bluuebunny/crossref_metadata_2025 huggingface dataset:
WTP8.12 Measurement of a panel of biological markers in breast cancer, a comparison between core needle biopsy and surgical excision samples
Authors: Parks Ruth , Green Andrew , Cheung KL
Published: August 2023

Aims

ER, PR and HER2 are routinely measured in breast cancer in clinical practice. Numerous other biomarkers exist which are only utilised in a research setting, but may have a potential role in breast cancer. The majority of research in breast cancer is conducted in surgical excision (SE) specimens due to the availability of tissue; however, it is important markers can be measured in core needle biopsy (CNB) samples in patients undergoing neoadjuvant or non-operative treatment.

Methods

A panel of 15 biomarkers was measured in 202 CNB and paired SE samples in a series of older women with primary breast cancer using immunohistochemistry and H-scores: ER, PR, EGFR, HER2, HER3, HER4, VEGF, p53, BRCA1, LKB1, Ki67, BCL2, CK5/6, CK 7/8, MUC1. Concordance rates were calculated between positive/negative cut-offs for each marker measured in the two samples.

Results

The percentage concordance rates between positive/negative cut-offs were >60% for ER, PR, EGFR, HER2, VEGF, p53, Ki67, BCL2, CK 7/8, MUC1 and <45% for HER3, HER4, CK 5/6, BRCA1 and LKB1. In general, cases were more likely to be positive in the SE sample. This could suggest SE result is an overestimation of the true value and CNB is more accurate, or at least not likely to overestimate.

Conclusions

The biomarkers most frequently studied in breast cancer (ER, PR, EGFR, HER2, VEGF, p53, Ki67) did show good concordance between SE and CNB samples. This may suggest that for markers less frequently studied, there is disagreement with interpretation of staining, leading to greater variation.
ThTP1.4 Should surgical candidates with a pancreatic head malignancy undergo resection within twenty-eight days of staging or undergo a repeat scan prior to surgery?
Authors: Russell Thomas , Labib Peter ,   RAW Study Collaborators, Aroori Somaiah
Published: August 2023

Aims

Suitable patients with a suspected pancreatic head malignancy should undergo timely pancreatoduodenectomy (PD) as pancreatic cancer is aggressive and recurrence rates are high. This study aimed to compare the outcomes of patients who did and did not undergo PD within 28 days of staging.

Methods

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

Results

595 patient were included; median time from staging computed tomography (CT) to PD was 32 days (IQR: 38). The groups were similar in terms of age, sex and radiological stage. A similar number of patients in each underwent preoperative magnetic resonance imaging, positron emission tomography-CT and/or endoscopic ultrasound (EUS). However, those who underwent delayed PD had more often undergone staging laparoscopy (13.6% vs 5.9%, p=0.002) or preoperative biliary stenting (PBS, 69.2% vs 45.6%, p<0.00001). This group also had higher rates of histological T3 disease (85.4% vs 72.5%, p=0.0001) and R1 resection (57.8% vs 46.5%, p=0.01). Five-year recurrence/survival rates were similar.

Conclusions

Patients who underwent delayed PD had more often undergone staging laparoscopy or PBS. These investigations/interventions should only be performed when necessary. Although those with a delayed CT were more likely to have at least one positive resection margin, five-year outcomes were similar.
ThTP2.4 Long-Term Changes in Leptin, Chemerin, and Ghrelin Levels Following Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy
Authors: Salman Mohammed , Noureldin Khaled , Issa Mohammed , Agwa Hisham , Fadlallah Elhaj Mujahid Gasemelseed , Shalaby Ahmed
Published: August 2023

Aim

Published reports showed conflicting results regarding the sustained alterations in leptin, chemerin, and ghrelin concentrations after metabolic surgery. Therefore, we performed the present work to contrast the alterations in leptin, chemerin, and ghrelin levels one year after Roux-en-Y gastric bypass (RYGB) versus laparoscopic sleeve gastrectomy (LSG).

Methods

The present research is a prospective, comparative one that followed 100 cases for whom RYGB or LSG was done. We assessed the serum values of adiposity-associated mediators, including adipokcytokines (leptin and active chemerin) and gastrointestinal hormones (total ghrelin). The primary outcome in the present study was the alterations in leptin, chemerin, and ghrelin values at 12 months after RYGB and LSG.

Results

The serum leptin level decreased significantly in the LSG group with a mean change of − 170.8 ± 29.4 ng/mL (p <0.001). Similarly, the serum leptin concentration decreased significantly in the RYGB group, with a mean change of − 165.42 ±53.4 (p < 0.001). In addition, the mean reduction in baseline chemerin levels 12 months after the operation was considerable in the LSG cohort (− 23.24 ± 9.5 ng/mL) and RYGB group (− 22.12 ± 15.9 ng/mL). The ghrelin values demonstrated a notable reduction in the LSG cohort (− 0.083 ± 0.11 pg/mL) and RYGB group (− 0.068 ± 0.097 pg/mL). However, the changes in the three hormones were not substantially different between both groups (p > 0.05).

