulants can impact FIT measurements, hence thresholds for a positive result may need to be altered for these patients. We seek to study this further.
985 The Temporal Changes in the Urine of Severe Traumatic Brain Injury Patients
Authors: Cetin M
Published: August 2023

Aim

Neuroinflammation is a secondary injury mechanism that contributes to significant mortality and morbidity with severe traumatic brain injury (TBI). This study aimed to evaluate the temporal neuroinflammatory pattern of the ionised calcium-binding adaptor molecule 1 (Iba1) and transmembrane Protein 119 (TMEM119) microglia marker proteins in the urine of severe TBI patients for 7 days post-injury.

Method

Urine samples were acquired from fifteen patients with severe TBI upon hospital admission and the subsequent 7 days post-injury. Western blot analysis was used to quantify the urinary levels of Iba-1 and TMEM119 expression in each sample. The patients were stratified by functional outcomes (group 1, death- vegetative state; group 2, moderate-to- severe disability; group 3, good outcomes).

Results

Iba1 was detected in all (100%) whilst TMEM119 was detected in 65% of acquired urine samples. The mean total normalised Iba1 expression increased for group 2 whilst the opposite response was observed for groups 1 and 3. The mean total normalised TMEM119 expression decreased for group 3 whilst the opposite response was observed for groups 1 and 2. However, these findings were not statistically significant. No significant differences were found in Iba1 or TMEM119 expression between favourable and unfavourable outcome groups.

Conclusions

Overall, this study cannot associate urinary Iba1 or TMEM119 expression with functional outcomes. However, the presence and temporal patterns of the urinary microglia markers suggest it may be reflective of the underlying neuroinflammatory process and merits further studies.
1051 Procedure-Specific Consent Forms in Clinical Practice: A Systematic Review
Authors: Norvill J , Bent C , Mawhinney J , Johnson N , Bainbridge C
Published: August 2023

Aim

Consent forms play an active role in the consent process. Generic, hand-written consent forms are used as the standard across the NHS. However, increasingly procedure-specific consent forms (PSCF) are being used as an alternative. Their proponents suggest PSCF improve the consent process however concerns remain about whether they meet the standard for consent. We therefore conducted the first review evaluating the use of PSCF in clinical practice and give suggestions regarding their future use.

Method

A literature review was conducted via PubMed using the key terms ‘pre-printed consent form’ and ‘procedure-specific consent form'.

Results

Few studies investigating PSCF in clinical practice were identified including no systematic reviews. Most studies identified were quality improvement projects. However, no studies assessed the role of PSCF in litigation after procedural complications. PSCF were associated with improved legibility, documentation and patient understanding versus generic consent forms. PSCF generally improved documentation of procedure-specific complications and risks versus generic consent forms. PSCF are not routinely used in clinical practice and are not endorsed by the Department of Health and Royal College of Surgeons. There is no definitive legal guidance attesting to their use in the consent process, despite concerns their use will lead to procedures and associated complications not being fully explained to patients.

Conclusions

Evidence supporting the use of PSCF is available however it is heterogeneous and substantial legal concerns remain. Additional, high-quality studies evaluating their use is warranted, including their impact on medico-legal claims. Finally, a collaborative approach between clinicians and those within the legal profession is necessary.
1110 Reconstructing the Stereotype - a Systematic Review of Medical Students’ Perceptions, Awareness, and Influences for a Career in Plastic Surgery
Authors: Petmeza C A , Georgiannakis A , Glynou S P , Zargaran A , Zargaran D , Mosahebi A
Published: August 2023

Aim

This systematic literature review evaluates medical students’ knowledge and perceptions of plastic surgery as a primary outcome, whilst identifying barriers and facilitators to choosing a career in plastic surgery as a secondary outcome.

Method

A systematic literature search was conducted on EMBASE, PubMed, PsychInfo and Web of Science according to the PRISMA statement. Three independent reviewers screened the studies on COVIDENCE to set inclusion and exclusion criteria. Cochrane and STROBE checklists were used for risk of bias assessment as well as a qualitative and quantitative synthesis of the results.

