bluuebunny/crossref_metadata_2025 huggingface dataset:
SP10.1.6 Effect of hyaluronate-based bioresorbable membrane (Seprafilm) on outcomes of abdominal surgery: a meta-analysis and trial sequential analysis of randomised controlled trials
Authors: Hajibandeh Shahin , Hajibandeh Shahab
Published: November 2022

Background

We aimed to evaluate comparative outcomes of abdominal surgery with and without hyaluronate-based bioresorbable membrane (Seprafilm).

Methods

We conducted a systematic search of electronic databases and bibliographic reference lists with application of a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits. Small bowel obstruction, anastomotic leak, surgical site infections, ileus, and severity of adhesions were the evaluated outcome measures.

Results

Thirteen randomised controlled trials reporting a total of 3,665 patients evaluating outcomes of abdominal surgeries with (n=1,800) or without (n=1,865) use of Seprafilm were identifed. Use of Seprafilm was associated with significantly lower risk of small bowel obstruction (RR:0.53, 95% CI 0.38–0.73, P=0.0001) but significantly higher rate of anastomotic leak (RR: 1.85, 95% CI 1.15–3.00 P=0.01). Moreover, while Seprafilm resulted in significantly more adhesions-free patients (RR:5.57, 95% CI 3.37–9.19, P<0.0001) compared to no Seprafilm, its use was associated with significantly lower grade 2 (RR:0.57, 95% CI 0.35–0.95, P=0.003) or 3 (RR:0.31, 95% CI 0.17–0.55, P<0.0001) adhesions. There was no significant difference in surgical site infection (RR:1.21, 95 CI 0.86–1.70, P=0.28), intra-abdominal abscess (RR: 1.46, 95 CI 0.92–2.32, P=0.11) or paralytic ileus (RR:0.97, 95 CI 0.68–1.38, P=0.87) between two groups. The trial sequential analysis demonstrated that the meta-analysis findings are conclusive.

Conclusions

Seprafilm reduces the risk of small bowel obstruction and severity of adhesions after abdominal surgery. However, it may increase the risk of anastomotic leak. We recommend use of Seprafilm in any abdominal surgery which does not involve an anastomosis.
SP10.1.8 Acute uncomplicated diverticulitis: to scope or not to scope?
Authors: Howie Emma , Almafreji Ibrahim , Cole Charlotte , Watt David
Published: November 2022

Aims

To investigate whether endoscopic follow up after a CT proven diagnosis of acute uncomplicated diverticulitis detected additional pathology, specifically colorectal cancer, and if our findings support the European Society of Coloproctology's consensus statement that “a single episode of CT verified uncomplicated diverticulitis endoscopic follow-up remains controversial and may not be necessary”.

Methods

A retrospective study evaluated every General Surgical emergency admission with acute uncomplicated diverticulitis to our unit in a 5 year period (2015–2020) to assess for radiological diagnosis and endoscopic follow up.

Results

Over the 5 years there were 685 admissions with acute uncomplicated diverticulitis affecting 547 individuals. 74.3% of admissions and 80.3% of individuals underwent a Computerised Tomography (CT) during admission. 244 admissions (48%) went on to have an endoscopic examination, with 12.3% of these being inpatient investigations. 50% (122) of patients undergoing endoscopy had confirmed uncomplicated diverticulitis. Of the remaining patients undergoing endoscopy, 79.5% had no pathology detected. Only 1 malignant polyp was discovered on endoscopy with no tumours detected.

Conclusions

CT has a high sensitivity and specificity in the diagnosis of acute uncomplicated diverticulitis. We suggest that it is reasonable not to utilise endoscopy as a screening tool after uncomplicated diverticulitis and the risks versus benefits must be carefully considered, especially in the era of Covid-19 where resources are tight and waiting lists ever growing. An endoscopic procedure is a costly, uncomfortable procedure that puts the patient at risk of morbidity and mortality.

Our findings support the European Society of Coloproctology's statement regarding endoscopic follow-up.
SP10.1.9 Routine preoperative group and save is not necessary for emergency appendectomy in adults – A retrospective multicentre study
Authors: Sundarraj Karuniya , Khan Khurram
Published: November 2022

Aims

The use of routine Group and Save (G&S) for appendectomy is practised commonly with little evidence behind this practise. Our aim was to assess whether routine pre-operative G&S before appendectomy is required by identifying rate of perioperative blood transfusion.

Methods

A multicentre retrospective observational study of all adult patients who had emergency appendectomy across four hospitals between August 2018 and November 2020. Patients were identified through pathology records. Data was extracted for demographics, pre and post-operative imaging and operative details, G&S, cross matching and peri-operative blood transfusion.

Results

1,105 patients were identified, 635 (57.4%) were male. Median age was 37 years (IQR 26–52). 1,012 (91.6%) were ASA 1 or 2. Surgical approach: 890 (80.5%) laparoscopic, 79 (7.1%) converted to open, 119 (10.8%) open and 17 (1.5%) laparotomy. Severity of appendicitis: 804 (72.8%) inflamed, 56 (5.1%) gangrenous, 235 (21.3%) perforated and 10 (0.9%) were normal.

921 (83.3%) patients had pre-operative G&S. 42 (3.8%) patients also had cross match (36 patients had 1 unit and 6 patients had 2 units). None of the patients required blood transfusion in 30 days post appendectomy. The total cost of G&S is estimated to be £56,733 in this cohort.