Conclusion

Both RYGB and LSG result in a considerable, comparable decrease in the postoperative serum concentrations of leptin, chemerin, and ghrelin.
ThTP2.7 A 5-year retrospective review of intra-operative cholangiogram utilisation: do we need a pathway?
Authors: Bezzaa Sabrina , Kapsampelis Panagiotis , Murabit Ferass , Khalifa Khalid , Gerogiannis Ioannis
Published: August 2023

Aim

Current guidance gives no clear consensus on using routine vs selective intra-operative cholangiograms (IOC) during laparoscopic cholecystectomy. This is a controversial area with underuse risking bile-duct injury but overuse wasting theatre time and resources. The study aimed to review our local practice of IOC.

Method

Data was collected from electronic records for all patients undergoing IOCs from 2017 to 2022 at a single District General Hospital (DGH). Statistical analysis was performed using R.

Results

Ninety-six patients underwent IOC (74 elective, 22 emergency). In 64 (67%), use of IOC was decided pre-operatively (planned), 28 (29%) was decided intra-operatively (unplanned), and unclear in four cases (4%). All patients underwent pre-operative imaging. Imaging was negative for choledocholithiasis in 61 cases (64%). Indications for IOCs were abnormal anatomy (18%), deranged biochemistry (32%), abnormal imaging (21%) and confirmed choledocholithiasis (7%). The indication for IOC was unclear in 21 patients (22%). IOCs revealed abnormal findings in 21 cases; 10 required post-operative ERCP/EUS, 6 required further imaging and three were referred to a tertiary centre (for potential bile duct injury). On average, elective cases with unplanned IOC lasted 28 minutes longer (95% CI 4 to 52, p=0.013) than planned IOC.

Conclusions

Our study revealed that IOC indication was not documented consistently, and unplanned elective IOC cases lasted significantly longer. Therefore, we propose a local pathway to identify, pre-operatively, the patients who need IOC. This will result in safer patient care and less operating time and resources. Furthermore, dedicated IOC lists may help DGHs streamline theatre lists and improve efficiency.
ThTP4.5 Outcomes of colorectal cancers can be improved - 10 year Results from a South Asian Tertiary Center
Authors: Kazi Mufaddal , Raj Prudvi , Nadkarni Shravan , Sharma Vivekanand , Saklani Avanish
Published: August 2023

Introduction

Colorectal cancers are the most common gastrointestinal cancers and continue to rise in numbers. We aimed to compare the outcomes of all colorectal cancers after a five year period of change in practice.

Methods

We compared the demographic, clinical, treatment, and outcomes parameters of all rectal cancer patients registered at our hospital in the year 2013 to those in 2018. A total of 1442 patients, 511 in 2013 and 931 in 2018 were included.

Results

Median age reduced from 46 years to 40 years, with the proportion of young rectal cancers (≤45 years) increasing from 49% to 70% in 2018. A shift towards low rectal cancers, poorly differentiated and signet-ring cell histology was also observed in 2018. More patients in 2018 presented with advanced T and N stage with similar rates of distant metastatic disease at initial diagnosis. Curative intent treatment was offered to 1179 patients, and neoadjuvant radiation was offered to similar proportions with an increasing use of short-course radiation in 2018. Higher default and progression rates were observed in 2018 (30.2% vs 40.8%), and fewer patients could receive definitive surgery. At a median follow up of 96 months for the 2013 group and 32 months for the 2018 cohort, the 3-year OS was 47.5% and 73.3% for the 2013 and 2018 registered patients, respectively.

Conclusions

The increase in survival for every stage of rectal cancer in five years interval despite more advanced and aggressive tumours, suggest the augmentation and improvement in services offered at the colorectal unit.
ThTP5.3 Outcome of weekend physiotherapy input post emergency laparotomy
Authors: Ng Hwei Jene , Burke Mhairi , Clark Maggie , Moug Susan
Published: August 2023

Aims

Early ambulatory has been shown to reduce risk of morbidity and length of stay. It is evident in elective laparotomy patients but there is limited data on emergency laparotomy patients. We aim to explore the outcome of morbidity and physiotherapy input over weekend.

Methods

Patients ≥18 years old underwent emergency laparotomy (EmLap) as per NELA criteria from July 2021 to Dec 2021 in a busy district hospital were reviewed. Data on demographics, physiotherapy input and morbidity (post-operative ileus and pneumonia) were analysed. P-value of <0.05 was considered significant.

Results

A total of 81 patients were included with 56% female and median age 69 years. Ratio of smoker: Non-smoker: Ex-smoker was 1:4:1. 74% were seen by physiotherapist over the weekend (POW) and 48% had chest physiotherapy post-operative day 1. The overall rate of post-operative ileus was 18.5% (19% no-POW vs 18.3% POW; p= 0.942) while the rate of post-operative pneumonia was 11.1% with 2/3 non-smoker (9.5% non-POW vs 11.7% POW; p= 0.855). Median post-operative length of stay was 10 days (8 days No-POW vs 11 days POW).

Conclusion

Physiotherapy input post EmLap over the weekend did not significantly improve morbidity. Weekend input is provided by the oncall physiotherapist and the requirement of the service could reflect the high risk status of patients. Besides physiotherapists, ward nurses play an important role in continuous encouragement of mobilisation post-operative to reduce morbidity rate.
ThTP5.6 Decision to Incision Time: Can the principle be applied to emergency general surgery in order to tackle delays in patient care?
Authors: Smith Charlotte , Aly Emad
Published: August 2023

Introduction

General surgical patients who require emergency surgery should have timely access to operating theatre to ensure optimal outcomes. It is important to evaluate delays to identify contributing elements and help to improve standards of surgical care. The decision to incision time interval is a benchmark used in obstetric practice. This study aimed to assess the use of this time interval in the emergency general surgical setting to consider whether the principle may be translatable.

