bluuebunny/crossref_metadata_2025 huggingface dataset:
197 Burden of Traumatic Spinal Cord Injury in SubSaharan Africa: A Scoping Review
Authors: Jesuyajolu D , Ayantayo T , Oyesiji E , Bakare S , Okere M , Adewale O , Zubair A , Ekennia-Ebeh J
Published: July 2024

Introduction

With a varying incidence across populations, traumatic spinal cord injury (TSCI) remains a public health concern of utmost importance, especially in developing countries with an incidence rate ranging from 12.7 to 29.7 per million people and a postulated increase in the number of patients living with the complications of this condition. We reviewed the literature to bring to light the epidemiology, burden, management, and outcomes of TSCIs across Africa.

Method

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used in this study. We included descriptive studies with data on the incidence, presentation, management, and outcomes of TSCIs in African surgical centers. We conducted our search on PubMed and OVID Embase and supplemented it with an extensive review of African Journal Online and Google Scholar.

Results

Thirteen papers were identified from our search. Most papers were from Nigeria (n = 4) and Tanzania (n = 3). In total, our review included 1332 persons across the different centers. There were more males than females (n = 1029/1332, 72%). The most common etiology was road traffic accidents, constituting 44%, while falls and other mechanisms like assault and sports injuries had 28% each. The incidence of TSCI varied from 13 per million population per year in Botswana to 75.6 per million population per year in South Africa.

Conclusions

The incidence of the traumatic condition in certain parts of Africa is significantly higher than in other parts of the world, suggesting the need for an urgent call to action regarding addressing its key drivers.
887 A Review of the Management of Paediatric Spinal Injuries in Low- and Middle-Income Countries
Authors: Ejide C , Bandyopadhyay S , Lakhoo K , Dabasia H , Rosseau G , Demetriades A
Published: July 2024

Aim

Paediatric spinal cord injuries (SCI), particularly in the low-and middle-income countries (LMICs), present a pressing global health concern. There is a lack of dedicated research protocols for managing these injuries. To address this, we conducted a review to characterise the methods of management strategies of paediatric SCI in LMICs and drew comparisons with established protocols in high-income countries (HICs).

Method

MEDLINE, Cochrane library, and Global Index Medicus were searched from database inception to August 1, 2023. Studies reporting the management of paediatric SCI from LMICs were included. Randomised control trials and cohort studies reporting the management of Paediatric SCI from HICs were included. Pooled statistics were calculated using measures of central tendency and spread.

Results

A total of 685 studies were identified, of which 5 were included from LMICs. A total of 286 patients in the LMIC setting were included in our review with age of participants ranging from 0 to 18 years. The number of patients receiving prehospital immobilisation was characterised in one study (n= 6/36; 17%). Patients transported to the hospital by ambulance was characterised in only one study (n= 18/44; 41%). In the studies reporting the data, most patients underwent surgery (n=151/250; 60.4%). Patients receiving methylprednisolone or long-term management data was not present in any of the included studies.

Conclusions

There is a paucity of studies reporting the management of paediatric SCI in LMICs. There is insufficient data for accurate comparison and analysis. This study calls for more research to develop international guidelines that inform clinical practice.
670 Investigating Delay During Presentation of Trauma in Young Adults: A UK Major Trauma Centre Retrospective Audit and a Systematic Review of the Literature
Authors: Drinkwater E , Nightingale K , Burke J , Smith S R
Published: July 2024

Introduction

The current evidence in major trauma highlights that delays at multiple points along the patient care pathway, from incident to surgery, are associated with decreased survival. The aim of this audit was to assess performance across select delay parameters in juveniles aged 16-18 presenting to an adult MTC service following a systematic review of the literature.

Method

Patient records were interrogated between 1/10/2022-1/3/2023 and audited against 3 national standards: (1) Ambulance Response and Transfer (7 and 45mins respectively) (2) Tranexamic Acid infusion (<3hrs) and (3) CT scan (<60mins). A systematic search was also performed using EMBASE and OVID databases (01/01/2005-/01/11/2023). All studies assessing impact of time to theatre in patients with acute trauma were considered.

Results

32 consecutive patients (3F:29M) (median 18 years[16-18]) were identified within the audit period. 40%(n=13) presented following penetrating injury and 35%(n=11) following a road traffic accident. Mean time from incident to admission was 83mins[±36], from incident to tranexamic acid infusion 50mins[±35], and from admission to CT Trauma Series 61mins[+/-100]. Median length of stay was 4 days [IQR=5]. The systematic search yielded 25 studies which were included in the analysis. An Incident2Surgery framework is presented which highlights key time-critical points for diagnosis and intervention.

Conclusions

Local compliance to national standards for tranexamic acid infusion in appropriate patients and performance of trauma CT was excellent with poor compliance to ambulance arrival and transfer time. The proposed Incident2Surgery framework could be incorporated into mortality prediction and audit tools and assist in the assessment of interventions.
982 Timing of MRI Spine for Patients Presenting with Suspected Cauda Equina Syndrome (CES)
Authors: Zafar R , Dinesh A , Panselinas I
Published: July 2024

Introduction

Cauda Equina Syndrome (CES) is a neurosurgical emergency requiring urgent intervention within 24 to 48 hours to prevent irreversible paralysis and incontinence. Recognizing the gravity of CES, The Society of British Neurosurgeons and the British Association of Spine Surgeons set care standards in 2017, emphasizing the necessity for a 24/7 MRI service in every healthcare trust. The recently released GIRFT National Suspected CES Pathway also advocates for performing an MRI scan within 4 hours of presentation.