Conclusions

The need for peri-operative blood transfusion is rare in patients undergoing appendectomy via any surgical approach. It has significant cost impact as well as it causes unnecessary delays if not done in timely manner. Our study suggests that routine G&S policy is not necessary and we suggest a more ‘selective’ G&S policy.
SP10.1.11 What happens when you VAC?
Authors: Abdalazeez Tasabeeh , McDonald Rosie , Miller Andrew
Published: November 2022

Aims

Abdominal VAC dressings are part of the surgical armamentarium in the management of the open abdomen. This study examined the number, indication and outcomes of patients with VAC dressings in a tertiary surgical unit.

Methods

Retrospective review of the operating theatre database identified all patients with abdominal VAC dressing between February 2016 and July 2021. Medical records were reviewed for demographics, operative, outcome and discharge data.

Results

76 patients had abdominal VAC dressings. 40 (53%) were female and 57 (75%) were aged >50 years. For 54 (72%) the primary surgery was an emergency. Major indications for VAC included intra-abdominal sepsis 41 (53.9%) and wound dehiscence 16 (21.1%). Mean VAC changes under GA 2.07 (range 0–10). Mean VAC changes on the ward 2.1 (range 0–11). Mean length of hospital stay 48.6 days (range 4–258). 49 (70%) had the VAC removed in hospital, in this cohort mean duration of VAC therapy was 22 days. 11 (15%) were discharged to community hospitals and 56 (77%) directly home. 4 (5.3%) patients developed entero-atmospheric fistulae, 1 (1.3%) bleeding and 1 (1.3%) wound infection.

Conclusions

Abdominal VAC therapy is safe. However, it comes with significant immediate and medium-term burdens, in terms of hospital bed days, theatre time and specialist staff input, all of which are costly. Longer term, incisional hernias are associated with morbidity for patients and a financial cost for the Trust. The authors therefore advocate an attempt at early fascial closure where possible, through techniques such as mesh mediated fascial closure.
SP11.1 What happens to hernias if we don't operate? A Covid-19 waiting list study
Authors: Bruce Nikki , Young Jamie
Published: November 2022

Aims

Many patients with symptomatic abdominal hernias have suffered delays and cancellations due to the reduction of elective operating lists. This waiting list study looks to examine what has happened to patients who were on the waiting list on the day of the first lockdown in March 2020, and whether there were any adverse outcomes.

Methods

We used coding data, TrakCare IT information and op notes to identify the outcomes of those patients between March 2020 and December 2021. We looked at whether elective surgery had been done, waiting times, if the patient had presented as an emergency, and if they had been removed from the list. We included any symptomatic abdominal hernia ie inguinal, incisional, paraumbilical, ventral.

Results

There were 78 patients included. 33 had elective repair, min waiting time 6 months, max 18 months. There were 5 emergency presentations for operative repair (6.4%) including 1 death (3 inguinal, 2 incisional). A further 3 required expedited repair at 5, 8 and 9 months. 4 patients removed themselves due to improvement in symptoms and 27 patients remained on the list (min 19 months, max 27 months).

Conclusions

Waiting lists for benign surgery have been adversely affected by the pandemic and this difficulty is seen clearly in our small district general. Patients who have been waiting a long time are at risk of emergency presentations and ongoing symptoms. Those with the fewest symptoms are waiting over two years and are at risk of continued waits due to ongoing service pressures.
SP11.3 Impact of Covid on emergency laparotomy activity
Authors: Kronberga Madara , Saha Arin
Published: November 2022

Aims

National surgical guidance during the Covid-19 pandemic cautioned against surgical intervention with subsequent unsurprising falls in emergency activity.

Our unit, in contrast to national guidance, treated patients normally but with enhanced quality measures and without withholding surgery where indicated; key measures introduced included two-consultant operating, early consultant decision-making and daily consultant ward rounds to facilitate early discharge. This study outcomes from these locally developed guidelines.

Methods

All emergency laparotomies are entered contemporaneously on to the NELA database. Activity and outcomes from two time periods, from before and after the advent of Covid-19 (March 2019–2020 vs. March 2020–2021) were compared.

Results

Emergency laparotomy activity increased from 154 cases to 192 cases (24%). There were no pre-operative differences in frailty scores, ASA, pre-operative predicted mortality (7.4% vs. 6.9%) or predicted morbidity between the two periods.

Although 2% of patients developed Covid-19 infection, there was no increase in crude mortality (9% to 8%) or post-operative complications. The proportion of patients who went to critical care after surgery fell though post-operative length of stay also fell (mean 18.8 days vs. 12 days).

Conclusions

With local guidelines and enhanced consultant-delivered care, emergency surgery was increased during the Covid pandemic without increased complications. This may reflect the marked reduction in activity in neighbouring hospitals and additional capacity due to falls in elective activity. Given the reduction in emergency surgery nationally, it is likely that guidance which cautioned against surgery has led to patients unnecessarily missing out on operative treatment with subsequent poorer outcomes and greater mortality.
SP11.4 Imaging recommendations during the Covid pandemic for the investigation of right iliac fossa pain: an unachievable and unnecessary burden on radiology services?
Authors: Doughty Alice , Cheetham Stephanie , Kenber Melisa , Smellie Eloise , Saha Arin
Published: November 2022

Aims

Initial Covid-19 surgical guidance, produced without radiological input, recommended that patients with right iliac fossa (RIF) pain should have imaging before intervention. This study quantified the burden on imaging services from these guidelines.

