bluuebunny/crossref_metadata_2025 huggingface dataset:
SP10.7 Robotic versus laparoscopic surgery for colorectal cancer treatment – a comparison of outcomes in the quest for superiority
Authors: Grewal Callum Singh , Karri Rama , Yassin Nuha
Published: August 2023

Background

This research analysed short-term outcome results of robotic and laparoscopic surgery for colorectal cancer patients. The objective was to determine the advantages of using robotics in minimal invasive surgery and to investigate if there is a significant variation in outcomes based on the surgical method utilised.

Methods

The study conducted a retrospective analysis of all patients who received robotic and laparoscopic surgery for colorectal cancer treatment between 2020 and 2022. The data collected included demographics, as well as information on pre-, intra-, and post-operative periods.

Results

This study evaluated 120 surgeries for colorectal cancer patients, 83 were robotic and 37 were laparoscopic. The rate of stoma formation was higher in laparoscopic procedures (48.6%) compared to robotic surgeries (30.1%). Robotic surgery had a slightly longer average length of operation (279.6 minutes) compared to laparoscopic procedures (254.8 minutes), but the average length of hospital stays for patients who underwent robotic surgery was approximately 5 days shorter. Furthermore, the rate of readmission within 30 days was 12% higher for patients who underwent laparoscopic procedures compared to those who underwent robotic surgery. No patients in the robotic group required conversion to open surgery whereas one laparoscopic procedure necessitated conversion to open. Globally, the mortality rate was 0%.

Conclusion

This study suggests that robotic surgery can be a safe and effective option for approach to surgical colorectal cancer treatment. Robotic surgery offers shorter hospital stays compared to laparoscopic surgery with fewer complications and readmissions. Overall, these findings suggest that robotic surgery may be a superior approach to minimally invasive surgery for colorectal cancer patients.
SP10.8 An overlooked step in colorectal cancer anastomosis: a potentially small step in prevention of exfoliated malignant cells
Authors: Haq Iram , Kemp Alison
Published: August 2023

Introduction

Recurrence after potentially curative surgery has a significant clinical impact with a related poor prognosis. There is an abundance of literature surrounding efficacious techniques for anastomosis. However, to our knowledge comparatively there is minimal evidence reviewing the use of simple anti-septic agents with concurrent cytotoxic properties (ie. betadine or cetrimide) in prevention of anastomotic recurrence. This is despite both historic and newer evidence demonstrating tumour implantation of exfoliated malignant cells (EMCs) at the site of anastomosis leading to recurrence. This is also evident in low grade cancers.

Methods

A literature search was conducted between January 1980 to January 2022. The studies were to incorporate the use of simple anti-septic agents that were swabbed on the ends of the bowel before anastomosis. The search was restricted to articles published in English. Further more the selected publications were searched for additional studies.

Results

A result of 243 papers were reviewed, observational studies were found, n- 24. The reported reduction in EMCs was significantly lower at only 2 -7% compared to 16 to 55% in the control groups. Also evidenced were multiple papers providing significant experimental evidence of EMCs on staplers, gloves and the bowel anastomosed. We excluded rectal irrigation from this review article, as it is not employing the method of delivery suitable for all colonic anastomoses.

Conclusion

These results supporting the theory that cleansing with a cytocidal agent is associated with significantly reduced incidence of local luminal recurrence. We propose that this overlooked step in anastomotic techniques should be revisited.
SP10.9 Impact of sarcopenia on prognosis following neoadjuvant chemotherapy and resection for locally advanced rectal cancer
Authors: Hatt Jacob , Smart Thomas , Hardy Edward , Doleman Brett , Lund Jon , Phillips Bethan
Published: August 2023

Aims

Sarcopenia is characterised by the progressive and generalised loss of muscle mass and function. There is an increasing body of evidence to suggest that cancer patients with pre-existing sarcopenia are at a greater risk of both short- and long-term clinical complications. The aim of this review is to examine the impact of pre-existing sarcopenia on prognostic outcomes in patients with locally advanced rectal cancer (LARC) who undergo neoadjuvant chemoradiotherapy (nCRT) prior to surgery.

Methods

Medline, PubMed and Embase databases were searched from inception to October 2021. Any comparative studies relating to the prognostic outcomes of sarcopenic versus non-sarcopenic patients with LARC who received nCRT prior to surgery were included. Risk of bias was assessed using ROBINS-I. Meta-analysis was performed on reported hazard ratios (HR) and 95% confidence intervals (CI) using DerSimonian–Laird random-effects models.

Results

A total of 598 patients from 5 studies were included in the analysis of hazard ratios for overall survival, whilst 505 patients from 4 studies were available for analysis of HR for disease-free survival. Meta regression analysis showed a significant association between pre-existing sarcopenia and worse overall survival (HR: 1.69, 95% CI: 1.15-2.48). The association between pre-existing sarcopenia and shorter disease-free survival was not statistically significant (HR: 1.07, 95% CI: 0.63-1.82).

Conclusions

The review highlights the role body composition can play on prognostic outcomes in patients undergoing multi-modal cancer treatment. Given the complex underpinnings of sarcopenia progression, more research is needed to develop strategies to mitigate this impact in a physiologically vulnerable population.
SP10.10 Assessment of coronary artery calcification on pre-operative imaging to predict cardiovascular complications in colorectal cancer patients
Authors: Hughes Rebecca , Moug Susan , Good Richard , Shelley Benjamin
Published: August 2023

Background

All patients undergoing operative management of colorectal cancer have pre-operative Computer Tomography (CT) imaging of thorax to exclude metastatic disease. Incidental coronary artery calcification is rarely reported on CT. There are a variety of risk scores to predict cardiac complications in the peri-operative period. Current cardiac risk stratification tools do not incorporate radiological evidence of coronary artery calcification in their scoring systems.

