bluuebunny/crossref_metadata_2025 huggingface dataset:
SP4.1.15 Maintaining elective surgery in a district general hospital during a global pandemic. Lessons in surgical leadership and collaborative working from the first wave of COVID-19
Authors: Jones Dylan , Owen Amy , Swarnkar Keshav , Gomez Kelvin , Somasekar Krishnamurthy , Delicata Raymond
Published: October 2021

Aims

To share our experience of maintaining elective surgery, during the 1st wave of COVID-19. Paucity of evidence regarding COVID-19 pathogenicity provided an opportunity for surgical leadership to collaborate with infection control in establishing local guidelines for mitigating Nosocomial transmission. We aim to demonstrate that early engagement with management facilitating an interdepartmental collaborative approach can provide lessons for maintaining clean elective surgical pathways.

Methods

Retrospective audit April – June 2020 using a digital electronic patient record system (CWS) linked to an operating theatre system (Ormis). Review of published guidelines.

Results

Mean Age 61 (24-89). Mean ASA 2, Performance Status <1. 86% swabbed <5 days pre admission, 25% <3. 3 -ve postoperative COVID-19 swabs. No deaths. Peak Community case rate 110\100,000 population.

Conclusions

Elective Colorectal/Breast Cancer and urgent Biliary/General surgery was successfully maintained at the peak of the 1st wave in a region with high community transmission. No perioperative COVID-19 infections\mortalities. Our experience of leading collaboration with management\key departments can provide lessons in maintaining elective surgery in the face of repeated waves of COVID-19 or indeed future viral pandemics.
SP4.2.1 The Global impact of COVID-19 on Surgeons and Team members (GlobalCOST) Study
Authors: Jaffry Zahra , Sobti Anshul , Negida Ahmed , Singh Bijayendra , Brennan Peter , Imam Mohamed
Published: October 2021

Aims

To describe the impact of the COVID-19 pandemic on the well-being of surgeons and allied health professionals across the world and assess the support provided by their institutions.

Methods

An online survey was distributed through medical organisations, social media platforms and collaborators from the 15th of July to the 15th of December 2020.

Results

1590 responses were received. 80.0% were surgeons, 6.4% nurses, 5.3% assistants, 3.1% anaesthetists, 1.4% operating department practitioners and 3.8% classed as other. Of participants, 64.0% had found difficulty gaining access to personal protective equipment (PPE), 29.8% had not received training on its use and 32.0% had become physically ill since the start of the pandemic (59.9% of which were due to COVID-19 symptoms). 29.0% saw a decrease in salary and 35.2% a decrease in time spent with family. Between a time two weeks before the start of the pandemic and after, there was a significant increase in mean scores for depression (4.22 (CI = 3.98-4.46)) and anxiety (2.24 (CI = 2.01-2.46)), based on the Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder Assessment (GAD-7) respectively (p < 0.0001). In terms of support, only 36.0% had easy access to occupational health, 58.5% were able to take regular breaks, 16.5% had access to 24 hour rest facilities and 14.2% to 24 hour food and drink facilities.

Conclusions

This work has highlighted a need and ways in which to improve conditions for the health workforce. This will inevitably have a positive effect on the care received by patients.
SP4.2.2 The hidden harm of conservative management in emergency general surgery during the COVID-19 pandemic
Authors: Jackson Andrew , Ng Oliver , Bharathan Balamurali , Simpson Alastair , Humes David , Parsons Simon
Published: October 2021

Aims

Appendicitis, biliary disease and abscesses make up almost half of the emergency general surgery (EGS) workload. Our aim was to establish whether the shift towards non-operative management during the COVID-19 pandemic for these conditions has led to adverse patient outcomes.

Methods

Patient data were analysed from a prospective EGS database at a large UK tertiary centre. Patients were grouped by admission date into quarters (January-March, April-June, July-September, October-December) and compared with the corresponding time period from the preceding year.

Results

EGS saw 8226 and 7589 patients in 2019 and 2020 respectively. Following the first lockdown EGS admissions fell by 31%. Operative management of appendicitis fell from nearly 100% in 2019 to 32.9% and 54.7% in two of the four study periods. Complicated appendicitis was more common in 2020 leading to a 50% rise in length of stay (LOS), 4.5 days average. 30 day readmissions increased by 228% (n = 7, 2019 v n = 16, 2020). Biliary disease was managed conservatively with 11 patients undergoing percutaneous drainage from Apr-Dec 2020.Very few patients received emergency cholecystectomy in 2019 or 2020 due to institution preference. Readmission rates and LOS remained similar between years. Fewer abscesses were seen and operated on in 2020 with similar readmission rates and LOS between years.

Conclusions

Non-operative management and delays in presentation of appendicitis during the pandemic has had an adverse effect on patient outcomes. The rise in more complex cases has led to higher readmission rates and longer lengths of stay. The outcomes for biliary disease and abscesses remained unchanged.
SP4.2.6 Colorectal cancer services during COVID-19; an experience of a tertiary centre
Authors: Shang E , Hamer N , Jha T , Abu Talib M , Garg D , Jha M
Published: October 2021

Aims

COVID19 has placed unprecedented constraints on healthcare services. Colorectal cancer (CRC) care was one of the many areas predicted to suffer due to these additional pressures. We believe that despite the challenges posed by COVID19, we have continued to deliver a standard of care for elective and emergency CRC resection that compares favorably with the national average.

