bluuebunny/crossref_metadata_2025 huggingface dataset:
EP-276 Tall Cell Carcinoma with Reverse Polarity (TCCRP) of the breast; a rare form of breast cancer
Authors: Shulman Zachary , O’Neill Anne , Kouneli Sofia , Shaaban Abeer , Jenkins Stephanie
Published: November 2022

Aim

A case report on the diagnosis and treatment of this rare low grade triple negative breast cancer.

Case Report

A 41 year old female presented with a palpable left breast lump. Family history includes a sister with a rare myeloproliferative disorder. On examination, a left breast lower outer quadrant 2–3 cm hard irregular lump was palpable. Mammography and ultrasound revealed a 25 mm suspicious lesion (which was biopsied), with normal appearing lymph nodes.

Results

Biopsy revealed a grade 2 invasive apocrine carcinoma. Oestrogen and Herceptin receptors negative. Breast conserving surgery with sentinel lymph node biopsy was performed. Histology revealed a 22 mm well circumscribed tumour with nests of epithelial cells in micropapillary pattern with apocrine like appearance. The most striking feature was that the nuclei were at the apical rather than the basal poles of the epithelial cells (reverse polarity). No lymphovascular invasion present. Lymph nodes were negative (0/3). Diagnosis was then confirmed by molecular testing.

Conclusion

Tall cell carcinoma with reverse polarity (TCCRP)1, a rare cancer resembling tall cell variant of papillary thyroid carcinoma, was first reported by Eusebi et al in 20032. Although morphologically similar to metastatic papillary thyroid cancer, neither the immunohistochemical markers nor genetic profiles have established any connection3. Accurate diagnosis of TCCRP is important as it carries an excellent prognosis. Treatment is local regional radiotherapy. There is no indication for systemic therapy in this case, due to its indolent low metastatic potential.
EP-289 Acute gallstone pancreatitis – if a picture is worth a thousand words, how many images do we need?
Authors: Chen Si , Karki Smriti , Iqbal Qamar , Mallappa Sreelakshmi
Published: November 2022

Aims

Accurate diagnosis and prompt definitive management of choledocholithiasis is vital in acute gallstone pancreatitis (GSP). Sensitivity of detection of choledocholithiasis varies across imaging modalities. Magnetic resonance cholangiopancreatography (MRCP) is most sensitive, but may not be necessary, and may result in delayed implementation of definitive management.

We aimed to evaluate the range of radiological investigations patients with acute GSP underwent at our Trust, and the clinical appropriateness of MRCP if performed.

Methods

An observational study of patients diagnosed with acute GSP between 01/05/2019 and 26/02/2021 was performed. Data were collected from electronic patient records.

Results

50 patients were diagnosed with acute GSP (median age 56years). 41 had transabdominal ultrasound (USS), 22 had computed tomography (CT) and 16 patients had MRCP. Median waiting time was 1, 0 and 4 days for respectively. All patients who had MRCP had prior USS and/or CT (Table 1).

As definitive management, 14% underwent endoscopic retrograde cholangiopancreatography (ERCP), 28% underwent laparoscopic cholecystectomy and 30% had initial ERCP followed by laparoscopic cholecystectomy. 14% patients were readmitted with pancreatitis prior to definitive management.

Conclusions

Detailed description of the CBD in initial radiology reports in acute GSP may mitigate the need for unnecessary subsequent imaging, reducing cost and facilitating early definitive management. We recommend establishment of a guideline to streamline imaging in the assessment of acute gallstone pancreatitis.
EP-325 Congenital peritoneal encapsulation rare pathology for Acute intestinal Obstruction
Authors: Chowdhury Ashim , Shamsuzzama Md , Paisios Evangelos , Shah Ankur
Published: November 2022

Background

Congenital peritoneal encapsulation (CPE) is a rare, congenital entity in which the small bowel is surrounded by an accessory peritoneal membrane. This condition is usually asymptomatic and rarely causes intestinal obstruction. This report highlights this rare congenital anomaly as a cause of intestinal obstruction.

Case

A 28-year-old fit man presented to A&E with classical features of intestinal obstruction. Abdominal CT scan showed features of mechanical small bowel with 360-degree rotated mesentery, and a suspicion of closed loop obstruction. An emergency laparotomy was performed. A large congenial peritoneal sac, wrapped the small bowel from D-J flexure to proximal part of ileum, and this sac was rotated 360 degrees with multiple adhesions and a single band to the left lateral wall. Early ischemic changes were noted, along with congested mesentery. The sac was opened, dissected and adhesiolysis was performed. The thick solitary band was released. There was immediate restoration of the blood supply and the bowel was viable. Patient recovered and discharged home on day 3

Discussion and conclusion

Worldwide, only 50 cases on CPE have been published till date, with the maximum reported from the UK. The other common conditions that mimic CPE are internal paradodenal hernia, abdominal cocoon and sclerosing encapsulating peritonitis. Young patients with abdominal pain and feature of closed loop high small bowel obstruction on CT scan will need a high index of suspicion, before confirming the diagnosis. At this point, it will remain a rare occurrence and an incidental finding at laparotomy.
EP-345 How do we get these lines out?
Authors: Teo Tessa , Alim Adam , Vasanthan Biruntha , Durojaiye Abiola , De Figueiredo Fatima , Gambhir Raghvinder
Published: November 2022

Aims

The aim of our study was to identify the factors influencing patient decision-making in conversion from tunnelled lines to arterio-venous fistulas/ grafts (AVF/G).