Methods

Patients who presented to our surgical unit with RIF pain from March to October 2020 were identified. Clinical parameters, radiology and final diagnosis were recorded. Minimum follow-up was 12 months to identify re-admissions and morbidity.

Results

There were 417 patients. There was a drop in admissions in the first months of each new wave of Covid (March/April, September/October) compared with intervening months (36% vs. 64%, P=0.036). 266 patients (64%) had a CT scan increasing from 42% of patients in March to 75% in September (P=0.019). The proportion of patients with normal imaging increased correspondingly with over a third (34%) of CT scans being normal. 93 CT scans (35%) showed appendicitis, which was the suspected diagnosis in all but 7 of these patients.

Patients with normal imaging had lower white cell counts (Mean 10.1×109 vs. 14.8×109/L, P<0.001) and CRPs (Mean 21 vs. 99, P<0.001). Patients seen first by a consultant were less likely to require imaging.

Conclusions

During the first year of Covid-19, two-thirds of patients with RIF pain had a CT scan with a third being normal. Most scans showing appendicitis had clinical parameters consistent with this diagnosis. Current guidelines may lead to unsustainable pressures on radiology services; ensuring consultant assessment prior to imaging requests may reduce the burden on these teams.
SP11.5 Effect of COVID-19 Pandemic on Thyroid Surgery
Authors: Rezkallah Emad , Elsaify Wael
Published: November 2022

Introduction

The rapidly expanding COVID-19 pandemic has affected all aspects of daily life, including health care systems. The impact on COVID 19 on thyroid surgery is clear due to the delay in most thyroid related activities, including the delay in the thyroid investigations, screening and surgery.

The aim of the current study is to illustrate the impact of COVID 19 on thyroid surgery.

Methods

Retrospective review of our activities during 7 months (January – July) in 2021 during COVID-19 pandemic and comparing it with a similar period in 2019.

Results

During the period of seven months in 2019, we performed 69 thyroid surgeries, while during the same period in 2021 we performed 16 thyroid operations. In 2019, 35 patients had diagnostic thyroidectomy (malignancy was found in 9 of them), while only one case in 2021 had diagnostic thyroidectomy. Six patients in 2019 had completion thyroidectomy; one of them had thyroid cancer, while four patients in 2021 had completion thyroidectomy; all were benign. Malignancy was diagnosed in 26 patients in 2019 and in 10 patients in 2021. Most patients in 2019 had early stage disease (T1: 14 patients, T2: 4 patients, and T3: 6 patients), while most patients in 2021 had high stage disease (T1: 3, T2: 1, T3: 5, and T4: 1). Lymph node involvement was found in 9 patients from 24 in 2019, and in 9 patients of 10 in 2021.

Conclusion

Because of the COVID pandemic, most thyroid cancer patients presented with advanced disease with high incidence of lymphatic metastasis.
SP11.6 End of Life Care and Advance Care Planning for Outpatients with Inoperable Abdominal Aortic Aneurysms – A Retrospective Cohort Study
Authors: Davies Henry , Vleugels Marie-José , Kwan Jing Yi , Aerden Alexander , Wyld Lucy , Mees Barend , Scott D Julian A
Published: November 2022

Introduction

A proportion of patients with aortic aneurysms (AA) do not proceed to intervention after reaching treatment threshold diameter due to a combination of poor cardiovascular reserve, frailty and aortic morphology. This patient cohort has a high mortality, however, there exist no studies on the palliative care (PC) and advance care planning (ACP) they receive following discharge from the clinic.

Methods

We conducted a multicentre cohort study of 220 conservatively managed AA patients referred to centres in Leeds and the Maastricht for intervention between 2017 and 2021, from a combined total of 1506 patients - a non-intervention rate of 15%. Demographic details, mortality, cause of death, ACP and PC outcomes were analysed to examine predictors of PC referral and consultation efficacy.

Results

There was a 3-year mortality rate of 60%. Rupture was the reported cause of death in 17% of the decedents. Only 9% of all patients received PC referrals - a median of 3.5 days before death. Patients over 80 were more likely to have PCCs. Almost half of the decedents were readmitted to hospital before death and 37% died in hospital. Only 5% of patients had a documented preferred place of death. Patients with PCCs were more likely to have preferred place of death and care priorities documented.

Conclusion

Only a small proportion of conservatively treated patients with AAs had ACP, far below 2019 NICE end-of-life care guidance. It is also far below the level offered to oncology patients. Pathways and guidance should be implemented to ensure patients not offered AA intervention are offered end-of-life care and ACP.
SP11.7 Cost-effectiveness of carotid endarterectomy in symptomatic patients
Authors: Thapar Ankur , Perez-Troncoso Daniel , Hossain Mohammad , Davies Alun
Published: November 2022

Aims

In recent years, improvements in medical therapy for stroke prevention have emerged. Recent analyses of medically treated cohorts have suggested that early rates of stroke may have reduced, whilst reports for safety of carotid surgery have also shown improvements. Since the effectiveness of carotid surgery versus medical therapy was established in 1990s, it is important to evaluate whether surgery remains cost-effective.

Methods

A decision model was developed to estimate the lifetime costs and utilities of modern medical therapy with and without carotid endarterectomy in patients with symptomatic stenosis from perspective of the UK National Health Service. The base-case population consisted of adults 65 years of age with 70–99% stenosis. Costs and utilities were obtained from National Health Service tariffs and the literature. Univariate and probabilistic sensitivity analyses were carried out. Data on surgical safety was taken from the 2020 National Vascular Registry Report. Data on modern medical therapy was taken from Fisch et al. 2020.

