bluuebunny/crossref_metadata_2025 huggingface dataset:
EP.WE.791Assessing the use and effectiveness of catheter-directed thrombolysis in a single vascular centre
Authors: Ashmore Daniel , Pillay Woolagasen
Published: October 2021

Aims

In the UK, venous thromboembolism remains a leading cause of mortality and morbidity. This audit aimed to assess the use, success and cost of the average patient journey undergoing catheter-directed thrombolysis (CDT) following a diagnosis of a deep vein thrombosis (DVT) within a single vascular centre.

Methods

A retrospective audit of all procedures (n = 249) between 2010 and 2019 coded as 'angioplasty' were identified; only adults that had CDT for a confirmed iliofemoral DVT were included. Patient anthropological, biochemical and radiological data were collected. Cost of items were confirmed with appropriate hospital departments.

Results

In ten years, a total of 36 patients (21 female, 15 male, mean age 47 years) started CDT for iliofemoral DVT; one procedure was abandoned due to safety reasons. Almost half of DVTs were provoked. Ultrasound confirmed diagnosis in 92% of patients. CDT was successful in approximately 70% of patients. A quarter of patients developed another DVT following discharge. Average length of stay was 8 days at a cost of £11,235 per patient journey. All patients commenced an anticoagulant regime on discharge.

Conclusions

This audit supports the use and effectiveness of CDT to treat patients with iliofemoral DVT, however there is a room for improvement regarding long term success given the significant patient and financial costs involved.
EP.WE.1026Pathways to the Upper GI MDT; an evaluation of the factors influencing patient routes to diagnosis of oesphago-gastric cancer
Authors: Bullingham Roberta , McKane Thomas , Hughes Frances
Published: October 2021

Aims

To review the characteristics of the patient group referred to Barts Health with Oesphago-gastric (OG) Cancer in one year (2018-19). To evaluate demographic trends in patients presenting as emergency referrals and the effect of language on patients’ pathway to diagnosis.

Methods

We collated a list of patients referred to the Upper GI MDT with OG cancer in one year (2018-2019). We collected relevant pre-determined data points from the trust electronic record system. Patients with missing or insufficient data were excluded.

Results

Our population of 125 patients (median age 69) included 51% White British, 11% Bangladeshi, 10% Afro-Caribbean and 4% Pakistani; proportions which are significantly different to that of the UK average (p < 0.002). 46% of patients presented by GP 2WW referrals and 32% emergency referrals. The 29% of the population that did not have English as a first language were not shown to be more likely to present acutely (p = 0.49). 18.7% of patients had more than 62 days between referral and MDT discussion; themes of delay were inappropriate referral type, histology delay and atypical presentation.

Conclusions

Our OG cancer population has a significantly different ethnic makeup compared to UK average. Our data shows higher acute presentations and lower GP 2WW referrals. We did not demonstrate that language as a single parameter was linked to acute presentation. A number of modifiable delays to diagnosis were identified particularly the need for repeat biopsies. Further analysis is required using more sophisticated socio-economic parameters to assess how ethnicity can influence presentation of OG cancer.
EP.TH.5Online application for self-referral of the patients with breast symptoms
Authors: Rao Ahsan , Razzaq Humayun , Panamarenko Ben , Gray Emma , Bottle Alex , Majeed Azeem
Published: October 2021

Introduction

The study aimed to devise a self-referral mobile/web application for patients with new breast symptoms, giving them an outcome, thus bypassing the need for primary care consultation.

Methods

The online application was designed on the automated algorithm based on evidence-based guidelines for referral to breast onco-plastic units. A retrospective questionnaire-based anonymous survey was carried out at the breast unit in Southend University Hospital (January 2019 to March 2020). The outcome of the patients was recorded, the same data was entered in the software and its outcome was compared with their clinic outcome to assess and validate the software. Chi-square and t test were used in formulating results.

Results

Data was collected for 366 patients who were referred urgently to the clinic. Only 50.5% (n = 186) were appropriately referred, with the main complaint being breast lump (94.1%). 39.6% of referred patients did not require a secondary care referral. Sensitivity and specificity for identifying patients requiring urgent referral was 100% and 98%, respectively.

Conclusion

A significant number of urgent referrals to breast units do not require urgent specialist referral, and this results in a big strain on the hospital service. The discussed self-referral pathway is a promising alternative with the potential to reduce workload in primary and secondary care and improve patient satisfaction.
EP.TH.15Review of cholecystectomies laparoscopic & open plus conversion rate in a five year period
Authors: Ahmed Elmurtada , Jenner Deborah , Al-Robaie Basim
Published: October 2021

Aim

Look & audit our practice of cholecystectomy & try to identify areas that require improvement

Method

Look at all cholecystectomies, laparoscopic & open in 5 years from January 2014 till December 2018, we looked at demographics, number of operations per year, conversion & re-admission rate, information collected from electronic note record

Results

male to female ratio similar to national figures, number of laparoscopic operations (2422 in that period, 61 cases converted, conversion rate 2.5%) going up steadily over the 5 years while open & conversion rate are dropping significantly, early re-admission rate higher than national figure, reasons for conversion determined & analysed Reasons for doing it open from the start also determined, commonest cause for conversion in our trust is: previous surgery/adhesions, obscure anatomy & severe inflammation of gall bladder . Commonest cause of re-admission is pain followed by wound complications collections retained stone & bile leak. Number of open cholecystectomies was 22 in 2104 dropping to only 2 in 2018. 3 deaths occurred in the group giving rise to a mortality of 0.12%