Method

We conducted an analysis of the elective and emergency CRC resections carried out at a tertiary center over a 10-month period (Feb-Dec 2020). Data was collated from patient, operative, and theatre records and compared to the national average as defined by the 2020 National Bowel Cancer Audit (NBOCA).

Results

A total of 227 patients underwent surgery (189 elective and 38 emergencies), with a median age of 69. Of these, 153 were laparoscopic (67%), 57 open (27%), and 17 robotic (7%). The median length of stay was less than the national average; 5 days for elective surgery (NBOCA: 6) and 8 days for emergencies (NBOCA: 10). Within 30 days, overall unplanned readmissions rate was 6.5% (NBOCA: 11.6%) and return to theatre was 3.2% (NBOCA: 8.4%). Elective surgery had a 90-day mortality of 1% (NBOCA: 3%) compared to 7.8% for emergencies (NBOCA: 10.5%).

Conclusion

Despite the added constraints of the COVID19 pandemic, CRC resection in our unit remains safe with better outcomes than the national standard. We have demonstrated that with adequate precaution and a concerted team effort, delivery of safe care with reasonable outcome is achievable.
SP4.2.11 Access to emergency theatre during the COVID -19 pandemic
Authors: Dosis Alexios , Lim Jie Qi , Reveendran Dharsshini , Paramjothy Kiara , Lockwood Sonia
Published: October 2021

Aims

To investigate the impact of the COVID-19 pandemic on general surgical emergencies and access to theatre during the pandemic.

Methods

We retrospectively reviewed emergency theatre lists in three distinct time periods: October 2019 (pre-COVID-19 era), April 2020 (first peak) and October 2020 (regional second peak). We extracted and compared data from a prospectively maintained database to calculate patient waiting times. Statistical analysis was performed with SPSS software v21.0 to compare median waiting times between groups and significance was set to a p value of < 0.05.

Results

Conclusions

Despite the initial major drop in general surgical procedures and waiting times, the decreased availability of theatre lists due to staff redeployment and sickness, the introduction of routine pre-operative COVID-19 testing have all resulted in a significant increase in waiting time for urgent (CEPOD 2A) cases during the second peak.
SP4.2.15 An international multi-centre appraisal of the management and outcomes of acute CHOLEcystitis during the COVID-19 pandemic: The CHOLECOVID Study
Authors: Spiers Harry VM ,   CHOLECOVID Collaborative
Published: October 2021

Introduction

National guidance issued in response to COVID-19 resulted in adoption of non-surgical modes of treatment in emergency surgery, including acute cholecystitis (AC). The CHOLECOVID Study is the definitive global audit of the management and outcomes of AC during COVID19.

Methods

Patients >18 years admitted to hospital with radiologically confirmed AC, during two predefined 8-week time periods: P1 (pre-pandemic) 12/09/19- 12/11/19; P2 (during the pandemic) 12/03/20-12/05/20, were included. The primary outcome was 30-day all-cause mortality. Secondary outcomes included severity of AC, radiological diagnostic modalities implemented, definitive management and pulmonary complications.

Results

9,615 patients were included from 39 countries (P1:5,381; P2:4,234). 30-day mortality was higher in P2 (1.7%vs2.4%; p < 0.015). Higher rates of moderate and severe AC were seen in P2 (30.1%vs35.1%;3.7%vs4.1%). First-line CT imaging was more common in P2 (36.3%vs46.3%; p < 0.001). There were higher failure rates of conservative management in P2 (37.4% vs 44.4%; P < 0.001). Cholecystostomy rates were higher in P2 (5.8%vs8.8%; P < 0.001). Overall 4.6% (n = 193) of P2 patients were COVID-19 positive, with overall mortality of 0.7% (n = 30). There was no significant difference in pulmonary complications between COVID-19 positive or negative patients.

Conclusion

During the COVID-19 pandemic, a small increase in mortality among AC patients was noted, when compared to the pre-pandemic cohort. Patients during the COVID-19 pandemic presented with more severe AC, resulting in altered trends in diagnosis and management. New guidance and clear pathways are required to safely manage AC moving forward, in the face of further waves of COVID-19.
SP5.1.1 The harsh reality of a long waiting list for bariatric surgery, a prospective study regarding health-related quality of life (HRQoL) among morbid obese patients following bariatric surgery versus those on a waiting list, a two-year follow-up study
Authors: Rodicio Jose , Moreno María , Vico Tamara , Negrete Emilio , Valdés Covadonga , Sanz Lourdes
Published: October 2021

Aims

The aims of this study were to assess the changes in HRQoL during the 2 years follow-up between patients who underwent surgery and those on a long waiting list .

Methods

Between January to December 2017, 70 surgical patients and 69 patients on the waiting list were interviewed at baseline, 12-month and 24-month follow-up. Quality of life was measured by the SF-12v2 and the Impact of Weight on Quality of Life-Lite (IWQoL) questionnaires. Socio-demographics, clinical, and surgical-related variables were collected.

Results

139 patients were analyzed, with similar baseline characteristics. Analyzing the entire sample: the higher the BMI, the worse the scores in the IWQoL. Performing more qualified work improves several aspects of the SF-12v2. In contrast, patients with depression tended to score worse on all dimensions of both questionnaires, women scored worse on the Self-Esteem domain and men improved on the Mental Health one. At 12 and 24-month follow-up, statistically significant differences were found among all aspects of the questionnaires between both groups (P<.001). Furthermore, scores were lower in all domains in the evolution of wait-listed patients, with statistically differences among Bodily Pain, Emotional Role, Mental Health, and Mental Component Summary domains (P<.05) at 12 months, but differences were not found at 24 months.

