bluuebunny/crossref_metadata_2025 huggingface dataset:
SP5.2 High Nuclear Receptor 4A1 (NR4A1) expression is associated with poor prognosis in breast cancer patients
Authors: Jones Stacey
Published: August 2023

Aim

To evaluate the relevance of NR4A1 expression with respect to clinical prognostic markers and outcomes in a breast cancer cohort, as well as the METABRIC dataset.

Methods

Breast cancer tissue was obtained from a tissue microarray comprising all tumour subtypes, with common factor of use of adjuvant chemotherapy (n=305). Expression of NR4A1 was determined by immunohistochemistry. METABRIC data were accessed via cBioPortal. Records with suitable NR4A1 expression data and clinical data of relevance were obtained (n=1886). For both cohorts, cases were then dichotomised into high or low NR4A1 expression by performing receiver operator curve analyses, and relationships between expression and survival were tested.

Results

Kaplan-Meier survival analyses showed that high NR4A1 nuclear protein expression was associated with a poorer disease-free survival (DFS) and disease-specific survival (DSS), by means of 487 days, p=0.005; 621 days, p=0.001 respectively in the whole cohort. A sub-analysis of triple negative and ER-negative breast cancers also showed that high NR4A1 nuclear protein expression was associated with both a shorter DFS, by 1452 days, p=0.002; 1141 days, p=0.006 respectively and DSS, by 1603 days, p=0.001; 1187 days, p=0.001 respectively. Analyses of the METABRIC dataset demonstrated no significant influence of NR4A1 mRNA expression on DFS (p=0.978) or DSS (p=0.288) in the whole cohort, or the molecular subgroups, or depending on chemotherapy use.

Conclusion

High nuclear NR4A1 expression correlates with decreased DFS and DSS after chemotherapy in breast cancer and these findings suggest that NR4A1 could act as a potential target for inhibitor drugs in breast cancer.
SP6.6 Long-term effects of one-anastomosis gastric bypass on liverhistopathology in NAFLD cases: a prospective study
Authors: Salman Mohammed , Noureldin Khaled , Issa Mohamed , Fadlallah Elhaj Mujahid Gasemelseed , Agwa Hisham , Shalaby Ahmed
Published: August 2023

Background

Weight reduction can effectively improve nonalcoholic fatty liver disease (NAFLD), which is a constant companion of severe obesity. This study aimed to determine the effect of one-anastomosis gastric bypass (OAGB) on pathological liver changes in severely obese cases with NAFLD.

Methods

The present prospective research comprised 67 subjects with morbid obesity scheduled for OAGB during the period from February 2015 to August 2018. Clinical, biological, and histologic data were evaluated pre and 15 months postoperatively.

Results

Fifteen months after surgery, a considerable reduction was noted in the grades of fat deposition, liver cell ballooning, and lobular inflammatory changes, in addition to the total NAS score. Fifteen months after surgery, nonalcoholic steatohepatitis (NASH) disappeared in 42% of the patients. A significant regression of fibrosis stage occurred after surgery in 79.1% of patients (p < 0.001). After surgery, patients had substantial reductions in aspartate aminotransferase, alanine aminotransferase, γ-glutamyltransferase, HbA1c, total cholesterol, and Low-density lipoprotein (p < 0.001, for all comparisons). Diabetes mellitus, hypertension, and dyslipidemia resolved in 54%, 59%, and 69% of the patients, respectively.

Conclusion

OAGB resolved NASH from nearly 42% of patients and reduced the histological features of NAFLD 15 months after surgery. Bariatric procedures might be adopted as a therapeutic modality in severely obese cases with NAFLD after the failure of lifestyle modifications.
SP8.3 Aetiology and Management Outcomes of Adult Mechanical Bowel Obstruction in Nigeria: A Systematic Review and Meta-analysis
Authors: Falola Adebayo , Dada Oluwasina , Ndong Abdourahmane , Akande Damilola
Published: August 2023

Aim

Adult mechanical bowel obstruction (AMBO) has been previously reported to be majorly caused by hernias in developing countries. In Nigeria, however, there has been a recent change in pattern with adhesions now being the leading cause. The changing pattern of the causes, clinical features, mode of management and factors influencing the outcome of adult patients managed for bowel obstruction in Nigeria necessitated this review.

Method

Relevant keywords relating to AMBO were used to conduct a search on PubMed, Google Scholar and AJOL. 452 articles were subjected to title, abstract and full text screening, according to the inclusion and exclusion criteria. 10 articles met the inclusion criteria and were included in the final qualitative synthesis.

Results

The total sample size across the 10 studies was 1033. Adhesions, hernias and intra-abdominal tumours, responsible for 46.25%, 26.31% and 12.23% of cases, respectively, were the major causes of AMBO. 65.6% of cases were managed operatively and 34.4% were managed conservatively. The meta-analysis revealed high morbidity and mortality rates of 31% (95% CI: 17, 44) and 11% (95% CI: 6, 15), respectively, among adult patients managed for mechanical bowel obstruction in Nigeria.