Conclusion

Majority of cases attempted laparoscopically & most patients discharged home within 48 hours, our conversion rate is low = 2.5% with consultants with higher number of operation having less conversions, ours re-admission rate is high mainly for pain, our mortality is low. We recommend looking closer at re-admissions to see how that number could be reduced.
EP.TH.30Effect of One Anastomosis Gastric Bypass on Haematinics, Vitamin D, and Parathyroid Hormone Levels: A comparison between 150 cm and 200 cm Bilio-Pancreatic Limb
Authors: Omar Islam , Sam Miraheal , Pegler Maya , Pearson Emma , Boyle Maureen , Mahawar Kamal
Published: October 2021

Introduction

There is little data on the effect of One Anastomosis Gastric Bypass (OAGB) on Haematinics, Vitamins D, and Parathyroid Hormone levels. It is further unclear if an OAGB with a Bilio-Pancreatic Limb (BPL) of 150 cm (OAGB-150) would deliver better outcomes than that with a BPL of 200 cm (OAGB-200).

Methods

We investigated our records to obtain information on patients who underwent an OAGB-200 or OAGB-150 until 31st July 2018 in our unit.

Results

A total of 405 patients underwent either an OAGB-200 (n = 234) or OAGB-150 (n = 171). The mean age was 46±10.98 years and 276 (67.3%) were females. The mean preoperative weight and the Body Mass Index (BMI) were 139±29.96 kg and 49±8.14 kg/m2 respectively. With OAGB-200 there was a significant increase in anaemia rates at 1 and 2-years compared to preoperative levels with a significant fall in haemoglobin levels. After OAGB-150 there was a significant fall in haemoglobin levels at 1 and 2-years but the increase in anaemia rate was only significant at 2-years. There was a significant increase in PTH levels and the number of abnormal values at 1 and 2-years with OAGB-200. With OAGB-150, PTH changes were significant at 2 years only.

Conclusion

Both OAGB-200 and OAGB-150 are associated with a significant increase in anaemia and secondary hyperparathyroidism. Our findings should prompt the evaluation of supplementation protocols with higher dosages than we recommend for iron, folate, and calcium. Consideration should also be given to evaluating shorter BPL lengths than 150 cm with OAGB.
EP.TH.37Radioembolization with yttrium-90 microspheres for management of breast liver metastases: a systematic review and pooled analysis
Authors: Feretis Michael , Fedotovs Arturs , Solodkyy Andriy
Published: October 2021

Aims

Radioembolization with yttrium-90 microspheres is an emerging option for management of liver metastases of breast cancer when other systemic therapies have failed. The aims of this systematic review were to assess the effect of radioembolization on i) tumour response and ii) patient survival post -radioembolization.

Methods

The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic literature search was performed using the PubMed and EMBASE databases from January 2007 to December 2019. The initial search yielded 265 reports which were potentially suitable for inclusion in this review. Studies published in English reporting at least one outcome of interest were considered to be suitable for inclusion. Conference abstracts; case reports, animal studies and reports not published in English were excluded from this review.

Results

The final number of studies which met the inclusion criteria was 12 (n = 452 patients). There were no randomized controlled trials identified. The age of the patients included in this review ranged from 52 to 61 years. The duration of follow-up ranged from 6 to 15.7 months. The total number of patients with breast metastases not confined to the liver was 236 (52.2%). Cumulative analysis revealed that radioembolization conferred tumour control rate in 81% of patients. Overall survival post-radioembolization ranged from 3.6 to 20.9 months with an estimated mean survival of 11.3 months.

Conclusion

Radioembolization with ytrrium-90 appears to confer control of tumour growth rate in most patients, however its effect on patient survival need to be elucidated further.
EP.TH.43Biliary cooling during radiofrequency ablation of liver tumours close to central biliary tree: A systematic review and pooled analysis
Authors: Feretis Michael , Zhang Bridget , Wang Yishen , Liau Siong-Seng
Published: October 2021

Aims

Biliary cooling during radiofrequency ablation (RFA) of liver tumours has been proposed as a protective measure for RFA-related biliary complications in cases whereby the RFA-site is close to central biliary tree. This systematic review aims to assess the effect of biliary cooling on i) the development of biliary complications and ii) tumour recurrence rates at ablation site.

Methods

A systematic literature search was performed using the PubMed/EMBASE databases using PRISMA methodology (2000-2019). The initial search yielded 75 reports which were potentially suitable for inclusion. Studies reporting at least one outcome of interest were considered to be suitable for inclusion. Conference abstracts, case reports and animal studies were excluded. Data was retrieved on patient demographics, tumour characteristics, method of cooling, biliary complications, local tumour recurrence and duration of follow-up.

Results

The final number of studies which met the inclusion criteria was 7, involving 100 patients. There were no randomized controlled trials identified after the literature search. The mean age of the patients included was 65 years. Biliary cooling was performed with the use of a nasobiliary tube in 4 out of 7 studies, via a choledochal incision in 2 out of 7 studies and through the cystic duct in a single study. The overall biliary stricture rate was 2% and the overall tumour recurrence rate at RFA treated site was 14.5%.

Conclusion

Biliary complications appear to be low after biliary cooling during RFA close to central biliary tree. More evidence is required to assess the tumour recurrence rates.
EP.TH.76Re-audit of Surveillance Cystoscopies in Bladder Cancer
Authors: Elsllabi Mohamed , Shams Muhammad , Sahl Abdullah Bin
Published: October 2021

Aim

To ensure guidelines are followed for cystoscopic surveillance

Method

Results and discussion

WERE GUIDELINES FOLLOWED?

