bluuebunny/crossref_metadata_2025 huggingface dataset:
EP.WE.372Has COVID-19 affected the attention surgical papers are receiving?
Authors: Baker Megan , Hanton Alice , Perin Giordano , Lumley Emma , Mahendran Ashuvini , Saha Arin
Published: October 2021

Aim

Unsurprisingly, much of the medical profession has focussed on treating covid-19 over the past year often to the detriment of other pathologies. Engagement with academic literature may follow a similar trend; this paper used standard social media attention and citations metrices to assess whether the pandemic has affected engagement with surgical literature.

Method

Twitter Mentions and Mendeley Readers Data were retrieved for all papers published in Annals of Surgery, BJS and JAMASurgery between January 2019 and October 2020. The non-parametric Mann-Whitney U test was used to compare Twitter Mentions and Mendeley Readers for COVID surgical vs non-COVID surgical publications (in 2020) and all surgical papers published before and after the advent of COVID-19. A control database of all papers published in NEJM, BMJ and Lancet over the same period of time was also created.

Results

There was no difference in Twitter mentions between COVID-19 and non-COVID-19 papers (p-value 0.604); however there were significantly more Mendeley readers of COVID-19 papers than non-COVID-19 papers in 2020 (55 vs 5 median readers, p < 0.001). Surgical papers published in 2020 received significantly fewer Twitter mentions than those published in 2019 (15.5 vs 27, p < 0.001).

Analysis of the non-surgical control dataset revealed the opposite trend; papers published in 2020 received significantly more attention than those published in 2019 (39 vs 30 median Twitter citations, p < 0.001).

Conclusion

Surgical papers published during the COVID-19 pandemic received significantly fewer social media mentions. Such reduced visibility has the potential to affect future citation metrics and dissemination of surgical knowledge
EP.WE.548The prevalence iron deficiency anaemia in patients with oesophago-gastric cancer
Authors: McCollum Catherine , Khan Khurram , Chuntamongkol Rongkagorn , Forshaw Matthew
Published: October 2021

Aims

Blood loss from the gastrointestinal tract is the most common cause of iron deficiency anaemia (IDA) in adult men and post-menopausal women. Up to 10% of patients with IDA have underlying gastrointestinal cancer. The aim of this study was to investigate prevalence of IDA in patients with oesophago-gastric cancer.

Methods

A retrospective cohort study of all newly diagnosed oesophago-gastric cancers (adenocarcinoma and squamous cell carcinoma) and high grade dysplasia discussed at tertiary multi-disciplinary team meeting between October 2019 and September 2020. Electronic case notes and blood profile at presentation, including ferritin and serum iron level, were analysed. Patients who did not have blood profile within three months of presentation were excluded.

Results

A total of 349 patients were identified, 12 were excluded due to missing data. 226 (67.1%) were male and the mean age was 69.7 ± 11.7 years. 260 (77.2%) were referred from primary care. After initial investigations, 256 (76.0%) were oesophageal cancer, 248 (73.6%) were adenocarcinoma, and 134 (39.8%) were metastatic at presentation. 128 (38.0%) patients were anaemic: 30 (23.4%) microcytic, 88 (68.8%) normocytic and 10 (7.8%) macrocytic. 98 (76.6%) anaemic patients had ferritin and/or iron levels checked. Analysis of these identified 63 (49.2%) patients with bloods consistent with IDA: 22 (34.9%) microcytic, 40 (63.5%) normocytic, and 1 (1.6%) macrocytic.

Conclusions

This study confirms that while there is high prevalence of anaemia in patients presenting with oesophagi-gastric cancer, IDA was diagnosed in only half of these. The predominant form of anaemia identified in these patients is normocytic.
EP.WE.567Regional anaesthesia for infra-inguinal revascularisation in patients with symptomatic peripheral arterial disease
Authors: Tait Sophie , McGillivray Kay , McKenna Roisin , Hussey Keith
Published: October 2021

Introduction

General anaesthesia is considered to be an aerosol generating procedure. The global Covid-19 pandemic has resulted in review of practice to reduce risk to both patients and health care workers. The outcome of regional anaesthesia (RA) for infra-inguinal arterial reconstruction in patients with symptomatic occlusive atherosclerotic has been explored and compared with patients managed with general anaesthesia (GA).

Methods

Patients undergoing infra-inguinal revascularisation between 2019-2020 were identified from a prospectively maintained administrative theatre dataset. Case-linkage was used to complete the dataset. Specific end points included to critical care admission and peri-operative mortality.

Results

There were 204 patients identified (46 RA and 158 GA). The mean age of patients in both groups was 67-years and procedures were commonly performed in male patients (although the male:female ratio was higher in the RA group 2.8:1 than in the GA group 1.4:1). More patients in the RA had intervention for chronic limb threatening ischaemia (80% versus 59%). The interventions performed were comparable in both groups. The mean length of procedure was less in the RA group (142-minutes versus 160-minutes). No patients in the RA required admission to critical care (10 patients managed with GA required admission to critical care). The 30-day mortality was comparable in the RA and GA groups (2.2% and 1.9% respectively).

Conclusions

Regional anaesthesia would appear to be feasible for patients undergoing infra-inguinal arterial reconstruction with a reduction in operating time and critical care admission without increased peri-operative risk.
EP.WE.641Spectrum of Right Iliac Fossa Pain Presentation and Management During the First COVID-19 Lockdown: A Single Institution Experience
Authors: Bodla Ahmed Salman , Ndegbu Chinedu
Published: October 2021

Aims

Acute surgical presentations and management approaches have witnessed a changing pattern occasioned by COVID-19 pandemic and attendant lockdown. We report the spectrum of right iliac fossa (RIF) pain referrals and management trend within an acute surgical unit before and during the National lockdown.