Methods

Prospective data were collected on patients undergoing emergency general surgery in a tertiary care centre over four weeks. Data were extracted from patient notes and anonymised for statistical analysis.

Results

No statistically significant associations were found with the studied variables and decision to incision time. However, this study identified clear delays, with 66% of emergency operations taking place after target time assigned by NCEPOD classification. It identified trends in varying decision to incision time in patient and procedure type. It also identified issues with documentation and an association between longer decision to incision time and post-operative length of stay.

Conclusion

This study highlights important delays in emergency general surgery. Decision to incision time reveals important trends and, with larger sample sizes, may identify areas which hinder time-sensitive procedures. This study recommends that decision time could be more formally incorporated into surgical documentation to better monitor delays. The findings of this study could inform future research, which is required to determine the true potential of using decision to incision time interval in emergency general surgery.
ThTP5.11 The positive impact of our efficient Surgical Assessment Unit use on general surgery emergency readmission rates
Authors: Yahia Shuker , Wu Ting-Wei , Haji Altaf , Marimuthu Kalimuthu , Piramanayagam Bala
Published: August 2023

Aim

Hospital readmission rates are a general indicator of quality of care, however these rates are currently variable nationally. Lowering these rates will not only alleviate the financial burden of the National Health Service but will improve patient outcomes. Our primary aim was to establish if implementing a senior-led Surgical Assessment Unit would reflect positively on reducing the rates of avoidable emergency readmissions within 30 days of discharge, in our General Surgery department at a district general hospital.

Method

We compared two 3-month cycles of all General Surgery emergency readmissions in our department within 30 days of discharge from June to August 2022 versus August to October 2021. Data of 361 patients in cycle 2 versus 389 patients in cycle 1 were collected and analysed to determine the readmission rates and to prevent the potential avoidable factors.

Results

A total of 6.6% of patients were readmitted with various surgical conditions, and the number of extra days of hospital stay totalled to 26 extra days collectively. This is compared to 11%, and 69 days respectively from the previous cycle. The main reasons for readmission were recurrences of the original problem (namely pancreatitis), and post-operative infections.

Conclusion

Overall, our implemented action plan has reduced the rate of emergency surgical readmissions by 4.4%. However, the main factors for readmissions remained similar. We will continue to provide an efficient use of the Surgical Assessment Unit and senior-led discharge to ensure we minimise the rates of surgical readmissions.
ThTP6.5 Long term major adverse cardiovascular events following myocardial injury after non-cardiac surgery (MINS): A systematic review and meta-analysis
Authors: Quintela Ella , Strickland Scarlett , Wilson Matthew , Lee Matthew
Published: August 2023

Aims

Myocardial injury after non-cardiac surgery (MINS) is diagnosed following asymptomatic troponin elevation in the perioperative period. MINS is associated with high mortality rates and significant rates of major adverse cardiac events (MACE) within the first 30 days following surgery. However, less is known regarding its impact on mortality and morbidity beyond this time. This systematic review and meta-analysis aims to establish the rates of long term morbidity and mortality associated with MINS.

Methods

This review was registered with PROSPERO (CRD42021283995). Medline, EMBASE and Cochrane CENTRAL were searched, and abstracts screened by two reviewers. Observational studies and control arms of trials reporting mortality and cardiovascular outcomes beyond 30 days in adult patients diagnosed with MINS following non-cardiac surgery were included. Risk of bias was assessed using the Quality in Prognostic Studies tool (QUIPS). A random effects model was used for meta-analysis of outcome subgroups.

Results

Searches identified 40 studies. Meta-analysis of 37 cohort studies found a rate of MACE associated MINS of 21% and mortality following MINS was 25% at one year follow-up. A non-linear increase in mortality rates was observed up to 1 year post surgery. MACE rates were also lower in elective surgery compared to a subgroup which included emergency cases. Analysis demonstrated a wide variety of accepted MINS and MACE diagnostic criteria within the included studies.

Conclusions

A diagnosis of MINS is associated with high rates of poor cardiovascular outcomes up to one year. Work is needed to standardise diagnostic criteria and reporting of MINS related outcomes.
ThTP6.8 Incidence and management of non-resolution of Biliary Colic or Right Upper Quadrant pain Post Laparoscopic Cholecystectomy
Authors: Tabassum Tanzin , Lu Yanqiang , Sabri Atikah , Gupta Sanjay
Published: August 2023

Background

The pathogenesis and risk of chronic pain after laparoscopic cholecystectomy are not well understood. Post-cholecystectomy syndrome describes persistence of biliary colic or right upper quadrant pain with a variety of GI symptoms, similar to features prior to cholecystectomy. It is attributed to biliary (retained stone, biliary stricture), extra-biliary (pancreatitis, gastritis, IBS) and psychiatric or neurological disorders.

Aim

To find out (1) the incidence of post laparoscopic cholecystectomy pain. (2) if patients were counselled on non-resolution of pain during consenting for surgery. (3) if patients were investigated for non-resolution of pain.