Conclusion

Recommendations
EP.TH.136Does laparoscopic transversus abdominis plane (TAP) block reduce postoperative opioid usage in bariatric patients?
Authors: Lin Yi-Tzu Linda , Goh Ian , Cheng Anthony
Published: October 2021

Introduction

Laparoscopic TAP block has been used in various surgical subspecialties to reduce postoperative opioid requirement and hence its side effects. The aim of our study was to evaluate the effect of laparoscopic TAP block in bariatric surgery.

Methods

We performed a retrospective analysis in patients who underwent bariatric surgery by two surgeons at a metropolitan public hospital from January 2019 to March 2020. One surgeon routinely performed laparoscopic TAP block (TAP group) with 80ml of 0.2% ropivacaine and the other surgeon performed port-site infiltration (non-TAP group) with either 0.2% or 0.75% bupivacaine. Patients with chronic pain were excluded. Baseline characteristics (age, gender, pre-op BMI, types of bariatric surgery), postoperative usage of opioids (in recovery, in the first 24 hours and opioid dosage) and length of stay (LOS) were collected and analysed.

Results

Seventy-nine patients were included in this study, of which 46 (58.2%) received laparoscopic TAP block and 33 (41.8%) received port site infiltration. Opioid requirement rates were lower in the TAP group: 54.3% (n = 25/46) received no opioids in recovery and 21.7% (n = 21/46) in the first 24 hours, compared to 48.5% (n = 16/33) in recovery and 9.1% (n = 3/33) in the first 24hours in the non-TAP group. However, there was no statistically significant difference (p = 0.61 and p = 0.13 respectively) between the two groups. Mean LOS was comparable in both groups.

Conclusion

Our study showed a non-statistically significant trend in reducing postoperative opioid usage with laparoscopic TAP block. Further evaluation with a prospective randomised controlled trial is warranted.
EP.TH.140Enhanced Recovery in Liver Surgery: Effect on Survival in Patients with Colorectal Liver Metastases
Authors: Stefanova Irena , Martinou Eirini , Kumar Rajesh , Riga Angela , Worthington Tim , Karanjia Nariman
Published: October 2021

Aims

Enhanced recovery after surgery (ERAS) has shown to reduce perioperative stress and improve short-term postoperative outcomes. However, little is known regarding the effect of ERAS on long-term oncological outcomes. This study aimed to investigate the impact of ERAS on overall survival in patients undergoing liver resection for colorectal liver metastases (CRLM).

Methods

Between 2006 and 2014, 387 patients underwent liver resection for CRLM at Royal Surrey County Hospital. The ERAS protocol after liver surgery was implemented in 2011. Data regarding patients’ demographics, oncological characteristics, long and short-term postoperative outcomes were obtained from a prospectively maintained institutional database. Comparative analysis was performed between the ERAS and non-ERAS patients. The primary objective was overall survival (OS) and secondary objective included identification of factors affecting OS.

Results

The groups were similar in terms of demographics, primary and secondary disease oncological characteristics. Intrahepatic recurrence rates were comparable between ERAS and non-ERAS group (30.3% vs 27% p = 0.496). Patients in the ERAS group demonstrated better 3-year survival rates in comparison with the non-ERAS ones (78.2% vs 68%, p = 0.027). Although survival was better at 5-years as well, this did not reach statistical significance (54.2% vs 50%, p = 0.470). The Cox proportional hazards analysis showed that increased length of hospital stay (HR 1.338, 95% CI 1.039-1.723, p = 0.024) and operative time (HR 1.580, 95% CI 1.173-2.128, p = 0.003) were the only parameters associated with increased risk for worse OS.

Conclusions

ERAS protocol may be associated with improved 3-year survival in patients undergoing liver surgery for CRLM.
EP.TH.155Assessment of the appropriate use of imaging and reporting in acute pancreatitis in a secondary care setting
Authors: Kirchhoff Chris , Omokehinde Tope Johnson , Achunine Portia , Marshall Caitlin , Ikechi Chijoke , Shah Ankur
Published: October 2021

Background

Acute pancreatitis is the world's most common gastrointestinal disease requiring hospital admission. Our audit aim was to assess the timeframe within which Abdominal Ultrasound Scans (USS) and Computerised Tomography (CT) were performed, reported indications for CT and the prognostic factors noted in imaging reports.

Methodology

A retrospective search included admissions with acute pancreatitis between 01/09/19 to 30/11/19, collecting demographics, admission time & date, time and date of both radiological investigations and imaging reports. Patients under the age of 18 were excluded.

Results

This search identified 75 patients (M:F, 40:35) with a median age of 53 (18-95) years. USS were performed within 24 hours of admission in 40.0% (n = 30) of cases. Out of the patients (n = 44) who received a CT scan, 15.9% (n = 7) were scanned after more than 72 hours of onset of symptoms and 84.1% (n = 37) were scanned within less than 72 hours. Furthermore, 88.6%(n = 39) of CT request indications were in keeping with our standards. The average length of hospital stay was 6.1 days when scanned within 72 hours and 11.8 days when scanned after more than 72 hours.