Methods

A retrospective review of all patients referred to the acute surgical unit with RIF pain before and during first National lockdown was undertaken. Patients managed during these periods were segregated into Pre-Lockdown (January-2020) and Lockdown (April/May-2020) cohorts. Relevant data were obtained from patients’ electronic medical records and main outcome measures compared between both arms were definitive diagnosis, rate of acute appendicitis, diagnostic imaging modality utilised, management approach and post-operative 30-day complications.

Results

RIF pain referrals were fewer (17% vs. 23%, P = 0.045) but more likely to be related to acute appendicitis during the lockdown (52% vs. 28%, P = 0.002). However, the risk of presenting with complicated appendicitis did not alter significantly (26% vs. 19%, RR = 1.34, P = 0.56). Diagnostic imaging was increasingly deployed (for RIF pain: 91% vs. 74%, P = 0.07; for appendicitis: 77% vs. 42%, P = 0.007) especially computerised tomography scan (45% vs. 31%). Increased adoption of conservative approach in the management of acute appendicitis was significant (61% vs 23%, RR 2.65, P = 0.01) although other outcomes such as length of stay, post-operative complication and 30-day re-presentation rates were comparable to pre-lockdown phase.

Conclusion

Fewer RIF pain but more likelihood of acute appendicitis, increased use of radiological imaging and conservative approach to management reflect an evolving pattern during the lockdown phase.
EP.WE.805From bench to bedside; A rationale for Immunotherapy in the adjuvant setting for Oesophageal cancer
Authors: Donlon Noel , Davern Maria , Sheppard Andrew , Reynolds John , Lysaght Joanne
Published: October 2021

Background

Immunotherapy is being intensively investigated for its utilisation in the curative setting as a single agent and in the multimodal setting, however, the most appropriate time to incorporate ICIs remains unknown. Our study profiles systemic anti-tumour immunity perioperatively to provide a rationale for adjuvant immunotherapy.

Methods

Systemic immunity was immunophenotyped pre and post-oesophagectomy on days 0, 1, 3, 7 and week 6 by flow cytometry (n = 14). The frequency of circulating lymphocytes, T cells, cytotoxic and helper T lymphocytes was profiled longitudinally including the proportion of T cell subsets in circulation. This study also profiled immune checkpoint expression on circulating T cells including: PD-1, CTLA-4, TIGIT, TIM-3, LAG-3, PD-L1 and PD-L2. Markers of immunogenicity (calreticulin, HMGB1 and MIC-A/B) were also assessed.

Results

The frequency of circulating CD27 + T cells increases sequentially in the immediate post-operative period peaking on day 7 in OAC patients. (p < 0.01) There is a sequential decrease in the percentage of effector memory and central memory T cells in circulation and an increase in the percentage of naïve T cells in peripheral circulation of OAC patients in the immediate post-operative period. The expression of CTLA-4 on the surface of circulating CD4 + T cells decreases 6 weeks post-operatively in OAC patients.

Conclusions

We observed increased T cell activation and immune checkpoints immediately post-surgery with returns to baseline by week 6. These results suggest that immune checkpoint inhibitors such as anti-PD-1 may be beneficial immediately post-surgery to maintain T cell activation and prevent exhaustion of this increased population of activated T cells observed immediately post-surgery.
EP.WE.842Maintaining Recruitment to Surgical Trials during the Pandemic
Authors: Shahid Mishal , Barton Jessica , Richardt Mike , Shovelton Charmaine , Hollyman Marianne
Published: October 2021

Aims

Recruitment to Randomised Controlled Trials (RCTs) has traditionally been the domain of Research Nurses. Due to the unprecedented pressures of the COVID pandemic, the majority of Research Nurses have been redeployed to other clinical roles, or those still working within research have had to focus on COVID-related projects. This has left existing surgical trials struggling to recruit. We report on our experience of engaging Specialist Nurses without a research background as well as Consultants and Trainees to support surgical research in these challenging circumstances.

Method

The Sunflower RCT was first opened to recruitment in August 2019 at our trust. The recruitment was led by single Research Nurse, but the delegation log included a range of Consultants, Trainees, and Specialist Nurses. Due to the COVID pandemic, recruitment was paused from March 2020 and restarted in July 2020. Data were collected on recruitment until January 2021.

Results

In the seven months before the recruitment pause, 80 patients were recruited (average 11 per month), with the highest proportion of recruits by the sole Research Nurse. Following the recruitment pause, a further 45 patients were recruited (average 7.5 per month). These patients were recruited by Consultants (20, 44%), Specialist Nurses (12, 27%), Trainees (7, 16%), Research Nurse (3, 7%) and postal consents (3, 7%).