Methods

A retrospective review of 100 patients with confirmed or suspected colorectal cancer. Demographic data was collected. A review of pre-operative CT thorax imaging was completed to ordinal score coronary artery calcification into none, mild, moderate and extensive. Peri-operative and post-operative cardiac and non-cardiac complications were documented.

Results

Seventy-nine percent of patients had evidence of coronary artery calcification on pre-operative CT thorax. 29 mild, 21 moderate, 29 extensive. Seven percent of patients had a cardiac complication and all of these had coronary artery calcification on CT pre-operatively. Twenty-six had non-cardiac complication and 22 of these had evidence of coronary artery calcification on pre-operative CT.

Conclusions

There is significant burden of coronary artery calcification in this patient population. This corresponds positively with peri- and post-operative cardiac and non-cardiac complications. Identification pre-operatively can help predict cardiac risk and therefore allow pre-operative cardiac optimisation.
SP10.11 Does Specialised training reduce the recurrence rate of pilonidal sinus disease surgery?
Authors: Issa Mohamed , Kausar Maria , Adeyera Victor , Easwaran Archana , Kawesha Anthony
Published: August 2023

Background

Pilonidal sinus surgery is challenging, and its recurrence rates have been reported to be high as 30% in a number of series. Long-term morbidity, recurrent infection, non-healing, and chronic wound discharge affect patients’ quality of life. This study aimed to compare the recurrence rate of the different surgical techniques of pilonidal sinus disease in our institution.

Methods

A retrospective study was done of adults who had elective pilonidal surgery from 2016-2021. Recurrence was defined as an active disease that required surgical intervention >30 days after surgery. Results were analysed for the different operative techniques used.

Results

208 patients were included,167 (80.3%) were male with a mean age of 31.2 years. The mean follow-up was 47 months. The recurrence was reported in 19 cases (9%). Out of 17 cases done by excision and lay-open technique, 11.8% had a recurrence, while 9.8% of 143 recured after simple excision and closure. Only 3 of 48 cases with the flap technique had a recurrence. When the surgeon specialty was analysed as a factor of recurrence, colorectal surgeons did 38% (19/208) of the cases including flap technique, and their recurrence rate was 6.3% (5/79). In comparison, non-colorectal general surgeons operated on 50.5% (105/208) of the cases with no flap technique, and their recurrence rate was 11.4% (12/105). Only 2 out of 24 cases were operated by plastic surgeons had a recurrence.

Conclusions

Flap reconstruction yields a low recurrence rate in pilonidal sinus disease surgery. Specialised training for this procedure should be encouraged for the colorectal trainees, that may improve the outcome.
SP10.15 Review of the Two-Week-Wait Suspected Lower GI Cancer Referral Process: Incomplete Information Delays Investigation
Authors: Sargsyan Narek , Hassan Adil , Vijay Vardhini
Published: August 2023

Aims

With a rise in lower-GI2ww referrals compared to pre-pandemic levels, straight-to-test (STT)pathways in secondary-care are increasingly relied on to achieve the 28day faster diagnosis standard. Incomplete referral forms can delay the diagnosis. This study analyses lower-GI2ww referrals to a DGH to assess the impact on the straight to test pathway.

Methods

A prospectively maintained database of 2ww lower-GI cancer referrals between January2021to June2022, was analysed. Key referral criteria were identified as essential to make a STT decision (haemoglobin, renal function, ferritin, performance status/frailty index, FIT). With prior agreement with primary care partners, incomplete referrals were returned to GPs with request for further information, with patient remaining on the pathway.

Results

In an 18month period, 4740 2ww referrals were received. The cancer diagnosis rate was 3.1%. Assessing NG12 symptoms, 64.1%of patients were triaged STT. Incomplete referrals formed 22.6% of referrals. Upon requesting more information 4.1%of incomplete referrals were withdrawn from the 2ww pathway by GP. 10.4% of incomplete referrals were downgraded to routine pathways once more information was provided. 7.9% had no symptoms noted, 21.8% did not have blood tests and 73.7% lacked frailty score/performance-status. The median time to receive requested information was 7days. The median number of reminders required was 2. In those diagnosed with cancer, there was an average delay of 5 days in diagnosis when inadequate information provided. The proportion of patients requiring more information reduced over the 18month period from 25.7% in first 6months to 19.4% in final 6months.

Conclusion

Submission of complete referral forms facilitates faster diagnosis, enabling secondary care clinicians to make timely informed decisions about STT investigations for suspected cancer in accordance with BPTPs (BestPracticeTimedPathways) to achieve the Faster Diagnosis standard.
SP11.1 A co-ordinated approach to trainee quality improvement projects to reduce mortality and length of stay in patients undergoing emergency laparotomy
Authors: Bateman Kellie , Cripps Peter , Hanratty Daniel
Published: August 2023

Aim

To support trainees in completing specific and achievable quality improvement projects (QIP) that are beneficial to patient care and aligned with clinical priority areas in emergency general surgery.