Results

In the base-case scenario, the 5-year absolute risk reduction with endarterectomy was 5%, and incremental cost-effectiveness ratio was £23,632 per quality adjusted life year. Surgery was more cost-effective if performed rapidly after presentation. In patients with 50–69% stenosis, surgery appeared clinically ineffective.

Conclusion

In symptomatic patients with 70–99% stenosis, carotid endarterectomy would remain cost-effective if performed rapidly after presentation. Surgery may have lost clinical efficacy in those with moderate stenosis. However, these results are uncertain because of limited data on modern medical therapy. A new randomised controlled trial of surgery versus modern medical therapy is needed.
SP11.8 Postoperative outcomes are significantly worse among patients undergoing repair of ruptured versus unruptured iliac artery aneurysms – a 10-year longitudinal cohort study
Authors: Laloo Ryan , Aimar Kelsey , Khanom Johura , Bailey Marc , Scott Julian
Published: November 2022

Aim

The European Society for Vascular Surgery defines iliac artery aneurysms (IAA) as beyond 1.5 times its normal diameter. Common iliac arteries (CIA) beyond 1.8cm in men and 1.5cm in women are considered aneurysmal. This study assessed outcomes following IAA rupture as their natural history is poorly understood with treatment recommendations based on low-level evidence.

Method

Patients with IAAs at a single vascular centre between 1st January 2010 and 31st August 2021 were identified from a prospectively collected departmental database and Caldicott-approved data collection performed. The primary outcomes included aneurysm rupture, rupture diameter, post-operative complications, 30-day, 1-year and 5-year mortality rates. Statistical analysis with SPSS® was performed using chi-squared tests.

Results

Of the 203 patients included, 90.6% were men and median(IQR) age at detection was 77 (71–83). Co-morbidities included hypertension (54.2%), hyperlipidaemia (42.9%) and ischaemic heart disease (35.5%). IAA were in the CIA (85.2%), IIA (21.7%) and EIA (2.0%), mostly asymptomatic (78.8%). Overall IAA rupture rate was 7.9% with CIA (81.2%) and EIA (18.8%). Mean (SD) diameters at rupture were 4.6 (2.4)cm for CIA and 4.6 (3.0)cm for IIA. Post-operative major adverse cardiovascular events (MACE) more frequently occurred following repair of ruptured compared to unruptured IAA (33.3% vs 3.5%, p=.011). Mortality at 30-days, 1-year and 5-years postoperatively were higher following repair of ruptured vs unruptured aneurysms (88.9%, 88.9%, 100% vs 1.2%, 10.6%, 36.1% respectively).

Conclusion

Early detection and elective treatment of IAA aneurysms before they approach 4.6cm may reduce rupture risk, morbidity and mortality associated with emergency repair following rupture.
SP11.9 Balancing Risk of Haematoma and Venous Thrombosis in VTE Prophylaxis for Breast Cancer Surgery: A Systematic Review and Meta-Analysis
Authors: Dhannoon Amenah , Balasubramanian Ishwarya , Hill Arnold
Published: November 2022

Introduction

Venous thromboembolism (VTE) is a largely preventable cause of morbidity and mortality in post-operative patients, however Guidelines for VTE prophylaxis in breast cancer surgery are not well-established.

Methods

A comprehensive search was undertaken of all studies that described the role of VTE prophylaxis in breast cancer surgery. Comparative studies that reported on postoperative outcomes between patients who received VTE prophylaxis (prophylaxis) and those who did not (no prophylaxis) were included in the analysis. A meta-analysis using random-effects model was used to analyze key outcomes, with data presented as odds ratio (OR).

Results

A total of 2470 patients from 6 studies were included in this study. Of these patient, 60.9% (n: 1504) received prophylaxis. The haematoma rate in this study is 0.05% (n: 133). The incidence of haematoma was significantly associated with the use of prophylaxis (6.85% versus 3.11%, p: 0.001). Surgical intervention for haematomas was also significantly associated in this group (3.15% versus 0.83%, p: 0.004). However there was no difference in VTE events between both groups (0.26% versus 0.36%, p: 0.88).

Conclusion

The use of VTE prophylaxis in breast cancer surgery is associated with increased haematomas without any benefit in preventing venous thromboembolic events. Further studies that examine the use of risk assessment tools for VTE prophylaxis in high risk patients may be beneficial.
SP11.11 Developing the Mobile App ‘ABCs of Breast Health’ - Pioneering Digital Innovation to raise awareness of Breast Health in India
Authors: Pillarisetti Sai , Pillarisetti Raghu Ram
Published: November 2022

Aims

Breast cancer is the most common cancer affecting women, both in India & the world. Due to a lack of awareness and the absence of an organised population-based screening programme in India, more than 60% of breast cancers present in the advanced stages, with most succumbing to the illness within a year of being diagnosed.

This mobile app aims to empower people about various aspects of Breast cancer & Benign breast disease explained in simple, easy-to-understand format.

Methods

To help address these striking realities, I worked with a Breast Cancer Charity based out of India, to create the Mobile App - ‘ABC's of Breast Health’ - available in English and 11 regional Indian Languages.

The app has an interactive ‘Myths & Facts’ section which is aimed at debunking many of the common myths surrounding breast cancer and ensuring that users are well informed with accurate information, thus filling a huge void in the delivery of Breast Health Care in India where counselling is not given much importance.

A dedicated breast health helpline was launched in 2021 to further support users.