Conclusions

We have demonstrated that surgical research activity can be maintained even with minimal Research Nurse recruitment by engaging all members of the surgical team, especially utilising Specialist Nurses, who may not commonly be approached for such a role.
EP.WE.852Role of Prophylactic steroids in the prevention of post-thyroidectomy hypocalcaemia and voice dysfunction
Authors: Ahmed Raheel , Dhahri Adeel Abbas , Bhatti Dujanah S , Ahmad Sheikh Haseeb , Kirmani Naveed
Published: October 2021

Aim

Total thyroidectomy, being a common surgical option, for multinodular goitre and selective cases of Graves’ disease, is associated with risks related to temporary hypocalcaemia and vocal quality dysfunction. Dexamethasone, as a steroid, has well-established anti-inflammatory and immune-modulating effects. As researchers continue to understand its pathophysiology on hypocalcaemia and voice quality, we aim to assess the effect of preoperative dexamethasone used to improve hypocalcaemia and vocal cord function/post-thyroidectomy voice disorder.

Methods

We conducted a single-centre, non-randomised, double-blinded placebo-controlled, parallel-group study with short follow-up in a public sector hospital from January 2014 to December 2019. Patients were equally distributed in two groups to compare the effect of dexamethasone with placebo on hypocalcaemia and vocal cord function/post-thyroidectomy voice disorder

Results

Out of 192 patients, 36 (18.75) male patients while 156 (81.25) were female. Age range was 18 to 60. Eighteen patients had both low calcium level at 24 hours after the operation and hypocalcemic symptoms, of which 4 remain to have hypocalcaemia on third postoperative day. Forty patients defined as having voice dysfunction at 24 hours after being scored using Voice scale. Of these 40 patients with voice dysfunction, 8 had low calcium level in blood at 24 hours while only 2 of these remained with low calcium level on third postoperative day. 6/8 patients had symptomatic hypocalcaemia on first postoperative day.

Conclusions

Single-dose dexamethasone, during the preoperative period, is as safe and as effective in improving transient postoperative hypocalcaemia and Temporary vocal quality dysfunction/post-thyroidectomy voice disorder.
EP.WE.962Pre-emptive arterial stenting with covered vascular stents to prevent mycotic haemorrhage in infected fields following failed kidney and pancreas transplants prior to graft explant
Authors: Spiers Harry , Burke Kelly , Anantha-Krishnan Ganapathy , Van Dellen David , Moinuddin Zia , Augustine Titus
Published: October 2021

Aims

Allograft nephrectomy and pancreatectomy present a significant surgical challenge in contaminated surgical fields, with risks of post-operative pseudoaneurysms and mycotic bleeds. We report on our experience of prophylactic endovascular stenting shortly before or after allograft nephrectoym and pancreatectomy to reduce the risk of subsequent pseudoaneurysm formation from the donor arterial conduit.

Methods

A retrospective analysis of all patients undergoing arterial stenting by interventional radiology prior to graft explant in our unit was performed.

Results

Twelve patients were identified, 6 of whom had undergone kidney transplant and 6 simultaneous pancreas kidney transplant (SPK) with an average age of 46. Iliac stenting was prophylactic in 7 patients, for pseudoaneurysm (28%), graft pancreatitis (28%), acute rejection (28%), enteric anastomotic leak (16%) and transplant pyelonephritis (14%). Therapeutic stenting was performed in 5 patients, all of whom had ruptured pseudoaneurysms. Post-operative 30-day mortality occurred in 1 patient resulting from an acute on chronic limb ischaemia and subsequent sepsis and death. Of the remaining patients, none experienced complications from stenting. 9 of the 12 stented patients remain alive, with the 3 mortalities resulting from other pathology not relating to stenting.

Conclusion

Prophylactic iliac stenting around the time of graft excision in inflamed or infected fields provides a safe and effective technique to completely exclude the donor arterial stump, with no subsequent vascular complications reported within our series. Preventing mycotic aneurysm formation in this way may mitigate the risk of potentially catastrophic post-operative mycotic arterial bleeds.
EP.TH.3Male Breast Cancer: A Series of Three Extremely Rare Cases
Authors: Latif Ahmed , Suliman Amna , Nagarajakumar Anupama , Khan Mihir , Metafa Anna , Uhercik Michal
Published: October 2021

Aims

Male breast cancer (MBC) is rare and accounts for 1% of all breast cancers. We present a case series of three very rare histological subtype MBC within one year in a UK hospital.

Methods

We retrospectively identified all MBCs from the local breast cancer database. Their presentations, radiology and histopathology were analysed.

Results

Three MBCs were identified from 2019 to 2020. A healthy 28-year-old presented with a right breast lump. Ultrasound (USS) revealed a partially cystic 15mm U3 lesion. Mammography (MMG) was suggestive of gynaecomastia (M2). Biopsy was inconclusive. Diagnostic excision revealed Papillary Ductal Carcinoma in Situ (DCIS) with involved margin. Mastectomy and Sentinel Node Biopsy (SNB) confirmed low-grade Papillary DCIS.

A 48-year-old with background of hyperlipidaemia presented with a 2-year history of left axillary lump. PET CT demonstrated an FDG-avid lesion. USS showed a superficial U3 28mm lesion. MMG showed a 34mm density (M4). Biopsy identified Mucinous Carcinoma. Wide Local Excision and SNB confirmed grade 2 Mucinous Carcinoma.

A 75-year-old with history of cardiac disease, COPD and Type 2 Diabetes, presented with a right retro-areolar lump. MMG identified a 47mm mass (M4). USS showed a 41mm cystic lesion with wall thickening (U4). Cytology was inconclusive. Biopsy identified intra-cystic papillary carcinoma. Mastectomy and SNB confirmed intra-cystic papillary carcinoma. All three histological subtypes are extremely rare and account for less than 4% of all MBCs.