Method

A fishbone analysis of factors contributing to poor outcomes in patients undergoing emergency laparotomy was created. From this, key priorities for improvement were identified by a multidisciplinary team, enabling multiple QIP with clear aims to be developed. QIP included National Emergency Laparotomy Audit (NELA) data capture, risk scoring and documentation of mortality, identification and management of sepsis, pre-operative antibiotics, infection prevention and early radiological imaging. QIP were allocated to groups of trainees comprising of at least one foundation doctor, one core trainee and one specialty registrar. Mortality and length of stay data was collected over 6 months using the run charts for the hospital site available at data.nela.org.

Results

In 6 months, 9 QIP were started, with the first cycle of data collected in all projects and 3 projects completed by trainees. Initial QIP results have been presented locally for 5 projects and 2 QIP have been presented nationally, thus supporting completion of ARCP requirements and specialty job applications, as well as the sharing of outcomes. Although not statistically significant a downwards trend in length of stay and mortality has also been observed.

Conclusion

Having a focused and co-ordinated approach to quality improvement with clear aims and objectives can support training and improve patient outcomes. Further study is required to assess the sustainability and longevity of these results.
SP11.8 Deep learning for performance assessment of laparoscopic sleeve gastrectomy (LSG): validation against objective structured assessment of technical skills (OSATS) and clinical outcomes
Authors: Lam Kyle , Patel Sajan B , Darzi Ara , Lo Benny , Purkayastha Sanjay , Kinross James M
Published: August 2023

Background

Current methods of surgeon performance assessment are unstructured, labour-intensive and subjective. Machine learning could provide rapid, automated and subjective assessment. We design a custom deep learning model to output performance metrics from videos of LSG and validate these against OSATS and clinical outcomes.

Methods

A novel dataset of 3210 images from videos of LSG was annotated to train an instrument segmentation framework based on Mask R-CNN, a state-of-the-art deep learning algorithm. Spatial outputs of detected instruments were used to determine workflow through a Markov chain and secondly to determine instrument metrics for assessment of surgical performance. Metrics including time spent in stage and instrument time, distance, smoothness, concentration, and efficiency were then validated against OSATS ratings from 2 independent scorers and clinical outcomes from 35 LSGs.

Results

Grasper and ligasure efficiency and smoothness were higher in videos rated within the top quartile by OSATS score when compared to those in the bottom quartile and when comparing consultants to trainees. Videos in the top quartile for grasper smoothness had higher total OSATS scores (17.31±2.27) compared to those in the lowest quartile (15.69±2.93) and across all 5 individual OSATS domains in addition to higher percentage of total weight loss at 3, 6, and 12 months.

Conclusions

This study demonstrates how vision based deep learning can be used for surgeon performance assessment. Future work will aim to validate this against a large number of videos, expand upon the range of metrics produced, and look towards the steps needed for clinical translation.
SP11.12 Improving Radiology Scan Requests in Acute General Surgery
Authors: Sanmugam Kischentaran , Rutherford Georgia
Published: August 2023

Background

Junior doctors submit majority of requests for radiological scans in most surgical departments. We aimed to evaluate the accuracy of clinical information entered by referring doctors based on five define parameters recommended by a consultant radiologist in a tertiary hospital.

Method

All scans requested by clinicians within 48 hours of admission to the acute surgical receiving unit across two weeks were reviewed. Outpatient and ambulatory requests were excluded. The five required parameters were: clinical presentation, relevant past medical history, relevant blood results, clinical examination findings and clinical question. Education, in the form of posters and an online tutorial, were provided with the aim of improving scan requests. Data was collected on Excel and statistical analysis was performed using a paired t-test.

Results

Over two weeks, majority of 127 scan requests (21% USS, 64% CT scans, 15% MRCP) were made by doctors. Prior to our interventions, 60% of the defined parameters were included in scans request, with 83% of patients receiving their scans within 24 hours. This increased to 80% following delivery of medical education but this did not increase the number of scans performed within 24 hours. A paired t-test demonstrated a statistical significance between pre and post intervention scan requests (p=0.0471), however this did not correlate to shorter scan times.

Conclusion

Quality of scans improved following medical education in the form of posters and online tutorials. An induction tutorial on submitting quality scan requests would benefit referring clinical and radiologist on highlighting critical information required for timely scans.
SP11.13 A Systematic Review on the Effectiveness of Augmented Reality for Medical Students’ Surgical Training
Authors: Shah Aishwarya , Kaka Anaiya , Kumar Niraj , Patel Arpit , Yunus Azedah , Patel Akash
Published: August 2023

Aims

Interest in augmented reality (AR) technologies within an educational setting has surged in recent years. However, few studies evaluate the use of AR in a primarily medical student population. This systematic review with meta-analysis was conducted to evaluate the existing literature on this topic.

Methods

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adhered to during this review. Using relevant synonyms for the terms “augmented reality”, “medical students” and “surgery”, the databases Embase, Medline and Scopus were searched. Data was extracted for outcome measures such as errors/fails, attempts/retries, time for task completion, motion sickness/nausea and focus shifts.

Results

826 records were initially retrieved; 19 studies were included in the final review, with a total of 485 participants. The AR group performed better than the comparator group in 84% of the statistically significant main outcomes. The groups showed no statistically significant difference in likelihood of failing assessment, with a pooled odds ratio of 1.76 (95% CI:0.06-51.71, p=0.74, I2=81%). One study reported 57% fewer critical errors in the AR group than the comparator group. Two studies reported nausea/motion sickness as an outcome (12% (n=3) and mean Likert-scale score of 3 (out of 10) in the AR groups).