Conclusions

Adhesion, which results majorly from appendicectomy is the most common cause of AMBO in Nigeria. This is unlike former reports where hernia was the most common cause. Morbidity results majorly from wound infection, recurrent adhesions and post-operative enterocutaneous fistula. The mortality rate is similar to reports from various West African studies and it is significantly influenced by surgical intervention time.
SP10.5 Effectiveness of Enhance Recovery After Surgery (ERAS) Protocols in Malignant Colorectal Cancer Resections: A 15 year cohort study
Authors: Gok M A , Mughal H N , Bughio M , Khan U A
Published: August 2023

Aims

ERAS improves post operative recovery following colorectal resections. ERAS is applicable to both laparoscopic and open surgery. Aim of study is to assess effectiveness of ERAS in malignant colorectal cancer (CRC) resections.

Methods

Single-centre cohort study evaluated post operative outcomes in elective malignant CRC resections from January 2008 to February 2023. CRC resections performed without ERAS were used as controls.

Results

Conclusion

ERAS was employed in more laparoscopic CRC resections. ERAS discontinuation in major surgical complications. Despite prolonged operation in ERAS group (p < 0.0001), hospital stay was significantly shorter (p < 0.0001). Survival rates were better in the ERAS group (Logrank p < 0.05), explained by ERAS wholly implemented & non ERAS were historical cases. Delayed ERAS occurred in 6.9 % of cases & can account towards delays in hospital discharge. This study demonstrated a targeted rehabilitation programme and early diagnosis of surgical complications can facilitate post-operative recovery.
SP10.6 Comparison of clinicopathological features of colorectal cancer during and after lockdown
Authors: Gowda Manoj Srinivas , Mesut Erel , Peter Bennett , Venkatesan Gowtham , Thulasiraman Sri , Jha Madan
Published: August 2023

Aims

When the UK entered the lockdown, the cancer pathways changed in order to deal with the pandemic and protect cancer patients who are at high risk from the virus. The objective of our study is to compare the clinicopathological features of colorectal cancer (CRC) during and after lockdown.

Methods

Patients who underwent colorectal surgeries for CRC between Feb-2020 to Aug-2022 were included in the study. All patient related and disease specific details were obtained from the prospectively collected database. Patients were divided in to two groups: Surgeries before (group-A: during lockdown) and after 22/2/21 (group-B: after lockdown). Patient demographics and pathological details were collected and analysed using standard statistical tests.

Results

A total of 528 patients underwent surgeries during this period, of which 422 had cancer resections. During lockdown 187 patients had cancer resections (Group-A) and 235 patients had surgery for cancer after lockdown (Group-B). The median age of patients is 72 and 73 years in group-A and B respectively (p-value:0.29). There is no difference between the two groups with respect to tumour, nodal staging and extramural vascular invasion. The median lymphnode yield is 20 (range:0-80) in group-A compared to group-B where the yield was 21 (range:0-102) (p-value:0.720). There were 44 patients with rectal cancer in group-A of which 4.55% had circumferential resection margin positivity (CRM) and 6.77% (4 of 59) of rectal cancers patients in group-B had CRM positivity (p-value:0.229).

Conclusions

There was no difference in clinicopathological features of patients having colorectal surgery during and after lockdown.
SP10.14 Comparing packing and non-packing of the abscess cavity post incision and drainage of perianal abscess. A meta-analysis
Authors: Nour Hussameldin M , Elmansi Abdalla Hashim E. , Magsi Abdul Malik , Peristeri Dimitra V , Mcwhirter Alexandra , Al Jebaie Khalid , Sajid Muhammed S
Published: August 2023

Aims

Wound packing following incision and drainage of perianal abscess has been found to be very painful. The aim of this study is to compare packing the wound and not packing the wound after incision and drainage of perianal abscess.

Methods

Standard medical electronic databases were searched and relevant published randomised controlled trials (RCT) were shortlisted according to the inclusion criteria. The summated outcome of post-operative pain score, recurrence rate and rate of occurrence of perianal fistula was evaluated using the principles of meta-analysis on RevMan 5 statistical software.

Results

Three RCTs on 490 patients undergoing incision and drainage of perianal abscess were included. In the random effects model analysis, the post operative pain score was statistically lower in NPG [risk ratio 0.66, 95%, CI (0.36, 0.97), Z=4.25, P=0.0001]. There was no heterogeneity [Tau2 = 0.15; chi2 = 9.32; df = 6; I2 = 36 %; p= 0.16] between the studies, however, statistically it was not significant. In addition, there was no statistical difference between the 2 groups in terms of recurrence of perianal abscess or the occurrence of perianal fistula [risk ratio 0.64, 95%, CI (0.31, 1.31), Z=1.23, P=0.22], [risk ratio 1.41, 95%, CI (0.89, 2.23), Z=1.47, P=0.14] respectively.

Conclusion

Not packing the wound post incision and drainage of perianal abscess is associated with significantly reduced VAS pain scores and has no effect on recurrence rate or the occurrence of perianal fistula. However, more RCTs recruiting a greater number of patients are required to endorse these findings.
SP11.7 Do women surgeons have autonomy in the operating theatre? Exploring the lived experience of female surgical trainees
Authors: Govind Garima , Mahendran Arunthathi
Published: August 2023

Background

Female surgeons routinely face biases at work such as microaggressions, mistitling, lack of opportunities and are held up to a higher standard than their male colleagues. Female trainees feel that their abilities are routinely underestimated, and literature shows they are objectively given less operative autonomy than male colleagues.

Methods

Snowball sampling recruited nine participants to the study. Four participated in a focus group, and the remaining five participated in a one-on-one semi structured interview. The focus group and interviews were transcribed and analysed using thematic analysis to understand the lived experience of female surgical trainees and their experience of autonomy in the operating theatre.