Methods

We consented and interviewed 40 patients who were currently dialysing through lines at a main dialysis unit in a tertiary hospital to understand factors influencing their decision. We designed and implemented a patient intervention education programme.

Results

Age range 24 to 86 years, (median 59), Females to Males ratio-1:1.4. Twenty-three patients (57.5%) started dialysis on a line and have remained on a line, 8 (20%) have a maturing graft and 9 (22.5%) have a fistula that is not maturing well or one that has failed.

None on lines had had any previous face-to-face education regarding the benefits of fistulas over lines. After one session, 14/18 patients (78%) agreed to attend the access clinic. The remaining 5 patients did not participate in the intervention.

Conclusion

We were able to convert 78% of patients in just one single face-to-face education session. In the Patient Reported Experience of Kidney Care in the UK 2020 (PREM) report “Patient experience of Sharing Decisions About Your Care” received the lowest scores (5.49/7) among the 13 theme scores. Just providing a leaflet to the patient is not enough. Hence, an educational intervention like ours should be made part of the routine practice at all dialysis units.

Reference

The Renal Association and Kidney Care UK (2020) ‘Patient Reported Experience of Kidney Care in the UK 2020’, p. 14. Available at: https://renal.org/sites/renal.org/files/KQuIP/PREM report 2021.pdf
EP-364 The new normal in the post-pandemic world: Our experience of organising a three-part webinar series for the CST 2022 Applicants
Authors: Rahman Atiqur , Badawi Marwa , Swamad Mohamed , Ali Ramla , Vincent Elizabeth , Sharp Elizabeth
Published: November 2022

Introduction

In the time of COVID-19, the influx in the use of the online platform has been paramount. The surgical world is no exception with the first virtual selection process for Core Surgical Training (CST) 2021 applicants. We, the current core trainees from the Kent, Surrey and Sussex (KSS) deanery organised this three-part webinar series for CST 2022 applicants to aid our future colleagues.

Materials and Methods

The event poster was circulated among the surgical tutors, medical education department across the KSS region, all the foundation schools and to Foundation Trainees Surgical Societies (FTSS) across the UK. It was advertised on Facebook, Twitter, WhatsApp and Eventbrite. Google Workspace was used to manage registered participants and Microsoft Teams were used for the webinars.

Discussion

A total of 526 participants registered. 69.9% of them registered through social media whereas 16.4% and 9.8% through the medical education department and word of mouth respectively. The first part covering the CST program overview and self-assessment guidance was attended by 96 of them on 16 November 2021. The second part covering interview stations was attended by 29 participants on 14 December 2021. We received positive feedback from 42 and 8 participants following each webinar respectively. We currently have 88 participants registered for our mock interview sessions planned for late January 2022.

Conclusions

The virtual selection process is here to stay. Well-organised events like this will help the candidates prepare well for their interview as well as helping the current trainees with their teamwork, leadership and organisation skills.
EP-370 Contemporary clinical management strategies in lower gastrointestinal bleeding: A single-centre retrospective observational study
Authors: Julius Barbara , Chan Kin Yik , Jaffer Alisha , Liau Yun Hui , Tormey Shona
Published: November 2022

Aim

Significant heterogeneity exists in the recommendations for the diagnosis and management of acute lower gastrointestinal bleeding (LGIB). This study aims to demonstrate the contemporary management strategies adopted by a busy tertiary hospital.

Methods

We conducted a single-centre retrospective review of adults presenting to our institution with LGIB between January and March 2021. Demographic data, observations, laboratory results, endoscopy and radiology reports, operation notes and discharge summaries were collected for each patient via a retrospectively maintained registry.

Results

23 patients were included. Mean age was 66.6 years with a mean initial haemoglobin of 10.9 g/dL (Range 4.1–15.5g/dL). 17% of patients were in circulatory shock on presentation. 70% of patients presented with haematochezia. 47.8% of patients were on either an anticoagulant or anti-platelet agent at presentation. The transfusion index in this cohort was 30%. 26.1% of patients had a re-bleed during their admission. The diagnostic yield of cross-sectional imaging amongst 11 patients was 27.3% with no correlation with haemodynamic status or active bleeding. 47.8% of patients underwent endoscopy and 27% of patients who underwent an endoscopic procedure required endoscopic haemostasis. Flexible sigmoidoscopy was the commonest endoscopic modality (55%), followed by gastroscopy (27%) and colonoscopy (18%). No patients required surgical or radiological intervention. No cause of bleeding was identified in 26% of patients.

Conclusion

This study confirms the variation in diagnosis and management of LGIB. Despite access to onsite interventional radiology, endoscopy remained the predominant diagnostic and therapeutic modality. Routine cross-sectional imaging may not be justified given its suboptimal diagnostic yield.
EP-383 Correlation between delays to emergency laparotomy and outcomes at a large District General Hospital (DGH)
Authors: Patel Maitreyi , Thomas Joel Joy , Aguayo Xavier , Gutmann Daniel , Wain Mehmood
Published: November 2022

Aims

Significant morbidity and mortality are associated with emergency laparotomies. Delays to theatre inevitably increase the risk of sepsis, deterioration, failure to rescue and death. The aim of our study was to determine the outcomes associated with delays of non-vascular emergency laparotomies at a large DGH.