Results

This App is South Asia's First Mobile App on Breast Health and is also the World's first breast health app available in so many languages. Within the first month of its launch, it recorded 9000+ downloads.

Conclusion

The content of the app in 11 commonly spoken regional languages has ensured that accurate information relating to breast health is accessed by women in rural India, where 70% of the population resides.
TU1.2 Revisional Bariatric Surgery: 7-Year Experience from a Tertiary Institution
Authors: Panesar Harrypal , Desai Chaitya , Mohamed Guleed , Ghassemi Nader , Davies Sian , Cheruvu Chandra
Published: November 2022

Background

Revisional surgery is an expanding area in bariatric surgery which reflects a rising need to treat adverse sequelae of primary procedures. Despite the increase, their safety and efficacy remain unclear. We aimed to review revisional bariatric surgery indications and outcomes at our tertiary centre.

Methods

Data on revisional bariatric surgery was collected prospectively from 2013 and analysed retrospectively, including indications and postoperative outcomes.

Results

From January 2013 to December 2021, 80 patients (mean age: 51.4 years) undergoing revisional surgery were identified: 38 laparoscopic gastric band (LGB) to Roux-en-Y gastric bypasses (RYGB), 34 sleeve gastrectomies (SG) to RYGB, 6 mini-gastric bypasses (MGB) to RYGB and 2 RYGB revisions. The most common indication for revision was weight regain (56.4%) followed by intolerable reflux (21.3%). Other indications included band complications (15%), obesity-related problems (2.5%), excessive weight loss (2.5%), corkscrewing of sleeve (1.3%), and dumping syndrome (1.3%). There were 11 post-operative complications, with mean length of stay of 2.8 days. In addition to treating primary complications, the mean change in BMI at 12 months for LGB to RYGB revisions and SG to RYGB revisions was -9.5 and -5.3 respectively. Average change in BMI at 24 months for LGB to RYGB revisions and SG to RYGB revisions was -9.4 and -8.6 respectively.

Conclusion

Revisional bariatric surgery effectively treated the undesirable results from primary surgery. Laparoscopic revisional surgery can be performed after both failed open and laparoscopic procedures with minimal complications. In experienced hands, with careful patient selection & education, satisfactory additional weight loss can be achieved.
TU1.3 A pilot survey of surgeons’ knowledge regarding vagus nerve injury
Authors: Dunstan Matt , Kaur Vasha , Bezzaa Sabrina , Nehra Dhiren
Published: November 2022

Aims

Vagus nerve injuries occur in up to 42% of patients following anti-reflux operations. Vagal nerve injuries may have a significant impact on patients’ quality of life after benign Upper GI hiatal surgery, and may go unrecognised. We aimed to explore surgeons’ knowledge and practice regarding consenting, identifying the vagus nerve intraoperatively, and managing vagus nerve injuries.

Methods

A pilot survey was distributed to General Surgical Trainees and Consultants in South East England via social media groups and Twitter. Respondents from other regions were permitted.

Results

Nineteen respondents comprised 1 SHO, 14 Registrar grades/fellows and 4 Consultants. Seventy-four percent reported routinely discussing vagus nerve injury, of whom over 70% discussed symptoms of fullness and/or bloating, but only 36% discussed the need for further procedures. Eighteen respondents were involved in anti-reflux and paraoesophageal hernia procedures, of whom 94% routinely visualised the posterior vagus nerve during these procedures, whilst around 60% visualised the anterior vagus nerve. Ten respondents were involved in gastric band insertion, of whom 60% did not identify either vagus nerve. Only 7 respondents had experience of managing patients with vagus nerve injury.

Conclusions

Work is required to guide education around informing patients of the risk of vagus nerve injury, and around managing this complication. This pilot survey informs wider national work to explore this topic.
TU1.6 Endoscopic Management of Broncho-Oesophageal Fistula Caused by Impacted Denture
Authors: Elnabil-Mortada Ahmed , Afonso Matias Mariana Rita
Published: November 2022

Background

Oesophageal foreign body impaction in adults is fairly common. Although, dentures being often accidentally ingested among the elderly, it is very unusual to develop a broncho-oesophageal fistula (BOF) secondary to a retained denture. The few cases reported in the literature were mostly managed with thoracotomy.

We present a clinical case of a BOF successfully treated by endoscopic approach following a combined assessment and planning between intervention radiology, general and cardiothoracic surgery.

Case Report

A 60-year-old male was transferred from neighbouring DGH to our centre due to worsening of dysphagia. Patient reported that he had swallowed a denture 6 month earlier. The CT scan showed the denture along with a left BOF. Imaging was further reviewed and discussed amongst interventional radiology, cardiothoracic, and upper gastrointestinal surgeons. Endoscopic retrieval of impacted denture plate was successful, followed by the insertion of left bronchial stent, and percutaneous gastrostomy tube. The left bronchial stent was removed after three months with successful closure of the fistula.

Conclusion

Our clinical case highlights that multidisciplinary team discussion is crucial in the management of complex surgical cases in order to achieve the best outcome possible. Additionally, endoscopic management of BOF is a safe alternative option to thoracotomy when the required resources are available.
TU1.8 Laparoscopic partial gastrectomy as day-case surgery: Our 12-month experience
Authors: Peristeri Dimitra , Jaunoo Shameen
Published: November 2022

Aim

Procedures performed in ambulatory surgical centers (ASC) can provide several advantages over hospital-based surgery. We present our experience in same-day discharge after laparoscopic partial gastrectomy (LPG) in 19 consecutive patients during 2021. Our aim was to review our outcomes and assess the safety and efficacy of outpatient LPG over 12 months to determine if this procedure can be safely performed in the ambulatory setting.