Conclusion

Only 17.3% (n = 13) of the patients audited met all our standards and were managed according to the guidelines. The average length of hospital stay was half in those who had a CT scan after more than 72 hours of admission and this was also used to monitor disease progression/regression.
EP.TH.166Evaluation of the impact of the COVID-19 pandemic on the practice of axillary node dissection
Authors: Harris Grant , Townend Alice , Youssef Madgi
Published: October 2021

Aims

The Association of Breast Surgery's "COVID-altered" guidance for management of breast cancer during the COVID-19 pandemic, includes that neoadjuvant chemotherapy was only to be used only in inoperable disease and not to downstage the axilla. Delayed presentation with increased nodal involvement was also a concern.

We aim to establish if axillary node dissection (AND) increased in the context of pandemic.

Methods

Patients undergoing surgery for breast cancer were identified from theatre coding in a UK breast unit. Pre-COVID (March 2018 - February 2020) and COVID pandemic (March - September 2020) cohorts were compared. Indication, tumour receptor status, neoadjuvant chemotherapy (NAC) and deviation from routine practice were ascertained for those undergoing AND. Trust Caldicott and audit department approval was obtained for this retrospective review of practice.

Results

AND was performed in 20.2% (23/114) of breast cancer operations during the pandemic compared with 18.97% (78/411) pre-COVID. Indication for AND during the pandemic and pre-COVID respectively - clinically node positive 82.6%/79.4%; positive sentinel node biopsy 4.3%/17.9%; recurrence or metastases from contralateral cancer 13%/2.5%. NAC preceded AND in 30% of cases in both cohorts. NAC for one node positive HER2+ cancer was omitted due to the pandemic and another patient had adjuvant chemotherapy omitted for a HER2+ cancer with a single positive sentinel node mandating an AND which yielded no further positive nodes.

Conclusions

The COVID-19 pandemic has not significantly impacted rates of AND in our practice. However, we identified 2 patients who may have avoided AND with normal chemotherapy protocols.
EP.TH.210Our Take on Prophylactic Cholecytectomy in Patients Undergoing Bariatric Laparoscopic Roux En Y Gastric Bypass (Lrygb)
Authors: Virupaksha Suvi
Published: October 2021

Aim

The concept of prophylactic cholecystectomy in bariatric patients undergoing laparoscopic roux en y gastric bypass despite extensive discussion remains controversial. We aim to resolve this controversy by our observational study.

Method

Data extracted from our prospective Bariatric and theater database between 2012 and 2018 of patients having undergone roux en Y bypass and laparoscopic cholecytectomy in a retrospective manner. The primary endpoint was determining the incidence of laparoscopic cholecystectomy in bariatric bypass patients. The second endpoint of data analysis was to compare the outcomes between post laparoscopic roux en y gastric bypass and laparoscopic cholecystectomy in non bariatric.

Results

Incidence of laparoscopic cholecystectomy in 511 LRYGB patients was 19.17%. These were performed before (9.70%), after (7.20%) and concomitantly (2.15%). Ultrasound was done in 71.60% of patients of which 28.10% had evidence of Gallstones. MRCP was done in 1.56% for suspected CBD stone before LRYGB and 4.10% after LRYGB. Only 2(0.39%) patients required a laparoscopic assisted ERCP. Over all complications from Laparoscopic cholecytectomy performed after or concomitantly with LRYGB was similar to the non bariatric cohort.

Conclusion

We reported a low incidence of post and concomitant laparoscopic cholecystectomy There was no statistical deference in post operative complications from laparoscopic cholesystectomy between LRYGB and non bariatric population. To conclude there is no evidence support prophylactic cholecystectomy. However, a randomized controlled trial should be considered to support our conclusion.
EP.TH.311The 100 most influential Economic Analyses in medicine: a bibliometric and altmetric perspective
Authors: Eley Catherine , Gravell Wil , Powell Arfon , Lewis Wyn
Published: October 2021

Aims

Bibliometric and Altmetric evaluation identify the most cited publications which have historically shaped the development of Economic Analysis (EA).

Methods

Thomson Reuters Web of Science was used to identify EA’s 100 most cited articles (search terms “economic analys*”, “cost-effectiveness analys*”, “cost-benefit analys*” or “cost-utility analys*”, alongside “medic*” or “surg*”) which were examined by topic, journal, author, year, institution, and Altmetric Score (AS).

Results

Articles numbering 9,895 were returned: median citation number 293 (interquartile range (IQR) 240-539). JAMA contributed most articles (n = 17) and citations (9,106). The country and year with most articles were the USA (n = 60), and 2003 (n = 9) respectively. The most ubiquitous topic was health economic methodology (n = 57). AS ranged from zero to 237.00 (median 8.00, IQR 3.00-20.75). Citation Rate Index increased in parallel with AS before and after 2006 (m = 0.29, m = 0.24), and before and after 2010 (m = 0.27) but with a higher initial gain (constant difference 13.1 and 15.1 respectively).

Conclusion

The most cited articles described effective tools for economic analyses with Altmetric Scores becoming increasingly influential in promoting citations. This review provides a reading list of the most influential references in this arena, and a guide to what constitutes citable medical economic research.
EP.TH.335Through the Lens of a Pandemic: The Impact of COVID-19 on Breast Cancer
Authors: Ribbits Alexander , Subramanian Ash , Shah Elizabeth
Published: October 2021

Aims

On March 11th 2020 the UN accorded COVID-19 pandemic status. On March 15th, the Association of Breast Surgery released guidelines in light of the pandemic. Eight days later the UK government announced the first lockdown. GP referrals fell in April/May. The aim of this study is to review how COVID-19 affected breast cancer management.