Conclusions

AR can be an effective surgical teaching and training tool for medical students. However, the limitations of AR, including visually induced motion sickness, have not been explored extensively by primary studies. Gradual integration of AR is therefore proposed until further studies elucidating benefits and risks can be undertaken.
WTP2.8 There are Acceptable Allograft Survival outcomes Of Kidney Transplants In recipients From the Black population In The UK, But Are The Outcomes At Par With Caucasians Receiving Renal Transplants?
Authors: Ng Oon-hui , Devkaran Bhavesh , Arora Anoushka , Gunawardena Thilina , Mehra Sanjay , Sharma Hemant
Published: August 2023

Purpose

Those of black descent make up 22.7% of people in the UK receiving dialysis. A UK Registry data analysis of transplant outcomes on the Black-Population (BP) was done and a comparative assessment with the Caucasian-Population (CP) renal transplant recipients was performed.

Methods

We harmonized the UK Renal-Transplant Registry Data to shortlist the renal transplants done on Black and Caucasian patients from the year 2000-2019. The demographics and survival analysis at 1,3 and 5 years post-transplant were analyzed. Regression was done to identify survival predictors.

Results

Renal-Transplant rates in the BP have improved >10 times since the last decade. 18% of transplants in the UK are performed on black-minorities. N=1878 Transplants have been done on the BP since the year 2000 compared to N=28960 on CP cohort. Both Cohorts had similar donor and recipient characteristics with normal distribution. BP was most likely to receive a cadaveric kidney-transplant, while CP had odds of 2.3 times (1.19-4.66) p=0.009 higher to receive a living donor kidney. The eGFR at 3 & 12 months post-transplant was similar in both groups (p=0.77). The median-CIT for cadaveric kidneys was 832 min for BP and 855 min for the CP cohort (p=0.15). The Graft survival was similar in both cohorts at 1,3 and 5 years post-transplant. (CP-87%, 81%, 66%; BP - 87,80%, 64%). Immunologically high-risk (p=0.02), KDRI >1.1(p=0.003), rejection within first 3 months (p=0.01), and CIT>14hrs (p<0.01) predicted poor graft-survival.

Conclusions

There were no noted differences in renal-transplant outcomes in both black and Caucasian populations. The Transplantation-rates in the BP cohort have impressively increased over the last 10-years.
WTP3.3 Percutaneous cholecystostomy: an intervention requiring re-admission and re-intervention?
Authors: Baggus Elisabeth , Henry-Blake Connor , Chrisp Benjamin , Coope Ashley , Gregory Andrew , Lunevicius Raimundas
Published: August 2023

Aims

A national database study reported a 723% increase in cholecystostomy procedures in England between 2000 and 2019 (Lunevicius, 2022). We aimed to evaluate short and long-term clinical outcomes following percutaneous cholecystostomy for acute cholecystitis (AC) at our centre.

Methods

A single-centre, retrospective cohort study was conducted utilising data from a tertiary centre database, 2012–2020. Tokyo guidelines were used to grade AC severity. Outcomes were evaluated.

Results

Seventy-six patients were included. The median age was 76 (IQR 67.5-83.3). The M:F ratio was 1.1:1. Twenty-nine patients (38.2%) had Tokyo Grade 3 AC. The remaining 47 patients (61.8%) had Tokyo Grade 2 AC. Forty-seven patients (61.8%) experienced at least one post-cholecystostomy complication. During index admission, seven patients (9.2%) required admission to ITU, seven patients (9.2%) died, and six (7.9%) required emergency cholecystectomy. The median length of stay was 12 days (IQR 9.33-17.0).

Of the 69 patients who were discharged, 23 (33.3%) required emergency readmission due to AC recurrence; 12 of these (17.4%) were readmitted within 30 days. Eleven patients (15.9%) had recurrence of AC whilst the gallbladder catheter remained in-situ, and a further 15 patients (21.7%) had recurrence of AC after catheter removal. Twenty patients (29.0%) required additional percutaneous drainage, of which 11 (15.9%) received repeat cholecystostomy. Twelve patients (17.4%) underwent elective cholecystectomy, with a median interval between PC and elective cholecystectomy of 62.5 days (IQR 20.3-118).

Conclusions

PC is associated with high post-procedure mortality and morbidity. Clinicians should be discerning in patient selection criteria for PC.
WTP3.12 Value of magnetic resonance cholangiopancreatography (MRCP) in acute gallstone pancreatitis
Authors: Ng Shou Kee , Stevenson Carla , Ansari Fraz , Khan Khurram
Published: August 2023

Aims

Magnetic resonance cholangiopancreatography (MRCP) is commonly performed in acute pancreatitis to rule out bile duct stones (BDS). The aim of this study was to determine if MRCP is required to rule out BDS in patients admitted with gallstone pancreatitis (GS).

Method

A retrospective cohort study of all consecutive MRCPs in a single surgical unit from October 2021 to September 2022 was conducted. Patient demographics, laboratory results and MRCP result data was analysed. Patients with MRCP proven BDS were compared to those without.

Results

Sixty-one patients were identified, 39 (63.9%) were female. Median age was 62 years (IQR 45-75) and median Scottish Index of Multiple Deprivation was 4 (IQR 3-7). 55 (90.2%) MRCPs were inpatient and 30 (49.2%) were urgent requests.