Methods

Retrospective review of all consecutive patients who underwent ambulatory LPG from January 2021 to December 2021. Patient age, social circumstances, and other demographics were recorded as well as any comorbidities and ASA score. All patients were discharged home the same day after surgery without an overnight stay at the hospital. Incidence of complications and re-admission to the hospital after discharge were reviewed up to 30 days from surgery.

Results

From January 2021 to December 2021, 19 consecutive patients underwent LPG. The mean age was 47 years (range, 23–74 yr). 17 patients (89%) had gastric GIST tumor resected. Mean recovery room time was 131 minutes (30–385 min). No patients (0%) were readmitted within 30 days. There were no complications and no open conversions or deaths occurred in the series.

Conclusion

With stringent patient selection and utilization of enhanced recovery pathways, our study indicates that LPG may be suitable for the outpatient setting. Our low overall readmission and complication rate portends to the feasibility of laparoscopic PG as a safe outpatient procedure.
TU1.9 Oesophageal manometry and ambulatory pH monitoring prior to laparoscopic anti-reflux surgery – is it a necessity? An evaluation of a newly established anti-reflux surgery service at a district general hospital
Authors: Slim Naim , Shamali Awad , Williamson James
Published: November 2022

Background

Laparoscopic fundoplication is an effective surgical option for patients with symptoms of reflux refractory to proton-pump inhibitor (PPI) use. Oesophageal manometry and ambulatory pH monitoring are typically advocated as part of the evaluation of gastro-oesophgeal reflux disease, when anti-reflux surgery is considered. However, the requirement for these as a mandatory procedure remains controversial, particularly in the context of large hiatus hernia or presence of endoscopic reflux oesophagitis.

Methods

A retrospective review of all cases performed since the inception of the anti-reflux service at a single-centre district general hospital was undertaken. All patients who underwent an elective laparoscopic anti-reflux operation were included. Data pertaining to preoperative symptoms, preoperative investigations and postoperative outcomes (resolution of symptoms and PPI cessation) was collected.

Results

Over the three-year period, 22 anti-reflux operations were performed, of which 17 were followed up. The mean length of follow-up was 9.5 months. Most patients (91%) had typical reflux symptoms with a large hiatus hernia or endoscopic reflux oesophagitis. Only 4 (18.2%) patients underwent oesophageal manometry and ambulatory pH monitoring—each of these had either a normal preoperative OGD or barium swallow, or atypical symptoms. Alleviation of symptoms was achieved in 14 (82.3%) patients; 9 (52.9%) of which achieved complete resolution. PPI cessation was achieved in 12 (70.1%) patients, comparable with current literature.

Conclusion

Anti-reflux surgery can safely be performed without routine oesophageal manometry and ambulatory pH monitoring in the context of typical symptoms, a large hiatal defect or evidence of endoscopic reflux oesophagitis, as exemplified in our newly established anti-reflux service.
TU1.11 Patients’ views on laparoscopic cholecystectomy consent process: Consent in clinic improves quality of informed consent and patient satisfaction
Authors: Yang Peiming
Published: November 2022

Aims

Informed consent for elective laparoscopic cholecystectomy should begin at first clinic consultation. Due to clinic time pressures, informed consent is often obtained on the morning of surgery for the first time. This study aims to assess whether consent quality and patients’ consent satisfaction are better in clinic compared to day of surgery.

Methods

Retrospective review of all elective laparoscopic surgeries between April and June 2021. Self-administered questionnaire was also completed by the same cohort to ascertain consent satisfaction.

Results

38 patients in total during study period. 16(42.1%) were consented in clinic, and 22 were first consented on day of surgery. 25/38(65.8%) patients prefer to be consented in clinic, 13(34.2%) prefer consent on day of surgery. Significantly higher proportion of consent forms from clinic had full documentation of risks and benefits of cholecystectomy (P<0.001) compared to consents from day of surgery. Significantly higher proportion of patients consented in clinic felt adequately informed of procedure, had alternative options explained to them, were informed regarding recovery process, and felt there was adequate time for consent (P<0.05). Insignificantly higher proportion of patients consented in clinic received information leaflet about procedure.

Overall consent satisfaction was significantly higher in patients consented in clinic (77% versus 55%, P=0.048%)

Conclusions

Consent quality and patient satisfaction levels for elective cholecystectomy were statistically significantly higher when consent was carried out in clinic prior to surgery compared to on the day of surgery. We recommend that all elective cholecystectomy consent is performed formally in clinic prior to surgery.
TU2.1 Colonoscopic Polyp Tattooing: To Tattoo or Not to Tattoo?
Authors: Jeilani Milad , Mosoneke Michael , Riad Mahmud , Hassan Mohamed , Abdelsaid Kirolos
Published: November 2022

Aims

Colorectal cancer is often investigated with colonoscopy, where tattooing is performed to identify the location of potentially tumorous polyps to aid surgery and colonic surveillance. BSG guidelines state that polyps ≥20mm in size should be tattooed, except those in the rectum/caecum. Tattoos should be recorded and local policy should be in place. At our trust, St Mark's protocol is used which advises all suspicious lesions be tattooed except those in the rectum/caecum, and 3 tattoos be placed circumferentially. Here, we audit adherence to these guidelines.

Methods

Retrospective analysis of data collected from Endobase for endoscopies revealing polyps during 2020 at DGH.