Methods

This is a retrospective analysis of patients diagnosed with breast cancer attending their initial appointment between March 16th to September 18th (pandemic phase) and 1st January to 15th March(pre-pandemic). Primary outcomes were pandemic-related modification of treatment plans, and diagnosis of COVID-19 or related complications. Secondary outcomes were delay in presentation or advanced disease. B-Map-C and the CovidSurg Collaborative were used as Gold Standards.

Results

39 patients were in the pandemic phase and 45 in the pre-pandemic. 3/39(7.69%) and 14/45(31%) had surgery delayed. There were no COVID diagnoses. In-situ cancers were held on a deferred list until local guidelines changed. 2 patients had interim endocrine therapy. 9/39 underwent chemotherapy, of which 4 were neoadjuvant. 2/39 patients presented late to their GP, of which one had widespread metastases. 9/39(23.08%) were lymph node positive. In the pre-pandemic group, 6/45(13.3%) were lymph node positive, 2/45(4.4%) had distant metastases.

Conclusions

This study shows that breast surgery can be safely carried out during this pandemic and treatment postponement should be avoided as the pandemic continues. It remains to be seen if delayed treatments during 2020 will impact on local relapse and overall survival rates.
EP.TH.444Long-term recurrence and complication rates in patients with self gripping mesh hernia repair
Authors: Elnaggar Mahmoud , Verdiyeva Gunay , Thamaran Nisha Rajesh , Fafemi Oladapo , Munteanu Alexandru
Published: October 2021

Aim

Assessment of long term complications of self gripping mesh used in different types of hernia repair procedures more than 4 years ago aiming to compare the results with sutured prolene mesh with regards to safety and efficacy.

Methods

70 patients (3 emergency & 67 elective) ventral hernia repair procedures, done in 2016 using self gripping mesh, were followed for recurrence and complications on the long term.

Results

There were 2 right (6.45%) and 1 left (3.44%) inguinal hernia recurrences. There were no cases of chronic groin pain or foreign body sensation. As compared to the meta-analysis of postoperative pain using non-sutured or sutured single-layer open mesh repair for inguinal hernia, where 19 studies including 4531 patients analysed recurrence, no significant difference was found in recurrence rates between the 2 mesh repair groups after 1 year of follow-up. With regards to the incidence of chronic pain at 12 months, there was no significant difference between Self gripping and suture fixation.

Conclusions

The self-gripping mesh in this study has better results as compared with a sutured mesh regarding the incidence of chronic postoperative inguinal pain and foreign body sensation.

Recurrence rates are comparable to most studies, however, long-term results still are based on relatively small patients numbers.
EP.TH.528The Accuracy of the Multi-slice detector CT Scan (MDCT) in staging borderline resectable periampullary carcinoma
Authors: Noureldin Khaled , Mahmoud Afsheen , Panamarenko Ben , Shalaby Ahmed
Published: October 2021

Objectives

Assess MDCT accuracy in staging cancers periampullary cancers.

Introduction

Periampullary malignancies are highly aggressive with poor outcomes. Surgery is the only curative option. It is crucial to define the patients who can advantage from a Whipple’s resection and who can avoid.

Methodology and Results

RCT investigated randomly 28 patients over 15 months. The patients were sub-divided into 2 groups. Group A, we relied mainly on the MDCT for preoperative staging, while in Group B staging laparoscopy was added before the abdominal exploration. Sensitivity of the MDCT and its accuracy were 100% in defining the signs of irresectability. For borderline staging, the accuracy of the scan was 62.5% and 71%, in groups A and B. The Overall accuracy of MDCT was 75%. It decreased to 68.1% for borderline lesions. The addition of staging laparoscopy to the diagnostic work up, increased the accuracy to 92.5%. The camera test was able to see occult findings which were missed in the images. liver Mets and malignant peritoneal fluid were localized in 18% and 9% respectively. 3 cases in group A and one in group B underwent unnecessary laparotomy. Thus, the false negative incidences were 21% and 7% in group A and B, with overall incidence 14.2%.

Conclusion

MDCT is highly sensitive and specific with high stage periampullary cancers. These parameters drop in border tumors with reduced accuracy in detecting the degree of vascular abutment and distant-occult findings. Addition of other adjuncts to decrease the rate of un-indicated laparotomy is advised.
EP.TH.664Breast lump recurrence - malignancy or iatrogenic disease process?
Authors: Fox Katherine , Khan Lucy
Published: October 2021

Backgound

Fibromatosis is a rare disease, accounting for 0.2% of breast tumours and 3% of soft tissue tumours. Due to its rarity there is a lack of multi centre trials and therefore evidence and guidance on the best treatment options. Likewise, many clinicians are unfamiliar with how to best manage these patients, even in specialist centres.

Methods

We present the case of a patient presenting with a suspicious breast lump, diagnosed as fibromatosis. Literature search enabled review of current trends and opinions in the management of such patients.

Results

We discuss the case of a 70 year old patient with a right breast lump, presenting 3 years following wide local excision and radiotherapy for DCIS. Imaging and examination were suspicious for malignancy. Biopsy demonstrated fibromatosis, for which the patient is currently being managed with active observation.