Results

Autonomy was associated with being able to make decisions peri- and intra-operatively and with being trusted to carry out the operation. Participants believed that positive relationships between themselves, their trainers and the wider theatre team is paramount to improving autonomy. A major barrier in improving training and autonomy is a disconnect between organisations and trainees’ learning needs.

Discussion

an appropriate level of autonomy is vital for trainees’ development and career progression. Due to persisting biases in surgery, the training needs of female surgical trainees are unique, and this study has brought their lived experiences of operative autonomy to light. It is vital that women surgeons are visibly represented in leadership roles at all levels so that they can advocate for, not only for their female counterparts, but for all surgical trainees, allowing a more individualised training programme and ultimately improving the overall training experience.
WTP2.4 Can we predict parathyroid adenoma size preoperatively with biochemical markers?
Authors: Kho Jason , Kuan Jen Yee , Turner Paul , Shetty Vinutha
Published: August 2023

Aim

In primary hyperparathyroidism, parathyroidectomy remains the mainstay of treatment. However, localising abnormal parathyroid glands can often prove challenging, and re-operations may be necessary. We aim to evaluate any correlation that might exist between parathyroid hormone (PTH) levels, preoperative peak corrected calcium levels and cinacalcet use with adenoma size.

Methods

We retrospectively reviewed consecutive parathyroidectomies performed for primary hyperparathyroidism by two experienced upper gastrointestinal surgeons (VS and PT) in a teaching hospital between April 2013 and December 2022. Hospital database was accessed to obtain data for biochemical markers, operation notes and histopathology reports. Spearman correlation coefficient was computed to evaluate linear relationship between PTH, peak calcium levels and adenoma size. Mann-Whitney-U test was used to compare cinacalcet use and adenoma sizes. P-value<0.05 was statistically significant.

Results

170 parathyroidectomies for primary hyperparathyroidism were performed during the study period. Patient cohort was predominantly female (n=131, 77.1%). Mean age of study population was 58±12 years. There were positive correlations between adenoma size and preoperative peak corrected calcium levels (R=0.25, p=0.001) and PTH levels (R=0.4, p<0.001) respectively. In patients who took cinacalcet preoperatively (n=46, 27.1%), there was an association with larger adenoma size (18±8mm vs 22±12mm, p=0.009).

Conclusion

Higher preoperative PTH levels and peak corrected calcium levels along with cinacalcet use may be associated with larger adenoma sizes. Further studies are required to validate these findings.
WTP2.9 Early Deceased Donor Kidney Transplant outcomes: Results from a Prospective National Transplant Access to Theatre (NTACT) Audit
Authors: Borbas Balint , Mujeeb Mariyam , Tanase Andrei , Aroori Somaiah
Published: August 2023

Background

Renal transplantation is increasing, yet there is a paucity of data describing post-operative complications. Therefore, this national audit aims to identify the incidence of early complications that impact patient outcomes.

Methods

We conducted a multicentre, prospective audit of adult deceased donor kidney-only transplants across 14 UK transplant centres between February and September 2022. Data was collected on significant checkpoints pre, intra and post-operatively, assessing for 30-day complication and mortality rates. Data was recorded on RedCap and analysed using descriptive statistics.

Results

476 kidney-only transplants were recorded, (59 excluded for incomplete/incorrect data). Of 417, 215 were donation after brainstem death (DBD) organs and 202 were donation after circulatory death (DCD) organs. The 30-day mortality was 0.47% (n=2/417). The primary graft function rate was 81%. The 30-day readmission rate was 18%, and median number of readmissions was 1 (IQR: 1-3). Of the readmitted recipients, 92% were readmitted once and 8% were readmitted more than. The 30-day reoperation rate was 12%, and median number of reoperations was 1 (IQR: 1-2), of these, 91% had 1 reoperation and 9% had more than 1 reoperation. Most common indications for reoperations were bleeding 49% (n=25), assessment of graft perfusion 17% (n=9), and wound dehiscence 10% (n=5). We noted a difference in rates of reoperations between DCD and DBD organs, 16% and 9% respectively, however, this was not significant. There was no significant difference in the readmission and mortality rate between DBD and DCD organs.

Conclusion

The overall early postoperative complication rates and 30-day mortality following deceased donor kidney transplantation are low.
WTP3.8 Histological stage and five-year outcomes in patients who undergo pancreatoduodenectomy for distal cholangiocarcinoma: an international multicentre study
Authors: Russell Thomas , Labib Peter ,   RAW Study Collaborators, Aroori Somaiah
Published: August 2023

Aims

Patients with a distal cholangiocarcinoma (CC) may be offered pancreatoduodenectomy (PD) with curative-intent providing they are appropriate surgical candidates. Patients with early disease are known to have better outcomes. This study aimed to investigate and quantify the relationship between histological stage and five-year recurrence/survival.

Methods

Data were extracted from the Recurrence After Whipple’s (RAW) study, a multicentre study of PD outcomes (29 centres in 8 countries, n=1484). CC patients were grouped by their T stage and N stage, and five-year recurrence/survival rates were compared using Fisher’s exact test.