Methods

A retrospective review of a prospectively maintained database was performed of all patients who underwent general surgical emergency laparotomy over a 10 week period from 10th June 2021 to 25th September 2021. Outcomes of patients were compared between delayed and non delayed surgery as per NCEPOD classification.

Results

76 patients were included in the study, 46.05% were males. 15 (19.74%) patients had a delay to surgery. The most common indication for surgery was obstruction (63.16%), followed by perforation (27.63%). The patients requiring urgent surgery were least likely to arrive in theatre within the correct timeframe. 18.34% of patients experienced a delay if a decision is made for surgery during the day (0800–2000) compared to 30% at night (0000–0800). Severe complications, (Grade 3 and 4 on Clavien Dindo classification) occurred in 13% of those who had a delay to surgery, compared to 16% in those without delays. Total 30-day mortality was 9.2%. There was no significant difference in the outcomes of patients who had a delay and those who did not.

Conclusion

Delay in arrival to theatre was more amongst patients requiring urgent surgery. The time of day or week did not affect the time to theatre. Delay did not result in significant difference in outcomes.
EP-422 Operating in the outpatient department: the future of flexor tendon repair?
Authors: Rayner Anthony , Mohamed Ahmed , Mikhail Mark , Gardiner Matthew
Published: November 2022

Aims

Flexor tendon injuries are debilitating with rupture of repair leading to significant morbidity. The SARS-CoV-2 pandemic has led to a shift to out-of-theatre operating, with many flexor tendon repairs being performed on the same day as initial assessment in our outpatient department (OPD) procedure room. We aimed to compare the rupture rates before and after the start of the pandemic to assess the safety of this change in practice.

Methods

Patients who underwent repair of one or more flexor tendons were included from two six-month periods: July to December 2019 and April to September 2020. Patient records were reviewed to identify operation location, number of flexor tendons repaired per patient and rupture incidence. In the second period, patients whose operation was performed in theatre were excluded.

Results

28 patients were included for the initial period with a total of 49 flexor tendons injured. All repairs were performed in theatre and 3 ruptures were recorded (6%). 17 patients underwent flexor tendon repair during the second period. 11 patients were operated on in the OPD with a total of 16 flexor tendons injured. 1 rupture was recorded (6%).

Conclusions

The rupture rate of OPD operating is comparable to that of the traditional theatre pathway. OPD operating also allowed us to circumvent theatre waiting lists and thus avoid costly delays to patient care. This project demonstrates maintained safety for patients and offers a platform for further research to confirm OPD operating as a viable and sustainable alternative for future practice.
EP-490 Management of femoral non-union with post-traumatic bone defect using second-generation PRECICE® nail - A Case Report
Authors: Lu Victor , Zhang James , Krkovic Matija
Published: November 2022

Introduction

The management of post-traumatic bone defects with non-union remains a surgical challenge. Common limb length discrepancy (LLD) procedures involve Masquelet technique, vascularised bone grafts, distraction osteogenesis using external fixators, yet they pose a functional and economical challenge for patients, given high complication rates and need for revision surgery. Magnetically-driven PRECICE nails are self-lengthening internal devices activated via an external controller. We present one patient with post-traumatic femoral non-union with concomitant bone defect, using second-generation PRECICE nail.

Case

One 57 year-old gentlemen suffered open femoral fracture after a motorcycle accident. Having previously undergone open reduction internal fixation, he presented to us with atrophic non-union and bone defect, which were simultaneously treated with a second-generation PRECICE nail. Our treatment protocol was based on the strain theory, and involved initial distraction by ∼5mm at non-union site, at a rate of 1mm per day, to decrease strain on bone graft cells and promote callus formation. One week later, the non-union site was compressed to close the gap completely. After another four weeks, distraction using the PRECICE nail started, in increments of 0.25mm, four times a day, until the desired length was achieved. The patient achieved union and the initially planned limb lengthening regime was achieved with minimal complications.

Conclusions

By initially distracting the bone defect by ∼5mm, then compressing the gap, before distraction started, strain on bone graft cells was minimised, allowing robust callus and regenerate growth. Self-lengthening, magnetically-driven PRECICE nails can successfully restore union and manage limb length discrepancies with reasonable patient satisfaction and minimal complications.
EP-499 Is cleaner and greener NHS a pipe dream or a real possibility?
Authors: Bodapati Shruti , Gambhir Raghvinder Pal Singh , Kimura Shiori
Published: November 2022

Aim

In October 2020, the NHS committed to become the world's first carbon net-zero National Health Service by 2045. The aim of the study was to see what is Surgeon's role towards sustainability.

Methods

To review the Sustainable NHS with target of Net zero NHS proposal and analyse the changes being implemented at national and regional level. To assess how the surgical practice needs to contribute.

Results

Operating theatres contribute 30% of hospitals carbon footprint as the NHS contributes to nearly 5% of the country's carbon emissions. Exhaled anaesthetic gases are major contributors to the greenhouse effect and account for 5% of NHS foot print. Switch to more renewable sources of energy, to LED lights will offset some of that as will local products in the Supply chains.

In theatres abandoning the use of single use plastics and switching to reusable instruments, as well as water free hand washes will help. Blue-zone technologies’ that capture, reclaim and purify halogenated agents should become a standard practice. Record of daily theatre waste is not being recorded.