Discussion and Conclusion

Desmoid tumours of the breast are a rare but important differential in patients presenting with a breast lump. The aetiology remains poorly understood but they have been linked to genetic conditions, and trauma. As with this case, trauma may be iatrogenic in the form of surgery or radiotherapy. Due to the destructive nature of fibromatosis, the current trend in the management of these patients advocates wide local excision where possible. However, there is a high recurrence rate. There has been some success with medical therapies such as NSAIDs and tyrosine kinase inhibitors. These may be viable options in patients in whom surgery is not suitable.
EP.TH.670Antibiotic Prophylaxis Use In Paediatric Robotic-Assisted Laparoscopic Pyeloplasty: A Systematic Review
Authors: Schaffer Sierra , O'Neill Parker
Published: October 2021

Aim

A systematic review was conducted to evaluate the current evidence for prophylactic antibiotic use in paediatric robotic-assisted laparoscopic pyeloplasty (RALP). As pyeloplasties are ‘clean contaminated’ procedures, prophylactic antibiotics are recommended, however, recent evidence suggests that antibiotics may be unnecessary. Prophylactic antibiotics are often either under or over prescribed in paediatric surgery, which increases the risk of developing antibiotic resistance. In general, minimally invasive surgery is associated with less postoperative infections, however, it is not yet clear how RALP compares with other approaches. Recent reviews have indicated prophylactic antibiotics may not decrease postoperative infections, however, there are no clear guidelines.

Methods

A systematic review was conducted of the following electronic databases: Pubmed, Medline Ovid, The Cochrane Library, TRIP Database, NICE Evidence Search, and EMBASE. The search terms used were: paediatric, pyeloplasty, robotic, antibiotic and were used as keywords as well as in combination as MeSH terms.

Results

Forty-one articles were retrieved, and after screening for relevance and redundancy, 2 articles remained including a total of 315 pyeloplasties. Prophylactic antibiotics did not reduce the incidence of postoperative UTIs in RALP.

Conclusion

Prophylactic antibiotics for RALP is not associated with lower rates of UTIs and therefore, may be reserved for patients with risk factors. However, due to the limited data and confounding factors, further research is required to optimise antibiotic stewardship and infection prevention.
EP.TH.729Spontaneous Complete Regression of Sacroma: A Case Report And Review of Literature
Authors: Ravindran Sharanya , Westbroek David , Kryjak Zibigniew
Published: October 2021

Spontaneous complete regression (SR) of cancer is complete or partial disappearance of the cancer without any treatment which is very rare(1).

Case Report

58 year old female, with a palpable right breast lump from the chest wall at 7o clock position. It was 25mm in size, axillae demonstrated no LAD. Imaging was performed which showed a suspicious lesion with malignant features,core biopsy done. It showed pleomorphic spindled and epitheloid cells. Immunohistochemistry was negative for AE1/AE3,MNF116,CK19,CK7,P63,CK14,CK5/6 was diagnosed as sarcoma with a possibility of phyllodes tumour. Plan was made in MDT to discuss in regional sarcoma meeting and staging CT which was normal.

Sarcoma MDT recommended surgery, planned for wide local excision. On the day of surgery patient came for wire localisation, however no tumor noted on imaging and patient also confirmed the same. Patient had CT and MRI which revealed no abnormalities. This was discussed in local and central MDT, advised imaging after 3 and 6 months.

Discussion

Spontaneous regression of breast sarcoma in Pub med yielded no cases. This process has not been clearly explained yet. Several mechanisms have been suggested for spontaneous regression, including immune modulation, withdrawal of carcinogens, infection, apoptosis, antiangiogenic and maturation mechanisms gene therapy, vaccine-mediated mechanisms among many.

Conclusion

This is the first case of SA of primary breast sarcoma to our knowledge and our main aim to present this case is due to its rarity.
EP.TH.915An Audit of BAUS Guidelines and Complications of Suprapubic Catheter Insertion
Authors: Malik Salim , Dermanis Alexander , Kalejaiye Odunayo , Dowson Christopher
Published: October 2021

Introduction

The National Patient Safety Agency (NPSA) noted between September 2005 to June 2009, 259 incidents relating to suprapubic catheter (SPC) insertion were reported. 9 of these were bowel perforations. BAUS produced guidelines for SPC insertion which included recommending open or ultrasound guided insertion of SPCs in patients with previous lower abdominal surgery. The aim of this audit was to assess compliance with BAUS guidelines and complications following SPC insertion.

Methods

All patients who had a SPC inserted in theatre at this District General Hospital (DGH) between October 2012 to October 2019 were identified. Patient demographics, ASA grade, co-morbidities, previous abdominal surgery and complications were recorded.

Results

A total of 154 patients (59.1% male; 40.3% female) were identified. Mean age was 65 and mode ASA was 3. 21 (13.6%) of patients had previous lower abdominal surgery. Of these 2 (10%) had ultrasound guided insertion, 3 (14%) were open, 11 (52%) had cystoscopy guided insertion alone and for 5 (24%) the method was unknown. 4 (2.6%) of patients had a bowel injury following SPC insertion.

Discussion

At this DGH there was poor compliance with BAUS guidelines with a significant number of patients with lower abdominal surgery not having open or ultrasound guided insertion of SPC. 2.6% of patients had a bowel injury, however none of these had previous lower abdominal surgery. For these patients BAUS guidelines were adhered to, but bowel injury was not prevented. We therefore recommend the consideration of image guided insertion of SPCs in all patients where possible.
EP.TH.1046Probing the cost variation in Laparoscopic Cholecystectomy using PLICS
Authors: Hossain Tanvir , Ahmed Nauman , Menon Achyuth
Published: October 2021

Aims

This pilot study followed the introduction of PLICS (Patient-Level Information and Costing Systems) in our trust. Data for for Q2 2018 was probed to understand cost variation in procedures and to plan how to utilize this system.