Results

A total of 205 patients (13.8%) had CC confirmed. The number of patients with T1, T2, T3 and T4 disease was 11 (5%), 25 (12%), 158 (78%), and 8 (4%), respectively (Tx: 3). Five-year recurrence was 9%, 32%, 70% and 75%, respectively. T1-2 patients (vs T3-4) had lower rates of five-year recurrence (OR: 0.1, 95% CI: 0.1-0.3). Five-year survival was 90%, 60%, 23% and 38% in patients with T1, T2, T3 and T4 disease, respectively. T1-2 patients (vs T3-4) had higher rates of five-year survival (OR: 5.8, 95% CI: 2.8-12.3). 69 patients (34%) had no lymph node involvement and 136 (66%) had positive regional lymph nodes. N0 patients (vs N1) had lower five-year recurrence (OR: 0.3, 95% CI: 0.1-0.5) and higher five-year survival (OR: 4.5, 95% CI: 2.4-8.7) rates.

Conclusions

In our multicentre study of PD outcomes, increasing T and N histological stages were found to correlate with increased five-year recurrence and reduced five-year survival rates in patients with CC.
WTP4.3 A Service Evaluation of Emergency Laparotomy and Total Parenteral Nutrition at a Single Teaching Hospital
Authors: Ashmore Daniel , Lee Matthew , Wilson Timothy
Published: August 2023

Aims

Malnourished patients undergoing emergency general surgery (EGS) have a greater risk of mortality than those not malnourished. There is often a need for nutritional support in EGS. This study investigated the risk factors for total parenteral nutrition (TPN) in patients undergoing emergency laparotomy, and whether there is an association with the NELA risk score.

Methods

A five-year review (June 2016-2021) of the local NELA database and referrals to the Nutrition Support Team was performed. Pre-operative, operative and post-operative data for patients who received TPN and those who did not was collected. Associations between risk factors including NELA score and TPN use were examined using chi squared test and Mann Whitney U, as appropriate.

Results

There were 931 NELA patients, of which 22.8% (n=173) received TPN. Intestinal obstruction was the commonest indication for surgery at 51.3% (n=478) with no difference in age or sex. Despite patients receiving TPN being more likely to be frail (0.004), have higher ASA scores (0.001), lower albumin levels (<0.001), and worse pre- and post-operative NELA scores (both 0.002), stoma formation (0.002) and mortality (<0.001) was half that in patients without TPN. Sub-analysis reveals this was irrespective of when TPN was administered.

Conclusions

Two mutually exclusive explanations exist. TPN may be a predictor of disease severity and subsequent clinical intervention, or it may indeed improve the nutritional and clinical outcomes in this high risk EGS group. Further studies are needed to clarify this, in addition to the most appropriate method of identifying malnutrition in NELA-eligible patients.
WTP4.4 A national survey of NELA Leads to identify current nutrition practices and pathways in NELA-eligible emergency general surgery patients
Authors: Ashmore Daniel , Wilson Timothy , Halliday Vanessa , Lee Matthew
Published: August 2023

Aims

No nutritional data are collected by the National Emergency Laparotomy Audit (NELA), despite the association of malnutrition with worse outcomes. This study aimed to describe the current practices, pathways and barriers encountered in identifying malnutrition in NELA-eligible patients.

Methods

Following piloting and validity assessment, anaesthetic and surgical NELA Leads at hospitals across England and Wales that submitted data to NELA’s 7th report were emailed a survey link. Responses were gathered using Qualtrics. Descriptive analysis and correlation with laparotomy volume and professional subtype was performed in SPSSv26. University of Sheffield ethical approval was obtained.

Results

There were 166/289 NELA Leads and 117/167 hospitals that completed the survey (57.4% and 70.1% response rates, respectively). Respondents reported low rates of nutritional screening (25.3%) and assessment (15.7%) for malnutrition pre-operatively with no awareness of local screening tools (41.0%) despite 68% of units having a Nutrition Support Team. Contrary to guidelines, NELA Leads report albumin levels continue to be used to determine malnutrition risk (73.5%). Post-operative pathways were common (71.7%). Reported barriers to nutritional screening and assessment included a lack of time, training and education, organisational support and responsibility. NELA Leads indicated nutrition risk is inadequately identified, and is an important missing data item from NELA (71.2%). Responses were not correlated with hospital laparotomy volume or professional subtype.

Conclusions

Identifying malnutrition risk in NELA patients requires attention. Barriers are wide reaching and include a lack of time, knowledge and ownership. Nutrition pathways that encompass the pre-operative phase and incorporation of malnutrition data in NELA may support improvements.
WTP4.13 The Quality of Service of Index Admission Laparoscopic Cholecystectomy For Patients With Acute Biliary Symptoms: Re-audit From a Rural District General Hospital
Authors: Mohamed Samy , Rees Ryan , Sonanis Sagar , Mohamed Omnia , Dean Thomas , Sallami Zeyad
Published: August 2023

Aims

To continue evaluating our service of index admission laparoscopic cholecystectomy for acute biliary diseases.

Methods

A retrospective analysis was conducted. All patients who had an index admission laparoscopic cholecystectomy between 2016 & 2021 were identified from the hospital database. Data including demographics, time to diagnostic imaging, surgical technique, complications, re-operation, re-admission and mortality were collected from the hospital clinical information system “Myrddin” and patients’ notes.