Optimal use of video technology for remote clinics and providing diagnostics and some interventions at non hospital sites will decrease patients need to travel and their carbon footprint.

Conclusions

There is need to accelerate awareness and encourage surgical care groups to change practice. Green sustainable theatres have to be standard in all new builds. Specialty specific, theatre waste analysis reports need to be presented in Monthly audits.

Reference

1. https://www.gov.uk/government/news/uk-health-services-make-landmark-pledge-to-achieve-net-zero
EP-503 An Audit of Day case surgery for Inguinal Hernia Repair
Authors: Gulnaz Nadia , Akram Farhan , Masala Ilaria , Dar G.Murtaza , Siddique Khurram
Published: November 2022

Aims

To compare the trust-wide performance with the standard by the British Association of Day Surgery in the management of inguinal hernias.

Methods

Electronic data of patients who underwent Inguinal Hernia Repairs in the trust from September 2019 to December 2019 was analyzed.

Results

A total of 122 male and 11 female patients had hernias repaired in this time period.18 were emergency while the rest of the cases were elective. The ages ranged from 19–91 with a mean age of 62. Of the 115 electives, 60% were performed as day-case. The mean length of stay was 1.7days (R 0–12).34 out of 46 (74%) patients who stayed inpatient were actually booked as day-case. 73% had no documented reason for their admission.4 patients were admitted for medical reasons 2 for post-operative surgical complications. Of patients pre-booked as inpatients,10 were quoted to have serious medical issues while 5 had no clear reason. The vast majority had open repairs while 26% of the 115 patients had laparoscopic repairs.

Conclusion

Our Performance was noted to be 30% lower than the BADS standard. There is a need of:

Development of inpatient surgery booking criteria and adherence.

Discussion with anesthetic colleagues to assist drive towards day-case surgery.

Clear documentation in the clinical letters to explain the reason for inpatient management and booking.

Perioperative notes need improvement.
EP-569 Case Report: An unusual case of prodigious Gigantomastia with macroprolactinemia and suspected autoimmune disease
Authors: Malik Mariam , Brookes Phil , Green Matthew J , Kasana Mohammad Iqbal
Published: November 2022

Macroprolactinemia is characterized by most authors, as a benign condition with no clinical implications. Gigantomastia is the progressive breast enlargement, usually bilateral. Due to its rare presentation, fewer numbers of cases have been reported and its association has yet to be fully established. It is usually presented during puberty and pregnancy and its association with hyperprolactinemia, macroprolactinemia, and autoimmune diseases are reported but in small numbers. Its management is improving the clinical symptoms and it varies from case to case. A 47 female premenopausal with sudden onset of massive enlargement of the bilateral breast without galactorrhea over 18 months. She also noticed joint pain and swelling with her breast enlargement. She was referred to the breast clinic for managing breast-related symptoms associated with gigantomastia like mastalgia, neck and back pain, postural issues, and recurrent breast skin eruptions. Her serum investigation showed a Prolactin level of 1708 mIU/L and was also referred to an endocrinologist to rule out prolactinoma. She underwent bilateral breast reduction and a total of 12 KG breast tissue from both breasts were removed and she is under further investigation for autoimmune diseases. The present report followed this patient from diagnosis, surgical intervention, and establishing its association to any other condition. Even though gigantomastia is an erratic condition and is a rare entity, its timely investigation and association to other clinical conditions like hyperprolactinemia or macroprolactinemia and arthritis are essential in the efficacious management of this condition. Gigantomastia outside the reproductive age group needs further research.
EP-570 Rare case of pre-pyloric perforation of stomach secondary to foreign body ingestion
Authors: Hopkisson Lucy , Pangeni Anang , Shrestha Ashish
Published: November 2022

Background

Gastrointestinal perforation remains a common cause of acute abdomen in clinical practice. However, pre-pyloric perforation secondary to ingested foreign body (FB) in the adult population is rare. Nearly 80–90% of ingested foreign bodies will pass through the GI system spontaneously with only 1% requiring surgery. We report a rare incidence of pre-pyloric perforation in a patient unaware of ingestion of any foreign body.

Case presentation

A 59 year old female with no medical history, presented to the ED department with severe epigastric pain, vomiting and fever. She had a peritonitic abdomen and corroborative inflammatory markers. An urgent computed tomography scan demonstrated a 7×5cm collection near the transverse colon and a linear streak of hyperdense material near the collection. Patient had no recollection of ingestion of FB. Diagnostic laparoscopy followed by laparotomy, revealed inflammation and necrotic adipose tissue between the transverse colon and stomach walling of a purulent cavity. A 2cm shard of glass was retrieved. Examination of the posterior wall of the stomach eventually located the site of perforation. Generous washout, debridement and suture repair with omental plug was performed. She made an uneventful recovery.

Conclusion

Sharp objects do not pass via the pylorus easily and can cause perforation in the proximal part of gastrointestinal tract. Any features of complication mandates exploration and examination of the posterior surface of the stomach is quintessential
EP-577 Seasonal Variation of Presentation of Perforated Peptic Ulcer Disease: An Overview of Patient Demographics, Management and Outcomes in Northern Ireland
Authors: Yawar Bakhat , Marzouk Ahmed , Ali Heba , Ghorab Tamer , Asim Ayeisha , Abousamra Mohammad , Asim Asim
Published: November 2022

Background

Perforated peptic ulcer disease is one of the most common causes of acute peritonitis. It carries significant mortality and morbidity. Several previous studies have reported a seasonal variation in presentation of patients with perforated ulcers. Here we present this study from a Northern Irish perspective on perforated peptic ulcers.