Aim

This study aimed to assess adherence to the 4-hour target for MRI scans in suspected CES cases at the Royal Surrey Hospital and examine the impact of delays on hospital stay length.

Method

Data from a 6-month period (August 2022 to January 2023) involving 70 patients were collected using the Cerner electronic system and inpatient lists, excluding cases of outpatient MRI and urgent transfers to Saint George's Hospital.

Results

Results showed an average time from Emergency Department admission to scanning of 21.3 hours (range: 3.5 to 87.4 hours), with a mean wait from request to scan of 14.5 hours (range: 0.7 to 76.7 hours). Hospital stay duration averaged 4.5 days (range: 1 to 22 days).

Conclusions

Recommendations include empowering ED clinicians to order MRI scans, implementing an MRI Safety questionnaire on Cerner, collaborating with radiographers to meet the 4-hour target, and advocating for a 24/7 MRI service within the trust. Subsequent re-audit efforts will evaluate the impact of these recommendations and identify factors influencing the achievement or non-achievement of the 4-hour target.
217 Outcomes of Reoperation for Residual or Recurrent Obstruction After Previous Myectomy in Patients with Hypertrophic Cardiomyopathy
Authors: Qamar Y , Schaff H
Published: July 2024

Aim

Describe the mechanism(s) of residual or recurrent obstruction in patients who have previously undergone septal myectomy for hypertrophic cardiomyopathy and assess early outcomes of reoperation.

Method

From January 1989 to March 2022, we performed 73 repeat myectomies at our institution. Patients’ demographics, operative details, echocardiographic parameters, and postoperative complications were retrieved from a prospectively maintained surgical database and electronic healthrecords.

Results

Median age at reoperation was 48.3 years (IQR 38.6-58.6); 51 patients were women (69.9%). 90.4% presented with NYHA class III/IV symptoms. Median interval between previous myectomy and reoperation was 2.7 years (IQR 1.2-4.5). Mechanism of obstruction was an inadequate length of previous septectomy in 41 patients (56.2%), a combination of inadequate length and midventricular obstruction in 30 (41.1%), and isolated midventricular obstruction in 2 patients (2.7%). There were no instances of recurrent LVOT obstruction due to muscle regrowth at the site of previous resection. All patients had an extended transaortic septal myectomy; 14 patients (19.2%) had concomitant transapical myectomy. Preoperatively, the median LVOT gradient was 83 mmHg (IQR 60-122), which reduced to 2 mmHg (IQR 0-7) following repeat myectomy. There were no perioperative deaths. Postoperatively, 4 patients (5.5%) developed a new CHB, necessitating PPM implantation. The 5-,10-, and 20-year survival after reoperation were 100%, 91%, and 76%, respectively.

Conclusions

Inadequate resection at the time of primary septal myectomy is the commonest cause of residual or recurrent obstruction in oHCM patients. However, repeat myectomy, including a combined transaortic and transapical approach has minimal risk with excellent hemodynamic and long-term survival outcomes.
620 Outcomes of One Anastomosis Gastric Bypass Conversion to Roux-en-Y Gastric Bypass for Morbid Obesity: A Systematic Review and Meta-Analysis
Authors: Das B , Sargsyan N , Robb H , Namgoong C , Ali I , Mitra A , Fehervari M
Published: July 2024

Introduction

One anastomosis or ‘mini’ gastric bypass (OAGB) is a highly effective procedure to treat morbid obesity. However, conversion to Roux-en-Y gastric bypass (RYGB) for OAGB-related complications such as bile reflux is increasing. We therefore conducted the first systematic review to determine the weight outcomes, safety and efficacy associated with OAGB-RYGB conversion surgery.

Method

A systematic search was conducted by three independent reviewers using Medline, Embase and the Cochrane library following PRISMA guidelines. Data extracted included patient demographics, weight, and reflux outcomes. Risk of bias was assessed using the Newcastle-Ottawa scale. The mean BMI difference was analysed using a random effects model. This study was registered on PROSPERO (Registration ID: CRD42022379759).

Results

6 studies were selected which included data from 134 patients undergoing OAGB-RYGB conversion surgery. Follow-up ranged from 6-60 months. Patients' baseline BMI at conversion was 30.2 (S.D. 2.85). Common indications for conversion surgery were reflux (47.8%), malnutrition (31.3%) and inadequate weight loss (8.2%). Biliopancreatic limb length ranged from 50-200cm. Weighted mean of study outcomes demonstrated biliary reflux symptoms resolved in 90.9% cases (95 % CI 78.8-n100%). Studies reporting BMI at >24 months reported overall stable medium-term weight (mean BMI difference -0.71 (-4.03-2.61)) with moderate study heterogeneity (I2 = 82%). The rate of major post-op complications was 14.7% (6.25%-23.1%).