Conclusions

The quality of life of patients undergoing bariatric surgery is normalized one year after surgery, while patients on the waiting list get worse. Knowing the benefits of bariatric surgery, working on programs with long waiting lists should move us to fight against an unfair and unacceptable situation.
SP5.1.13 Upper gastrointestinal (UGI) mural thickening on Computed Tomography (CT) and its significance in the multi-disciplinary team (MDT) pathway
Authors: Ashmore Christopher , Hunter David , Kenningham Richard , Bowrey David
Published: October 2021

Aims

Patients are frequently referred to the UGI MDT based on CT reported thickening of either the oesophagus, stomach or duodenum. We have sought to illustrate the efficacy of CT within the UGI cancer referral pathway.

Method

A retrospective analysis was carried out on patients referred to the UGI MDT at a University Teaching Hospital over a 22-month period. Patients referred with CT evidence of UGI tract thickening prior to endoscopy were included. CT findings were correlated with symptomatology, subsequent endoscopy and histology findings.

Results

442 patients were referred to the UGI MDT between April 2014 and February 2016. 125 were referred for CT thickening alone (67 (53.2%) oesophageal, 49 (39.2%) gastric, 9 (7.2%) duodenal). 49 (39.2%) patients were subsequently diagnosed with UGI cancer, 57 (45.6%) had evidence of benign disease and 18 (14.4%) patients had no abnormality evident on endoscopy. CT thickening of 15mm and above was significantly more likely be malignant versus thickening less than 15mm [42/87 (48.3%) vs 7/38 (18.4%); p < 0.05]. Patients with thickening in the presence of a hiatus hernia were significantly less likely to have an associated cancer vs those without [3/26 (13%) vs 20/42 (51.1%); p < 0.05].

Conclusion

We conclude that patients should not be referred for MDT opinion on CT evidence of UGI thickening alone. All patients should have an endoscopy prior to referral, particularly those with a hiatal hernia on CT. A high index of suspicion for malignancy should be adopted in patients with thickening greater than 15mm on imaging.
SP5.2.3 Comparison of Open Abdomen Management Techniques in a cohort of patients with Encapsulating Peritoneal Sclerosis – A large single centre retrospective review
Authors: Bannon Aidan , Leatherby Robert , Birtles Linda , Augustine Titus , Moinuddin Zia , Dellen David van
Published: October 2021

Aims

Encapsulating peritoneal sclerosis (EPS) is a rare phenomenon characterised by encasement and obstruction of the bowel by thickened peritoneum. In our centre, EPS laparotomies are typically managed with open abdomen (OA) and planned relook at 24-48 hours. The aim of the study was to compare ABTHERATM open abdomen negative pressure wound therapy (NPWT) with packing (betadine-soaked gauze) as temporary abdominal closure (TAC) techniques in OA management.

Methods

We performed retrospective analysis of a contemporaneously maintained database of all patients who underwent surgery for EPS between 2010-2020. A variety of variables were included with the primary endpoint being time to definitive fascial closure. Patient demographics, surgical complications, subsequent method of closure (including mesh usage) and outcomes were recorded.

Results

99/122 patients underwent open abdomen management. 43/99 were managed with NPWT and 56/99 were managed with packing. The NPWT group had significantly higher fascial closure rates without need for subsequent bridged (mesh) closure when compared to the packed abdomen [62.8% vs 12.5%, (p < 0.001, c2 test)]. In the NPWT group, there were also fewer failed closures [4.7% vs 19.6%, (p = 0.03, c2 test)] along with shorter time to definitive closure and reduced theatre episodes. No incidence of intestinal fistulation was associated with NPWT.

Conclusion

This study provides definitive guidance as to the benefit of ABTHERATM open abdomen NPWT for fascial closure following open abdominal management. ABTHERATM open abdomen NPWT provides significant advantages over traditional methods of TAC and may provide benefit in OA management in other patient groups (sepsis and trauma) as well.
SP5.2.6 Adrenal Incidentalomas in Living Kidney Donors: A Dilemma?
Authors: Theodorou Chloe , Moinuddin Zia , Dellen David Van , Augustine Titus , Giuffrida Giuseppe
Published: October 2021

Aims

During donor multi-detector CT angiogram (MDCTA), incidental findings occur, commonly adrenal incidentalomas (AIs). These are usually benign and non-functional with an estimated incidence of 4%.1 These potentially limit organ donation due to the need to exclude malignancy. There is no consensus on the management of donors with AIs.1,2 This study aims to explore the incidence and clinical course of AI’s in living kidney donors.

Methods

We performed a single-centre, retrospective study on all prospective living kidney donors between November 2000 and September 2020. Patients with adrenal lesions during work-up were identified and further information was collected from electronic patient records.

Results

Six (1.09%) of the 546 donors during that period had an AI. All were small (<4cm) and non-functional with benign radiographic features. Five (83.3%) proceeded to donation while 1 (16.7%) was unsuitable for donation due to complex vascular anatomy. Of the five donors that proceeded, 2 (40%) were contralateral and 3 (60%) ipsilateral AI’s to the side of nephrectomy. Of the 3 ipsilateral AIs, 2 (66.7%) underwent nephrectomy alone whilst 1 (33.3%) underwent a simultaneous nephrectomy and adrenalectomy. There was no evidence of malignancy or functional change in AIs post-donation.

