bluuebunny/crossref_metadata_2025 huggingface dataset:
SP6.1.6 Symptoms and Satisfaction after Nissen Fundoplication – A 10 Year Follow Up
Authors: Innes Ailsa , Hughes Georgina , Menon George , Virupaksha Suvi
Published: November 2022

Introduction

Laparoscopic Nissen fundoplication remains a key option for surgical treatment of refractory gastro-oesophageal reflux disease. However, limited long term data are available on postoperative symptoms and satisfaction. We aimed to evaluate these in our patients 10 years following their operation.

Methods

144 patients were contacted by telephone. Participants were asked about heartburn and obstructive symptoms. If heartburn or dysphagia was present they scored this on a scale of 1–5. Satisfaction was scored from 0–5 and using a four point outcome scale. Respondents were also asked whether they would recommend the operation or have a reoperation if needed.

Results

We gained 49 participants with operation dates from 2009–2011. 5 participants had since had a redo operation so were excluded from the symptom analysis. There was a high prevalence of obstructive symptoms in the respondents, and a significant minority still experience a degree of heartburn.

Conclusion

Satisfaction with Nissen fundoplication remains high for most patients 10 years post-operation. However, there remains a significant obstructive symptom burden. This is important to consider as alternative procedures such as Toupet fundoplication become more prevalent.
SP6.1.8 The Impact of Drain and Reinforcement on the Outcomes of Bariatric Surgery: A Prospective Study
Authors: Noureldin Khaled , Salman Mohamed , Tourky Mohamed , Issa Mohamed
Published: November 2022

Purpose

Aimed to investigate the impact of reinforcement and abdominal drains on the outcome of laparoscopic sleeve gastrectomy (LSG).

Methods

A prospective study included obese patients scheduled for LSG. Patients were assigned to receive drain, reinforcement, or both according to surgeon's preference and followed up for one month after surgery. Primary outcome was identification of the association between intraoperative drain/reinforcement and incidence of postoperative complications.

Results

125 (20.3%) patients received intraoperative drains. The proportion of postoperative morbidity was comparable between the drain and non-drain groups (3.2% versus 1.6%; p = 0.25). Drain group had similar incidence of blood transfusion (2.4% versus 1.7% in non-drain group; p = 0.43) and postoperative leakage (0.8% versus 0.2% in non-drain group; p = 0.36). Incidences of blood transfusion (p = 0.56) and reoperation (p = 0.98) were comparable between the drain and non-drain groups. There were no statistically significant differences between the drain and non-drain groups regarding postoperative mortality and wound infection (p > 0.05). In contrast, 440 (71.3%) patients received reinforcement. The proportion of postoperative morbidity was comparable between reinforcement and non-reinforcement groups (1.6% versus 2.8%, p = 0.07). Patients in reinforcement group were less likely to develop postoperative bleeding (0.7% versus 4% in the non-reinforcement group; p = 0.004), while no significant difference was detected in terms of postoperative leakage (p = 0.33) and in-hospital mortality.

Conclusion

Abdominal drainage did not reduce the complications of LSG patients. Reinforcement has role in controlling the bleeding but not leaks. Both techniques did not significantly impact the mortality rate.
SP6.1.10 Prevention of internal hernia by closure versus non-closure of the mesenteric defect in patients undergoing Roux-en-Y gastric bypass- a meta-analysis of published randomized controlled trials
Authors: Ojofeitimi Oluwamayowa , Ahsan Amiya , Sajid Muhammad , Khan Mansoor , Singh Krishna
Published: November 2022

Objective

The objective of this article is to evaluate the prevention of internal hernia by mesenteric defect closure (MDC) versus non-closure of the mesenteric defect (MDNC) in patients undergoing Roux-en-Y gastric bypass.

Method

Standard medical electronic databases were searched, and relevant published randomized controlled trials (RCT) were shortlisted according to the inclusion criteria. Summated outcome of post-operative surgical variables including the incidence of internal hernia were analyzed using principles of meta-analysis on RevMan 5 statistical software.

Result

Five RCTs on 3285 patients undergoing Roux-en-Y gastric bypass operation for any indication or approach were found suitable for meta-analysis. There were 1635 patients in the MDC group and 1650 patients in the MDNC group. The duration of the operation was statistically longer in MDC [random effects model, standardized mean difference (SMD) 0.73, 95% CI (0.22–1.25), z=2.78, p=0.005]. There was no statistical difference related to length of hospital stay [random effects model, standardized mean difference (SMD) 0.15, 95% CI (-0.41, 0.44), z= 1.01; P= 0.31] between the two groups. The incidence of internal hernia was significantly reduced in MDC group. This difference was statistically significant [random effects model, odds ratio 0.36, 95% CI (0.19–0.66), z=3.27, p=0.001]. However, there was significant statistical heterogeneity (Chi2= 31.99, df = 4 (P < 0.00001) among included RCTs.