Results

325 polyps were found in 255 patients (70% male). Sessile and pedunculated polyps were most common, accounting for 77%. Smaller polyps (15–19mm) were most prevalent (52%). Tattooing of smaller polyps (15–19mm) remains low (30%), whereas tattooing of larger polyps has improved (85%). Tattooing of rectal/caecal polyps remains prevalent (19%). Only 30% of tattooed polyps had 3 tattoos. Tattoo information was recorded well in certain sections of Endobase (83% in ‘conclusion’) but poorly in others (61% in ‘therapeutic’).

Conclusions

There has been an increase in male predominance, and in smaller and pedunculated polyps. These demographic changes are useful to be aware of. Teaching and clearer display of guidelines is required to improve tattooing of smaller polyps, and reduce tattooing of rectal/caecal polyps. However, clearer trust guidelines should accommodate operative variability. Recording tattoo information in Endobase is technically challenging and requires improvement to avoid loss of data.
TU2.2 Endo-Sponge Carries Good Outcome for Low Rectal Anastomotic Leak; Case Series study
Authors: Ahmed Salma , Abbakar Malaz , Hassan Karim , Mohammed Mohammed , Magee Conor , Wilson Jeremy
Published: November 2022

Introduction

Rate of anastomotic leak is considered rare, and the low rectal ones are approximately 10% of all leaks. Management of anastomotic leak is variable and could be challenging. ENDO-SPONGE is advised by experts to be considered given some criteria to be met but in general, ENDO-SPONGE is thought to improve patients’ life quality and maintains the possibility of stoma reversal after resolution of the leak.

Objective

To assess the management of anastomotic leak using ENDO-SPONGE in our hospital and to compare our practice with the international published data.

Methods

Case study of patients diagnosed with anastomotic leak and treated with ENDO-SPONGE. All cases from 2016 to 2021 were included. Concordance with the NICE briefing and recommendation which was published in 2019 was studied. All data were collected in a Microsoft forms then transcribed into an Excel sheet.

Results

13 patients treated with ENDO-SPONGE were identified – median age is 66. Guidelines suggest that ENDO-SPONGE changes should occur within 24–72 hours and the compliance from the trust was only 25%. However the compliance with the number of changes, place of insertion, and the outcome was 100%. 99% of the ENDO-SPONGE replacement took place in the theatre, only one patient's ENDO-SPONGE was replaced in endoscopy department. Complete resolution of the leak occurred in 11 of the 13 patients and only 2 required open drainage. 5/13 were eventually reversed.

Conclusions

More Compliance with timing of replacement of ENDO_SPONGE should be improved but overall ENDO_SPONGE carried a good outcome with complete resolution in nearly 85% of patients.
TU2.3 Flexible sigmoidoscopy after management of CT proven uncomplicated acute diverticulitis: a closed loop audit of local practice at tertiary care centre
Authors: Ahsan Amiya , Ma Jenifer , Krasicka Dominica , Ray Kausik , Swaminathan Christi , Sajid Muhammad S
Published: November 2022

Background

Routine practice of offering a flexible sigmoidoscopy after patients undergoing medical management of CT proven uncomplicated acute diverticulitis (UAD) has been revisited recently and is not required in the absence of red flag symptoms as per the recommendations of the World Society of Emergency Surgery (WSES). The aim of this audit project is to evaluate whether local practice in requesting flexible sigmoidoscopy after the medical management of UAD is in line with WSES guidelines.

Methods

The data of all patients undergoing medical management of CT proven UAD for 19 months (2019–2021) was collected and analysed as per guidelines provided by the WSES.

Results

The study cohort included the subjects treated both as in-patients as well as out-patients in the ambulatory care unit. Out of 115 admissions with acute diverticulitis during first loop of the audit, there were 80 (69.5%) patients diagnosed with CT proven UAD. Thirty-nine patients (48/8%) with UAD were booked to undergo flexible sigmoidoscopy and only 10 patients (25.64%) were diagnosed with sub-centimetre colonic polyps. Second loop included 49 patients, of which 34 patients were diagnosed with UAD and 10 (29.4%) patients underwent flexible sigmoidoscopy showing polyps in 3 (8.8%) patients.

Conclusion

This audit project successfully has shown reduced booking rate of flexible sigmoidoscopy following the medical management of UAD. Given the low rate of positive findings, the high rate of outpatient request for sigmoidoscopy in the uncomplicated group appeared unjustified.
TU2.6 Pre-Operative Optimisation of Elective IBD Patients: Are we meeting the standard?
Authors: Allan Jennifer , Craig Sarah , Wallace William
Published: November 2022

Aim

Inflammatory bowel disease represents a significant healthcare burden. Management requires a multi-disciplinary approach and a combination of both surgical and medical considerations. The aim of this study was to compare current practice within our colorectal unit for pre-operative optimisation of IBD patients with ACPGBI recommendations, with the view of introducing a proforma for these patients to ensure pre-operative optimisation standards are met.

Methods

This was a retrospective study identifying patients undergoing elective surgery for IBD in our unit between January 2019-October 2020. Data was collected on pre-operative management and compared to the broad principles of optimisation outlined by ACPGBI in their 2018 guidelines. Clavien-Dindo classification was used to define post-operative complications.

Results

94 patients were identified, 67 in 2019 and 27 patients in 2020. 4.3% had active intra-abdominal sepsis. No patients had a clearly documented comprehensive nutritional assessment. 15.6% patients were on oral steroids pre-operatively (Dose ≤30mg). 43.8% were on biologic therapy. Mean length of stay was 11.3days. 39.7% of patients experienced post-operative complications. However, only 12.8% of patients had a Clavien-Dindo score of ≥3. There was no mortality.