Conclusion

The incidence of adrenal pathology in living donors is low and largely benign. These patients should not be excluded from donation. Such patients could benefit from open discussion regarding simultaneous adrenalectomy vs conservative management.
SP6.1.2 Colorectal Liver Metastases - Novel Assessment Tools for Resectability (The CoNoR Study): Results from an International Questionnaire of Hepatopancreatobiliary Surgeons
Authors: Parmar Kat , O'Reilly Derek , Jones Rob , Balaa Fady , Welsh Fenella , Renehan Andrew
Published: October 2021

Aims

Hepatic resection offers the only chance of cure for colorectal liver metastases (CLM), yet wide variation in resectability decision-making has been demonstrated. This study aims to evaluate the potential value of two novel assessment tools in aiding resectability decision-making: the LiMAx test (hepatic functional capacity) and HepaT1ca interactive pre-operative MR scan (MR-based volumetry and functional assessment).

Methods

This study utilises four workstreams: WS1 systematic review, WS2 international HPB interviews, WS3 international HPB online questionnaire, and WS4 online scenario-based survey to assess change in decision-making resulting from the novel tools. The WS3 questionnaire closed in January 2021; participation was increased by professional association endorsement (AUGIS, GBIHPBA, E-AHPBA, AHPBA, CHPBA, IHPBA).

Results

197 complete responses were received from 37 countries in 6 continents. The clinical scenario in which HPB surgeons found resectability decisions most challenging was post-chemotherapy downsizing, with >90% of respondents agreeing that the following scenarios also present a challenge: recurrent disease post-liver resection, post-portal vein embolisation, and close proximity to major ducts/vessels. Substantial variation was demonstrated in the percentage future liver remnant at which surgeons preferred further investigation in all scenarios. >90% of respondents felt the novel tools would be potentially useful in decision-making; wide-ranging free-text feedback was also provided.

Conclusions

The questionnaire lends support to the previously documented variation in resectability decision-making and confirms international HPB community support for investigation of these novel tools. Response analysis has facilitated the appropriate case selection to best assess their potential utility in the WS4 survey, due to launch this spring.
SP6.1.5 Morbidity following emergency and elective laparoscopic cholecystectomy for cholecystitis: a retrospective comparative cohort study
Authors: Lucocq James , Radhakishnan Ganesh , Scollay John , Patil Pradeep
Published: October 2021

Aims

A comprehensive comparison of post-operative outcomes between emergency and elective laparoscopic cholecystectomy (LC) for cholecystitis has not been conducted and the relative morbidity associated with emergency LC remains uncertain. Our aim was to evaluate the difference in early post-operative outcomes between emergency and elective LC for patients with cholecystitis.

Method

LC performed for cholecystitis across three surgical units between January 2015 and January 2020 were analysed retrospectively from multiple regional databases using deterministic records-linkage methodology. Rates of complications, further imaging, re-intervention, prolonged post-operative stay and re-admissions over a 100-day follow-up period were compared between emergency and elective groups using univariate and multivariate analysis.

Results

LC were performed for cholecysitits in 962 cases (median age, 52 years; M:F, 1:2.7; emergency:elective; 1:3.9). Emergency cholecystectomy had higher rates of complication (15.8% versus 8.8%;p<0.0001), prolonged post-operative stay (40.3% vs. 12.7%;p<0.0001), post-operative imaging and intervention (19.1% vs. 9.4%;p<0.0001) and readmission (11.1% vs. 7.0%;p=0.017). In the multivariate regression analysis, emergency LC was associated with prolonged admission (OR,5.7;p<0.0001), complication (OR,2.97;p<0.0001), post-operative imaging and intervention (OR,2.4;p=0.002) and readmission (OR,1.9; p = 0.06).

Conclusions

Despite current guidance, an emergency cholecystectomy remains a morbid procedure and we demonstrate increased risks of emergency LC versus elective LC. The increased risk of an emergency LC needs to be weighed up against the risk of further attacks from biliary pathology until elective surgery. Our data indicates that we need to readjust our selection criteria for the ‘emergency cholecystectomy patient’ and identify patients who will specifically benefit from earlier surgery.
SP6.1.7 Meta-analysis of procedural outcomes of laparoscopic-assisted endoscopic retrograde cholangiopancreatography in patients with previous Roux-en-Y gastric bypass surgery
Authors: Hajibandeh Shahab , Hajibandeh Shahin , Mansour Moustafa , Satyadas Thomas
Published: October 2021

Aims

To investigate the procedural outcomes of laparoscopic-assisted endoscopic retrograde cholangiopancreatography (ERCP) in patients with previous Roux-en-Y gastric bypass (RYGB) surgery.

Methods

We performed a systematic review in accordance with PRISMA statement standards to identify all studies reporting procedural outcomes of laparoscopic-assisted ERCP in patients with previous RYGB. The ROBINS-I tool was used to assess the risk of bias of the included studies. Fixed-effect and random-effects models were applied to calculate pooled outcome data.

Results

A total of 17 case series, enrolling 256 patients, were included. The mean age of included patients was 49. The mean procedure time was 137 minutes (95% CI 102-172). In terms of procedural success rates, the overall technical success was 95.3% (95% CI 92.5-97.5,I2=0%), papillary access success was 95.3% (95% CI 92.5-97.5,I2=0%), cannulation success was 95.3% (95% CI 92.5-97.5,I2=0%), sphincterotomy success was 96.1% (95% CI 93.5-98.1,I2=0%), and stone removal success was 95.9% (95% CI 92.4-98.4, I2=0%). Conversion to open was required in 4.7% (95% CI 2.5-7.6,I2=0%). In terms of complications, pancreatitis occurred in 4.7% (95% CI 2.3-8,I2=17%), cholangitis in 1.7% (95% CI 0.5 to 3.6,I2=0%), and perforation in 3.7% (95% CI 1.8- 6.3,I2=0%). The length of hospital stay was 3 days (95% CI 2-4).