Methodology

Retrospective cohort study was performed by interviewing patients undergoing laparoscopic cholecystectomy from April2022-October2022. Direct telephone consultation to enquire about non-resolution of pain. Digital case notes were reviewed for subsequent admissions.

Results

A total of 50 cases met the audit inclusion criteria over the period of 7months. Mean age of the selected population was 47.98 years (SD 15.47). Male:female ratio was 11:39. 24%(n=12) patients were reported non-resolution of pain post-op. 48%(n=24) patients were counselled on non-resolution of pain while consenting for surgery.

Discussion

The study suggested a significant number of patients experience non-resolution of pain post-cholecystectomy. However, less than half of the study population were counselled during consenting. Limitations include low number of patients and risk factors like urgent surgery like ‘hot gallbladders’ and choledochotomy could not be assessed. To improve clinical practice, non-resolution of pain should be mentioned during consenting. Additionally, a potential follow-up system should be introduced to review non-resolution of pain and guidelines on investigation of the residual pain should be produced.
ThTP7.9 The Optimal Timing of Colectomy for Acute Severe Ulcerative Colitis
Authors: Ryan Elliot , Tyrrell-Price Jonathan , Phillips Jennifer
Published: August 2023

Aims

Acute severe ulcerative colitis (ASUC) is a medical emergency which, if left untreated, can be fatal. Some cases require colectomy. The timing of this operation is important to reduce post-operative morbidity. The primary study aim is to assess whether the timing of this operation impacts upon post-operative outcome. The secondary aim of this study is to determine whether pre-operative blood albumin level may be able to predict post-operative complication rates.

Methods

All patients who underwent colectomy and ileostomy formation for ASUC at Bristol Royal Infirmary between 2010-2020 were identified. Patient demographic information, duration of pre-operative hospital stays, blood results and post-operative complications up until the most recent follow up were recorded. Patients undergoing elective colectomy for ulcerative colitis were analysed separately.

Results

Twenty-one ASUC admissions were identified who were all treated with intravenous steroids for a median of 9 (range 1-18) days before colectomy. 16 patients (76%) received either ciclosporin or infliximab rescue therapies. Median admission CRP was 41 (range 4-231). Median admission blood albumin was 29 (range 16-38). <30-day and >30-day post-operative complication rates were 52% (11/21) and 25% (5/20) respectively.

Conclusions

Previous literature shows significant association between the length of pre-operative medical therapy and post-operative complications. Surgeons can learn from the, so far, negative findings of our study. A surgeon’s own clinical judgement is the most important factor in the decision of when to take an ASUC patient to theatre. Biomarkers can aid a decision, but cannot be used as a solitary justifier for the timing of colectomy.
ThTP8.9 The SARS-CoV-2 first wave impact in the acute inflammatory surgical pathologies
Authors: Lathan Ross , Guadalajara Hector , de Nova José Luis Muñoz , Yiasemidou Marina , Rico María Recarte , Garcia-Olmo Damian
Published: August 2023

Anecdotal evidence suggests that community infection control measures during the COVID-19 outbreak have modified the number and natural history of acute surgical inflammatory processes (ASIP-appendicitis, cholecystitis, diverticulitis and perianal abscesses) admissions. This study aims to evaluate the impact of the COVID-19 pandemic on the presentation and treatment ASIP and quantify the effect of COVID-19 infection on the outcomes of ASIP patients. This was a multicentre, comparative study, whereby ASIP cases from 2019, 2020 and 2021 (March 14th to May 2nd) were analyzed. Data regarding patient and disease characteristics as well as outcomes, were collected from sixteen centres in Madrid, and one in Seville (Spain). The number of patients treated for ASIP in 2019 was 822 compared to 521 in 2020 and 835 in 2021. This 1/3rd reduction occurs mainly in patients with mild cases, while the number of severe cases was similar. Surgical standards suffered a step back during the first wave: Lower laparoscopic approach and longer length of stay. We also found a more conservative approach to the patients this year, non-justified by clinical circumstances. Luckily these standards improved again in 2021. The positive COVID-19 status itself did not have a direct impact on mortality. Strikingly, none of the 33 surgically treated COVID positive patients during both years died postoperatively. This is an interesting finding which, if confirmed through future research with a larger sample size of COVID-19 positive patients, can expedite the recovery phase of acute surgical services.
FTP2.3 A Systematic Review and Meta-Analysis Comparing Outcomes of the Common Perineal Procedures for Rectal Prolapse -Delorme Vs Altemeir
Authors: Bhattacharya Pratik , Zaman Shafquat , Hussain Mohammad Iqbal , Peravali Rajeev
Published: August 2023

Introduction

There is no consensus yet as to the best surgical option for treatment of rectal prolapse. In this systematic review and meta-analysis we compared the outcomes for the two most commonly employed perineal operations for rectal prolapse – Delorme’s and Altemeier’s procedure.

Methods

A systematic search of multiple electronic databases was conducted. Peri- and post-operative outcomes following Delorme’s and Altemeier’s procedures were extracted. Primary outcomes included total operative time, anastomotic leak rate, post-operative wound infections and length of hospital stay. The analysed secondary outcomes were operation time, volume of blood loss and length of hospital stay. Revman 5.3 was used to perform statistical analysis.