Conclusions

MBC is rare but increasing in incidence. More research and awareness are needed to minimise delays in diagnosis and treatment even in young men.
EP.TH.108A Descriptive Case Series of Incisional Hernia Repair Using Dual Mesh Technique
Authors: Theodorou Chloe , Moinuddin Zia , Dellen David Van
Published: October 2021

Aims

Incisional hernias are a common complication after surgery that cause significant patient morbidity. Symptomatic patients are offered repair but many surgical techniques exist, with abdominal wall reconstruction becoming preferable for large complex defects. This paper describes our experience of abdominal wall reconstruction using a dual mesh technique.

Method

22 patients underwent incisional hernia repair between March 2019 and September 2020. All patients received dual mesh, placed in retrorectus or transversalis fascial/retromuscular space. Absorbable BIO-A GORE mesh was used with a polypropylene mesh above. All patients were followed up to assess for complications and recurrence.

Results

No patients experienced fistula formation, long-term pain or obstructive symptoms.

We report one true hernia recurrence (4.5%) and one case of infected mesh (4.5%), these both await further treatment. One patient had a proven wound infection which resolved with conservative treatment. 4 patients (18.2%) experienced seromas, 3 of these resolved spontaneously, one requiring image-guided drainage.

Conclusion

Incisional hernia repair using combination polypropylene and bio-absorbable mesh provides a safe and effective repair with low recurrence and incidence of surgical site occurrences in the short term. Longer follow up and further studies are needed to evaluate this mesh technique to support ongoing use of absorbable meshes in complex hernia repair.
EP.TH.109Full cycle audit reviewing the post-operative blood transfusion rate in open hernia repairs in order to reduce the number of pre-operative Group and Save Tests required: an aid to rational resource utilisation of finite resources during the COVID-19 pandemic
Authors: Wong Nicholas , Anantaprakorn Navamint , Conn Gemma , Pearson Thomas
Published: October 2021

Aims

Open hernia repairs are common elective and emergency surgical procedures; the majority are performed without complication. A primary audit indicated pre-operative group and save could be disregarded without compromising safety. A selective group and save policy was introduced, and safety of this approach examined with a 2nd cycle audit.

Methods

Retrospective review of electronic patient records between October 2019 to September 2020. Cross referencing of operative and blood transfusion records performed compared to the primary audit cycle of April 2018 to March 2019.

Results

A total of 225 open hernia repairs including inguinal, femoral and all other abdominal wall hernias were performed during the 2nd cycle compared to 410 in the 1st cycle. Patients were ASA 1-5 including emergencies.

The post-operative blood transfusion rate was reduced from 1.46% to 0% following implementation of the selective policy. The number of pre-operative group and saves obtained reduced to 117; saving £6,840.19.

Conclusions

This single centre full cycle audit indicates pre-operative group and save tests are unnecessary in open hernia repair. A selective group and save policy introduced for certain patient characteristics such as emergency repair, ASA ≥3 or abdominal wall reconstruction reduced the post-operative blood transfusion rate to 0%.

Discontinuing mandatory pre-operative group and save is a safe approach synchronously reducing clinical and financial burden. COVID-19 has stretched already limited resources, resulting in reduced surgical services and diminished case numbers during the 2nd cycle. Therefore, rational resource utilisation with a selective group and save policy maintains patient safety during the pandemic.
EP.TH.111Assessing the efficacy of the modified S-PECS anaesthetic block in patients undergoing breast augmentation surgery – a randomised double-blind control trial
Authors: Saghir Noman , Saghir Reyan , Sidhu Manu , Okhiria Terrell , Okhiria Renee , Sforza Marcos
Published: October 2021

Aim

Postoperative acute chronic pain following breast surgery is a common complication which needs resolving to allow for improved patient outcomes. Previously thoracic epidurals and paravertebral blocks (PVB) have been the gold standard administered intra-operatively. However, more recently the introduction of the Pectoral nerve block (PECS and PECS-2 blocks) has looked promising to control the pain more effectively, but further robust analysis is required to prove its efficacy. The authors aim to study the efficacy of a new block S-PECS that comprises a serratus anterior and a PECS-2 block associated.

Methods

In this study we performed a prospective, single-centre randomised controlled double-blind group trial in 30 female patients undergoing breast augmentation surgery with silicone breast implants and the S-PECS block. Divided into groups of 15, the S-PECS group received local anaesthetics with the no-PECS control group receiving a saline injection. All participants were followed up at recovery (REC), 4, 6 and 12 (4H, 6H and 12H) hourly postoperatively.

Results

Our results showed that the pain score in the S-PECS group was significantly less than the no-PECS group across all time points REC, 4H, 6H and 12H. Furthermore, the patients that received the S-PECS block were 74% less likely to request pain medications compared to the no-PECS group (p < 0.05).

Conclusion

Overall, the modified S-PECS block is an effective, efficient and safe method of controlling pain in patients undergoing breast augmentation surgery with additional applications yet to be explored.
EP.TH.174The FLIP Study – Fluid Resuscitation in Pancreatitis
Authors: McGovern Julia , Moir John , Tingle Sam , Hawthornwaite Emma , Robinson Stuart ,   Northern Surgical Trainees Research Association NOSTRA
Published: October 2021

Acute pancreatitis is a common condition encountered in emergency general surgical presentations. The severity of this condition can range from mild to severe and potentially life threatening in up to 20% of cases. Intravenous fluids are the cornerstone of management however there is very little guidance and poor quality evidence regarding optimal intravenous fluid administration. Aim to establish current clinical practice regarding the rate of intravenous fluid administration in acute pancreatitis and the effect this has on patient morbidity and mortality.