Median wait time for inpatient MRCP was 1 day (IQR 0.7-1.8) and 17.1 days (IQR 14.6-28.3) for outpatient requests. 14 (23%) patients had BDS proven on MRCP. Of these, 6 (42.8%) had evidence of dilated bile ducts on preceding imaging and 8 (57.1%) had hyperbilirubinaemia and raised alkaline phosphatase levels. Median wait time for MRCP for patients with BDS was 0.8 days (IQR 0.35-1.5) compared to 1.2 days (IQR 0.85-2.85) in MRCPs with no evidence of BDS.

Conclusion

We conclude that MRCP is not required for low-risk patients with acute gallstone pancreatitis. However, MRCP will be beneficial in patients with jaundice and preceding radiological evidence of ductal dilatation. Intraoperative cholangiography is recommended in patients who proceed to laparoscopic cholecystectomy where MRCP has not been performed.
WTP4.1 Can Deep Stomal Fixation and Extraperitoneal Stoma Creation Improve Stoma Morbidity? Systematic Review and Meta-Analysis
Authors: Albendary Mohamed , Mohamedahmed Ali Yasen Y , Peravali Rajeev , George Anil
Published: August 2023

Aim

This systematic review evaluates the efficacy and safety of two operative techniques: deep stomal fixation (fixation of stoma to the sheath of abdominal wall muscles and/or peritoneum) and extraperitoneal approach of stoma creation.

Method

PubMed, Medline, Cochrane, and Google Scholar were searched for studies comparing stoma fixation to the sheath and/or peritoneum to the conventional skin-only fixation and extraperitoneal to transperitoneal approaches of stoma formation. Clinical endpoints included parastomal hernia (PSH), stoma prolapse, retraction and associated adverse effects.

Results

2 randomised and 2 retrospective studies investigated deep stomal fixation. There was no statistically significant benefit of this technique in terms of PSH (OR 1.19, P=0.82), prolapse (OR 0.62, P=0.53) or retraction (OR 1.16, P=0.80). Some technical difficulties on stoma reversal were reported in one of the studies.

As for extraperitoneal stoma creation, 2 randomised and 8 retrospective studies compared it to the conventional transperitoneal approach. A statistically notable reduction in PSH was identified in extraperitoneal stomas (OR 0.29, P=0.004). This technique showed statistically insignificant reduction in prolapse (OR 0.74, P=0.53) and retraction (OR 0.48, P=0.36). There was no significant difference in operative time (MD 3.45, P=0.71) or the associated risk of small bowel obstruction (OR 0.68, P=0.57).

Conclusion

Stoma fixation to the abdominal muscle sheath and/or peritoneum does not lower stomal complications, and conversely it may make stoma reversal technically challenging.

Extraperitoneal approach minimises PSH occurrence with no remarkable adverse effects; yet more randomised trials are required for further evaluation.
WTP4.6 Assessment of the Over 75’s undergoing Emergency Laparotomy
Authors: Banks Philippa , Edginton Oscar , Harper Alexander , Mehrem Anna , Yiasemidou Marina , Clarke Rory
Published: August 2023

Introduction

The National Emergency Laparotomy Audit (NELA) 2019 reported 55% of patients undergoing emergency laparotomies were over 65 years old. 19% had formal frailty assessments and 37% had geriatrician input. Due to the multi-morbid nature of frailty this population carry additional surgical and post-operative risk and may require intensive rehabilitation. NELA and The Centre for Preoperative care recommend patients over 65 should have clinical frailty assessments and be reviewed by an MDT with early Care of the Elderly (COE) input. This audit reviewed use of these recommendations at a large District General Hospital (DGH).

Methods

We performed an audit on all patients over the age of 75 who had an emergency laparotomy between September 2020 to September 2022. We collected data from their admissions, including clinical frailty scores, AMTS and if COE reviews had occurred.

Results

We collected data on 57 patients. The average age was 82 (75-96), and the average length of stay was 22 (5-80) days. No patients had either clinical frailty or AMTS scores documented. 16% had a COE review. 16% (9) patients died before 30 days.

Conclusion

The DGH failed to meet the recommendations for frailty assessment and COE input for patients over 75 having an emergency laparotomy. Suggested improvements may include: a referral pathway to prompt elderly care reviews, or the creation of the “general surgery geriatrician” similar to that of ortho-geriatrician role may be of benefit. Documenting clinical frailty assessments could improve patient outcomes, reduce mortality/morbidity, and provide a more holistic patient approach.
WTP4.14 Major Trauma Amongst E-scooter and Bicycle Users: A Nationwide Cohort Study
Authors: Clough Richard , Platt Esther , Cole Elaine , Wilson Mark , Aylwin Christopher
Published: August 2023

Aims

To determine the number of E-Scooter related admissions due to significant trauma in comparison to bicycle related trauma within England and Wales. To compare morbidity and mortality associated with each form of transport.

Methods

A retrospective cohort study based on data which has been prospectively collected and submitted to the UK Trauma Audit and Research Network (TARN) registry. Patients of any age who were admitted to major trauma centres or trauma units in England and Wales with injuries following E-Scooter or bicycle incidents between the dates 01/01/2021- 31/12/2021. All patients must have met TARN database inclusion criteria.

Results

There were 293 E-Scooter trauma incidents compared to 2538 bicycle incidents. E-Scooter users were more likely to be admitted to a major trauma centre (p=0.019) or an intensive care unit (p=<0.001). Amongst e-scooter users, serious head injury (Abbreviated Injury Scale >2) was almost twice as common (p=<0.001) and the rate of serious limb trauma was also higher in this group (p=<0.001). Rates of serious chest and pelvic trauma were greater in the bicycle cohort (p=<0.001 and p=0.003 respectively). Over a third of E-Scooter injuries were incurred outside the remit of current legislation by patients who were under the influence of alcohol and drugs (75/293) or under the age of 17 (41/293).