Results

A total of 17 studies were included after inclusion and exclusion criteria were applied. The most frequently reported negative perceptions concerned a focus on non-life saving cosmetic procedures, with little variety and the salience of financial incentives. Positive perceptions included financial benefits, skills, and challenging specialty. Studies after 2010 identified social media as a significant determinant of perception and awareness of plastic surgery, whilst studies prior to 2010 suggested that lectures and student-surgeon interaction were the primary influence. Plastic surgery courses or rotations had a positive effect on perceptions, awareness, and interest in the specialty.

Conclusions

There is a lack of knowledge of the breadth of plastic surgery driving negative perceptions, with greater awareness of cosmetic surgery amongst medical students. Social media is an important influencer of student perception of plastic surgery. Greater positive exposure to plastic surgery and its subspecialties both in medical school and on social media may represent an important avenue for future recruitment to the specialty.
1165 National Surgical Undergraduate Peer-to-Peer Teaching Course. Analysis and Insight From Feedback for Predictors of Teaching Success
Authors: Zhang J , Stevenson A , Boylan C , Rawlins E , Zhu J
Published: August 2023

Aim

Throughout the COVID-19 pandemic, ward-based teaching to medical students has been disrupted. Remote teaching platform options have emerged and encourage inter-regional collaborations in learning. This style is likely to remain. We report on our course and elucidate factors that could guide iterative improvement.

Method

The authors organized a 12-week, 36-session teaching course for medical students nationally. Each week, one university representative recruited three students to deliver topics on a surgical specialty to a national audience. Anonymized information about pre/post-session subject confidence, quality of teaching, relevance and usefulness was collected in a Likert type 1-10 scale and analysed.

Results

A total of 176 responses were noted for the first 9-week portion of the course. On paired t-test, there was an increase (mean = 2.9,s.d = 1.5,p<0.001) in confidence post seminar. Pre-(p<0.001) and post-(p<0.001) course confidence, perceived quality of teaching (p = 0.029), relevance to course (p<0.001), usefulness for exam preparation (p<0.001), and right level taught (p<0.001) were all positively associated with higher year groups. Percentage increase in confidence was negatively associated with year group (p = 0.001). Single teacher sessions had higher absolute (p = 0.011) / percentage (p = 0.020) change in confidence, perceived quality of teaching (p<0.001) compared to two teacher led sessions.

Conclusions

Online, inter-regional peer-to-peer teaching provides an invaluable way of providing medical education during and beyond the global pandemic. Our analysis elucidates different factors that may have an effect on teaching effectiveness and outcome. We hope these insights will guide us for the remainder of the course, as well as similar courses for the readers organised in the future.
282 Radiological Features Predicting Shunt Response in Normal Pressure Hydrocephalus, a Systematic Review and Meta-Analysis
Authors: El-Khatib M , Thavarajasingam S G , Vemulapalli K , Iradukunda H A S , Vishnu K S , Borchert R , Russo S , Eide P K
Published: August 2023

Aim

To produce a systematic review and meta-analysis to identify radiological features that predict shunt response in normal pressure hydrocephalus (NPH), evaluate their effectiveness and therefore recommend the most predictive feature.

Method

The authors searched MEDLINE, Embase, Scopus, PubMed, Google scholar and JSTOR databases for all original studies investigating NPH radiological features that predict shunt response. Selected studies were assessed with ROBINS-1 tool and included studies were evaluated by a univariate meta-analysis.

Results

301 full text papers were selected from screening, 28 studies were included, and 26 features were identified, of these 5 were selected for the meta-analysis based off the inclusion criteria: disproportionately enlarged subarachnoid space (DESH), callosal angle, periventricular white matter changes, cerebral blood flow (CBF), and computerized tomography cisternography. The diagnostic odds ratios of colossal angle (1.88) and periventricular white matter changes (1.01) showed they were significant differentiators between shunt responders from non-responders. None of the other features could differentiate between the two.