Conclusions

OAGB to RYGB conversion surgery is associated with a high resolution of reflux symptoms. However, it is associated with weight regain, albeit this may be acceptable to patients to treat biliary reflux as the weight gain is small and stable over the long-term.
968 Optimal Timing for Endovascular Aortic Repair in Patients with Blunt Thoracic Aortic Injury: A Systematic Review and Meta-Analysis
Authors: Godoi A , Fernandez M , Ayala R , Velasquez C
Published: July 2024

Aim

The optimal timing of thoracic endovascular aortic repair (TEVAR) for blunt thoracic aortic injuries (BTAI) remains a topic of debate. We performed a systematic review and meta-analysis to compare early versus delayed TEVAR in BTAI.

Method

We systematically searched PubMed, Embase, Cochrane Central and Clinicaltrials.gov in up to October 2023 to include studies comparing TEVAR performed <24 hours versus >24 hours in BTAI. Safety outcomes were pooled as odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI). Subgroup analysis was performed with propensity-score matching or multivariate-analysis studies. Statistical analysis was performed with RevMan 5.4.1 and R software. The protocol was registered in PROSPERO (ID:CRD42023427392).

Results

Nine studies with 4163 patients were included, of whom 30.2%(n=1257) underwent delayed TEVAR. Mortality was significantly lower in the delayed TEVAR group (OR 0.44; 95% CI 0.32–0.59; p<0.001; I²=0%), with consistent results when restricted to multivariate studies (p<0.001). Although delayed TEVAR resulted in significantly lower rates of sepsis (OR 0.37; 95% CI 0.18–0.78; p=0.009; I²=67%), it was also associated with increased durations of hospital stay (MD 3.28; 95% CI 1.58–4.98; p<0.001), ICU stay (MD 2.53; 95% CI 0.92–4.14; p=0.002), AKI (OR 1.71; 95% CI 1.04–2.83; p=0.04), and ventilator use (MD 1.20; 95% CI 0.51-1.89; p<0.001).

Conclusions

Our findings show that delayed TEVAR is associated with lower mortality and sepsis, but also an increased risk of in-hospital complications. This may guide future prospective studies to investigate optimal timings according to grades of injury and associated complications.
227 Retrospective Study to Assess Axillary Management and Oncological Outcome After Neoadjuvant Chemotherapy for Patients with Breast Cancer
Authors: Ewedah M , Asal M , El-Faiomy T , Abouelnagah G , Khedr G
Published: July 2024

Aim

Evaluation of the effect of neoadjuvant chemotherapy on axillary nodal status. The secondary objective was to evaluate the percentage of patients who are eligible for SLNB after neoadjuvant chemotherapy.

Method

This retrospective study was conducted by collecting data during the period from October 2019 to July 2021. The study included 64 patients who had biopsy-proven locally advanced breast cancer with clinically or radiologically positive axillary LNs, had been receiving neoadjuvant chemotherapy at the Clinical Oncology Department, and underwent surgery after neoadjuvant therapy at the surgical oncology unit of Alexandria Main University Hospital.

Exclusion criteria were as follows: Patients with early-stage breast cancer, metastatic stage IV breast cancer, unfit/refusing neoadjuvant therapy, aged less than 18 years or more than 75 years or clinically and radiologically negative axilla.

Data were collected retrospectively to assess the oncological and surgical outcomes after completing NAC. The files of 450 patients were reviewed, and only 64 patients were eligible patients to be included in our study.

Results

Complete pathological response (ypT0ypN0) was found in six of the 64 patients in our study. Four patients were triple-negative, and two patients were HER2-enriched biological subtype. One patient was T1, one patient was T2, one patient was T3, and three patients were T4. One patient was N1, four patients were N2, and one patient was N3.

Conclusions

Post-neoadjuvant ultrasound is essential for assessment of axillary response. Approximately 44.4% of patients with negative post-neoadjuvant axillary ultrasound can avoid unnecessary ALN clearance. Accurate axillary staging is the cornerstone for omission of axillary clearance after neoadjuvant among patients.
997 Ascending Aorta Pseudoaneurysm 40 Years Following Surgical Atrial Septal Defect Repair
Authors: Yong H J , Lang P , Dreisbach J , Veldtman G , Smith R , Nair S
Published: July 2024

Background

Ascending aorta pseudoaneurysm is a rare postoperative complication of cardiac surgery. It is often attributed to infection and dehiscence at sites of aortotomy, cannulation, cross-clamp placement, and proximal coronary anastomoses. Mortality risk is 29-46% and this requires prompt surgical intervention.

Case summary

A 48-year-old woman who underwent atrial septal defect repair at 8 years of age, presented with chest pain radiating to the right shoulder and dyspnoea. Cardiac-gated CT angiography demonstrated a 21mm pseudoaneurysm arising anteriorly from the proximal ascending aorta, 6mm above the right coronary artery ostium, likely the site of previous cardioplegia cannula. There was active blood flow from the aorta into the pseudoaneurysm sac. It was heavily calcified, apart from a thinned irregular wall inferiorly, from which rupture was imminent. She underwent emergency surgery. Using femoro-femoral cardiopulmonary bypass, the chest was safely re-entered. Under mild hypothermia and distal ascending aorta cross-clamping, the pseudoaneurysm was resected and aorta repaired using a Gelweave patch. The patient recovered uneventfully and was discharged home after one week.