Methods

A retrospective cohort study was conducted on perforated peptic ulcer patients who presented to Altnagelvin Area Hospital emergency department between 2015 to 2020. Data on patient demographics, clinical presentation, investigations, management and outcomes were collected. Primary outcome was to investigate if seasonality was associated with incidence of perforated peptic ulcers. Followup data was also collected. Seasons were defined as per UK Met Office.

Results

A total of 50 patients presented with perforated PUD. Male:female ratio was approximately 3:2. Peaks were noted in spring and winter. April was the most common month for presentation followed by December. Smoking was the most common risk factor followed by alcohol abuse. 14 patients (28%) were either very frail or had contained perforations and were conservatively managed. 3 deaths were noted (6%). 13 patients (26%) required ICU admission at some stage in their management.

Conclusions

Slight seasonal variation was noted in presentation of perforated peptic ulcers in our study with more common incidence in winter and spring months. The month of April was noted to have the peak incidence of the disease in our study.
EP-585 An Evaluation of Plastic Surgery Post-Operative Follow Up Planning in Line With Local Guidelines
Authors: Khanna Rahul , Carhart Benjamin , Mwaura William
Published: November 2022

Aim

Post-operative follow up is an important aspect of surgical management plans. This audit evaluated whether the documentation of post operative follow up plans within plastic surgery operation notes, for three common operation categories, adhered to local guidelines.

Methods

This audit looked at one month's worth of follow up plans within a plastic surgery department in 2021. Specifically, the documentation within the operation note was audited for three operation categories: tendon repairs, K wire insertions and manipulations under anaesthetic (MUA). These operation notes were compared to local follow up guidelines and adherence was analysed. The results were presented within the department. Posters displaying the guidelines were created and placed in theatres, as well as circulated via WhatsApp. A second cycle was then undertaken.

Results

Each operation category guideline, consisted of various aspects of recommended follow up. Issues noted from the first cycle included an inaccuracy in the timing of follow up appointments. This was particularly evident in the MUA category where only 55% of cases having follow up appointments documented for the correct date. Following intervention, the K wire one week follow up appointment documentation improved from 40% to 67%.

Conclusions

Overall, an improvement in adherence to guidelines was observed during the second cycle following the intervention. The best impact was seen in the K-wire category, where all three aspects of that specific follow up guideline showed an increase in compliance. Publicising the follow up guidelines had a positive impact on the documentation of surgical follow up plans.
EP-624 Pioneering makeshift endosponge in the management of Post Low Anterior resection leak: Experience from a resource limited country
Authors: Rehman Abdul , Anwer Abdul Wahid , Mushtaq Usman , Khattak Shahid , Ali Syed Aamir
Published: November 2022

The aim of our study was to devise a method of salvaging anastomotic integrity in patients who develop leak post low anterior resection for rectal cancer. Although endopsonge is an established entity and has been in use for a while now as minimally invasive method but its availability is non existent in our region of the world.

We came up with a method based on the principle of endosponge to be used in patients who develop anastomotic leak. We used a Jackson Pratt drain to create a low cost and easily reproducible endosponge. We did regular washouts in the theater, endoscopy suite and in the ward. Until now we have managed 2 patients who developed defect in anastomotic integrity.

The results are very promising. Both patients have shown complete response in terms of complete resolution of pre sacral cavity and closure of the defect in the anastomotic integrity.

Although these are only 2 cases but this makeshift endosponges can prove to be a very important part of the armamentarium of a colorectal surgeon in areas of the world where endosponges are not available.
EP-625 An audit looking at whether consent has been gathered to upload patient details to the National Vascular Registry in Countess of Chester Hospital
Authors: Mewse Jacob , Iqbal Faisal
Published: November 2022

Aims

The National Vascular Registry (NVR) forms part of The Vascular Society and aims to improve the quality of care for patients with vascular disease by measuring the quality and outcomes of care for patients who undergo major vascular surgery.

Within the vascular department at Countess of Chester Hospital, patients had not consented for their information to be uploaded to the NVR but were still being uploaded post procedure.

Methods

A retrospective audit collected data from all vascular procedures performed in September 2021 in the Countess of Chester Hospital. For each procedure, we checked whether the data was uploaded to the NVR and where consent had been gathered from the patient to upload their data to the NVR.

Results

Of 57 procedures performed in September 2021:

Conclusion

Of 57 procedures, data was uploaded to the NVR 42.3% of the time and of these, consent from the patients was only gained 43.5% of the time.

With these results there is room for improvement within the department, firstly to consent patients to allow their data to be uploaded to the NVR and then to upload the data following procedures.
EP-664 Remnant of stomach strangulation post Roux-en-y gastric bypass and hiatal hernia repair for obesity
Authors: Al-ardah Mahmoud , Philip Ken , Cota Allwyn
Published: November 2022

Introduction and Background

Herniation of the remnant of the stomach post Roux-en-gastric bypass and hiatal hernia repair is a very rare complication that require high index of suspicion to diagnose and immediate surgical intervention. In the literature, there were reported cases of herniation of gastric pouch and Roux limb but not the remnant of the stomach hence we report this unusual case.