Conclusions

Colossal angle and periventricular white matter changes are the only statistically effective features which can identify shunt responders. Their role, however, may be overstated as their DORs approximate 1, therefore it is advised they be used in combination with other diagnostic predictors, such as clinical tests, of shunt responders. More research is required to evaluate the combined use of multiple radiological features together.
814 Bifrontal Craniectomy and Reconstruction with Synthes - a Surgical Approach for the Management of Symptomatic Hyperostosis Frontalis Interna
Authors: Matthews J , Matthews M , Randle J
Published: August 2023

57-year-old Caucasian female presented with depression, apathy, and personality changes with a markedly “flaccid face”. A computerized tomography (CT scan) revealed remarkable bilateral hyperostosis frontalis interna with significant frontal lobe compression. A definitive operative procedure with bilateral craniotomies was undertaken to relieve frontal compression and prevent further complications.

During surgery, the bone flaps were found to be very hard to cut through with a craniotome or even a drill. The procedure was further complicated by dense adherence to the underlying dura. Craniotomy was eventually completed with multiple drilling efforts. Trimming down bone flaps proved to be difficult, thus they were not replaced back and were elected to be removed. Dura was covered with DuraGen and the galea was closed without the skull plates. Postsurgical imaging was done and synthetic bone plates made by “Synthes” were placed in a second-stage procedure. The patient recovered without significant focal deficits and remained stable at six months with an improved mental state. Pathology showed benign hyperostosis.

This case highlights the difficulties of the surgical management of this rare case and discusses the improvised techniques adopted for the successful completion of the procedure with excellent outcomes.
1316 Chronic Epidural Hematoma: A Systematic Review and Meta-Analysis
Authors: Agada N , Bankole N D A , Badirou O B A , Nyalundja A D , Dossou M W , Lawson L D , Obame F L O , Murhega R B , Togbenon N D L , Emeka A C , Dokponou Y C H
Published: August 2023

Background

Epidural hematoma constitutes a common condition in neuro-traumatology. If its acute form is well known, the chronic one remains less described. In this study, we aimed to evaluate the epidemiology, presentations, management, and outcomes of chronic epidural hematoma (CEDH).

Method

Systematic searches of PubMed, Google Scholar, and ScienceDirect were performed from a database searching for all studies reporting CEDH. Pooled statistics were calculated using measures of central tendency and spread.

Results

Totally, 3009 studies were identified, of which 95 were included with 359 patients. CEDH was more common in intracranial than spinal (91.9% vs 8.1%). The average age of onset was 37.2 +/- 4.83 years. The common cause found was trauma (n = 279; 77,72%) with 271 (97.1%) cases for the head and 8 (2,9%) cases for the spine. The median delay between the trauma and the first symptoms was 13.31 +/- 3.43 days in intracranial level and 16.37 +/- 5.87 days in spinal level. CT-scan constituted the main diagnosis tool. The lesion was predominantly located in the temporal region at the intracranial level and lumbar region at the spinal level. Craniotomy and laminectomy constituted the most reported treatment option respectively at the intracranial and spinal level. The outcome was commonly uneventful. Correlation and Regression test for publication bias assessment show no significant Funnel plot asymmetry with high p-value (p = 0.8458 and p = 0.9596, respectively).

Conclusions

There was no clear risk factor found for CEDH. The treatment was mostly surgical.
220 A Systematic Review on Under-Recognized Condition: Duodenogastric Reflux After Cholecystectomy
Authors: Win M , Htet W , Sanyal J , Sanyal S
Published: August 2023

Aim

About 66,660 cholecystectomies are performed yearly in the UK. Dissatisfaction rates following surgery range from 7-41% and abdominal pain can persist post-operatively in 33% of cases according to literature. Duodenogastric reflux (DGR) has been suggested as a cause of persistent symptoms after cholecystectomy. Our study was the first systematic review to assess the DGR after cholecystectomy.