Conclusion

ACPGBI guidelines highlight key areas for adequate pre-operative optimisation. Our study highlighted that our morbidity following IBD surgery was comparable to those in literature. However, key areas of improvement were identified including comprehensive nutritional assessment. Current work involves creating a pre-operative proforma to encompass this and will be followed by a re-audit.
TU2.9 Under-investigation of iron deficiency anaemia in QFIT-negative suspected colorectal cancer patients
Authors: Bajomo Oreoluwa , Omassoli Jessica , Alsadoun Lara , Lascelles Simon
Published: November 2022

Introduction

QFIT (Quantitative faecal immunochemical testing) has become the first-line screening tool for suspected colorectal cancer due to a lower risk profile, higher sensitivity and specificity than routine colonoscopy and faecal occult blood testing.

Patients with QFIT measurements <10micrograms/ml are considered unlikely to have colorectal cancer and may be discharged from the 2-week wait (2WW) pathway without further investigations, in the absence of other concerning features including iron deficiency anaemia (IDA). We present our findings on the under-investigation of IDA in a cohort of QFIT-negative patients.

Method

We collected data on 100 patients in a district general hospital, referred via the 2WW suspected colorectal cancer pathway with QFIT measured as <10 micrograms/ml, over a 2-month period. Our data-points included whether iron, ferritin and haemoglobin were measured in the 6months preceding QFIT measurement.

Results

Our patients included 67 females and 33 males, with a median age of 67.5. 32 out of 100 patients underwent neither iron nor ferritin blood tests; 21 of which did not have their haemoglobin measured either. 25 out of 100 patients underwent iron, ferritin and haemoglobin blood tests in the specified time period.

Discussion

Failure to investigate IDA in QFIT-negative suspected colorectal cancer patients increases the risk of missed pathology. Studies have found patients with right sided colon cancer sometimes have false negative QFIT results but often present with IDA. We propose that mandatory investigation of IDA is incorporated into existing 2WW suspected colorectal cancer pathways, alongside QFIT measurement, to mitigate this risk.
TU2.11 Adherence to post-polypectomy surveillance guidelines in a district general hospital
Authors: Myintmo Aye , Butler Daniel , Flashman Harriet , Bethune Robert
Published: November 2022

Aims

National guidelines instruct clinical decision making around post-polypectomy surveillance. The current polyp surveillance guidelines were jointly published by the British Society of Gastroenterologists (BSG), the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and Public Health England (PHE) in 2019, updating the 2010 surveillance guidelines. Adherence to polyp surveillance guidelines is historically poor, both in the UK and globally.

This audit set out to establish the adherence rate of clinicians to the 2019 polyp surveillance guidelines in a district general hospital and to compare this to the adherence rate to the 2010 surveillance guidelines.

Methods

We aimed to collect 300 patients who had been treated under the 2010 or 2019 polyp surveillance guidelines. After exclusion criteria were applied we collected 152 and 133 patients who had respectively been treated under the 2010 and 2019 guidelines. Each patient record was analysed and it was determined by our team whether the chosen polyp surveillance was adherent to the respective guidelines or not.

Results

Of 152 patients treated under the 2010 guidelines, 41.4% (63) of patients were adherent. Of 133 patients treated under the 2019 guidelines, 66.2% (88) of patients were adherent. This represents a score difference of 24.7% (95% confidence interval of 13.5% to 35.9%, p<0.0001).

Conclusions

Our results show that following the introduction of the 2019 guidelines, adherence to polyp surveillance guidelines increased. Increased adherence to guidelines has significant implications for improving patient safety, financial savings and protecting endoscopy capacity.
TU2.12 Experience of Elective Colorectal Cancer Surgery at District General Hospital (DGH): Single centre study
Authors: Elzaafarany Ahmed , Tawfik Ahmed , Day Andrew
Published: November 2022

Background

Elective colorectal resection surgery is one of the most common surgical procedures performed for bowel cancer treatment. This study evaluates the whole practice of colorectal cancer surgery in a DGH in England.

Aims

The primary outcome is to measure postoperative length of stay (LOS), with secondary outcomes including approach of surgical operation and conversion rate, R0 resection, VTE prophylaxis and its compliance with NICE guidelines, postoperative DVT over a period of one year, readmission rate within 30 days of discharge and reasons for readmission.

Methods

A single centre, retrospective, observational study was performed over a period of a year from January 2018 –January 2019. Patients were eligible for study inclusion if they had undergone planned surgical resection for colorectal cancer after being discussed in the local colorectal cancer MDT.

Results

A total of 123 patients were included. Mean length of stay was 7.97 days. 74.7% of the procedures were performed by laparoscopic approach with conversion rate of 6.5%. R0 resection was achieved in 95.1%. 96.7% of patients who underwent surgery for colorectal cancer received extended VTE prophylaxis as per NICE guidelines. Six patients had developed post-operative DVT and one inpatient death recorded. 13.8% of patients that underwent colorectal surgery for cancer were readmitted within 30 days of discharge. SBO, abdominal/pelvic collection, wound dehiscence and SSI as the most common reasons for readmission.

Conclusion

Laparoscopic approach is the preferred method for elective colorectal resection surgeries with acceptable measures of patient outcome including R0 resection, postoperative length of stay, DVT and readmission rate.