Results

10 studies including a total of 605 patients were selected; 286 patients had Altemeier procedure, 39 patients had Altemeier and Plasty (perineoplasty or levatoroplasty) whilst 280 patients had Delorme procedure. Recurrence was found to be significantly lower in the Altemeier group compared to the Delorme group (OR: 0.66; 95% CI [0.44 – 0.99], P= 0.05). Anastomotic leak was found to be significantly less in the Altemeier group than in the Delorme group (RD: 0.05; 95% CI [0.00 – 0.09], P= 0.03). Hospital stay was significantly more after Altemeiers procedure than after Delorme procedure (MD: 3.05, 95% CI [0.95 – 5.51], p=0.004).

No significant difference was found with respect to operative time, Intra operative blood loss and mortality rates.

Conclusion

Our study indicates that between the two common perineal procedures, Altemeier’s operation has better outcomes. Future high quality RCTs with long follow up are required to corroborate these findings.
FTP2.6 Topical skin adhesive 2-octylcyanoacrylate dressing reduces the risk of superficial surgical site infections (SSI) in colorectal stoma surgery
Authors: Bukhari Ishtiyaq , Afzal Zeeshan , Judkins Nicholas , Summers Dominic , Dennis Robert
Published: August 2023

Background

Superficial surgical site infection is a common morbidity following bowel resection surgery involving stoma formation with clinical and financial implications. The aim of the study was to evaluate the role of topical skin adhesive, 2-octylcyanoacrylate (2-OCA) in reducing wound infections following colorectal stoma surgery.

Methods

We performed a retrospective, single centre, cohort study using clinical notes. Patients over the age of 18, undergoing bowel resection (elective or emergency) with stoma formation over a period 5 years from January 2015 to December 2019 were included. The primary endpoint was surgical site infection. Patients either received wound dressing with 2- OCA or standard wound dressing.

Results

604 patients were included. Median age was 69 (Range 18- 97). 187 (31%) patients received 2-OCA (group 1) and 417 (69%) received standard care (Group 2). 288 (47%) patients were female, 134 (22%) had body mass index > 30, 87 (14%) were diabetic and 90 (15%) were smokers. 279 (46%) patients had ASA score of 3 and 4 (37% vs 50% p=0.0006). 282 (47%) patients went through emergency surgery (34% vs 53% p<0.0001). 279 (64%) patients underwent dirty surgery (17% vs 32% p<0.0001). 220 (35%) patients developed SSI (28% vs 40% p<0.0015). BMI greater than 30 (OR 2.32, p<0.0001), Diabetes (OR 0.54 p<0.0241), dirty surgery (OR 0.43p<0.0001), standard care, no 2-OCA use (OR 1.52 p=0.0343) were associated with SSI.

Conclusion

Our study demonstrates that there is association between 2-OCA use and reduced SSI in colorectal surgery involving stoma formation when compared to standard methods of wound dressing. Further randomised clinical trial is recommended to demonstrate causation.
FTP2.10 Use of ICG in Assessing Anastomotic Perfusion – The First 100 Cases in a Tertiary Colorectal Cancer Unit
Authors: Dunlop Hannah , Coyne Peter
Published: August 2023

Aims

This project aimed to investigate if using intra-operative indocyanine green (ICG) fluorescence imaging to assess anastomotic perfusion in colorectal surgery affected the rate of anastomotic leak.

Methods

Data was prospectively collected for the first 100 patients who underwent colorectal surgery with ICG used to assess the perfusion of the anastomotic ends. The rate of anastomotic leak was calculated.

Results

ICG was used in 100 patients undergoing colorectal procedures with anastomosis, from June 2016 to May 2022. 98 were elective cases, 53 patients were male with a median age of 65 years. After infusion of ICG and assessment of perfusion, the resection margin was changed in 13 procedures (13%). In cases where the resection margin was changed, there was 2 anastomotic leaks (leak rate 15%). In cases where the resection margin was unchanged, there was 3 anastomotic leaks (leak rate 3%). There was not a significant difference in the leak rate when a change in resection margin was made based on the use of ICG (p=0.065).

Conclusions

The results demonstrate that the use of ICG did not significantly change the rate of anastomotic leaks in patients undergoing bowel surgery with anastomoses. However, this information indicates that poor perfusion at ICG fluoroscopy can help identify those patients at risk of leak, which can be used in post-operative monitoring of patients with cancer undergoing major colorectal surgery. It also raises the question of whether we should be changing the resection line by even more when ICG indicates poor perfusion at the resected end.
FTP3.6 Robotic Assisted Surgery – the future for patients with increased BMI?
Authors: Massie Eleanor , Hughes Rebecca , Saldanha James , Renwick Andrew , Vella Mark , Moug Susan
Published: August 2023

Introduction

Obesity increases the technical difficulty of laparoscopic colorectal surgery. The ROLAR trial concluded robotic assisted surgery (RAS) did not significantly reduce the risk of conversion to open surgery in rectal cancer resections. In Scotland, in 2021, 30% of adult population were obese (BMI ≥30kg/m2) and 4% morbidly obesity (BMI ≥40kg/m2.) We describe local experience of laparoscopic surgery and RAS in the obese population.