Method

Medline, Embase, and Cochrane were searched by two independent researchers up to June 2022. Eligible studies were appraised on correlation between DGR and post-cholecystectomy symptoms as well as on how DGR was diagnosed and managed.

Results

Initial 379 records were identified and screened leaving 11 papers in total. Out of included papers (2013-2022) studying 1334 patients from seven different countries, there were 2 randomised controlled trials (RCT) and 9 observational studies. The average Newcastle-Ottawa scale for observational studies was 6. Included RCTs had low to some risks of bias. Only 1 study could correlate between DGR and post-cholecystectomy symptoms. Six studies identified alkaline reflux and gastritis with combined investigations after cholecystectomies. The gold-standard investigation was yet to be identified although gastroscopy was commonly used. Single or combined medications were better than no treatment for DGR.

Conclusions

DGR induced gastritis was confirmed with investigations in this study. However, further research is required to prove extensive DGR related symptoms after cholecystectomy. There were limitations such as having more observational studies than RCT and having small samples in some studies. More substantial studies with great randomization and longer duration of follow up are recommended for future studies.
584 Extended VTE Prophylaxis in Patients Undergoing Oesophagogastric Cancer Surgery
Authors: Kuan J Y , Liew Y Y , Van Staa S , Turner P , Pursnani K , Ward J , Ball C , Shetty V D
Published: August 2023

Aim

Venous thromboembolism (VTE) is a life-threatening complication in cancer patients undergoing surgery. NICE recommends VTE-prophylaxis to 28days for patients undergoing major abdominal cancer surgery. The efficacy of in-hospital VTE-prophylaxis is well-documented, but the optimal duration of postoperative VTE-prophylaxis remains controversial. Patients undergoing oesophagogastric cancer surgery have a higher risk of VTE due to suboptimal oral intake, dehydration, need for adjuvant and neoadjuvant chemotherapy. Hence in 2014, extended VTE-prophylaxis to 28days from hospital discharge (HD) was adopted as a departmental policy. This study aims to evaluate its effectiveness, prescribing compliance and safety.

Method

This is a 10-year retrospective study from July 2012-2022. All patients who underwent cardio-oesophagectomy or gastrectomy for oesophagogastric cancers were included. Patients who died during the index admission, benign oesophagogastric surgery including excision of GIST, and central line associated VTE were excluded. The primary outcome is prescribing compliance with 28-day VTE prophylaxis from HD. The secondary outcome includes the incidence of VTE and bleeding complications requiring hospital readmission within 28days from HD.

Results

582 patients were included in our study. Since 2014, 423/490patients (86.3%) have been discharged with 28days VTE-prophylaxis from HD compared to pre-2014 (13/92patients,14.1%). There was a statistically significant difference in improving prescribing compliance following the introduction of this policy (p<0.05). No patient was readmitted due to bleeding complications. Only 1 patient (1/582,0.17%) developed VTE within 28days from HD.

Conclusions

We recommend extending VTE-prophylaxis for 28days from hospital discharge for all patients undergoing oesophagogastric cancer surgery. This improves prescribing compliance, reduces the incidence of post-discharge VTE and is safe.
713 The Role of Enteral Feed Composition on Chyle Leak Prevalence and Severity in Post-Oesophagectomy Patients
Authors: Pan S , Bushra R , Cheah L , Ribbits A , Grimes S , Bennett J , Hindmarsh A , Safranek P , Sujendran V , O'Neill R
Published: August 2023

Aim

Chyle leak presents as an uncommon yet significant complication for post-oesophagectomy patients. This study aims to evaluate the role of enteral feed in the prevalence and severity of chyle leaks post-oesophagectomy.

Method

We identified 334 patients who underwent an open or minimally invasive oesophagectomy for oesophageal cancer at a single institution between 2015-2022. The prevalence, classification (ECCG scale) and respective management of chyle leaks were retrospectively recorded. Patients who had significant post-operative complications and did not start enteral feed on post-operative day 1 were excluded from the study.