A prospective multi-centre audit of patients presenting with acute pancreatitis in the North East of England (Sixty days recruitment with 30-day follow-up, November 2020 – February 2021). Patients aged 18 years or above with acute pancreatitis will be included. Data will be collected on intravenous fluid administration within 72 hours of admission. The primary outcome measure will be admission to HDU/ITU with secondary end-points including 30-day mortality, length of stay, radiological evidence of necrosis, and evidence of organ failure.

Data collection has commenced across nine sites with over 150 patients recruited to date. The results of this study will be prepared in accordance with guidelines set by the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement for observational studies. Data will be analysed using SPSS. Statistical significance will be defined as a p value of ≤ 0.05.

Data collection will be completed in February 2021. Pending the results of phase one, an RCT will be designed to determine the optimal rate of intravenous fluids for improved patient outcomes.
EP.TH.249Evaluating the incidence and predictors of readmission in patients awaiting cholecystectomy for previously diagnosed acute gallstone disease
Authors: Noureldin Khaled , Razzaq Humayun , Najdawi Amal , Dick Georgina , Whelan Katy-Louise , Ayantunde Abraham
Published: October 2021

Background

Recurrent hospital admission remains a major issue with patients awaiting surgery for symptomatic gallstones. We evaluated the incidence and predictors of readmission in patients previously admitted with acute gallstone disease.

Patients and Method

We analysed laparoscopic cholecystectomies performed between January 2018 and December 2019. Data relating to the acute index admissions, readmissions, waiting time to surgery, operative details including emergency, elective procedures and conversion rates were analysed.

Results

532 procedures were performed over a two-year period. Patients with non-acute gallstones (111), primary open (4) and abandoned procedures (2) were excluded. Median age 415 included patients was 50(13-89) years and a male to female ratio of 1:3. Index admission presentations were acute cholecystitis (41.7%), biliary colic (23.1%), pancreatitis (15.9), obstructive jaundice (9.2%) and combinations (10.1%). 56.4% of the of the patients were readmitted between 1-6 times before surgery. Readmission diagnoses were cholecystitis (12.5%), biliary colic (26.7), pancreatitis (8.2%), obstructive jaundice (8.0%), acute cholecystitis with gallbladder perforation and abscess (0.5%), post-ERCP pancreatitis (0.5%) and pancreatic pseudocyst (0.2%). 14.9% of the patients underwent emergency procedures. Overall conversion rate was 1.4%. Median waiting time to surgery was 12(0-123) weeks. Waiting time to surgery was significantly lower in gallstone pancreatitis compared with other presentations (p-value 0.008). Acute pancreatitis (p-value 0.0001) and complicated index presentations (p-value 0.0001) were predictors of recurrent symptoms and readmission. Age, gender, comorbidities, high BMI, ASA have no significant impact on readmission episodes.

Conclusion

Readmission is a common occurrence following acute gallstone attacks with acute pancreatitis and complicated index presentations as significant predictors.
EP.TH.273Intestinal Malrotation in Adults: A case series and Literature Review
Authors: Rajebhosale Ramprasad , Chidambaranath Rajesh , Cleto Cindy , Parmar Dylan , Husain Najam , Thomas Pradeep
Published: October 2021

Aim

Midgut malrotation is a rare but a very well-known congenital anomaly. It is a result of non-rotation, incomplete rotation or reversed rotation and fixation of midgut. Delayed diagnosis due to non-specific symptoms in elective cases and conversion to laparotomy due lack of intra-operative anatomical understanding in emergency cases imposes increase in patient dis-satisfaction, delayed recovery and healthcare cost burden. Here we report an interesting case series which impose a significant diagnostic challenge due to atypical clinical and radiological signs. Management of such cases by minimal invasive surgery is possible if general surgeons are aware of unusual anatomy and general practitioners are aware of such known but rare cases.

Cases

Two patients who presented on background of on and off recurrent non-specific attacks of abdominal pain, one of them as an emergency as midgut volvulus, were diagnosed radiologically and treated laparoscopically. The other one presented as an acute appendicitis and was converted to laparotomy, in spite of good laparoscopic expertise due to lack intra-operative anatomical understanding.

Conclusion

In the era of laparoscopic surgery, a general surgeon should encounter such an unusual case once in a lifetime. It is of paramount importance to be well verse with such unusual cases. General Practitioners should be aware of such atypical presentations of rare conditions causing recurrent abdominal pain. They should consider appropriate further imaging investigations and referrals for best possible patient care.
EP.TH.282Adherence to ERAS® Society recommendations following elective colonic surgery (2012) in regard to urinary drainage, postoperative nutritional care and intra-abdominal drainage
Authors: Limnatitou Dimitra , Franklyn Joshua , Douie Walter
Published: October 2021

Aims

Evaluating adherence to ERAS® recommendations for post-operative urinary drainage, nutritional care and intra-abdominal drain placement in elective colorectal surgery.

Methods

Approval was obtained by the audit department of a university teaching hospital. Data was collected prospectively over a seven-week period for nineteen (n = 19) patients. Results were compared against the standard set by the ERAS® Society (2012).