Results

There were 335 patients (male: female 128:207) with median age of 62 years (range 16- 92years) presented as emergency with acute biliary symptoms and had index admission cholecystectomy. The reasons for acute admission were acute cholecystitis (n=205) acute pancreatitis (n=60), biliary colic (n=43) and calcular obstructive jaundice (n=27). The time to diagnostic imaging ranges from same day of admission to 3 days (mean= 0.81 days). Laparoscopic cholecystectomy was done in 333/335 with conversion rate of 1.5% (n=5). Five patients (1.5%) required re-operation because of bile leak. There was no major bile duct injury, no bleeding requiring any intervention. The re-admission rates within one week and within 30 days of surgery were (2.4%) and (0.9%) consecutively. Mean length of in-hospital stay (LOS) was calculated only for patients with acute cholecystitis and biliary colic (n=248) and it was 6.8 days. Mortality over 9 years period was 0.579% (3/518).These results are comparable to the available data from the national and international published data.

Conclusions

Index admission laparoscopic cholecystectomy is still safe and meets the recommended quality standards. Time to surgery has reduced compared to previous cycle and this led to decrease in LOS.
WTP6.7 Implementation of a Trust-wide electronic operation note proforma – a quality improvement project
Authors: Anand Easan , Tong KinSeng
Published: August 2023

Aims

The operation note is an important document that records intra-operative details and provides post-operative instructions. It ensures continuity of care and may be used for medicolegal purposes. In our Trust, there is a move towards electronic operation notes in line with the digitisation of patient records. Here we report initial data from our multi-staged implementation of a Trust-wide electronic operation note proforma.

Method

The Plan/Do/Study/Act (PDSA) method was used. Regular key stakeholder meetings were held involving the Information Technology (IT) department and various surgical teams. The Royal College of Surgeons’ Good Surgical Practice (GSP) provided minimum standards for operation notes. Forms4Health was used as the platform for electronic operation notes.

In PDSA cycle 1, a retrospective audit was performed involving 50 randomly selected handwritten or typed operation notes. The operation notes were audited by two independent reviewers against GSP standards. Handwritten operation notes were also assessed for legibility.

Results

A total of 29 handwritten and 21 typed operation notes were analysed. Among the handwritten operation notes, 15 (52%) were legible. Handwritten notes demonstrated 68% compliance with GSP standards, as compared to 79% for typed notes (p <0.05). Typed notes were superior at recording time of surgery (p <0.01), whether it was elective or emergency (p <0.01), complications encountered (p <0.05) and thromboprophylaxis instructions (p <0.01).

Conclusions

Our data indicate a significant improvement in GSP compliance via electronic notes. As next steps, we will integrate the proforma into existing Trust IT platforms and include additional features to increase user efficiency and re-audit service improvement.
WTP6.10 A validation & health economics review of a novel Augmented Reality solution to surgical training
Authors: Rawaf David , Sheikh Mohamed , Bahnasawi Mohammed El , Beghal Gurpreet , Toms Joseph , Harris Matthew
Published: August 2023

Aims

To validate the capability of AR in surgical training utilising objective & subjective assessment, health economics & systematic review (SR) of available literature.

Methods & Results

Initially an independent SR was conducted (n=26) comparing AR vs incumbent modalities (VR, box trainers, & cadaveric). We demonstrated that AR is preferred, improves procedural success & provides faster skill acquisition when compared to other modalities.

Several pilot studies were then conducted utilising the LapAR1. One (n=11) demonstrated through benchmarks of either appendicectomies (n=5) or vaginal vault (n=6) closures that intervening AR-based training under one hour with LapPass2 tasks significantly improved ‘completion time’ by 19% and 36.9%, and ‘distance travelled(m)’ by 25% and 56% respectively. Another (n=6) demonstrated through 10 appendicectomy benchmarks with three intervening LapPass tasks over the course of two weeks, significant savings in ‘completion time’ by 55-66% and ‘distance travelled’ by 39-72%. Finally, another study looking at self-confidence scores pre & post-LapAR exercises indicated that a mean improvement of 3.82 (likert, p=0.018) was found across all areas.

Finally, a BMJ peer-reviewed health economics review3 found that £79 could be saved per appendicectomy patient. Once validation of the efficiency assumptions were made using the study data, we can extrapolate and realise a potential cost saving of £455 through reduced anaesthetic time and shorter inpatient stay.

Conclusions

We can now infer that AR-based laparoscopic training with the LapAR is not only preferred, but it is more effective at providing clinically translatable, and scalable cost-effective laparoscopic training as a potential new gold standard.
WTP6.11 Are surgical technical errors inherited from lack of mental cognitive framework or lack of motor skills for a given surgical task? results of a pilot study
Authors: Mehmood Iftikhar , Riaz Mohammad , Kumwenda Ben , Tang Benjie
Published: August 2023

Aims

To study the impact of augmented terminal feedback designed by error type learning for developing surgical skill.

Methods

Twenty medical students were randomised in two groups, based on feedback they received; Video Feedback (VF) and Online Feedback (OF). Laparoscopic double square knot was selected as the task. Task was divided into subtasks and steps. Potential errors were studied and divided into types: Cognitive Based (CB) & Skill Based (SB). Laparoscopic Task was executed in four stages and feedback was provided after each stage. Error types and numbers were studied.

Results

9178 errors were studied in 80 tasks, 320 subtasks and 2080 steps in four stages. 5091 (55%) CB errors and 4087 (45%) SB errors were recorded. VF group enacted 2251 CB errors in stages (46%,29%, 18%,7%) and 1692 SB errors (41%, 28%, 18%, 13%). OF group enacted 2840 CB errors (29%, 26%, 25%, 20%): whereas, 2396 SB errors (22%, 23%, 21%, 34%). Both groups were comparable in enacting SB & CB errors in early stage of skill; nevertheless, highly significant difference was noted in 3 stages when SB errors are considered (p < 0.01 vs OF group). Although, there was steady improvement in CB type errors, but no significant different was noted (p > 0.5 vs OF group) in all stages of learning.