Methods

Retrospective review of patients with obesity (BMI ≥30kg/m2) undergoing laparoscopic and robotic colorectal surgery by three colorectal surgeons. Conversion to open, 30-day morbidity and mortality and length of stay were assessed.

Results

30 patients undergoing laparoscopic surgery and 37 patients undergoing RAS. Procedures include anterior resection; Hartmann’s procedure; left and right hemicolectomy, sigmoid colectomy, APER, subtotal colectomy, panproctocolectomy and completion proctectomy for benign and malignant conditions.

Conclusions

RAS resulted in fewer conversions to open procedures compared to laparoscopic surgery in the obese population. Fewer complications and returns to theatre in RAS group. The increased length of stay in RAS group can be explained by geographic considerations (25 RAS patients live >2 hours from hospital).
FTP4.2 Keeping it Simple: An Ongoing Near-Peer Teaching Programme Success for Surgical Skills and Simulation
Authors: Bruce Nikki , Smith Charlotte , Irvine Laura
Published: August 2023

Aims

Over 2 years in our DGH we developed a programme of surgical simulation for medical students including acute scenarios and basic surgical skills. We aimed to roll this out on a bigger scale to include near-peer teaching between medical students, PAs, and FYs, and gain feedback to assess our progress.

Methods

The previous programme involved simulated acute scenarios with the Sim Man run by registrars for medical students with help from FY1s. We invited FYs involved in delivering sessions, to write new scenarios and take over leadership. We linked sessions with a weekly Surgical Skills Club and handed ownership of specific sessions to FYs to run near-peer teaching on suturing, knot tying and US guided vascular access. Electronic feedback from trainers and trainees rated satisfaction with teaching, confidence in skills, and enjoyment.

Results

Feedback was gained from 24 students for 4 Sim sessions over 4 months. 100% of students rated the scenarios very good or excellent. 100% felt they improved their skills in management of acutely unwell surgical patients, eg pancreatitis, appendicitis. 6 FY trainers took part and 100% rated the experience as “excellent”. Weekly feedback from Surgical Skills session attendees was consistently rated Very Good or Excellent, and trainer feedback was highly rated for improving confidence and leadership.

Conclusion

Near Peer Teaching of a combined programme of surgical simulation and skills is an excellent tool to improve confidence in managing acutely unwell patients in a safe environment, develops surgical skills, and promotes leadership roles at an early stage.
FTP4.3 Improving awareness of total parenteral nutrition administration in general surgical patients: a tertiary care hospital experience
Authors: Grodzinski Benjamin , Rajput Jaikishan , Swaminathan Christie , Sajid Muhammad
Published: August 2023

Introduction

Dieticians on the general surgical ward are valuable in providing recommendations to optimise patient nutrition, including the administration of total parenteral nutrition (TPN). Prescribing TPN is time-intensive as patients' clinical status and biochemical profile are assessed to avoid re-feeding syndrome. This needs adjustment of the dieticians’ recommendations, highlighting the importance of clinician awareness of patients recommended for TPN.

Methods

We carried out a quality improvement project (QIP) on the general surgical ward of a tertiary centre teaching hospital which involved two plan-do-study-act (PDSA) cycles. We used primary and secondary qualitative surveys to collect data. In the first cycle, we implemented a daily whiteboard handover system in the doctors’ office which displayed the patients recommended for TPN. In the second cycle, we added a TPN recommendation section to the daily patient handover / ward patient list.

Results

Pre-intervention respondents reported lack in awareness of patients recommended for TPN, and felt prescription was often delayed. Use of a whiteboard was well accepted by junior doctors as well as dieticians and improved awareness of patients on TPN. However, this duplicated the workload and information sources for dieticians and doctors. Use of the patient handover list resulted further improved awareness and subsequently quicker timeliness of TPN prescribing.

Conclusions

Both whiteboard displays & highlighting the potential TPN patients in the handover lists were well-accepted and effective ways to improve awareness of patients on TPN. Sustainable interventions should not result in duplication of workload or information. Future work could include quantitative analysis of the above interventions.
FTP4.4 Feel Good Factor: Simple initiatives to improve team morale and mental wellbeing in the surgical workplace
Authors: Jeong Sue , Burford Charlotte , Zarsadias Prizzi , Shah Ankur
Published: August 2023

Aims

Healthcare professionals are vulnerable to stress and burnout. NICE guidelines on mental wellbeing in the workplace first recommend organisational-level approaches followed by individual approaches. Since December 2019, we have implemented monthly Feel Good Factor meetings to promote a culture of appreciation and improve moral in our surgical department. Previously, we found these meetings had a great impact on trainees feeling acknowledged and included, with no time taken off work due to mental health reasons for 20 months. However, participation in these meetings plateaued. Therefore we implemented a Feel Good Factor nomination box to improve involvement.

Methods

Everyone in the surgical department is encouraged to nominate colleagues who they have enjoyed working with. Previously, nominations were sent via messages or email. Since December 2022, we have implemented a physical box with nomination slips that are placed in every communal area of the surgical department. The surgical team is reminded once a month about the upcoming Feel Good Factor Meeting.

Results

Prior to the implementation of the Feel Good Factor box, the average number of nominations was 17.15 per month. Since the implementation, the average number of nominations has been 42 per month, an increase to over 240%.