Methods

Elective laparoscopic cholecystectomy data was extracted, providing costing for each procedure across a number of domains. We established a system to assess the domains with the most variation. We calculated the coefficient of variation (CV) for each domain. CV > 1 was seen as high variation and these domains were probed further to identify causes.

Results

Domains identified to be of notable variation (CV > 1) were length of stay, pathology test costs, drugs administered, medical staffing costs and pharmacy costs. Domains such as interest costs and device costs appeared to be arbitrary and directed our feedback on how to improve the system.

Conclusion

We identified variation of costs due to dispensation of drugs unrelated to laparoscopic cholecystectomy which can be easily addressed. Staffing cost variation provided data to drive theatre utilization strategies. Improvements in data capture such as device costs per procedure are imperative to evaluate and change practice for further cost efficiencies.

Key statement

PLICS is a powerful system to probe procedure costs, variation and drive efficiency. Our combined clinical and management team collaborated to understand the data. To use PLICS to the best advantage the data must be accurate, truly recorded at the patient level and be subject to regular scrutiny.
Moy.03Evaluation of the Basket in Catheter Technique for Transcystic Bile Duct Exploration and Suspected Ductal Stones
Authors: Nassar Ahmad , Qandeel Haitham , Khan Khurram , Nj Hwei , Hasanat Subreen , Ashour Haneen
Published: October 2021

Aims

The ‘Basket-in-catheter’ (BIC) technique facilitates laparoscopic transcystic ductal exploration (LTCE) and increases its success rate, being easier and safer than inserting the basket alone. This study evaluates the benefits in confirmed and suspected ductal stones. 

Methods

Prospective preoperative, operative and postoperative data on consecutive single session ductal explorations was collected over 28 years and analysed. BIC became our default technique for the transcystic approach to confirmed or suspected bile duct stones.

Results

741 of 1225 (60.5%) attempted LTCE were performed using retrieval baskets without dilating the cystic duct (CD). BIC was used in 646 (87.2%). Of 386 (52.1%) patients undergoing successful stone retrieval 62.7% had clinical and radiological risk factors for ductal stones and 92.0% had positive intraoperative cholangiography. 355 (47.9%) patients had preoperative or operative risk factors for CBD stones and equivocal cholangiography in 25%. Basket trawling was negative and repeat cholangiography confirmed resolution of abnormalities. Choledochoscopy was utilised in 484/1225 (39.5%), either primarily or when blind trawling failed to extract stones. Retained stones occurred in 7 patients, six requiring ERCP. Bile leakage occurred in 6 patients. There were two open conversions, no biliary injuries and no mortality. Post-operative pancreatitis occurred in 7 and recurrent stones in 8 patients.

Conclusions

The BIC technique achieves successful LTCE without CD dilatation in 40%, reducing the need for choledochoscopy and choledochotomy. It facilitates safe and speedy CBD trawling when stones are suspected due to preoperative or operative risk factors or equivocal cholangiography and helps surgeons acquire and consolidate ductal exploration skills.
BJS.05Stage Migration in Newly Diagnosed Oesophago-gastric Cancer during the first wave of COVID-19 Pandemic
Authors: Khan Khurram , Chuntamongkol Rongkagorn , McCollum Catherine , Gall Lewis , Forshaw Matthew
Published: October 2021

Aims

Covid-19 has significantly disrupted elective and emergency health care provision including cancer care within the UK. The aim of the study was to investigate the impact of the pandemic on the staging of oesophago-gastric cancers at presentation, determine the time delay in performing gastroscopy and the multidisciplinary team (MDT) treatment outcomes.

Methods

A retrospective cohort study of all newly diagnosed oesophago-gastric cancers (adenocarcinoma and squamous cell carcinoma) in a single regional MDT was performed between 1st October 2019 and 30th September 2020.  Electronic records were interrogated and patients dichotomised into two groups with those presenting before the introduction of the UK national lockdown of 23rd March 2020 compared to those presenting post-lockdown.

Results

349 new oesophago-gastric cancer patients were discussed in the MDT (192 pre-lockdown versus 157 post-lockdown). Demographics were evenly matched between the two groups.  More patients presented as an emergency admission post-lockdown (28.0% vs 12.5%, p < 0.001).  Median waiting time for gastroscopy was longer post-lockdown (23 vs 14 days, p = 0.035).   Metastatic disease at presentation was more frequent post-lockdown (47.8% vs 33.3%, p = 0.008).  Overall, more patients had a palliative rather than curative treatment intent post-lockdown (71.3% vs 57.8%, p = 0.005).

Conclusions

The Covid-19 pandemic has had a significant negative effect on the stage of oesophago-gastric cancers at presentation. This has translated into more patients receiving palliative treatment and ultimately having a poorer prognosis. This study highlights the importance of maintaining cancer services during Covid-19 pandemic.
EP.TU.6The Impact of Disability on Performance in the Intercollegiate Membership of the Royal College of Surgeons examination (MRCS)
Authors: Ellis Ricky , Brennan Peter , Cleland Jennifer , Lee Amanda , Scrimgeour Duncan
Published: October 2021

Aims

The number of medical students and doctors with disabilities is increasing, however there is a paucity of data on the performance of doctors with registered disabilities in the postgraduate environment. To address this gap in knowledge, we assessed the impact of disabilities on performance in the MRCS.

Methods

All UK medical graduates who had attempted MRCS Part A (n = 9,597) and Part B (n = 4,562) between 2007-2017 with linked disability data in the UK Medical Education Database (https://www.ukmed.ac.uk) were included. Univariate analysis identified associations with MRCS performance and logistic regression models identified independent predictors of success.