Case report

A 66-year-old lady was admitted with dysphagia, vomiting, epigastric and retrosternal chest pain. She has had laparoscopic Roux-en-y gastric bypass and hiatal hernia repair 8 years before this admission complicated with recurrence of the hiatal hernia which was repaired one year prior to this presentation.

CT scan of the chest and abdomen showed herniation of both the neo-stomach and the gastric remnant up in the posterior mediastinum through the hiatus. Patient consented for repair on the next day however her condition deteriorated over night and was taken to theatre and underwent emergency laparoscopic converted to open resection of strangulated ischemic remnant of stomach and preservation of the gastric pouch and the Roux limb.

Conclusion

This a very rare and uncommon event following a Roux-en-y gastric bypass and hiatal hernia repair, a prompt diagnosis and early surgical intervention is imperative to avoid catastrophic complications.
EP-674 Metastases to the breast from a primary lung adenocarcinoma: A case report and literature review
Authors: Westby Kealan , Mannion Evan , Davey Matt
Published: November 2022

Background

Primary breast cancer is the commonest malignancy in adult females. However, metastases to the breast is a rare occurrence with a frequency of approximately 0.2% - 1.3%. Lung adenocarcinoma is the most common type of lung cancer and distant metastases to other organs carry a poor prognosis. A wide variety of malignancies can metastasise to the breast, melanoma being most common. On review of the literature there is a paucity of published cases of primary lung adenocarcinoma metastasizing to the breast.

Case

A 77-year-old lady present to the emergency department (ED) with a 5-day history of presyncope. There were no other associated symptoms and the no findings on clinical exam. Computed tomography (CT) of the thorax, abdomen & pelvis reported diffuse opacities in both lungs and a solitary, 3×2cm mass in the upper inner quadrant of the left breast. A core biopsy of the lesion was carried out. Immunohistochemistry did not support a diagnosis of breast carcinoma but strongly suggested a primary lung adenocarcinoma. After a multidisciplinary meeting (MDM) discussion the plan was to commence a course of chemotherapy.

Conclusion

Given its atypical presentation it can be challenging to distinguish between a primary breast cancer and metastases. Metastatic disease, although rare, should be considered in the differential diagnosis as the treatment and prognosis differ greatly from primary breast cancer. Immunohistochemistry is essential for identifying the primary origin of the tumour.
EP-681 Adherence to VTE prophylaxis guidelines in general surgical patients: a single-centre study
Authors: Songra Lalana , Hussein Aliyah , Baker D
Published: November 2022

Introduction

Hospital acquired venous thromboembolism (VTE) is potentially preventable yet still accounts for 60% of all VTE seen. This study aimed to establish adherence to guidelines on VTE prevention including completion of VTE risk assessment within 24 hours of admission and appropriate prescription of mechanical and pharmacological VTE prophylaxis.

Methods

A database of all general surgical inpatients in our hospital at any point during the 48-hour period from 21/12/2021 to 22/12/2021 was obtained. Electronic records were examined to check for the presence of 11 established risk factors for VTE and to check for adherence to VTE guidelines. Every surgical patient was reviewed to check whether they were wearing anti-embolic stockings. Standard statistical analyses were undertaken.

Results

There were 107 general surgical patients in hospital during the study period. Of these, 33 (31%) had 3 or more risk factors on admission for VTE. 106 (99%) patients had VTE assessments completed within 24 hours of admission. Of these 107 patients, 93 (87%) had appropriate pharmacological VTE prophylaxis or had a documented reason why this was not prescribed. 14 (13%) patients had no pharmacological VTE prophylaxis prescribed. 84 patients were assessed as requiring anti-embolic stockings. Of these, 57 (68%) of patients were prescribed stockings, and 30 (36%) were physically wearing stockings.

Conclusions

This study has shown that adherence to VTE guidelines among surgical patients in our hospital is substandard. We suggest having a VTE safeguard during the ward round responsible for identifying any deficits in VTE prophylaxis and ensuring recommendations are acted upon.
Sustainability Prize 4 Back to the future: Re-introducing Reusable gowns to achieve #NetZeroSurgery
Authors: Beatty Jasmine Winter , Gan Jonathan , Robb Henry , Dryden Simon , Ortega Patricia , Purkayastha Sanjay
Published: November 2022

Aims

In view of the planetary health emergency, we aimed to introduce an efficient and safe intervention to rapidly decrease the environmental impact of our surgical department whilst delivering financial and social benefits.

Methods

The project was registered with the Audit and Quality Improvement Department. Carbon hotspot identification and process mapping were performed.

A survey of theatre staff members was completed prior to the trial to ensure agreement.

Disposable surgical gowns were replaced with reusable gowns in two theatres. Where appropriate, reinforced gowns were substituted with standard gowns.

Staff were notified and posters made to remind them of correct removal procedures.

Environmental savings were estimated using published figures (Vozzola et al. 2018) and weights. Trust procurement data from 2019 was used to estimate financial and environmental savings. Staff evaluations were collected.

Preliminary results were shared with heads of surgical specialties, surgical managers, A&E, ITU and Anaesthesia across the trust.

Results

97.7% (74/77) of staff were favourable to trying the reusable gowns prior to the trial. 91.3% (42/46) gave positive feedback after testing them clinically and 97.8% (45/46) were happy to continue using them again.