Conclusions

The relative incidence of moderate to severe injury amongst E-Scooter users is likely to outweigh bicycle users. These early results suggest an alternative pattern of injury amongst E-scooter users compared to bicycles.
WTP5.5 A 6 year Review of Pilonidal Operations in a DGH
Authors: Bruce Nikki , Berlansky Martin
Published: August 2023

Aims

Pilonidal Disease can be difficult to manage and operative management carries well known risk. We aimed to review all pilonidal operations from a 6 year period in our DGH, especially complications and reoperations.

Methods

An excel database was created and hospital coding data pulled for any pilonidal operation including elective and emergency over a 6 year period from 2015-2020. Hospital electronic and paper notes were used to cross reference coding data with op notes and discharge paperwork. Complications were then categorised as “Major” or “Minor” and type of complication documented. Number of reoperations was counted.

Results

183 operations were carried out on 151 individual patients (103 male and 48 female). There were 33 reoperations on 21 patients. 78 formal elective operations were done with 68 primary closure and 10 laid open. Of primary closure there were only 13 complications – 5 major and 8 minor. Major complications included return to theatre for wound dehiscence, and wound sepsis. Those with major complications mainly had pre-existing complicated disease and all had previous emergency I&D. All patients who had primary closure had ongoing symptomatic disease prior to operation with 29 having previous emergency I&D.

Conclusions

Most patients with ongoing symptomatic disease benefit from definitive management in the form of elective primary closure eg Bascom procedure. Despite the well recognised risks of this surgery, most complications are minor and major complications are often reflective of a history of problematic pilonidal disease.
WTP5.7 The use of porcine dermal acellular matrix mesh for ventral and parastomal hernia: an evaluation of outcomes from a tertiary centre
Authors: Daniel Sudin , Solkar Maseera , Sehgal Rishab , Riyad Kallingal
Published: August 2023

Aims and Objectives

Despite advancements in techniques for abdominal wall closure, 15-20% develop incisional hernia. Synthetic meshes are ill-advised for ventral-hernia repair at risk of wound-complications. Biologic grafts are an alternative given their biocompatible safety-profile. We evaluated the outcomes of fascial closure using a Porcine Dermal Acellular Matrix (PDAM) mesh (Cellis®).

Methods

A retrospective PDAM-mesh review was performed between 01/05/2016-30/09/2022, focusing on midline/parastomal hernias. Electronic charts were reviewed to obtain demographic and surgical data. Immediate/short-/long-term complications and radiological recurrence rates were collected.

Results

71 cases (acute/elective 10/61, F:M 4:3) were included in the study, median age 62yrs (25-93yrs), follow-up 12-72mos. Majority (69%) of the elective group had ASA2 vs. 70% acutes had ASA3. Of the 61 elective repairs, midline hernias constituted 37 (60%) and parastomal hernias in 24 (40%). Of the 10 acute cases, there were 8 midline-hernias and 2 parastomal-hernias. Component separation (CS) were performed in 29 cases (16-bilateral anterior-CS, 11-unilateral anterior-CS and 2-bilateral posterior-CS). Median LOS was 11d (1-180d)/15d (1-159d) for elective/acute groups. Seromas and minor wound infections were the commonest short-term Cx in both groups. There were 5 deaths within 90-days. From the elective group 6/37 (16%) midline repairs and 8/24 (33%) parastomal hernias had CT recurrences. In the acute group, one recurrence each were noted from 8 midline repairs (12%) and 2 parastomal hernias.

Conclusion

Our PDAM-mesh cohort demonstrates acceptable results regarding managing midline-ventral and parastomal-hernias in the elective/acute setting. Further comparative studies with synthetic mesh are warranted to fully evaluate the effectiveness of PDAM meshes.
WTP5.8 An International Multispecialty Survey of Work-Related Musculoskeletal Pain in Laparoscopic Surgeons
Authors: Dixon Frances , Vitish-Sharma Parveen , Khanna Achal , Keeler Barrie
Published: August 2023

Aims

Maintenance of uncomfortable body positions during laparoscopic surgery may lead to work-related musculoskeletal disorders in surgeons. Increasing laparoscopic surgical adoption worldwide necessitates understanding of the nature & extent of the impact on surgeons’ physical health.

Methods

An international open online survey of multispecialty laparoscopic surgeons was undertaken in 2022, with support from ASGBI. This was designed and reported in accordance with the CHERRIES checklist for internet e-survey research. There were no incentives offered or paid advertising. Questions included assessment of surgical experience, incidence, nature, and sequelae of pain.

Results

There were 259 respondents from 9 specialties across 32 different countries, with 90% reporting pain attributable to performing laparoscopic surgery. All training grades were represented. Longer average operative duration (>4hrs vs <1hr) and a greater number of years in practice (>15yrs vs <5yrs) were both associated with a significantly higher pain prevalence (p<0.01 & p=0.041 respectively). Surgeons with a pre-existing injury were significantly more likely to report pain than those without (p=0.029). Early retirement due to pain was being considered by 20%, particularly those performing longer operations. Thirty-five percent of surgeons sought treatment for laparoscopic induced pain, ranging from analgesia to surgery.