Conclusions

Laparoscopic-assisted ERCP seems to be feasible, effective, and a safe method to access the biliary tract in patients with previous RYGB as indicated by high technical success rates and low complication rates. There is a need for comparative evidence regarding outcomes of laparoscopic ERCP in comparison with alternative treatment options.
SP6.1.11 The Effect of the Enhanced Recovery Programme for Liver Surgery on Long Term Survival
Authors: Arujunan Kalaiyarasi , Shugaba Abdulwarith , Uwadiae Harmony , Lambert Joel , Sgourakis Georgios , Subar Daren
Published: October 2021

Aims

The Enhanced Recovery Programme for Liver Surgery (ERPLS) has been shown to promote functional recovery and reduce hospital stay. However, its effect on long term survival has yet to be established. The aim of this study was to determine the effect of the ERPLS on 5-year patient survival.

Methods

This was a retrospective study of patients who underwent liver resection for colorectal liver metastasis (CRLM) between January 2011 and December 2016 at a regional hepatobiliary centre. The cohort comprised of 60 pre-ERPLS and 60 post-ERPLS patients. The primary outcome was 5-year patient survival. The secondary outcomes were length of stay (LOS), postoperative complications and 90-day readmission rates. Multivariate analysis was performed to identify independent predictors of overall survival.

Results

There was no significant difference in the age (p = 0.960), gender (p = 0.332) and type of resection (p = 0.198) between both groups. ERPLS was not an independent predictor for overall survival (Gehan Wilcoxon Test, p = 0.828). There was no significant difference in the LOS (p = 0.874) and 90-day readmission rates (p = 0.349). Major postoperative complications (>3a Clavien-Dindo classification) were significantly less in the ERPLS group (p = 0.02). On multivariate analysis, positive resection margins and major postoperative complications were independent predictors for overall survival.

Conclusions

ERPLS does not seem to have an effect on long term patient survival. However, it appears to reduce the rate of major postoperative complications. LOS and 90-day readmission rates were not influenced by ERPLS.
SP7.1.5 Common General Surgical Never Events: Analysis of NHS England Never Events Data
Authors: Omar Islam , Singhal Rishi , Wilson Michael , Parmar Chetan , Khan Omar , Mahawar Kamal
Published: October 2021

Background

There is little available data on common general surgical Never Events (NE). Lack of this information may have affected our attempts to reduce the incidence of these potentially serious clinical incidents. The purpose of this study was to identify common general surgical NE from the data held by the NHS England.

Methods

We analysed NHS England NE data from April 2012 to February 2020 to identify common general surgical NE.

Results

There was a total of 797 general surgical NE identified under three main categories of Wrong-Site Surgery (n = 427;53.58%), Retained Items Post-Procedure (n = 355; 44.54%), and Wrong Implant/ Prosthesis and (n = 15; 1.88%). We identified a total of 56 common general surgical themes - 25 each in the Wrong-Site Surgery and Retained Foreign Body category and 6 in wrong implants.

Wrong skin condition surgery was the commonest wrong-site surgery (n = 117; 27.4%). There were 18 wrong side chest drains (4.2%) and 18 (4.2%) wrong side angioplasty/angiogram. There were 7 (1.6%) instances of confusion in pilonidal/perianal/perineal surgeries and 6 (1.4%) instances of biopsy of cervix rather than colon or rectum.

Retained surgical swabs were the most common retained items (n = 165;46.5%). There were 28 (7.9%) laparoscopic retrieval bags with or without the specimen, 26 (7.3%) chest drain guidewires, 26 (7.3%) surgical needles; and 9 (2.5%) surgical drains. Wrong stents were most common (n = 9;60%) wrong implant followed by wrong breast implants (n = 2;13.3%).

Conclusion

This study found 56 common general surgical NE. Increased awareness of these common themes of NE may help reduce their incidence.
SP7.1.12 Could surgery under local anaesthetic be the default for Pilonidal Sinus Disease? A systematic review
Authors: Ali Kiren , Tahir Ahmed , Chien Siobhan , Komolafe Olusegun
Published: October 2021

Aims

Pilonidal sinus disease (PSD) is a significant cause of morbidity. The purpose of this systematic review and meta-analysis is to determine the totality of evidence regarding the effectiveness of Local Anaesthesia (LA) when compared to spinal or general anaesthesia in individuals undergoing definitive surgery for PSD.

Methods

A systematic review of literature was conducted. Studies included randomized controlled trials comparing LA with other anesthetics and non-randomized studies focusing on ambulatory procedure of excising pilonidal sinus aiming wound closure, all performed under local anesthetics. We used Cochrane risk of bias tool. The statistical analysis was done using Revman and Excel.

Results

Four original RCTs and 10 observational studies were included, with a total of 1801 patients. There was no significant difference in operative time between the groups Patients in the local anaesthetic group experienced less pain than those in other group, lower rates of anaesthetic related complications, early return to work and increased satisfaction. However, the mode of anaesthesia used had no relation with recurrence.