Discussion

Accurate imaging, primarily via cardiac-gated CT angiography, is crucial for diagnosis and surgical planning in patients presenting with aortic pseudoaneurysm, particularly those close to the aortic valve and coronary arteries. Operative strategy, including need for deep hypothermic circulatory arrest and/or graft replacement of aorta, depends on pseudoaneurysm anatomy. It is recommended that preventative measures are taken during the primary operation, inserting the cardioplegia cannula tip through full-thickness purse-strings and/or addition of separate oversewing sutures after decannulation. Alternative techniques of pseudoaneurysm repair are also discussed.
1235 Challenges in Glaucoma Management: A Case Study on OMNI® Surgical System Interventions for Primary Open-Angle Glaucoma
Authors: Coelho M
Published: July 2024

Introduction

This report explores the challenges faced in addressing early-stage primary open-angle glaucoma (POAG) in a 74-year-old male. Following a steroid-induced elevation in intraocular pressure (IOP) after endoscopic cyclophotocoagulation (ECP) in the right eye, the patient underwent minimally invasive canaloplasty and goniotomy using the OMNI® Surgical System (Sight Sciences) on his left eye.

Case Description

IOPs at diagnosis measured at 28 mmHg and 27 mmHg in the right and left eye, respectively, leading to the prescription of bilateral latanoprost. An adverse reaction to latanoprost resulted in eye swelling, hyperaemia, facial and jaw discomfort, and photophobia, prompting the cessation of the medication. In December 2022, bilateral selective laser trabeculoplasty (SLT) was performed, with minimal impact on IOP. Subsequently, in March 2023, right cataract surgery with ECP successfully reduced right eye IOP to 16 mmHg. Postoperatively, the use of dexamethasone 0.1% drops caused an intraocular steroid-response, increasing IOP (maximal IOP =25 mmHg), resolving upon medication completion. To mitigate prolonged steroid drop-associated complications, left eye phacoemulsification with OMNI canaloplasty and goniotomy was conducted in June 2023. Standard 4-week low-frequency steroid drops were administered postoperatively with no complications.

Conclusions

Pressure control was successfully achieved with IOP normalization to 15 mmHg bilaterally. Significant visual acuity improvements were noted post ECP (right eye=6/24 to 6/6) and OMNI (left eye=6/7.5 to 6/6). This case highlights the efficacy of OMNI combined with phacoemulsification in the safe reduction of IOP and sustained IOP control in POAG patients, alluding to its favourable safety profile.
247 Prophylactic Use of 3D Intraperitoneal Mesh in the Prevention of Parastomal Hernia in Permanent Colostomies After Rectal Cancer Resection
Authors: Ngo V , Rajendiran A , Ferrie S , Chadwick M
Published: July 2024

Background

Parastomal hernia (PSH) is the most common complication of stomas associated with significant morbidity. Prophylactic mesh in preventing PSH is less well studied, and evidence is conflicting. We compare PSH rates in patients in whom 3D intraperitoneal mesh was and was not used prophylactically in a cohort of rectal cancer patients undergoing elective curative resection.

Method

Retrospective data from the Somerset Database and Electronic Patient Record were collected on patients under a single consultant surgeon between May 2016 and December 2021. Follow up was for a minimum of 2 years (excluding deaths). Appropriate statistical tests of difference significance were performed for proportions of categorical data, and time to hernia occurrence in patients with and without Dynamesh IPST placement. (Fisher’s Exact test; Kaplan Meier)

Results

From 397 colorectal cancer patients under the care of a single surgeon, 223 had elective surgery with curative intent, of which 63 (28%) underwent total mesorectal excision (TME) (30 TME & ileostomy, 12 TME Hartmann and 21 APER) - 90% laparoscopic.

16 patients had prophylactic mesh used. Demographics and co-morbidities between groups were similar. PSH incidence was 1 (6%) (radiological) vs.7 (41%) (clinical) in the mesh vs. non-mesh group; P=0.039. Post operative complications and pain scores differed only slightly. Time to hernia development did not differ between groups.

Conclusions

Use of prophylactic mesh during permanent stoma formation in our practice appears safe, and effective in preventing PSH. Further studies may answer the question “Should 3D collared mesh be routinely placed during the formation of permanent stomas to prevent parastomal hernia?”
669 Outcomes, Morbidity and Mortality Following Pelvic Exenterations at Cambridge University Hospitals
Authors: Theocharidou L , Dennis D , Manners W , Aker M
Published: July 2024

Aim

To evaluate patient outcomes following pelvic exenteration (PE) within the colorectal department, specifically length of admission, morbidity, and mortality over a 7-year period.

Objective

To identify factors affecting patient outcomes following PE.

Method

Data collected retrospectively on all colorectal patients who underwent PE from 2015 to 2022 at Addenbrooke’s Hospital, Cambridge, UK.

Results

89 patients underwent PE for colorectal cancer, with mean age 62.69 and male to female ratio 2:1. 74% had rectal adenocarcinoma, R0 resection was achieved in 82%. 82% experienced complications, most notably intra-abdominal collections (52%); this resulted in significantly longer admissions (p<0.01). Length of admission was higher in patients undergoing PE for cancer recurrence (p 0.048). Median survival was 68 months, and on multivariate Kaplan-Meyer analysis R0 resection was found to be the only significant factor affecting survival (p <0.01). In-patient mortality was 8% and 12-month mortality at 16%.