Results

The median age at operation was 68 (31-82), of which 82% comprised of males. In patients who were started on Nutrison standard feed (high energy or high protein), 22% of patients developed a chyle leak (ECCG IA – IIB). In contrast, in patients who were initially started on Nutrison high energy and high protein feed (HEHP), 11% developed a chyle leak (ECCG IA-IIA). All cases were initially managed conservatively (ECCG I) with a success rate of 81%, before escalating to parenteral nutrition. Moreover, patients with a chyle leak demonstrated an increased length of stay (14.4±7.4 days) in comparison to patients without a chyle leak (12.3±8.7 days; p = 0.03).

Conclusions

The heterogenous management of post-oesophagectomy patients is heavily influenced by centre and surgeon-specific preferences. This study suggests a potential correlation between enteral feed composition and its role in preventing and minimizing chyle leaks following an oesophagectomy. Further prospective, multicentre studies are required to elucidate an optimal nutritional approach in managing post-oesophagectomy patients.
834 A 5-Year Retrospective Review of Intra-Operative Cholangiogram Utilisation: Do We Need a Pathway?
Authors: Bezzaa S , Kapsampelis P , Murabit F , Khalifa K , Gerogiannis I
Published: August 2023

Aim

Current guidance gives no clear consensus on using routine vs selective intra-operative cholangiograms (IOC) during laparoscopic cholecystectomy. This is a controversial area with underuse risking bile-duct injury but overuse wasting theatre time and resources. The study aimed to review our local practice of IOC.

Method

Data was collected from electronic records for all patients undergoing IOCs from 2017 to 2022 at a single District General Hospital (DGH). Statistical analysis was performed using R.

Results

Ninety-six patients underwent IOC (74 elective, 22 emergency). In 64 (67%), use of IOC was decided pre-operatively (planned), 28 (29%) was decided intra-operatively (unplanned), and unclear in four cases (4%). All patients underwent pre-operative imaging. Imaging was negative for choledocholithiasis in 61 cases (64%). Indications for IOCs were abnormal anatomy (18%), deranged biochemistry (32%), abnormal imaging (21%) and confirmed choledocholithiasis (7%). The indication for IOC was unclear in 21 patients (22%). IOCs revealed abnormal findings in 21 cases; 10 required post-operative ERCP/EUS, 6 required further imaging and three were referred to a tertiary centre (for potential bile duct injury). On average, elective cases with unplanned IOC lasted 28 minutes longer (95% CI 4 to 52, p = 0.013) than planned IOC.

Conclusions

Our study revealed that IOC indication was not documented consistently, and unplanned elective IOC cases lasted significantly longer. Therefore, we propose a local pathway to identify, pre-operatively, the patients who need IOC. This will result in safer patient care and less operating time and resources. Furthermore, dedicated IOC lists may help DGHs streamline theatre lists and improve efficiency.
1027 Small Bite vs Big Bite Closure Technique in Elective Oesophagectomy Patients
Authors: Williams G , Devashetty A , McLaughlin E
Published: August 2023

Aim

After primary closure of a midline laparotomy wounds the estimated incisional hernia incidence can be as high as 25%. For many years large bite closure has been the standard in mainstream surgical training. Evidence has emerged to suggest small bite closure may be superior. We looked to examine the incidence of incisional hernias for elective oesophagectomies in one centre where both small bite and large bite techniques are performed.

Method

A retrospective analysis of 117 patients was performed. Follow up was for a maximum of five years and involved a combination of radiological and clinical reviews. Primary outcomes were defined as incisional hernia rates & wound infections. Patient risk factors were recorded including age, co-morbidities such as cardiovascular or renal disease, diabetes, smoking, weight, steroid use and post-op complications.

Results

74 patients had big bite closures and 38 had small bite closures. Overall there were 6 incisional hernias, 3 in each group (7.8% vs 4%, p-value 0.2). There were higher rates of wound infection in the small bite groups but again this failed to reach significance (7.9% vs 2.7% p-value 0.11).