Results

Right colonic surgery (n = 5): catheter removed on post-operative day (POD) 1 n = 1 (20%), normal diet started on POD 0 or 1 n = 3 (60%), IV fluids discontinued on POD 1 n = 3 (60%) and n = 4 (80%) did not have a drain placed. High anterior resection or left/subtotal colectomy (n = 9): catheter removed on POD 1 n = 3 (33%), normal diet started on POD 0 or 1 n = 4 (44%), IV fluids discontinued on POD 1 n = 3 (33%) and n = 2 (22%) did not have a drain placed. Low rectal surgery (n = 4*, *one patient, n = 1, excluded from all domains except intra-abdominal drainage due to immediate post-op complication): catheter removed on POD 3 n = 4 (100%), normal diet started on POD 0 or 1 n = 2 (50%), IV fluids discontinued on POD 1 n = 1 (25%) and all patients had a drain placed n = 5 (100%).

Conclusions

Adherence for urinary drainage in low rectal surgery and intra-abdominal drainage for right colonic surgery was satisfactory. Multiple areas of improvement were identified, in order to optimise compliance, and recommendations were generated. The exception may be drains for lower rectal surgery where recent data has recommended selective drain placement.
EP.TH.342Using aboutmyop.org to measure quality of life using ePROMs in patients undergoing elective laparoscopic cholecystectomy – a feasibility study
Authors: Daliya Prita , Lobo Dileep , Parsons Simon
Published: October 2021

Introduction

The collection of Patient Reported Outcome Measures (PROMs) have many benefits for clinical practice. However, there are also many barriers that prevent it from becoming a part of routine clinical care. The aim of this study was to pilot the use of aboutmyop.org; a digital data-sharing platform, as a means to collecting electronic PROMs (ePROMs) and validate the ePROMs questionnaires used.

Method

Patients listed for elective laparoscopic cholecystectomy were asked to complete digital versions of the Otago gallstones Condition-Specific Questionnaire (CSQ), and the RAND 36-item health survey (SF36) on aboutmyop.org, pre- and post-operatively. In addition to ePROMs, patient demographics and 30-day clinical outcomes were recorded. An assessment of methodological quality of ePROM questionnaires was also performed.

Results

Pre-operative ePROMs were completed in 200 laparoscopic cholecystectomy patients. Despite participant drop out a significant improvement in quality of life was seen across all health domains post-operatively when compared to baseline pre-operative values for both disease-specific (emotional functioning; Pre-operative: 48.9, 30-days: 15.6, 3-months: 16.7, 6-months: 7.9, p < 0.05) and generic (emotional well-being; Pre-operative: 60.1, 30-days: 73.7, 3-months: 74.3, 6-months: 73.5, p < 0.05) PROMs. Methodological quality was assessed as good to excellent in both digital questionnaires used in the aboutymyop.org system.

Conclusion

The collection of ePROMs by a digital utility such as aboutymyop.org is possible with current technological advances. Although it may be an acceptable, and convenient process for patients, and a useful measure of quality of life trends for clinicians, further developmental work is necessary to improve accessibility for patients and reduce reporting bias.
EP.TH.359Improved Oesophagogastric Cancer Outcomes in Rural Patients
Authors: Griffin Fiona , Hunter Ross , Nanthakumaran Shayanthan , Ramsay George
Published: October 2021

Introduction

Despite advances in medical therapies and surgical techniques, oesophagogastric cancer survival remains low. Poorer cancer outcomes and survival for rural dwellers is well documented worldwide and has been an area of focus in Scotland since 2007, with changes to suspected cancer referral guidelines and a government report on delivering remote and rural healthcare.

Methods

A prospective, single-centre observation study was conducted utilising data from oesophago-gastric cancer MDT referrals and outcomes from January 2013 to December 2019. The Scottish Index of Multiple Deprivation 2020 tool provided a rurality code based on patient postcode at time of referral. Survival outcomes for urban and rural patients were compared across demographic factors, disease factors and stage at presentation.

Results

1046 patients were included in this study. The median age of presentation for urban and rural patients was 73.7 and 72.4 respectively. There was no significant difference between oesophageal versus gastric cancer presentations nor was there any difference between T, N or M stage at presentation between the groups. No difference was identified between those commenced on a radical therapy with other treatment plans. On Kaplan-Meier analysis there was a difference in survival between the groups favouring rural dwellers (p = 0.012).

Discussion

The difference in survival demonstrated here between urban and rural groups is not easily explained but may represent improvements to rural access to healthcare delivered as a result of policy change. This is an interesting finding and this study should be expanded to include performance status at time of referral.
EP.TH.421A Systematic Review of Early versus Late Closure of Loop Ileostomy
Authors: Aljorfi Ahmed , Alkhamis Abdulhameed
Published: October 2021

Aim

A Loop ileostomy is one of the most common techniques used in colorectal surgery, in order to protect either a downstream colorectal anastomosis or a coloanal anastomosis. However, it is a procedure that can cause a plethora of complications. Currently, there is no consensus regarding the optimal time for its reversal. Some studies suggested the early reversal of ileostomy procedure as a solution to reduce these complications. This study aims to review the available literature in order to ascertain the benefits behind early closure of loop ileostomy.

Methods

The literature was searched for all studies that included a comparison between the outcomes of early and late closure of loop ileostomy in terms of morbidity, mortality, or quality of life, where available. Early closure of loop ileostomy is defined as closure less than three months and late as more than three months, in accordance with conventional literature. The resultant articles were filtered using our inclusion and exclusion criteria. Finally, the remaining articles were assessed for quality and their results were compared to one another in order to draw our conclusions.

Results

The results were slightly inclined toward early closure of loop ileostomy, despite the limitations of the studies reviewed.