Conclusions

A similar study by Choy et al. 2017 reported 16% 12-month mortality and 87% post-operative complications, marginally higher than our findings. In comparison, our study examined a wider range of factors affecting PE outcomes and identified significance of R0 resection. Our study has one of the highest patient cohorts in literature and findings are consistent with similar studies. Complications following PE are common, the most frequent being intra-abdominal collections. Although morbidity is high, most patients survive over 3 years; the only factor affecting survival appears to be R0 resection.
241 Predictors of Post-Radioiodine Ablation Outcomes in Thyroid Cancer: Analysis of Four Years of Data from a Regional Centre
Authors: Jones-Anderson M , Iqbal S , Hamilton D
Published: July 2024

Aim

To assess correlations between patient demographics, tumour and lymph node pathology and outcomes for patients with non-metastatic thyroid cancer. Outcomes examined were evidence of post-ablation residual disease on blood testing or ultrasound or thyroid cancer recurrence.

Method

Electronic records for thyroid cancer patients at a regional centre undergoing thyroidectomy followed by Radioiodine-131 ablation in the years 2018-2021 were reviewed with 191 records contributing to the analysis. Patient demographics, tumour characteristics, numbers of positive lymph nodes and radioiodine dosages were compared against patient outcomes.

Results

Increasing age, T stage of the tumour and lymph node involvement demonstrated the strongest correlations with negative outcomes. Age appeared to be a strong risk factor for thyroid cancer recurrence with 70% of the patient’s experiencing recurrence aged over 60 despite patients over 60 making up only 33% of the sample. Removal of over 4 metastatic lymph nodes has previously been found to predict poorer patient outcomes. The findings support this however over 50% of positive nodes removed had a stronger correlation with negative outcomes compared with raw numbers retrieved. 52.2% of patients with over 50% positive lymph nodes experienced poorer outcomes compared with 40.1% who had over 4 positive nodes removed. The correlation was stronger still for those with over 4 positive nodes of which over 50% were positive of whom 57.9% demonstrated poor outcomes.

Conclusions

Rather than raw numbers of lymph nodes removed, proportion of metastatic nodes of those harvested or a combination of total numbers and proportion appeared to give a better indicator of prognosis.
1234 Optimising Vitamin D and Calcium Management in Thyroidectomy Patients
Authors: Yussuf B , Tharakaran N , Roderick M , Thomas L
Published: July 2024

Aim

The study aimed to investigate the causes of temporary postoperative hypocalcemia and strategies for correction. Objectives included assessing the impact of preoperative trust guidelines on detecting and managing Vitamin D deficiency in thyroidectomy patients and analyzing its correlation with postoperative hypocalcemia at Northampton General Hospital.

Method

A three-cycle audit analyzed 16, 12, and 8 cases, respectively, encompassing total and completion thyroidectomies at NGH. Collaborative development of standardized trust guidelines involved the ENT Team, Endocrinology, and Pharmacists. Data collection covered various parameters, and departmental teachings were conducted to educate the team on the new guidelines.

Results

Thyroidectomy indications included Graves's disease, large Multinodular Goitre, and malignancy. In the third cycle, all patients underwent preoperative Vitamin D checks, aligning postoperative hypocalcemia with the national range. Our interventions increased preoperative Vitamin D checks from 56% to 100%, reducing deficiency from 25% to 0%. Postoperative hypocalcemia decreased from 56% in Cycle 1 to 8.3% in Cycle 2 and 12.5% in Cycle 3. Long-term hypoparathyroidism dropped to 0% in Cycle 3, with no correlation between surgeon technique or indication and postoperative hypocalcemia.

Conclusions

The introduction of preoperative guidelines significantly enhanced Vitamin D deficiency detection, substantially reducing postoperative hypocalcemia. This underscores the positive impact of standardized protocols on patient care. Future efforts involve re-auditing with the involvement of junior doctors to ensure continuous enhancement in clinical practice.
166 A Retrospective Observational Study on Laparoscopic and Open Hernia Repairs at a Single Centre
Authors: Madhusudanan Pillai G , Girijavallabhan Nair P
Published: July 2024

Aim

To compare Laparoscopic and open hernia repairs in terms of patient management and post operative complications was collected and compared against the existing standards regarding management of hernias.

Method

A retrospective observational study of all emergency and elective, laparoscopic and open inguinal hernia repairs that were performed during the years 2020-2021 was conducted. Demographic and outcome data were collected from electronic patient records including patient demographics, laterality, type of repair, conversion rate, peri- and postoperative complications, rates of recurrence, chronic groin pain and mortality. These were then analyzed using MS Excel and SPSS.

Results

108 patients were studied in total. In the post operative period, there was zero mortality in both groups, and only one patient developed recurrence as a complication. None of the other patients had any major complications. 1 patient complained of paraesthesia in the groin, 5 had scrotal edema, 5 developed seromas. Other minor complications were inguinodynia, post operative pain, bruising and haematoma in 1 percent of patients. The single incidence of recurrence occurred in a case where open repair was done and a greater proportion of minor complications were observed in people who underwent laparoscopic repair (19% of all laparoscopic repairs), while it was lower in patients who underwent open repair (14.7% of all open repairs). These differences were of no statistical significance as Chi-square test.