3051 gowns were substituted over 6 months, leading to a saving of 3.292 tonnesCo2e. Savings were estimated at £366 from reductions in waste disposal and standard gown use.

Conclusions

Approval has been gained to extend the trial across the trust and a business proposal is being considered.

Scaled to the whole trust this intervention could save 234.7 tonnesCO2e/year, equivalent to driving a car around the equator 23.6 times.
SP1.1.2 The significant impact of using virtual cross match on achieving 100% within-18 hour target of cold ischaemia time in transplanting kidneys from donors following brain death in a single centre in UK
Authors: Tasleem Sadia , Austin Sharlene , Lennon Veronica , Mckane William , Pararajasingham Ravi , Marie Yazin
Published: November 2022

Aims

To evaluate the impact of virtual cross match in donation following brain death (DBD) kidney transplants on the cold ischaemia time (CIT) as one of the factors in achieving better renal graft outcomes.

Methods

Every patient on the deceased donor renal transplant waiting list in our centre was asked to give a blood sample to test for Human Leucocyte Antigen (HLA) antibodies. Our transplant coordinators ensured that this process is updated three monthly as part of the eligibility criteria to perform virtual cross match.

Other factors contributing to CIT were intentionally ignored given that there are no significant changes in the kidney allocation scheme or kidney acceptance criteria. Comparison was made between CIT in the financial years 2014/ 2015 and 2020 /2021.

Results

Since the introduction of this strategy, our centre was the only centre in all 23 UK kidney transplant centres to achieve 100% transplantation within 18 hour CIT for DBD kidneys transplants in the financial year 2020/2021. This represented a significant improvement compared to 58% in the financial year 2014/2015.

Conclusions

Virtual cross match was a key factor in achieving the 18 hours target for DBD kidney transplant regardless of other contributing factors. It is highly recommended that a three-monthly screening for HLA Antibodies is regularly performed to achieve this result.
SP1.2.7 Relative quality of UK post graduate School of Surgery web-site information
Authors: Luton Oliver , Mellor Katie , Eley Catherine , Egan Richard , Lewis Wyn
Published: November 2022

Introduction

Internet-derived health care information is increasingly accessed by patients, yet its quality is variable and equivalent educational and training information for medical professionals is less well understood. The aim of this study was to assess the quality of information available on the UK's Post-Graduate School of Surgery (SoS) websites with a validated 20-point tool (WebQual 4.0).

Method

Eight clinicians (Consultants 2, SpRs 2, Core Surgical Trainees 2, and Foundation Program doctors 2) evaluated SoS web-site quality in three domains: Usability, Information Quality, and Interaction (Likert scale: 1 - very much disagree, 5 - very much agree). Ranked scores were calculated as the sum of domain medians. A separate eight trainee focus group then appraised the top three websites related to COREQ recommendations.

Results

Inter-rater agreement and correlation was good (rho >0.800, p<0.001). Median (range) overall website score was 3 (2–5) and individual domain scores were: Usability 3.75 (2–5, p=0.001); Information Quality 3 (2–5, p=0.001); Interaction 3 (2–5, p=0.001). The three highest ranked Deaneries were HENW, HEEE, and HEKSS with scores of 14, 13.5 and 12 (out of 15) respectively. Focus group priorities included: minimising text, embedding educational and extracurricular content, and clear hospital placement mapping.

Conclusion

UK SoS website information was in general poor, with greater than two-fold variance in overall quality. Improved web-site standardisation should help and enhance trainee application and career progression.
SP1.2.10 The First Delphi Consensus on Surgical Ward Round
Authors: Amr Bassem , Omar Islam , Abdelrahman Mohamed , Abdulkuddos Muhamed , El Ella Yasmin Abou , Mahawar Kamal
Published: November 2022

Background

The ward round is an integral part of everyday surgical practice. It is a complex clinical activity that requires clinical management and communication skills. It has an impact on patient safety, mortality and quality of the healthcare services delivered. This study reports the results of a consensus-building exercise on the common aspects of the general surgical ward rounds.

Methods

The consensus-building committee involving a range of stakeholders from 16 NHS trusts took part in this consensus exercise. The members discussed and suggested a series of statements concerning surgical ward round. An agreement of ≥ 70% amongst members was regarded as a consensus.

Results

Thirty-two members voted on 60 statements. There was a consensus on fifty-nine statements after the first round of voting, and one statement was modified before it reached consensus in the second round. The statements covered nine sections: a preparation phase, team allocation, multidisciplinary approach to the ward round, structure of the round, teaching considerations, confidentiality and privacy, documentation, post-round arrangements, and weekend round.

There was a consensus on spending time to prepare for the round, consultant-led round, involving the nursing staff, an MDT round at the beginning and end of the week, a minimum of 5 minutes allocated to each patient, utilisation of round checklist, afternoon virtual round, and a clear handover and plan for the weekend.

Conclusion

The consensus committee achieved agreement on several aspects concerning the surgical ward round. This should help improve the care of general surgical practice on wards.
SP2.1.2 Increasing Burden of Complications of Gastric bands on NHS Bariatric Services
Authors: Desai Chaitya , Panesar Harrypal , Kumar Nakulan Nantha , Xiang Jinpo , Idialu-Ikato Kelvin , Cheruvu Chandra
Published: November 2022

Background

Approximately 40% of patients that undergo laparoscopic adjustable gastric band (LAGB) insertion for obesity experience long-term complications and a lack of weight loss. This has caused a surge in LAGB removal procedures under the NHS. We review patient outcomes for these procedures at our tertiary bariatric centre.