Conclusion

Our findings support the use of LA in adult patients undergoing definitive surgical treatment for PSD. We aggregate the published evidence to demonstrate clear benefits clinically, patients’ preference, and economic benefits. Patient selection, and adequate dose of local anaesthetic, is the key. In the context of the current COVID—19 pandemic, novel care pathways need to be developed in all medical fields, and we would propose that surgery for Pilonidal Sinus Disease under local anaesthesia should now be the default.
SP7.2.1 Simultaneous intestinal surgery does not increase complication or recurrence rates after complex abdominal wall reconstruction
Authors: Wallace Alison , Garner Jeffrey
Published: October 2021

Aims

To compare post-operative outcomes in patients undergoing elective complex abdominal wall reconstruction (CAWR) alone vs. CAWR plus simultaneous intestinal surgery.

Methods

All patients undergoing elective CAWR over a 10-year period in our unit were identified from a prospectively maintained database and divided into those who had concomitant intestinal surgery (resection, ileoanal-pouch formation, stoma reversal, etc) and those who did not. Simple adhesiolysis, cholecystectomy and gynaecological procedures were not classed as ‘intestinal surgery’. Differences between groups were determined using the paired-t test and the (n-1) Chi-squared test.

Results

59 patients underwent elective CAWR, 16 with intestinal surgery and 43 without. The two groups had similar baseline demographics with no significant differences in age, BMI, sex or hernia size. The commonest post-operative complications were pneumonia (33.9%) and wound infections (25.4%) but there were no significant differences in any complication between groups. There was zero 30 and 90 day mortality in either group. The mean operating time in the intestinal group (IG) was significantly longer compared to the CAWR-only group (5.4 +/- 1.3hrs vs 4.1 +/- 1.8hrs, p = <0.05). There was no statistically significant difference between groups in rates of surgical site occurrence (37.5% IG vs 55.81% CAWR-only), mesh infections (0% IG vs 6.98% CAWR-only) or recurrent hernia (6.24% IG vs 9.30% CAWR-only) over a median follow up of 3.0 (0.1-7.8) years.

Conclusion

Performing simultaneous intestinal surgery during complex abdominal wall repair is safe and does not increase the risk of recurrence or mesh infections in a specialist abdominal reconstruction unit.
SP7.2.5 Robotic incisional/ventral hernia repair is feasible approach compared to laparoscopic repair: a systematic review
Authors: Imsirovic Anja , Bagga Rahul , Khan Mansoor , Singh Krishna , Sains Parv , Sajid Muhammad S
Published: October 2021

Aims

Robotic incisional/ventral hernia repair (R-IVHR) is gaining popularity due to higher safety as well as feasibility profile. The objective of this study is to present a systematic review exploring the role of robotics compared to laparoscopic approach in the management of incisional/ventral hernia.

Methods

A systematic review of all types of comparative studies until January 2021 published on Embase, Medline, PubMed, PubMed Central and Cochrane databases reporting the clinical outcomes in patients undergoing either R-IVHR versus Laparoscopic (L-IVHR) was performed.

Results

A total of 8289 patients in 7 studies were included. There was minimal heterogeneity (Tau2 = 0.29, chi2 = 9.10, df, I2 = 45 %) among included studies for the variables of recurrence rate and post-operative complications, but statistically significant heterogeneity (Tau2 = 1.05, chi2 = 132.81, I2 = 96 %) was observed for the duration of operation. In the random effects model analysis using the statistical software Review Manager, statistically the R-IVHR prolonged the duration of operation (Standardized mean difference, 2.24; 95% CI, 1.37, 3.11; z = 5.06; P = 0.00001) but the post-operative complication rate (OR 0.63; 95% CI, 0.30, 1.34; z = 1.20; P = 0.23) as well as the recurrence rate (OR 0.63; 95% CI, 0.14, 2.74; z = 0.62; P = 0.53) were similar.

Conclusion

R-IVH repair is feasible and safe, but the duration of operation is significantly longer. Major multi-center randomized controlled trial is mandatory to assess the long terms outcomes and cost effectiveness before the routine use of R-IVHR.
SP7.2.6 Where is the nerve? Review of operation note documentation practice for inguinal hernia repair
Authors: Farquharson Barnaby , Sivarajah Vernon , Mahdi Shareef , Bergman Henry , Jeyarajah Santhini
Published: October 2021

Introduction

Careful identification and management of inguinal nerves during inguinal hernia repair is important to avoid iatrogenic injury. Documentation of this practice informs postoperative clinical management. We set out to investigate how often surgeons identify inguinal nerves and document findings and management in operation notes.

Methods

Retrospective review of operation notes at single District General Hospital (DGH). Operation notes analysed for documentation of identification and intraoperative management (preservation vs sacrifice) of the inguinal nerves: iliohypogastric, ilioinguinal and genital branch of genitofemoral nerve. Data including baseline characteristics of each patient, hernia characteristics, and primary operating surgeon ascertained for subgroup analysis.

Results

A total of 100 patients were included in the analysis. Identification of any of the inguinal nerves (generic - “nerve”) was documented in 17% of operation notes. Documentation of named individual nerves in operation notes was limited. No documentation of intraoperative management of inguinal nerves found in 83% of operation notes. Preservation of the inguinal nerves (generic - “nerve”) was recorded in 8% and sacrifice recorded in 9% of cases. Subgroup analysis revealed similar incidence of documentation of identification and management of inguinal nerves across grades of primary surgeon, with overall incidence low for all grades.