Conclusions

The data obtained reveal that there is no significant difference between the outcomes of laparoscopic and open hernia repairs at a single Centre.
450 Outcomes of Groin Hernia Surgery in ELHT: A Comparative Retrospective Study with NICE, BHS, and EHS Statistics
Authors: Sallam A , Butt M , Yasin M , Hassan A , Abudeeb H , Obeidallah R , Atluri L Mm
Published: July 2024

Aim

The aim of this study was to evaluate the results of groin hernia surgery, at East Lancashire Hospitals Trust (ELHT) by comparing the severity of pain and recurrence rates with established standards set by the National Institute for Health and Care Excellence (NICE) British Hernia Society (BHS) and European Hernia Society (EHS).

Method

This retrospective analysis involved patients who underwent groin hernia repair between 2019 and 2021 at ELHT trust hospitals. The selection criteria were based on guidelines provided by the BHSs Hernia Commission Guide. Data was collected from records during the specified time frame.

Results

Out of all cases chronic pain occurred in 2.90% which's notably lower compared to the 10 12% range reported by the European Hernia Society. Furthermore, the recurrence rate at ELHT was found to be 2.51% below the rate of 15% mentioned by the European Hernia Society.

Conclusions

Based on these findings it can be concluded that ELHT has achieved outcomes in groin hernia surgery when compared to benchmarks set by the European Hernia Society. Notably ELHT demonstrated rates of chronic pain and recurrence highlighting successful surgical interventions and providing valuable insights for best practices in hernia surgery. These results have implications for optimizing outcomes. May influence future guidelines and practices, in groin hernia surgery.
1047 Umbilical Hernia Emergency Care: A Scoping Review
Authors: Kuligowska A , Walshaw J , Smart N , Blencowe N , Lee M
Published: July 2024

Aim

Umbilical hernias may become acutely symptomatic, strangulated, or obstructed, requiring emergency treatment. Robust evidence is required for high-quality care in this field. This study presents a scoping review on emergency care of umbilical hernias.

Method

The study is reported in line with PRISMA-ScR guidance. EMBASE, MEDLINE & CENTRAL databases were searched using a predefined strategy. A secondary hand-search was also performed. Eligible studies were primary research, reporting any aspect of emergency umbilical hernia care, published in the English language. Where emergency umbilical hernia care was not the primary focus, subsets of relevant data should be extractable. Two authors screened s and full texts, disagreement resolved by discussion and third author. Data were charted according to core concepts addressed by each study. A narrative synthesis was performed.

Results

The search generated 299 s, with 32 full texts for assessment and 15 included for final review. This encompassed 52,089 patients undergoing emergency umbilical hernia care. Most were retrospective cohort designs (11/15), equally split between single (7/15) and multi-centre (8/15) studies with only one RCT. Most multi-centre studies were from national databases (7/8). Themes arising included risk profile (n=4), timing of surgery (n=5), investigations (n=2), repair method (n=9, 5 mesh vs suture; 4 laparoscopic vs open), and outcomes (n=12). Most common outcomes reported were mortality (n=10), morbidity (n=8), and length of hospital stay (n=6).

Conclusions

This scoping review demonstrates paucity of high-quality data for this condition. There is a need for randomised trials addressing timing and technical aspects of repair, with umbilical hernia-specific patient reported outcomes measures.
163 Laparoscopic Surgery: Good for the Patient, Bad for the Surgeon. A Systematic Narrative Review
Authors: Abimbola A , Quiney G , Colucci G
Published: July 2024

Background

Musculoskeletal (MSK) injuries are very common among laparoscopic surgeons. These injuries can result in physician burnout, early retirement, and medical/surgical treatment. The aims of this study are to identify the causes of MSK injuries in laparoscopic surgeons, the most common injuries, and strategies to prevent them.

Method

Following the PRISMA guidelines, Medline, Embase and PubMed databases were systematically searched for relevant articles using the predefined inclusion/exclusion criteria. Data was extracted by two independent reviewers.

Results

A total of 321 papers were found, after screening 41 papers were selected for inclusion. Many study designs involved the use of biomechanical methods, surveys, and quality of life questionnaires. Studies varied drastically in their sample sizes. Results show that long periods of static postures held in non-ergonomic positions are a significant contributing factor to MSK injuries. This is more likely in laparoscopic surgery, as surgeons hold more fixed positions with more physical demand when compared with open surgery. Studies show that the most common sites for injury are the neck, back and shoulder.

Conclusions

MSK injuries are an ongoing problem which is often underestimated and poorly reported. There was clear evidence in the literature that microbreaks and strength training is beneficial, and that ergonomic training should be a standard element of surgical training.
728 Laparoscopic Fundoplication as a Day Case Procedure - Patient Comprehension for a Successful Model
Authors: Jayasankar B , Abdelsaid K , Hamouda A
Published: July 2024

Aim

The British Association of Day Surgery states that elective laparoscopic Nissen’s fundoplication procedures should be performed as a day case in 40% of patients. The purpose of the study was to design a model for laparoscopic fundoplication to increase the numbers done as a day case procedure.

Method

This was a retrospective study of all patients who underwent laparoscopic fundoplication from 2014 - 2019. We introduced patient information leaflets and awareness amongst the patients regarding the procedure following our initial audit in 2014. Further intervention in terms of the surgical team and theatre staff awareness to reach our goal by distributing surgery-oriented pamphlets and information. We re-audited to see if there were any improvements in 2016 and 2019 when compared to our previous cohort. A total of 104 patients were audited through the years.