Results

Candidates with registered disabilities had lower MRCS Part A pass rates (46.3% vs 59.8% respectively (p < 0.001)) but similar Part B pass rates (68.2% vs 70.9% (p = 0.339). They were nearly twice as likely to fail Part A (odds ratio 0.55 [95% Confidence Interval 0.46-0.64]). When prior academic attainment (A-Levels and medical school performance) was taken into account, there was no statistically significant difference in the likelihood of success at MRCS (p > 0.05). MRCS pass rates were similar for candidates with specific learning difficulties and those with other registered disabilities p > 0.05).

Conclusions

This is the first study to assess the impact of disability status and type on performance at a postgraduate medical examination. It appears that candidates with registered disabilities perform less well in formal, written examinations generally. Our data indicate that the MRCS itself is fair for candidates with registered disabilities and that the current testing accommodations enable performance unrestricted by disability.
EP.TU.45Organising The Huddle: An Audit Loop of the Surgical Handover
Authors: Ali Kiren , Gumber Ashutosh , Dampetla Srilatha , Pareek Raju , Shalli Kawan
Published: October 2021

Aim

Structured patient handover is a critical element for the patient safety. There are several guidelines including the ones from NICE and Royal College of surgeons emphasizing its importance in today’s practice. It entails appropriate coordination and communication among health-care providers to ensure safety of the patients and avoid adverse incidences. This audit was performed to assess and improve the current Surgical Handover Meeting in line with the Handover Guidelines from the Royal College of Surgeons of England (Rcseng.ac.uk, 2007).

Method

A questionnaire was circulated among the surgical doctors involved in the handover meetings. Outcomes were compared with the NICE and RCS guidelines. Recommended changes were implemented after training the staff which was followed by second cycle of audit.

Results

During the first cycle of audit, 80% of the junior surgical doctors contributed towards the study who agreed there was no standard format of handover, information was incomplete and there was lack of privacy. A standardized handover sheet was introduced which included accurate and concise information about patients with their management plans. There was noticeable improvement in staff satisfaction in second cycle but use of quiet room and nurse’s attendance remained poor.

Conclusion

Safe handover reflects quality of patient care. Despite achieving remarkable improvement after first audit we still lag behind the recommended practice. With all the support and coordination; further projects, meetings and presentations are required to achieve the outstanding standards.
EP.TU.53Mark of Cain: lessons from a field hospital Boot Camp under COVID’s Cloak
Authors: Luton Oliver , James Osian , Mellor Katie , Eley Catherine , Egan Richard , Lewis Wyn
Published: October 2021

COVID-19 restrictions have cursed and canceled most academic training events. Because of fears related to social distancing, centres normally housing >100 delegates now accommodate only 12.

Aim

To assess the feasibility of a multidisciplinary Core Surgical Trainee (CST) Boot camp training event at a UK field hospital.

Method

All CST1s within a single UK Statutory Education Body were invited to participate in a three-day Boot camp at the Dragon’s Heart Hospital, Millennium Stadium, Cardiff, consisting of simulated, Operative and Non-Operative Technical Skills for Surgeons (NOTSS). Primary outcome measures were; satisfaction and perceived competence using Likert scale (1-5).

Results

Attendees numbered 44 (median age 29 yr. 21 female, 23 male). Median satisfaction scores by domain were: Overall course satisfaction 4 (range 2-5), simulation skills 5 (3-5), lecture-based learning 4 (2-5), academic skills 4 (2-5), and NOTSS 5 (1-5). Levels of perceived confidence in performing simulated index procedures improved markedly (before median 2 (1-5) vs. after 4 (2-5), (p < 0.001). Free text comments reflected and praised the quality of staff commitment, enthusiasm, and in particular interactive workshops related to NOTSS. In contrast, resource limitations inherent to the marquee character of the venue (ambient temperature, IT limitations) received criticism.

Conclusion

COVID’s curse can be broken by creativity, enthusiasm, and engagement of translational multidisciplinary team leadership.
EP.TU.153Face to face teaching in the covid era: Basic Surgical Skill Development
Authors: Kirchhoff Chris , Davis Heather
Published: October 2021

Aims

According to literature,newly qualified doctors are at risk of being unable to perform practical procedures safely. This has been exacerbated by the disruptions to training and education which the covid-19 pandemic has caused. This intensive course has been developed to improve basic surgical skills and improve confidence in simple wound closure, to mitigate these disruptions.

Methods

Candidates attended a three-part course in small groups, where they learned hand ties, basic laparoscopic skills and wound closure on animal models. Self assessment data were collected pre and post workshop on a Likert scale. All data was assessed using basic descriptive analysis.

Results

Data was collected from 13 participants (M:F, 5:8) at the level of foundation year 1(61.5%,n=8) and foundation year 2(38.5%,n=5). Only 38.5% (n = 5) had previous basic surgical skills training. Our delegates reported an improvement in the following surgical skills: suturing (n = 11, 84.6%), hand tying (n = 10, 76.9%), laparoscopic skills (n = 10, 76.9%). Overall 61.5% (n = 8) of our delegates reported an improvement in all three domains.

Conclusions

Participants reported limited exposure prior to this course despite successfully completing an undergraduate curriculum. Overall, participants' self-scores improved in all three taught surgical skills. We believe ourcourse is a practical and reproducible solution to help bridge training gaps, which can be safely conducted with social distancing measures.