Conclusion

There were limitations of the studies reviewed, including the heterogenicity of studies, selection bias, lack of clear definition of measured outcomes, and small sample size. Taking that into consideration, the results of early closure of loop ileostomies in the selected patients were promising and require further investigation.
EP.TH.494Preclinical feasibility of in situ isolated normothermic liver chemoperfusion
Authors: Clark Tamsyn , Ebeling Georg , Voyce Daniel , Bau Luca , Coussios Constantin , Friend Peter
Published: October 2021

Aims

Up to 85% of patients with liver metastases have inoperable hepatic tumour burden. Isolated liver perfusion involves vascular isolation of the liver in situ and regional delivery of chemotherapy, avoiding dose-limiting extra-hepatic toxicity. In this series, we develop a surgical protocol to demonstrate the feasibility of isolated normothermic liver perfusion (INLP) and investigate short-term safety and feasibility of delivering high-dose chemotherapy.

Methods

Laparotomy and complete, vascular isolation of the liver was performed on 55-65Kg pigs (n = 6). The hepatic artery (HA), portal vein (PV) and inferior vena cava were cannulated and liver NMP established. Veno-venous bypass maintained systemic circulation. High-dose doxorubicin was administered to the isolated liver, circulated for 1 hour and vascular reconnection performed. Physiological parameters were measured and doxorubicin quantified in blood, bile and tissue by high-performance liquid chromatography.

Results

INLP with doxorubicin delivery achieved physiological flow rates (PV 0.7L/min (0.6-0.9L/min); HA 0.3L/min (0.2-0.4L/min)) and pH (median 7.3 (7.24-7.38)), with a median lactate of 0.42mmol/L. Median peak AST and ALT were 1045 U/L and 47 U/L respectively. Doxorubicin decay was fitted with a 2-compartmental model; distribution half-life was 1.9 minutes and plasma Cmax was higher than if given systemically resulting in mean hepatic tissue levels of 26+/-11.6 µg/g. There was no leak during INLP and doxorubicin was undetectable in kidney or heart.

Conclusions

Surgical isolation and NMP of the liver in situ, with concurrent veno-venous bypass is feasible and enables high-dose drug delivery resulting in therapeutic tissue levels with no off-target toxicity. Further safety studies are required.
EP.TH.594Is Laparoscopic Common bile duct exploration feasible after failed ERCP?
Authors: Al-Ardah Mahmoud , Barnett Rebecca , Whewell Harriet , Boyce Tamsin , Rasheed Ashraf
Published: October 2021

Aims

Concomitant gallstones and common bile duct stones are a common problem with no consensus on the best management approach. Our aim is to review the outcomes of laparoscopic clearance of common bile duct stones after failed ERCP.

Methods

We retrospectively studied all cases that had a failed ERCP prior to surgery in 200 cases of laparoscopic cholecystectomy with common bile duct exploration performed between 2006 and 2019.

Results

Twenty-two patients underwent a laparoscopic common bile duct exploration after failed ERCP. Seventeen of these were before 2013. Eleven (50%) of these were after at least one failed attempt at clearance. In 8 patients (32%) the duct was not accessible (failed cannulation) due to a variety of reasons. Nine patients had large and impacted stones, two patients had Mirrizi syndrome with concomitant CBD stones, 2 had multiple stones and one a missed stone discovered intraoperatively.

CBD clearance was successful in 19 patients (88%), 8 were completed by a transcystic approach and 14 by a transcholedochal approach.

Post-operative length of stay was 12 (±10) days. 1 patient had an unplanned re-admission within 30 days. 1 patient required re-operation for bleeding. 3 patients developed recurrent stones and 1 developed a subsequent stricture. No mortalities were recorded.

Conclusions

Laparoscopic common bile duct exploration is feasible and safe as a secondary procedure after failed ERCP. New technologies and advancements in surgical techniques will continue to improve success and morbidity.
EP.TH.602Exploring decision-making of healthcare professionals in patients with benign large non-pedunculated colonic polyps (BLNPCP) virtually using combined focus group and nominal group technique
Authors: Wheldon L , Morgan J , Lee MJ , Riley S , Brown SR , Wyld L
Published: October 2021

Aim

We aimed to elicit key factors that influence healthcare professional decision-making when deciding treatment for BLNPCP.

Background

Benign large non-pedunculated colonic polyps (BLNPCP) may harbour covert malignancy and opinions differ about the optimal treatment modality. There are several options available, including endoscopic mucosal resection, endoscopic submucosal resection, combined endoscopic laparoscopic surgery and surgical resection. Despite widespread availability of endoscopic resection techniques, there are high rates of surgery in the UK.

Methods

Three focus groups of healthcare professionals, comprised of either consultant colorectal surgeons, nurse endoscopists and consultant gastroenterologists, were conducted virtually utilising the Nominal Group Technique. Meetings were recorded and transcribed verbatim. Themes were devolved using the framework approach for qualitative analysis. A priority-ranked list of factors influencing healthcare professional decision-making in this setting was generated.

Results

Five main themes were identified as influencing decision-making: Shared decision making (patient preference, informed consent); Patient factors (co-morbidity, age, life-expectancy); Polyp factors (Location, size, morphology, risk of cancer); Healthcare professionals (skill-set, personal preference); System factors (techniques availability locally, regional referral networks). Nominal Group Technique generated 55 items across the three focus groups. Nurses and gastroentologists ranked patient factors (particularly drug history and tolerance of procedure) and shared decision making (patient preference) more highly then surgeons. Surgeons placed greater emphasis on polyp factors particularly location and the risk of submucosal invasive carcinoma.