Conclusion

This study has revealed a lack of appreciation of the importance of documentation of identification and intraoperative management of inguinal nerves in operation notes. Further consideration of the potential implications of poor documentation would be beneficial to improve standards.
SP8.1.1 Ultrasonic versus electrocautery dissection in modified radical mastectomy for breast cancer: A Systematic Review and Meta-analysis
Authors: Suliman Amna , Latif Ahmed , Giono Ilaria , Doddi Sudeendra , Uhercik MIchal , Kasem Abdul
Published: October 2021

Aims

Electrocautery (EC) remains the dominant dissection tool in modified radical mastectomy (MRM) for breast cancer. However, ultrasonic dissection devices (UDD) have emerged as popular alternatives on the basis that their mechanism of action limits tissue damage resulting in decreased blood loss, seroma formation and post-operative drainage. A systematic review and meta-analysis was performed to compare surgical outcomes for EC versus UDD in MRM surgery.

Methods

MEDLINE, EMBASE, PubMed and the Cochrane Database were searched and a comprehensive systematic review and meta-analysis performed according to PRISMA guidelines, comparing EC versus UDD in MRM for breast cancer. Outcomes of interest were post-operative drainage, incidence of seroma, intra-operative blood loss and operative time. Meta-analysis was performed using a random effects model to aggregate the data. Odds ratios (OR) were used as the summary statistic for dichotomous data and mean difference (MD) for continuous data. Data heterogeneity was assessed using the I2 statistic.

Results

Nineteen eligible peer-reviewed studies were analysed involving 1501 patients, UDD:744 EC:757. We demonstrated that in MRM, UDD significantly reduced post-operative drainage (MD = 312.26, 95% confidence interval (CI): 102.59-521.93, p = 0.004); seroma (OR = 0.51, 95% CI: 0.39-0.68, p < 0.00001) and intra-operative blood loss (MD = 111.68, 95% CI: 84.56-138.8, p < 0.00001) with no significant difference in operative time between the two techniques (MD = 0.32 (11.3-11.94), p = 0.96.

Conclusion

Using UDD in MRM for breast cancer presents significant advantages in decreasing post-operative drainage, seroma and intra-operative blood loss, without lengthening operating time compared to EC. It therefore appears favourable, however further cost-effectiveness analysis would be beneficial to guide selection.
SP8.1.4 Design features of the EPR-integrated Southampton Breast Cancer Data System (SBCDS), with timeline structured whole-of-life records on 20,000 sequential cases since the 1970s
Authors: Rahman Fatima , Hales Alan , Cable David , Rew David
Published: October 2021

Introduction

The digitisation of the electronic patient record (EPR) provides transformative opportunities for data visualisation. The synchronised timeline and iconographic interface permits the whole-of-life display, navigation and interpretation of all documents and reports of each and every EPR on a single screen, thus substantially facilitating clinical research.

Methods

Since 2010, we have conceived, programmed and iterated a radical interface, UHS Lifelines, within our Trust EPR using agile methodology. It is live for >2.5M record sets, and enriched with cellular pathology records back to 1990. We have integrated this interface into a unique, HTML-enabled, dynamic and continually updated database for the recording of treatments and pathologies of all cases of breast neoplasia from our current and historic record sets.

Results

As of January 2021, our data system contains ∼20,000 sequential whole of life records of patients with breast neoplasia, including ∼15,000 locally diagnosed and ∼ 5,000 externally referred cases. The unique Cancer Lifetrack timelines displays the disease course of every case from primary diagnosis, through loco-regional recurrence, to distant metastasis, other morbid cancers and cause of death, where relevant. An integral data mining system permits a wide range of analyses.

Conclusions

We believe our Breast Cancer Data System to be the first-in-class exemplar of a new and proven approach to clinical data visualisation. It permits near-instantaneous oversight and real time updating of every patient record in the system. We recognise its potential application for the whole-of-life study of all chronic diseases of childhood and adulthood as the model is more widely adopted.
SP8.1.7 Sentinel Lymph Node Biopsy or Neoadjuvant Chemotherapy- What comes first?
Authors: Karki Smriti , Hassen Yasmin , Chakravorty Arunmoy , Ajauskaite Karolina , Babu Ekambaram Dinkara
Published: October 2021

Aims

NICE guidelines have not defined the timing of Sentinel Lymph Node Biopsy (SLNB) with respect to neoadjuvant chemotherapy (NACT). While there is an ongoing debate, the emerging consensus is in favour of SLNB following NACT in clinically node-negative (cN0) patients which confers the advantage of better prognostic outcomes as a negative SLNB negates further Axillary Lymph Node Dissection (ALND) and prevents patients having further unnecessary surgery.

Thus, the aim of the study was to establish whether unnecessary ALND can be safely avoided by performing SLNB after NACT.

Method

Retrospective case records review of all patients treated with ALND at a single institution was undertaken from January 2018 to December 2019.

Results

73 patients had ALND in this time frame.

Patients received SLNB before NACT and ALND was performed if they were found node-positive on SLNB.

Out of 73 patients, 24 patients had no further nodal disease, 26 had 1-2 macrometastasis and 23 had 3 or more macrometastasis on ALND.

57/73 patients had early breast cancer (T1/T2). 21/57 were cN0 but and 5/21 had NACT following SLNB and ALND after NACT.

Of the 5 patients, 2 (40%) had no nodal disease on ALND.