Conclusions

The physical impact of performing laparoscopic surgery is significant and consistent across specialties and countries. Particular at-risk groups are those with prior injuries and longer operation times. Innovations such as robotic surgery and improved ergonomic education need further evaluation as to whether they may mitigate against these issues.
WTP6.14 The Effectiveness of Mental Practice in Surgical Skills Practice and Acquisition: A Review
Authors: Walshaw Josephine , Huo Bright , Banks Philippa , McClean Adam , Kwan Jing Yi , Yiasemidou Marina
Published: August 2023

Aims

Mental practice (MP) is an established method to enhance performance in other disciplines. The aim of this review is to assess whether the principles of MP are transferable to surgery and describe how it has been applied in our field so far.

Methods

A narrative review was conducted according to the four steps described by Demiris et. al.

Results

This review describes the different types of MP and their role on motor skill acquisition. The process of preparation, delivery and assessment of a MP session is described here in a reproducible manner; providing a ‘user guide’ to surgeons. MP has been shown in several reports to be an effective means in learning surgical skills, from basic surgical technique to the steps of a procedure. It has also been described as a technique applicable to both surgical trainees and established surgeons. Ten RCTs demonstrated a favourable effect of MP on technical skills and one trial showed that MP with MI is equivalent to additional physical practice. On the contrary two RCTs showed MP to be inferior or have no impact compared to other types of preparation. Reduced MP duration was identified as one of the possible reasons for a lack of positive results.

Conclusion

Mental practice is a feasible method for rehearsing surgical skills and procedures that has been demonstrated to enhance skills acquisition and surgical performance. Larger scale, randomised controlled trials are needed to standardise the duration, number of repetitions, and practical considerations for mental practice in surgery.
WTP8.7 Patient Reported Outcome Measures- Assessment of Breast Day Case Surgery treatment pathway
Authors: Jenkins Stephanie
Published: August 2023

Day Case Surgery is an advancement in patient care and efficiency for hospitals.

The success of day surgery is dependent on the patient’s experience of the pathway.

The usefulness of PROMS is dependant on the questions asked and the “comments box” that encourages any other patient related incidences to be conveyed.

Method

All patients undergoing day case breast surgery were assessed using PROMs to validate the surgical pathway with respect to pain control since patients were requested in advance to purchase simple over the counter analgesia to take according to their own requirements and hospital prescribed discharge analgesia was discontinued.

Results

All patients felt that their pain control immediately after surgery was good, no patients recorded that the pain kept them awake, all felt the pain was well controlled having left hospital and none felt they needed stronger pain relief. Importantly none sought medical help for pain from another source and all rated the service as good.

One patient stayed overnight for medical reasons and stated that this was a necessary and acceptable outcome in the circumstances.

Three patients experienced sore throats and two had post -operative nausea / vomiting and dizziness.

Despite these experiences all stated they liked having day case surgery.

Discussion

PROMS allows patient feedback of the treatment pathway and enables reflection and further improvement to be achieved.

The results support discontinuation of medication on discharge and patient self-medication with over the counter analgesia is acceptable and does not result in seeking pain relief from other sources.
ThTP1.1 Follow-Up of Young Patients Undergoing ERCP for Common Bile Duct Stones: Moving Algorithm Towards Surgery
Authors: Loo Shi Pei , Cooper Duncan , Ciscar Andrea Gonzalez , Katbeh Tarek , Glen Paul
Published: August 2023

Background

Historically, the default treatment for common bile duct (CBD) stones in our institution has been endoscopic retrograde cholangiopancreatography (ERCP). We aimed to assess the clinical outcomes following ERCP performed for CBD stones in patients aged 35 years old and younger, who may have been suitable for single-stage cholecystectomy with CBD exploration instead.

Methods

A database of all patients undergoing ERCP from May 2015 to May 2022 in a tertiary institution was prospectively maintained. We identified patients aged 35 and under who received ERCP for CBD stones, and reviewed data on their demographics and clinical outcomes from electronic clinical records.

Results

A total of 4079 ERCPs were carried out with a post-ERCP pancreatitis rate of 4.3%. 124 patients aged 35 and under (mean age 29±4 years, 84.7% female) were selected for further analysis. They had a post-ERCP pancreatitis rate of 12.1%. 100 patients (80.6%) proceeded to definitive surgery, with a median waiting time of 76 days. Of these, 38.0% experienced an unplanned admission resulting in emergency laparoscopic cholecystectomy; a proportion required repeat ERCP and imaging. Consequently, these patients accumulated a total hospital stay of 13±8 days.

Conclusions

A higher rate of pancreatitis was seen in younger patients and a delay to definitive treatment is described, resulting in unplanned admissions, re-interventions and extra imaging with the associated increased cost. Single-stage cholecystectomy with CBD exploration would reduce complications, unplanned readmissions and cost. It is now our choice of treatment for CBD stones in this group of patients.
ThTP1.3 Does radiological staging accurately predict histological stage in Whipple patients with pancreatic cancer? Results from an international multicentre study
Authors: Russell Thomas , Labib Peter ,   RAW Study Collaborators, Aroori Somaiah
Published: August 2023

Aims

Patients with a suspected malignancy of the pancreatic head should undergo preoperative radiological staging to ensure they are appropriate candidates for pancreatoduodenectomy (PD). Postoperatively, histological staging is performed as this guides adjuvant treatment and is useful for estimating prognoses. This study aimed to investigate the concordance of radiological and histological staging in patients with pancreatic ductal adenocarcinoma (PDAC).