Conclusion

Decision making is complex and multifactorial. These results support the benefits of complex polyp MDTs and patient involvement in the decision-making. The complexity of decision-making may underpin wide variation in practice.
EP.TH.625Consenting for a Bedside Procedure: A Prospective Observational Analysis of Consenting Practice in the Surgical Emergency Admissions Unit of a District General Hospital
Authors: Mishra Shashwat , Davis Heather , Balakumar Charannya , Shrestha Ashish
Published: October 2021

Aims

Consent is necessary to enable patient autonomy and essential to providing good clinical care. Recent case law has grown around consent and practice guidance has evolved. This was a prospective, observational study consisting of two cycles. It investigated the quality of consent for bedside incision and drainage (I&D) procedures performed in the surgical emergency admissions unit (SEAU) at a district general hospital compared with GMC guidance.

Methods

A prospective analysis of consent documentation was performed from August to September 2020. Data was gathered for quality of consent including risk and benefit discussions, local anaesthetic used, operation note documentation and procedure discussion. We communicated these results at a departmental level, increased awareness of available consent forms and placed them in more accessible locations. Data to see the benefit of these interventions were gathered from November 2020 to January 2021.

Results

In cycle one, of 20 cases (n = 20), 5.0% had written consent documentation, and 75.0% had verbal consent documentation. 20.0% of cases had no consent documented. Following interventions, of 14 cases (n = 14), 57.1% of cases had written consent documentation, and 7.14% had verbal consent documentation. 35.0% of cases had no consent documented.

Conclusion

This study highlighted a deviation from GMC guidance. Interventions have shown to increase the proportion of cases with written consent. Overall cases with no written evidence of consent remain high and further work is required to increase compliance. We aim to refine the interventions we have implemented in order to promote the highest quality of consent documentation.
EP.TH.640Outcomes in Elective and Emergency Laparoscopic Cholecystectomies in a District General Hospital
Authors: Nur Ahmed , Agrawal Aditya
Published: October 2021

Aims

To evaluate early perioperative outcomes following emergency and elective laparoscopic cholecystectomies in a district general hospital against the national average.

Methods

A retrospective audit was carried out on consecutive Laparoscopic Cholecystectomies performed between January 2020 and June 2018. All indications were included. Demographics and base data included; age, gender, ASA grade, type of surgery (Emergency/Elective), number of symptomatic days preoperatively, preoperative bloods, preoperative ERCP, operative findings, postoperative complications and length of stay. Data was gathered from physical and electronic patient records.

Results

166 laparoscopic cholecystectomies were included in the audit. Of the 166 included patients, 48 were male and 118 were female. Mean age at time of operation was 53.4 years. 106 of the laparoscopic cholecystectomies were carried out as Elective cases and 60 were performed as Emergencies. 100% of cases were performed laparoscopically, with 3 cases requiring conversion to open intraoperatively. Postoperatively, 5 patients had post-op pneumonia. There were 3 documented cases of bile leak with 1 patient requiring ERCP as a result. There were 2 cases of wound infection requiring re-admission. Other documented complications included; umbilical port sit abscess requiring incision and drainage, collection in the gallbladder fossa, small bowel injury and a post-op drop in Haemoglobin requiring transfusion.

Conclusions

Outcomes in this cohort of patients undergoing laparoscopic cholecystectomies are comparable to national data. The focus of further evaluation from this cohort should be to compare outcomes between Emergency and Elective Laparoscopic Cholecystectomies, with Emergency cases further stratified according to the number of symptomatic days preoperatively.
EP.TH.649Identifying Factors Associated with Readmissions after acute biliary admission. Can it help prioritising patients in COVID recovery plans?
Authors: White Annabelle , Refalo Andrew , Widlund Hedda. , Knight William , Ebied Husam
Published: October 2021

Aim

We conducted a retrospective analysis of readmissions after Acute admission with biliary pathology managed conservatively under the Surgical Team in a teaching London Hospital from 01/03/2019-29/02/2020

Methods

We obtained records of patients admitted with Acute Cholecystitis, Biliary Colic, Cholelithiasis, Choledocholithiasis and Gallstone Pancreatitis from the Audit Department between 01/03/2019-29/02/2020, and analysed these regarding patient demographics, comorbidities, duration of index admission, method of diagnosis and management and identified patients’ readmissions

Differences in readmission rates based on before mentioned characteristics were studied.

Results

157 patients presented between 01/03/2019-29/02/2020, 76 acute cholecystitis, 22 Biliary Colic, 24 Gallstone Pancreatitis, 6 Ascending Cholangitis and 29 Choledocholithiasis

The highest representation rate was for patients with choledocholithiasis (41.3%) followed by Acute Cholecystitis (31.5%), 3 patients required cholecystostomies.

Baseline characteristics and differences in these characteristics based on occurrence of readmission were studied.

45-60 age group, increasing comorbidity, and biliary obstruction were all associated with increased risk of readmission.

Conclusion

Readmissions is a substantial burden on the health care services and patient’s safety and QoL

We propose adherence to the NICE/BSG Guidelines for management of Acute Biliary Disease, to alleviate this pressure which is already sometimes challenging due to the logistics and resources and would be more challenging with the COVID situation and limited emergency and elective theatre availability so the group at high risk of readmission should be prioritised in the recovery plans.