Conclusions

Augmented terminal feedback in the form of videos feedback is superior to current standards in terms of reducing cognitive based errors; whereas, skill based errors rely on time and experience rather than type of feedback.
WTP6.13 A closed loop audit on the Quality of Electronic Discharge Summaries within General Surgery
Authors: Yaqoob Omar , Wain Mehmood
Published: August 2023

Aim

Following surgical admissions, Electronic Discharge Summaries (EDS) are vital to ensure patient safety through continuity of care to the primary care setting. It is also an official record to the patient about the treatment and care they received including any further treatment or follow up appointments they require and is therefore important they are not only accurate but detailed with all the relevant information included.

Methods

An audit of Electronic Discharge Summaries within a busy Emergency General Surgery department was undertaken using a gold standard which was established by using the 20 most important parameters within the standardized proforma. If a discharge summary had 80% or more parameters sufficiently completed it was deemed to be adequate. A first and second cycle of data collection of 100 EDS’s were undertaken and analysed using the gold standard criteria.

Results

A first cycle data collection of 100 EDS’s were analysed, it was found only 55% of these were adequate following the standard set. An educational teaching session to doctors at a local meeting was carried out to explain why 45% of the discharge summaries were not complaint with the standard set. The second cycle showed 91% of EDS’s to be of adequate standard.

Conclusion

This audit has shown that adhering to a gold standard template can significantly improve the quality of discharge summaries. A re-audit in 12 months should be carried out to ensure standards have been maintained.
WTP7.2 Post COVID-19 Pandemic Impact on Surgical Assessment Unit (SAU) Activity
Authors: Hamid Osama , Harker Emma , Cook Tim
Published: August 2023

Aim

Emergency surgical services were consolidated to one of our two hospital sites at the onset of the COVID-19 pandemic. All hospital services are under increasing pressure. This study aimed to assess the ongoing post-pandemic impact on the activity of our surgical assessment unit (SAU).

Method

Data was recorded prospectively on patients attending SAU. Comparison was made between the first three months of the pandemic (March-May 2020) and the two 15-month periods since (June 2020-August 2021 and September 2021-November 2022 respectively). The number attending, proportion admitted, and time taken to see a senior decision maker were recorded.

Results

The average number of patients attending per month in the first three months was 364. This rose to 760 and 880 per month respectively in the two post-pandemic periods. The proportion admitted was initially 28.3% but fell to 22.7% and 20.4% in the following periods. Admission numbers in the two 15-month periods were similar (173 vs 180). There was a reduction in the proportion seen by a senior decision maker within two hours across the three time periods (60%, 52% and 35% respectively).

Conclusions

SAU attendances have more than doubled since the onset of the pandemic. Attendances have continued to rise in the 30 months since the initial outbreak, with little effect on admission numbers. Consequently, fewer patients are seen quickly which likely has a detrimental impact on patient experience. Lack of access to other areas of healthcare may have influenced these changes. This increased activity should inform future service planning.
WTP7.4 Is there a role for ambulatory management of acute pancreatitis in selected cases?
Authors: Javanmard-Emamghissi Hannah , Knight Stephen , Kosti Angeliki , Hollyman Marianne , Study PANC
Published: August 2023

Aim

Pancreatitis is a common general surgical condition that presents with variable severity. The usual management involves a hospital admission for observation, lasting a median of five days. However, there may be a role for ambulatory management. We aimed to determine which patients presenting with acute pancreatitis may be suitably managed in the community.

Method

This prospective, multicentre cohort study at 113 UK sites included adult patients diagnosed with pancreatitis. Potential for ambulatory management was defined as the presence of mild pancreatitis, tolerating oral fluids, and oral analgesic requirement only. Multilevel logistic regression models determined relationships, accounting for the clustering of patients within hospitals.

Results

Of 2580 patients included, only 13 (0.5%) patients were managed without admission and 150 (6.1%) patients were admitted a single night only. Overall 1836 (71%) of patients had mild pancreatitis, of which 928 (50.5%) were potentially suitable for ambulatory care.

After accounting for median CRP peak at 48 hours, a CRP of <150 at 48 hours was associated with a lower risk of all complications (OR 0.35, 95% CI 0.30-0.42; P<0.001) and CT-confirmed collection and/or necrosis (0.18, 0.15-0.22; P<0.001). Patients were also twice as likely to be suitable for ambulation (OR 2.07, 1.75-2.44; P<0.001).

Conclusion

Just over a third of patients with pancreatitis could potentially be managed ambulatory. CRP at 48 hours is a strong predictor of pancreatitis-associated complications and may help direct further follow up.
WTP7.8 Adult Bowel Intussusception: A Case Report and new insights
Authors: Bodapati Venkata , Alseifi Shaker , Kaur Geetinder
Published: August 2023

Introduction

Intussusception in adults is rare and constitutes 1-5% of small bowel obstructions. This rarity along with atypical presentation make diagnosis difficult, sometimes delayed and makes cross-sectional imaging mandatory for correct management. Prompt diagnosis and treatment are essential to prevent serious complications like perforation, peritonitis etc. Usually, lead points have been thought to be caused by neoplastic polyps but recently, non-malignant causes (lipomas or nodal masses) are coming to the forefront. Postoperative histology review is important to plan for further management. Here we present an adult patient with intussusception who needed surgical intervention but no post procedure treatment.