Conclusion

Mental wellbeing should be a priority in the workplace. Our Feel Good Factor initiative has shown much success over 3 years. The simple implementation of a nomination box has greatly increased the level participation throughout the department. We believe this can be implemented in other departments to encourage a positive work environment.
FTP4.5 ANKI digital flashcards: an effective tool for undergraduate musculoskeletal revision
Authors: Laurent Edward , Ensor David , Vusirikala Anuhya , Phillips Staton
Published: August 2023

Introduction

ANKI is a programme that allows users to produce digital flashcards consisting of text, pictures and/or videos. It is based on the principle of active recall and spaced repetition creating an effective revision tool.

This study investigated the benefits of ANKI digital flashcards used by 2nd year medical students when revising their musculoskeletal (MSK) module.

Method

A prospective study of 121 2nd year medical students at the Anglia Ruskin University. Learning objectives were stated at the start of each MSK lecture. Each student created ANKI flashcards for the learning objective assigned to them. These flashcards were combined to create a crowdsourced complete MSK deck available to the entire cohort.

Anonymised student feedback was obtained at the beginning and end of the module.

Results

The mean value of a Likert scoring system (1least – 5most) from both surveys was used.

Pre-assignment questions assessing students’ familiarity and aspiration towards ANKI: Use cards as part of revision =3.24; Comfort with IT systems=3.82; Familiar with ANKI system=4.04, Interest in using ANKI =3.88.

Post assignment questions to assess the outcome success: Would you use ANKI for revision =4.55, Use ANKI in other modules =3.95.

Free text responses included praise towards communal effort, manageable workload and creation of a revision resource.

Conclusion

ANKI provided an additional useful digital resource learning and revision for medical students. The cards created by students, for students, provided autonomy. However, this effected the quality of some slides. Overall, the feedback was positive with this assignment expanded to other modules.
FTP5.10 Predictors of re-intervention following index cholecystectomy
Authors: Kho Jason , Kuan Jen Yee , Shetty Vinutha , Date Ravindra , Rajendran Ilayaraja
Published: August 2023

Aim

Index Cholecystectomy (IC) is safe and reduces patient morbidity. However, IC can be challenging due to inflammation of hepatocystic triangle, increasing the risk of postoperative complications. Study was conducted to evaluate factors influencing postoperative complications following IC.

Method

Retrospective review of consecutive IC performed as a primary procedure was carried out between February 2021 and July 2022 in our trust. Primary outcome was postoperative Grade 3 Clavien-Dindo (CDC) complication, in comparison to patients with uncomplicated recovery. Pre-operative factors including age, CRP, WBC, LFT, surgeon grade, modality (laparoscopic/open) and number of previous admissions were included for analysis. Categorical and continuous data were analysed using Chi-Square and Mann-Whitney-U tests respectively. P-value <0.05 was statistically significant.

Results

100 IC were included. Most IC were consultant-led [80/100(80%)]. 11/100(11%) patients developed Grade 3 CDC complication; 4/100(4%) bile leak requiring ERCP and stent insertion, 3/100(3%) post-operative collection requiring radiological-assisted drainage, 2/100(2%) retained bile duct stones requiring ERCP, 1/100(1%) incision and drainage of port site seroma and 1/100(1%) biloma requiring laparoscopic washout. Re-intervention was common in older patients (61±18years vs 55±22years, p=0.04) and higher median peak CRP levels (312±178 vs 154±284, p=0.01). There were no differences in LFT parameters, number of previous admissions or timing of operation from day of admission between the two groups.

Conclusion

Age>65 and higher pre-operative CRP were associated with increased risk of postoperative procedural intervention. Larger prospective studies are needed to confirm these findings. Surgeons should consider these factors for consenting and risk assessment purposes.
FTP7.7 Does bilateral combined Transversus Abdominis Plane (TAP) and rectus sheath block reduce postoperative pain after “hot laparoscopic cholecystectomy” compared to trocar site local anaesthetic infiltration?
Authors: Yang Peiming , Khan Saadia , Daniels Sarah , Jalal Qaiser
Published: August 2023

Introduction

Post-operative pain is the commonest reason for prolonged hospital stay and readmission following laparoscopic cholecystectomy. We aim to assess whether bilateral transversus abdominis plane (TAP) and rectus sheath block reduces post-operative pain compared to local anaesthetic (LA) wound infiltration following “hot” laparoscopic cholecystectomies.

Methods

Prospective study involving 15 patients who underwent laparoscopic cholecystectomy in dedicated “hot lists” between October and December 2022. Post-operative pain scores were recorded 4 hours, 3 days, and 5 days post-procedure. Pain scores of patients who received bilateral TAP and rectus sheath blocks were compared with those who received LA wound infiltration with 0.5% Levobupivacaine.

Results

9 patients received TAP and rectus sheath blocks, and 6 patients received LA infiltration. The time from start of anaesthesia to start of surgery in the TAP block group was significantly higher than the LA group (P=0.039). There was no statistical difference in pain scores on the pain analogue scale (1-10) between groups at 4 hours (P=0.73), 3 days (P=0.27), or 5 days (P=0.33) post-surgery. There was no statistical difference between the 2 groups in length of hospital stay post-procedure (P=0.75), or in re-admission rates due to poorly controlled post-operative pain (P=0.58).