Methods

All LAGB removals performed between October 2012 and August 2021 were reviewed. Data was collected prospectively & analysed retrospectively for demographics, body mass index (BMI), surgical indications and postoperative complications.

Results

During the study period, a total of 178 patients underwent LAGB removal (93.8% female). Most bands were inserted out of province, done privately and patients’ mean BMI pre-operatively was 41.6. Indications for band removal included dysphagia (41.1%), band slippage or tubing damage (25.8%), pain (15.2%), obesity-related health condition (11.2%), infected/ leaking band (3.9%), and band erosion (2.8%). At LAGB removal, patients’ mean BMI was 37.0 – thus there was a mean decrease of 4.6 in BMI between index and removal operations. One LAGB removal case was converted to open. The mean length of stay for LAGB removal patients was 2.9 days. 12 patients had post-operative complications: wound infection (58.3%), peritonitis (25.0%), pneumonia (8.3%) and food ball in stomach (8.3%). 38 out of 178 (21.3%) patients then underwent revision bariatric surgery in the form of laparoscopic Roux-en-Y gastric bypass procedures.

Conclusion

Although most primary gastric banding procedures are performed privately, the number of removals under NHS services is increasing. LAGB removal can be successfully performed to ease debilitating symptoms with excellent symptom resolution and minimal peri-operative complications.
SP2.1.5 A Systematic Review of Bariatric Surgery in Patients with Obesity and Type 1 Diabetes Mellitus
Authors: Appel Simone , Lee Lyndcie , Parmar Chetan
Published: November 2022

Background

The prevalence of obesity in the T1DM population has been increasing at a worrying rate. Bariatric surgery has proven to be effective in treating patients with T2DM, as weight changes had a direct effect on insulin resistance and requirements, and thus glycaemic control. However, evidence for the benefit of the procedure for patients with T1DM is still limited, demonstrating the need for a systematic review investigating this.

Methods

A systematic review was performed in accordance with the PRISMA guidelines. Articles not in relation to T1DM or lacking specific quantitative data were deemed unsuitable and excluded.

Results

26 studies were included with a total of 262 patients (F=167, M=73, N/A=22). The mean age was 37.08 years (n=207). The mean weight and BMI were 112.4kg (n=157) and 31.88 kg/m2 (24–58.9, n=261) respectively.

Most common procedures performed were SG with 120 patients (46%) followed by RYGB with 104 patients (39.3%). Insulin requirements changed from 90.77 IU/day (36.2–174) pre-operatively to a mean of 36.5 IU/day (5–75) post-operatively. No significant trend was found for changes of HbA1c levels. Main side effects were episodes of hypoglycaemia and DKA; mortality was not reported in any article. The mean %EWL was 72.3% (60–90.5%) at ≥6 follow up months. Reductions in co-morbidities such as hypertension and CVD were recorded in multiple studies.

Conclusion

Obese patients with T1DM can expect significant weight loss, potential resolution of co-morbidities, and reduction of insulin requirements, but it does not usually result in improved glycaemic control.
SP3.1.9 Implementation of colon capsule endoscopy (CCE) into the clinical setting – an early analysis
Authors: Pollock Alasdair , Pollock William , Moug Susan , Winter Jack , Boulton-Jones Rob , Witherspoon Paul
Published: November 2022

Aim

Analysis of the collaborative implementation of colon capsule endoscopy (CCE) within NHS Greater Glasgow and Clyde

Methods

Database collected prospectively from first 175 patients referred. Demographic data collected for those undergoing CCE.

Primary outcomes: negative, positive and incomplete/complications.

Secondary outcomes: those requiring further investigation and outcomes (normal, abnormal and not performed). Abnormal findings: benign disease, dysplastic changes, malignancy and unresulted.

Results

Of the first 175 patients put forward for CCE, 128 (73%) underwent CCE: n=47 deemed unsuitable due to patient preference (n=21) and consultant decision (n=15).

Mean age 57.8 (+/-13.9 SD), 56% female, 32% had ≥2 co-morbidities, and 6% having colorectal cancer family history.

CCE findings: negative 16% (n= 21), positive 71% (n=91), incomplete/complications 12.5% (n= 16).

Time from referral to CCE (Mean 130 days, Median 86 days). Time from CCE to reporting (Mean 9.4 day, Median 8 days). Time from referral (CCE report) to colonoscopy (Mean 127 days, Median 106 days). Colonoscopies still awaited (Mean 271 days, Median 269 days).

80% required further tests: 77% (n=98) colonoscopy or sigmoidoscopy and 4% (n=5) imaging. Results: 20% normal, 48% abnormal, 30% not yet performed and 2% inadequate/no longer required. Pathology: benign disease 38%, dysplastic changes 45%, invasive malignancy 9%, 9% unreported.

Conclusions

CCE has received significant investment to attempt to reduce the workload of endoscopy departments. However, 77% of the patients who underwent CCE require further investigation by scope. With an excellent safety profile, defining patient selection is key to optimising the clinical applicability of this evolving technology.