Case report

Our 78- year-old patient was admitted with sudden onset severe generalised abdominal pain for a day. Examination revealed a soft abdomen with a tender mass palpable in her right lower abdomen. CTAP revealed long segment ileocolic intussusception with a 3cm lipoma as the lead point. She underwent a laparotomy where oedematous bowel with irreducible intussusception and possible ischaemia were found; a right hemicolectomy was carried out. Histology revealed the intussuscipiens to be a lipoma. She made an uneventful recovery.

Discussion

It is important to consider intussusception in the differential diagnosis in adult patients with abdominal pain even in absence of typical obstructive symptoms. Adult cases are usually associated with neoplasm but there is increasing evidence of nonmalignant causes such as benign polyps, nodal masses or lipomas which act as the lead point in adult intussusception. Postoperative histology review is important to plan further management.
WTP7.9 Optimising Appropriate Referral, Early Diagnosis and Management of Patients Presenting to the Emergency Department with Right Iliac Fossa Pain; a Collaborative Approach in The Design of Local Right Iliac Fossa Pain Pathway
Authors: Forsyth Katrina , Pipe Michelle , Mellers Lucy , Mohamed Fatima , Vavasour Kate , Stewart-Parker Emma
Published: August 2023

Diagnostic uncertainty in patients presenting with right iliac fossa (RIF) pain to the Emergency Department (ED) is well established and multifactorial, leading to challenges in selecting the most appropriate specialty for initial referral. This study investigates local practice, which will form the basis for RIF pain pathway development.

Methods

We collected prospective data over one month for RIF pain presentations to our ED, with onward referral to General Surgery (December 2022 – January 2023). This included demographics, symptoms, appendicitis likelihood utilising validated scoring tools, investigations, management and final histology. The number of women undergoing gynaecological review was also assessed, as were negative laparoscopy rates.

Results

Data collection revealed 46 patients presented with RIF pain: 30(65%) female, median age 29(18-44), 16(35%) male median age 35(21-53.) Thirteen (28%) underwent diagnostic laparoscopy, two of which were negative, one male and one female. Ultrasound scan (USS) was conducted in 70% females, and 6% males; CT in 31% males, and 27% females. Gynaecology review & USS were conducted in 38% of women. Overall, 87% of women had imaging. Two women underwent a laparoscopy without imaging. Acute appendicitis was diagnosed definitively in 21%.

Conclusions

The majority of patients in this study were premenopausal women. This cohort poses a diagnostic challenge. Further data is required, with collection underway, to help understand the best way to manage these patients. The outcomes of our data collection highlight the need for a local right iliac fossa pathway to improve appropriate specialty referral, timely imaging, diagnostic certainty and avoidance of negative laparoscopy.
WTP7.13 Simultaneous pneumoperitoneum and pneumomediastinum- would you guess sigmoid diverticular perforation? A Case Report
Authors: Nevill Benjamin , Collier William , Lingam Gita , Sivarajah Vernon
Published: August 2023

Introduction

Simultaneous pneumoperitoneum and pneumomediastinum is a rare radiological finding. There are only 6 reported cases in the literature of this being due to a diverticular perforation.

Case report

A 78-year-old male presented with worsening shortness of breath, lower back pain and lower abdominal pain. Past medical history included myasthenia gravis, for which he took pyridostigmine. A computed tomography (CT) abdomen and pelvis with contrast identified pneumoperitoneum, pneumomediastinum and subcutaneous emphysema of the neck. The site of the perforation was unclear radiologically.

Urgent diagnostic laparoscopy revealed a sigmoid colon perforation secondary to sigmoid diverticulitis. The procedure was subsequently converted to an open Hartmann’s Procedure. Extensive emphysema within in the mesentery was noted intra-operatively.

Post-operative recovery was complicated by a chest infection but the patient recovered well and was discharged home on day 15.

Discussion

Colonic diverticular disease is increasing in prevalence worldwide. The most common site of diverticulitis is the sigmoid colon (an intraperitoneal structure). Perforation of diverticulitis is a serious complication that can require urgent surgery. Pneumoperitoneum is a well-recognised sign of sigmoid diverticular perforation, however pneumomediastinum is far rarer. Posterior perforations of the sigmoid colon have the potential to enter the posterior para-renal space, penetrate the diaphragmatic hiatus and present with pneumomediastinum.

Conclusion

Simultaneous pneumoperitoneum and pneumomediastinum is rarely caused by colonic perforation. This can lead to a delayed diagnosis and poorer patient prognosis.
WTP8.10 The ‘Let’s talk about Black Women and Breast Cancer’ Conference – a targeted healthcare intervention
Authors: Adeboye Teniola , Samuels Sabrina , Adomah Sarah , Oni Georgette
Published: August 2023

Aims

Studies show that targeted health interventions are more successful. The “Let’s talk about Black Women and Breast Cancer” (BWBC) annual conference was established to educate as well as empower the lay public but to also highlight the poorer breast cancer outcomes in the Black community for health care professionals (HCPs). The aim of the conference was to use a targeted intervention in the hope that it would contribute to the improvement of these poor outcomes through lectures and interactive workshops.

Methods

All those attending the conference were sent an online questionnaire. This consisted of 14 mixed method questions including qualitative data on whether the conference led to a change in health behaviours. Attendees were sent one reminder to complete the evaluation and were given 1 month to complete it.