Conclusion

40% patients could have avoided ALND if SLNB was done after NACT. Also, 68% (50/73) patients who had ALND only had <2 lymph node macrometastasis. This data implies that patients with early breast cancer may be getting subjected to a second operation which not only is unnecessary but also may have debilitating complications.
SP9.1.2 Sarcopenia and myosteatosis predict thirty-day emergency laparotomy mortality [The FrOGS study]
Authors: Body Samantha , Ligthart Marjolein , Ward James , Pucher Philip H , Curtis Nathan , West Malcolm
Published: October 2021

Aims

Sarcopenia (low muscle mass - SM) and myosteatosis (low muscle quality - SM-RA) are associated with poor outcomes after elective cancer surgery. Body composition parameters have not been explored in emergency surgery and may offer additive value to risk prediction scores. This multicentre study assessed the association of body composition and survival after emergency laparotomy.

Methods

A retrospective longitudinal cohort of 674 patients, across 10 hospitals in southern England were recruited (NCT03534765). All patients underwent emergency laparotomy, fulfilling NELA criteria, between August 2016 and November 2017. Pre-operative CTs were blindly analysed using L3 slices, assessing SM and SM-RA. Regression analysis was used to assess associations of body composition and 30-day mortality.

Results

Six hundred and ten patients were included [283(46%) men, median(IQR) age 71 years (57-79)]. P-POSSUM and NELA predicted mortality was 7% and 4.5% respectively, with a length of stay of 15 days (9-24), 30-day mortality of 7.8% and 1-year mortality of 18.9%. Significant univariate associations between 30-day mortality and age (OR1.04 (1.02-1.07);p=0.001), Charlson score (OR 6.84 (1.64-28.55);p=0.008), P-POSSUM (OR 1.03 (1.02-1.05);p<0.001, NELA mortality (OR 1.06 (1.04-1.08);p<0.001), SM (OR 0.98 (0.97-0.99);p=0.003 and SM-RA (OR 0.93 (0.9-0.96);p<0.001. Significant multivariate associations between 30-day mortality and NELA (OR 1.05 (1.03-1.07); p < 0.001, P-POSSUM (OR 1.03 (1.01-1.04); p < 0.001, SM-RA (OR 0.94 (0.9-0.97); p < 0.001.

Conclusions

Sarcopenia and myosteatosis are associated with increased mortality in patients undergoing emergency surgery. Body composition should be considered as an objective adjunct to traditional risk assessments, further informing the shared-decision making process around emergency surgery.
SP10.2.1 Use of a cost-efficient Colonoscopy simulation model to improve endoscopy skills
Authors: Edgar Ben , MacDonald Scott , Stokes Emily , McDade David , John Anderson , Angus Macdonald
Published: October 2021

Aims

The use of endoscopic simulators as a learning aid in surgical training has been well established, particularly in those with less experience. In the challenging time of COVID-19, when endoscopic procedures are at a minimum, this can become more valuable. However, their utility for training is countered by the high cost of equipment.

We demonstrate a cost-efficient alternative to traditional endoscopy simultators, which can be easily made in any centre.

Methods

A polypectomy simulator model was created using a drain-pipe and surgical gloves. Junior doctors were timed in their ability to remove the 3 polyps from within the simulator. The exercise was repeated over 6 sessions over the course of 3 weeks. Means were compared using ANOVA.

Results

There was a mean relative reduction of 75% in overall time taken to complete the task (p < 0.0001). This improvement was seen for both surgical trainees with previous endoscopy experience (p = 0.005) and FY1 novices (p < 0.0001).

Conclusions

In our group, we have seen improvement in performance across both surgical trainees and novices. In today's era of COVID-19, when direct training opportunities may become more scarce, simple alternatives may become vital in ensuring progression of basic surgical skills such as endoscopy.

This cheap polypectomy simulator can be easily re-created across surgical units and can be used as an adjunct to traditional endoscopic training.
SP10.2.2 Improving undergraduate surgical education: Comparing findings from the ASiT consensus report with the RCS Undergraduate Surgical Curriculum and GMC Outcomes for Graduates
Authors: Deekonda Praveena , Baker Daniel , Nally Deirdre , Srikandararajah Nisaharan , Humm Gemma ,   ASiT Medical Student and Junior Doctors Consensus Group
Published: October 2021

Aims

Previous work by ASiT has shown that undergraduate years can have a significant impact on the decision to pursue a surgical career. The Royal College of Surgeons England launched their recommendations in the undergraduate surgical curriculum in 2015. Our aim was to ascertain whether any additional areas of importance could be highlighted.

Methods

A consensus document was developed, using the RCS undergraduate surgical curriculum and GMC Outcomes for Graduates as baseline guides. An external advisory group made additional recommendations for inclusion which was then presented and discussed at a face-to-face consensus session at the 2019 ASiT International Surgical Conference. A consensus threshold of 80% was accepted.

Results

A total of 69 ‘core’ topics were reviewed and discussed, of which 10 did not reach consensus. These topics were predominantly considered to be ‘specialist’ in nature, and were under the domains of Head and Neck/ENT, neurosurgery, paediatric or vascular surgery. Of note, knot tying, which is included in the GMC guidance, was considered beyond the required level of a graduate and more suitable for those with the interest or intent to pursue a career in surgery.

Conclusions

Our consensus meeting and subsequent report has highlighted differences between the current available guidance and what medical students and junior doctors consider to be ‘core’ undergraduate surgical knowledge and skills. Topics that did not meet consensus may form areas of need in early postgraduate training. Our findings should be used in addition to the RCS and GMC guidance for undergraduate surgical education.