Conclusions

Overall both outcomes are lower than the national averages which may explain the difficulty reaching significance. However, the results do suggest there may be other factors involved contributing to outcomes between small bite and big bite closure including operator familiarity.
1254 Examining the Role of PET-CT in the Management of Oesophageal Cancer: A Single Institution Experience
Authors: O'Neill S , Fahy N , Elliott J , Mohan H , Carroll P , Muldoon C , Johnston C , Donohoe C , Ravi N , Reynolds J V
Published: August 2023

Aim

The role of PET-CT in oesophageal cancer is controversial. The aim of this study was to evaluate the utility of PET-CT in staging and response evaluation in oesophageal squamous cell carcinoma (SCC) and adenocarcinoma (AC).

Method

Patients undergoing curative-intent treatment were studied prospectively. PET1 was carried out at diagnosis and repeat scanning (PET2) was performed 2-4 weeks post-completion of neoadjuvant chemotherapy (nCT) or chemoradiation (nCRT). The association between PET parameters, histopathologic response and survival was determined using univariable and multivariable regression models.

Results

730 consecutive patients were studied. PET identified CT-occult M1 disease in 2.9% and synchronous neoplasm in 1.4%. Similar PET1 SUVmax values were observed in AC and SCC. The reduction in SUVmax was greater post-nCRT versus nCT (P = 0.021). SUVmax correlated with pT stage among patients treated with primary surgery (P<0.001), however 32.3% with AC and 15.8% with SCC who were predicted node negative were pN+. Post neoadjuvant therapy, PET parameters showed modest associations with major pathologic response, but no parameter accurately predicted complete pathologic response. Among patients with a metabolic complete response (mCR), 90.9% with AC post-nCT, 84.1% with AC post-nCRT and 54.8% with SCC post-nCRT had residual disease. Lower preoperative SUVmax was independently associated with improved survival outcomes in AC, but not SCC.

Conclusions

PET-CT identified CT-occult M1 disease or synchronous neoplasms in 4.3% at initial staging. After neoadjuvant therapy, PET is poorly predictive of histopathologic response – most patients with an mCR have residual disease. Nonetheless, improvements in SUVmax may reflect a more favourable long-term outcome in AC.
76 Incidence of Incisional Hernia Post-Colorectal Liver Metastasis Resection - a Longitudinal Radiological Cohort Study
Authors: Mallalieu K , Lynch A , Adams S , Jones R , Walsh C
Published: August 2023

Aim

The aim of this study is to determine the incidence and time to development of incisional hernia (IH) in post partial hepatectomy (PH) for colorectal liver metastases (CRLM) patients to enable surgeons to prepare and accurately consent patients for the operations.

Method

The radiological images and reports of all patients undergoing hepatectomy for CRLM at a tertiary hepatobiliary surgical unit between December 2010 and August 2015 were retrospectively followed up for 5 years post-procedure. The primary outcome was the radiological incidence of an incisional hernia post-hepatectomy within 5 years of the procedure. Secondary outcomes included risk factors for the development of IH and time to hernia development and incidence of incisional hernia repair.

Results

249 patients, 164 men (66%), 85 women (34%); median age 65, IQR 59-73 underwent open hepatectomy. Incidence of incisional hernia 19.1% (n = 40) at a median of 8.5 months, IQR 4.75-12 months. High BMI was a risk factor associated with IH (P<.0001), 95% CI 1.084 to 1.232. (10% (n = 4) of those with IH had radiological evidence of incisional hernia repair.

Conclusions

IH represents a significant risk for patients undergoing open hepatectomy for CRLM. IH has the potential to have large impact on patient’s quality of life and increases the risk to return to theatre, either for emergency operation in the event of incarcerated hernias or for planned elective hernia repairs. It is important to know accurate figures of incidence of IH to enable surgeons to adequately prepare and consent patients for open PH.