Methods

Data were extracted from the Recurrence After Whipple’s (RAW) study, a retrospective study of PD outcomes (29 centres from eight countries, n=1484). Patients were excluded if: they had staging data missing, they underwent neoadjuvant chemo-/radiotherapy, or if radiological staging was performed for another malignancy. Pre- and postoperative stages were then compared.

Results

Of the 595 included cases, 20%, 40%, 26%, 4% and 12% of patients were radiological stage T1, T2, T3, T4, and TX, respectively, and 7% (OR: 3.4, 95% CI: 2.3-5.0), 11% (5.4, 4.0-7.4), 80% (0.1, 0.1-0.1), 3% (0.8, 0.4-1.8) and 1% (27.0, 8.4-86.3) were T1, T2, T3, T4 and TX, respectively. Tumour size was significantly larger on histology (median difference: 3mm, p<0.00001). 66%, 27% and 7% of patients were radiological stage N0, N1 and NX, respectively, and 23% (OR: 6.5, 95% CI: 5.0-8.4), 77% (0.1, 0.1-0.1) and 0.3% (22.5, 5.4-93.5) were histological stage N0, N1 and NX, respectively.

Conclusions

In patients who underwent PD for PDAC, preoperative imaging appeared to underestimate disease stage. Histologically, patients had larger, more advanced tumours and were significantly more likely to have involved lymph nodes.
ThTP1.8 Comparison of clinic outcomes between face-to-face and virtual appointments in patients with gallstone pathology: a single-centre retrospective observational study
Authors: Park Eunsoo , Trung Le Ha Bao , John Jomcy , Couper Jasper , Raja Asdaq , Malik Momin
Published: August 2023

Aims

Precautions relating to the COVID-19 pandemic increased the use of virtual telephone and video consultations in the outpatient setting. This study aims to see whether the increased adoption of remote, virtual appointments affected clinic outcomes in patients presenting with gallstone pathology at a district general hospital.

Methods

Data on mode of consultation and clinic outcome was collected retrospectively for all patients reviewed at our department’s outpatient clinics between 01/04/2019 – 01/07/2019 and 01/04/2022 – 01/07/2022 (n=1243). Only patients with a primary diagnosis of gallstones, choledocholithiasis and cholecystitis were included in this study (n=179). Additional details on demographics and co-morbidities (age, ASA, BMI, previous abdominal surgery, abnormal LFTs) were collected for analysis of confounding factors.

Results

60 patients had face-to-face (F2F) appointments and 119 patients had virtual (Virt) appointments (video (VV) n=52, telephone (VT) n=67). Patients who had virtual appointments had a higher rate of discharge (Virt=18.5%, F2F=11.7%) and a lower proportion was offered an operation (Virt=68.1%, F2F=80.0%), although these differences were not statistically significant. When compared to F2F, VT appointments had a significantly higher rate of discharge (26.9%, p-value=0.0540) and a significantly lower proportion were offered operations (58.2%, p-value=0.0144). There were no significant differences in demographics or co-morbidities between the patient groups.

Conclusions

The use of virtual telephone consultations was associated with significantly lower operation offers and higher rates of discharge when compared to face-to-face appointments. Further continuous auditing across multiple centres is required to uphold the standard of care for patients requiring intervention for gallstone pathology following the widespread introduction of virtual outpatient appointments.
ThTP1.12 Stitch Closure of Gall Bladder Remnant during Laparoscopic Retrograde Subtotal Cholecystectomy for Difficult Gall Bladders
Authors: Shrestha Anuj , Basu Sanjoy
Published: August 2023

Background and Aim

Laparoscopic Retrograde Subtotal cholecystectomy (LRSC) recommended for difficult gall bladders (Grade 3&4, Nassar et al) reduces CBD injury (.08%), however, increases subhepatic collections (2.9%), reoperations (1.8%) and bile leaks (18%). Assess whether intracorporeal stitch closure of gall bladder remnant reduces complications and improves outcome.

Patients and Method

Prospective study of 1722 consecutive patients undergoing LC in a large DGH (2007-2022) with data of age, sex, BMI, ASA, grade of operation with postoperative stay and complications were collected and analysed. Group A: Conventional laparoscopic total cholecystectomy (LTC). Group B: LRSC includes a ‘fundus first approach’, piecemeal anterior & posterior wall transection with <1cm gall bladder remnant that is closed with a figure of 8 absorbable sutures.

Results

Group A: 1584(92%) with Male: Female 1:4 (363:1221), Age 51* (16-89) years, BMI 27* (17-65), ASA 2* (1-3), Grade 1* (1-4), Operating time 45* (15-200) minutes, PO stay 0* (0-15) day. 11(.7%) conversions, 3(.18%) CBD injury, 4 (.25%) bile leaks, 3(.18%) ERCPs, 13 (.82%) collections requiring 9 surgical wash outs and 4 radiological drainages.

Group B: 138(8%) with Male: Female 1:1 (64:74), Age 61* (21-88) years, BMI 29 * (19-60), ASA 2* (1-3), Grade 4* (3-4), Operating time 100 *(40-240) minutes, PO stay 1 *(0-13) day. One (.72%) conversion, 6(4.3%) bile leaks, 3(2.17%) ERCPs and 3(2.17%) collections requiring 1 surgical wash out and 2 radiological drainages.

Conclusion

We recommend routine stitch closure of the gall bladder remnant during LRSC that significantly reduces post operative morbidity (bile leak and collection) for a better outcome.

* Median