Results

132 delegates attended the conference and 60 evaluation forms returned (45.5% response rate). 80% of responders attended in-person with the remainder online. 95% (57/60) of attendees felt the conference taught them something new, 81% (49/60) felt encouraged to go for breast screening, 85% (51/60) felt encouraged to examine themselves and 83% (50/60) felt more empowered to engage in health consultations.

Conclusions

The BWBC conference was successful in educating attendees regardless of background, and helped to empower regarding decisions around breast health. The shared learning allowed it to be mutually beneficial for HCPs and lay public alike. Whilst the conference was a success, it highlights that there is much needed work to be done to improve healthcare inequalities for Black women with breast cancer.
ThTP1.7 Staging laparoscopy in bilio-pancreatic malignancies compared to radiological staging: A comparative study
Authors: Noureldin Khaled , Issa Mohamed , Salman Mohamed , Agwa Hisham Agwa , Fadlallah Elijah Mujahid Gasemelseed , Shalaby Ahmed
Published: August 2023

Introduction

The study was to compare the accuracy of laparoscopy in staging and selecting patients diagnosed with malignant obstructive jaundice, to the traditional investigation.

Methods

A prospective study conducted in the period between September 2017 and December 2018.30 patients, having malignant jaundice, were divided into two groups for cancer staging to assess their resectability and operability. Staging of 15 patients in group A was limited to conventional diagnostic methods, while 15 patients were in group B, Where Laparoscopy was added.

Results

Results showed that the accuracy of routine investigations in staging was 73%, while that of laparoscopy was 93%. The number of cases under staged by imaging were 8 cases(these were 3 in Group A and 5 in group B) thus they were diagnosed as operable. On the other hand, just 1 case was misdiagnosed by the laparoscopy. Regarding the morbidity and mortality, there were variable complications among those who had unrequired laparotomies including one mortality case. On the other side, the incidence of complications were markedly decreased in group B, with no mortality incidence.

Conclusion

Diagnostic laparoscopy has a crucial role in staging people with malignant jaundice and may decrease the rate of unnecessary laparotomy in people found to have resectable disease by conventional imaging.
ThTP1.13 Improving Practice in Acute Pancreatitis Management at University Hospital Wishaw
Authors: Slater Gabrielle , Mittal Sagar
Published: August 2023

Acute pancreatitis has an incidence of 150 to 420 cases per million population in the UK and appropriate management is essential given its high early mortality rate.

This clinical audit aimed to improve the initial management of acute pancreatitis in patients presenting to UHW between June 2021 and August 2022.

Retrospective analysis was performed for all acute pancreatitis patients discharged between 01/06/21 and 01/12/21. Management was compared against NICE, BSG and RCS audit standards which encompassed risk stratification, investigations, non-operative and operative management. Initial results were presented at the surgical monthly meeting in April 2022 to raise awareness of standardising care. An acute pancreatitis sticker was implemented to drive change. To assess the intervention impact, prospective data collection was performed from May to August 2022.

Results revealed an improvement in nine out of ten of the audit standards. Suitable investigation into pancreatitis aetiology improved from 25% to 50%, with a notable 83% reduction in clinicians assuming alcohol induced pancreatitis without prior investigation of cause. Initial risk stratification of patients improved from 36% to 52% and severity assessment was bettered from 4% to 36%. The provision of nutritional support to relevant patients rose from 11% to 46%. Comparison of sub-cohorts revealed that adherence with the pancreatitis sticker showed measurably better compliance with standards.

Raising awareness through departmental teaching and a pancreatitis sticker have demonstrated an improvement in standardisation of care, benefiting patient outcomes. Use of a visual aid has been shown to better standards therefore, future cycles should focus on compliance with sticker implementation.
ThTP2.13 Improving analgesia on discharge after Oesophagectomy: A three cycle quality improvement project
Authors: Fiander Louis , Lunt Adam , Easter Jacqueline , Carr William , Berrisford Richard
Published: August 2023

Introduction

Oesophagectomy is a painful operation. Poorly controlled post-operative pain increases the risk of complications including pneumonia and venous thromboembolism. On discharge, patients become more active and have less regular reviews, both increasing the risk of uncontrolled pain. Adequate analgesia is essential. We aimed to assess practice relating to discharge analgesia following oesophagectomy, implement interventions to improve discharge prescribing, then re-assess.

Methods

Retrospective data were collected for patients discharged following oesophagectomy between 22/03/2021 and 09/11/2021. Data were analysed in three subgroups: pre-intervention; following education programme; and following introduction of e-prescribing “order-sets”. Intervention comprised of the formulation of a guideline for discharge analgesia (see Table 1), an education programme and implementation of an order-set. Discharge prescriptions from each subgroup were then compared to the guideline.

Results

Data for 53 patients were analysed. Subgroups contained 18, 17 and 18 patients respectively. Pre-intervention, 14% of discharge prescriptions met the guideline standard, 14% prescribed no analgesia and 38% prescribed Paracetamol alone. Following education, 82.4% of discharge prescriptions adhered to guidelines. Following order-set introduction, adherence was 83.3%.

Conclusions

Effective analgesia is essential following oesophagectomy. By formulating and disseminating guidelines, alongside an education programme and introducing order-sets we have demonstrated significant and sustained improvement in discharge prescriptions for oesophagectomy patients.