Conclusion

Bilateral TAP and rectus sheath blocks do not significantly reduce pain post “hot laparoscopic cholecystectomy” any more than LA wound infiltration. Given the extra time taken to perform TAP and rectus sheath blocks, a larger study population would be required to more reliably assess their benefits, given the importance of avoiding overrunning of the “hot list”.
FTP8.14 Outcomes and complications of simple layered closure of persistent tracheocutaneous fistula after tracheostomy in childhood
Authors: Wong Tiffany , Macpherson Orla , Docherty Sophie , Gray Joyce , Clement Andy , Kubba Haytham
Published: August 2023

Up to half of all children with a tracheostomy develop persistent trachea-cutaneous fistula (TCF) after decannulation. Surgical closure of it is technically easy but post-operative complications can be immediate and life-threatening. We reviewed our experience in TCF closures to identify potential risk factors for complications.

Methods

Retrospective case records review of all children (0-16 years) who underwent surgical TCF closure between January 2010 and December 2021 following the development of a persistent TCF after decannulation of a tracheostomy.

Results

67 children were identified. They ranged in age from 14 months to 16 years (median 3 years 10 months) at the time of the TCF closure. Major medical comorbidities were present in 90%. Pre-operative pulse oximetry with the fistula occluded was used in 29 children (43%). An underwater leak test was performed in 28 (42%). A non-suction drain was used in 29 children (43%). Prophylactic antibiotics were prescribed for 30 children (45%). Post-operative complications occurred in 15 children (22%): life-threatening air leak occurred in the immediate post-operative period in 2 children (3%) and respiratory distress in 3 children (4%) in the recovery area immediately after surgery. None required re-tracheostomy. Three children suffered post-operative pneumonia (4%), and wound infections occurred in 8 children (12%). We were unable to show a significant association between patient or surgical factors and complications.

Conclusion

Further analysis of the potential associations between patient factors, surgical factors, and complications is necessitated in guiding future practice.
4 How we do it: laparoscopic cholecystectomy in patients with severe obesity
Authors: Russell Thomas , Aroori Somaiah
Published: August 2023

Aims

The number of patients with obesity is set to rise, as is the proportion with severe obesity. These patients are a high-risk subgroup who present additional challenges to the surgeon when performing laparoscopic cholecystectomy (LC). It is important that all surgeons who perform this procedure have a safe strategy they can revert to so that morbidity is minimised. Here we outline our approach.

Methods/Results

After obtaining a pneumoperitoneum via a supra-umbilical incision, we advise placing a fascial suture before proceeding with the operation. This allows for high-quality closure, reduces the incidence of incisional hernia, and reduces the risk of an inadvertent bowel injury. We also advise the repositioning of the patient on the operating table prior to port placement such that an ergonomic set-up can be achieved. In addition to the standard ports, we use an additional twelve millimetre port in the left upper quadrant (LUQ). A fan retractor can then be inserted via this port and used to gently retract the duodenum inferiorly. This provides adequate exposure for Calot’s dissection and arguably reduces the risk of injury to a fatty liver. This technique can also be used in non-obese patients in whom Calot’s dissection is particularly challenging e.g., those who undergo delayed LC.

Conclusions

When performing LC in obese patients, one can consider placing an additional twelve millimetre port in the LUQ. A fan retractor can then be used to gently retract the duodenum inferiorly to improve access and reduce the risk of injury to a fatty liver.
62 Does vitamin D deficiency lead to poorer health outcomes after (total) knee arthroplasty? A systematic review and meta-analysis
Authors: Vivek Kavyesh , Kamal Rayan , Perera Edward , Gupte Chinmay
Published: August 2023

Aims

Vitamin D deficiency is a predictor of poorer musculoskeletal disease outcomes and affects approximately 1-in-4 people. Prior literature has assessed the effects of vitamin D deficiency in joint arthroplasties. This updated systematic review and meta-analysis aims to evaluate and collate evidence available on vitamin D supplementation in total knee arthroplasty (TKA).

Methods

A targeted terms search related to vitamin D and TKA outcomes was conducted (data inception until 01/09/2021). PubMed, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov, American Academy of Orthopaedic Surgeons and British Orthopaedic Association databases were used. Analyses consisted of forest plots with I2 heterogeneity statistics, pooled effects with 95% confidence intervals (CI) and, p-values. A p < 0.05 was considered statistically significant.

Results

10 studies fitted inclusion criteria for narrative description and 3 for meta-analysis. 6 studies showed improved outcomes in revision surgery risk, joint infection incidence and postoperative function. Additionally, there were poorer outcomes in postoperative stiffness, prosthesis explanation and postoperative vascular events. Meta-analysis of the length of hospital stay (LOS) demonstrated a significant decrease in LOS between vitamin D sufficiency versus deficiency (standard mean difference = -0.54, 95% CI [-0.69, -0.38], p<0.00001) favouring vitamin D sufficiency.

Conclusion

Vitamin D supplementation demonstrated a statistically significant benefit for TKA patients regarding LOS. Most studies found positive effects of vitamin D supplementation improving patients’ health, reducing hospital resource use, and decreasing the burden on surgeons. Further research with standardised assessment scores is required to definitively prove the vitamin D screening and supplementation benefits in TKA.