Results

In 2019, 34.4 % patients regardless of hiatus hernia size were discharged on the same day; 48.2 % patients were discharged on the next day; 24.1% patients had a large hiatus hernia or gastric volvulus; 40.9% patients excluding large and complicated hiatus hernia were discharged on the same day; 75.8 % patients had intraoperative local anaesthetic inject at the operative field.

Conclusions

The main two factors which contributed to improvement of our results were Intraoperative injection of local anaesthetic medications to operative field and Patient information pamphlets. Also, when a patient is made aware of the procedure being a day case in advance, they are more prepared to return home the same day following the procedure.
1297 Factors Influencing Lymph Node Retrieval and Staging in Colorectal Cancer Resections: A Single-Centre Study
Authors: Khalid S Y , Bokhari M H T , Akhtar M A B , Zeeshan S
Published: July 2024

Aim

The American Joint Committee on Cancer (AJCC) recommends examination of a minimum of 12 total dissected lymph nodes to stage rectal cancer accurately. This study aimed to explore the factors influencing lymph node (LN) retrieval and their impact on nodal positivity and N category in colorectal cancer (CRC) staging.

Method

This retrospective single-centre study included patients with CRC who underwent laparoscopic excision by a single colorectal surgeon between July 2021 and July 2023. Data were extracted from the hospital's electronic database, with exclusion criteria for benign conditions.

Results

The average number of LNs in this cohort was 17.95±6.55. At least 12 LNs were recovered in 90.91% of the cases. The right colon was the most common tumour site. Right hemicolectomy, transverse colon resection, and sigmoid colectomy achieved 100% compliance with the adequate retrieval criteria. An increase in LN retrieval was observed with higher T stages. A positive linear correlation was observed between the number of harvested LNs and the length of the resected bowel. No significant difference in LN yield was observed between node-positive and node-negative cases.

Conclusions

Tumour site emerged as a significant factor influencing LN retrieval in CRC resections. While age and sex showed no substantial impact, tumour size and extent of resected bowel positively correlated with LN counts. The overall lymph node yield had no effect on node positivity, indicating that, following a careful inspection of the specimen, a lower lymph node yield may be deemed sufficient.
162 Outcomes Following Surgical Management of Temporomandibular Disorder in a Specialist Setting
Authors: Amin A , Pirmorad S , Dennis J , Zar Rab K , Komath D
Published: July 2024

Introduction

Temporomandibular joint (TMJ) dysfunction is an increasingly prevalent condition affecting 31% of adults and 11% of children/adolescents. Initial management is usually conservative with physiotherapy, diet modification, analgesics, and education. 5-10% of patients require surgical treatment. TMJ arthroscopies allows minimally invasive surgery for joints with early degenerative changes. The purpose is to provide symptomatic relief and improve function.

Aim

To evaluate clinical outcomes 3 months post TMJ surgery.

Method

Retrospective data was collected from the notes of all patients who underwent procedures between February 2019 and August 2023. Data collected included pain/diet scores, mouth opening, Wilkes staging, clinical diagnosis and the use of intra-articular Platelet Rich Plasma or steroid injections.

Results

147 procedures were undertaken. The average age was 43 with an 83.0% female predominance. Overall, 1 arthroplasty, 1 eminectomy, 11 total joint replacements and 134 arthroscopies with/without arthrocentesis were performed with positive results. Mouth opening scores increasing from an average of 27.4mm to 29.5mm, diet scores from 5.8 to 7.5 and pain scores reducing from 7.1 to 4.4. At the 3 month follow up, 53 patients were planned for further monitoring, 32 discharged, 9 listed for a further arthroscopy and 15 for a TMJ replacement.

Conclusions

Surgical management provides good outcomes and Level 2 arthroscopy is an essential tool in the armamentarium. Development of an integrated physiotherapy pathway as well as educational leaflets has been vital. Educational Leaflets improved patient experience with re-audit results showing positive outcomes. Involvement of clinical psychologists is required for a multidisciplinary approach.
435 Post ERCP Pancreatitis at a Tertiary Centre - a Retrospective Incidence and Causal Analysis
Authors: Jain S , Orabi A , Davis G , Anderson S , Mekhail P
Published: July 2024

Background

Post Endoscopic Retrograde Cholangio Pancreatography (ERCP) pancreatitis (PEP) is a serious and potentially life-threatening complication of ERCP. The overall incidence of PEP varies between 3.5% and 9.7% as per the recent meta-analyses in 2014. We aim to evaluate the incidence of PEP, conduct a causal analysis and financial implications at our hospital for general surgical patients.

Method

All General Surgical patients who had ERCP done between 01/10/2022 and 31/03/2023 were included in the analysis. The patient records on TrakCare® were analysed for demographic details, admission records, ERCP details, pre-procedural laboratory values and length of stay. The successful ERCPs defined as cannulation of the common bile duct were divided into the PEP and the non-PEP groups.

Results

A total of 155 patients had ERCP attempted but only 131 were successful. Of these 131, 13 (9.92%) developed PEP. Females in their 60s were predominantly affected. Three out of six patients undergoing ERCP for malignant biliary obstructions were affected (50%). Patients with grossly deranged Liver Function Tests (mean bilirubin levels >=134.92µmol/L) had a higher risk of developing PEP (p-value=0.021). The mean overall hospital stay was 3.5 days longer (2-49 days) for patients who developed PEP costing an extra £20,475 - £35,763 over 6 months to the NHS. There were no mortalities recorded.

Conclusions

Patients with gallstone disease should receive prompt cholecystectomy adhering to NICE guidelines to reduce the risk of developing gallstone-related complications. This in turn would lead to a reduction in PEP and positively affect the financial implications for the NHS.
798 Improving the Use of Ultrasound Imaging in the Diagnosis and Assessment of Paediatric Patients Admitted with Suspected Appendicitis
Authors: Renney O , Duhoky R ,   ALSGBI Academy research group, Morrison T E M
Published: July 2024

Aim

To investigate the barriers to and rate of ultrasonography use to facilitate the diagnosis of suspected appendicitis and assess its effect on negative appendicectomy rates in concordance with GIRFT guidelines for children with abdominal pain.

Method

Retrospective single-site data on paediatric patients presenting with suspected appendicitis was collected over 6 months, using operative and admission records, imaging requests and histology results. An anonymous survey was distributed amongst Surgical clinicians to determine the perceived impact of access to and influencers of ultrasonography use for children.

Results

Of 91 patients, 35 underwent a diagnostic laparoscopy. The operation findings were: 23% (8) not acute appendicitis, 23% (8) perforated or complex appendicitis and 54% (19) “other” acute appendicitis. 85% (30) of patients who were surgically managed did not have an ultrasound before theatre.

23% (21) of the total cohort underwent an ultrasound and none of the scans suggested acute appendicitis. Of these, 76% (16) of patients were managed non-operatively. Of the 5 patients who underwent an ultrasound and proceeded to laparoscopy; none had intraoperative findings of appendicitis. Further analysis aims to investigate why ultrasound was utilised for only 23% of patients and to clarify the decision-making processes behind a “straight to theatre” versus an “imaging-first” approach.

Conclusions

The negative paediatric appendicectomy rate in this District General Hospital was 23%. According to this data, ultrasonography is a reliable rule-out tool for suspected appendicitis and more frequent use could reduce unnecessary operations.
584 A Systematic Review of Generative Adversarial Networks (GANs) in Plastic Surgery
Authors: Zargaran A , Sousi S , Glynou S P , Zargaran D , Mosahebi A
Published: July 2024

Aim

Generative Adversarial Networks (GANs), based on zero-sum game theory, involve two neural networks—the generator and discriminator—to create realistic synthetic data. They're becoming increasingly significant in medicine and plastic surgery. This review assesses GANs' impact in Plastic Surgery, offering a framework for their application and evaluation in various subspecialties, highlighting their potential in research and patient care advancements.

Method

Following PRISMA guidelines, a systematic review was performed of all applications of GANs within Plastic Surgery and its subspecialties published from 2014 to 2022. Three independent reviewers screened studies using COVIDENCE review management software, from databases including PubMed, Embase, PsychInfo, Scopus and Google Scholar.

Results

A total of 70 studies were captured by the search, of which seven studies were included in the final analysis. The Kappa score for interrater reliability was 0.97. The most common subspecialty represented was craniofacial (n=4). Proposed uses of GANs ranged from facial recognition, burn estimation, scar prediction and post-breast cancer reconstruction anomaly scoring. All proposed GANs were conditional, with four of the studies using primarily collected training datasets, and the remainder using public datasets. Average dataset training size was 54,593 (range: 300,575-6). All of the studies had different reporting structures, and only four studies had a form of cross-evaluation qualitatively (n=1) or quantitatively (n=3)

Conclusions

GANs can transform research and patient care. Standardised reporting and diverse dataset transparency are essential. Despite their creation needing computational expertise, it's vital for plastic surgeons to understand GAN development to fully leverage their potential in plastic surgery and related fields.
725 Delphi Consensus to Improve Patient Safety in the Aesthetic Injectables Market: Consensus, Controversies and the 5Ps Framework
Authors: Zargaran D , Zargaran A , Sousi S , Knight D , Woollard A , Terranova T , Sines D , Weyrich T , Mosahebi A
Published: July 2024

Aim

The rapid growth of the aesthetic injectables sector presents a public health challenge given limited regulations to date. This study aimed to establish agreed proposals from industry experts and practitioners to uphold and safeguard patient safety.

Method

A Delphi consensus design was adopted comprising three survey rounds. Industry practitioners and experts were invited to suggest proposals to improve patient safety. We used the MoSCoW prioritization technique to aid practitioners in attributing importance and significance to proposals. Consensus was defined a priori as 75%.

Results

One-hundred-and-twenty-two practitioners completed Round 1, 100 completed Round 2 and 51 completed Round 3. A total of 38 proposals were identified after consolidation and removal of duplicates from Round 1. Round 2 established consensus on 16 items, and 18 items went to Round 3 but consensus was not achieved on all these items. Of the 38 proposals initially made, a series of five overarching themes emerged as fundamental for stakeholders. Issues relating to patients, practitioner skills or competence, product type and storage, place of practice and promotion techniques were the key themes. From these we propose and evaluate the five Ps framework: Patient, Practitioner, Product, Place and Promotion.

Conclusions

Our Delphi consensus study establishes consensus for 16 key proposals to improve patient safety. The study also highlights areas of controversy and proposes the novel 5Ps framework to help appraise the aesthetics industry.