Conclusion

The routine closure of mesenteric defect in patients undergoing Roux-en-y bypass may be an effective approach to reduce the risk of internal hernia. However, more RCTs of robust quality recruiting higher number of patients are required to validate these findings.
SP6.2.1 Dysphagia in the perioperative period: Preliminary audit of pre-operative weight loss in patients undergoing oesophago-gastrectomy for primary locally advanced oesophageal cancer
Authors: Russell Claire , Patel Pranav H , Lane Carol , Chaudry Asif , Allum William , Kumar Sacheen
Published: November 2022

Background

Malnutrition and dysphagia are highly prevalent in patients with oesophageal cancer. The International Dysphagia Diet Standardisation Initiative (IDDSI) is a global standard to describe oral intake for dysphagic individuals. Greater weight loss (WL) after oesophago-gastrectomy is associated with increased length of stay (LOS), rate of post-operative complications and worse five-year survival, placing a burden on resources. This audit aimed to determine associations between pre-operative IDDSI scores, WL and post-operative morbidity.

Methods

A retrospective audit of patients undergoing oesophago-gastrectomy for locally advanced oesophageal cancer was conducted in a single tertiary cancer centre between 2017 and 2018.

Pre-operative WL was compared with IDDSI scores, post-treatment WL, post-operative complications, Critical Care Unit (CCU) and inpatient LOS.

Results

78 patients were included, 65 male and 13 female with mean age 64 (range 40 to 80). Median pre-operative percentage WL was greater in patients with moderate dysphagia (IDDSI 5-6) than those with a normal swallow (IDDSI 7), though not statistically significantly.

There were 26 Grade 3/4 Clavien-Dindo complications. Pre-operative WL correlated with rate of complications, and WL five to seven months post-operatively (p=0.04, p=0.001). Greater pre-operative WL correlated with a longer CCU LOS and total inpatient LOS, but this was non-significant (p=0.09, p=0.07).

Conclusions

IDDSI scores 5/6 may be early indicators for nutritional intervention in the peri-operative pathway. Each clinical interaction in the cancer pathway provides an opportunity to identify and correct malnutrition and improve outcomes.

A criteria-specific nutritional pathway has been implemented to optimise patients peri-operatively. A prospective re-audit will indicate improvements on patient-related and oncological outcomes.
SP6.2.2 Oesophageal Perforation: The Experience of a Tertiary Referral Centre 2009–2021
Authors: Alasmar Mohamed , Shehata Zak , Altarawni Mohammad , Casey Patrick , Melhado Rachel , Sultan Javed
Published: November 2022

Aim

Oesophageal perforation is a relatively rare surgical condition associated with a high mortality risk. Currently there is no clear consensus on a superior approach to treating this condition, and the rarity of oesophageal perforation has led to a great variability in treatment between centres. This study aims to report the experiences of a tertiary referral centre over 12 years.

Methods

We collected data on patients presenting with oesophageal perforation at a tertiary referral centre from 2009–2021 (n=83). Demographics, presenting symptoms, length of stay and complications were collected retrospectively using the electronic patient record.

Results

The most common cause of perforation in our dataset was Boerhaave's (50.6%), followed by Iatrogenic (37.4%); other causes included trauma, malignancy and foreign body ingestion. Typical signs/symptoms included chest pain (54.2%), vomiting (48.2%), and pleural effusion (42.2%). For all aetiologies, operative intervention was required in 49.4% of patients. Patients presenting with Boerhaave's were more likely to be treated surgically (73.8%). Of these, thoracotomy/laparotomy with t-tube repair was the most common procedure performed (59.5%). The 30 day and 90 day mortality rates were 16.9% and 21.6% respectively. The median length of hospital stay was 40 days.

Conclusion

Here we show the experience from a high intake tertiary referral centre over 12 years. Our data confirms the severity of oesophageal perforation and its association with prolonged hospital stay and mortality. Further collaboration with other centres is needed to understand more about this condition.
SP7.1 Virtual classroom proficiency-based progression for robotic surgery training (VROBOT): a prospective, cross-over, effectiveness study
Authors: Patel Sonam , Nathan Arjun , Georgi Maria , Hang Man Kien , Fricker Monty , Sridhar Ashwin
Published: November 2022

Aims

Robotic surgery is an evolving surgical technique, requiring specialist training. The standardised Fundamentals of Robotic Surgery (FRS) curriculum incorporates proficiency-based modules to certify the skills of novice trainees. However, the curriculum is self-directed and non-interactive. We aim to determine the effectiveness of interactive virtual classroom training (VCT) in concordance with the FRS for robotic skills training.

Methods

11 novice surgical trainees were randomly allocated to two training groups. Both groups completed a one-week robotic skills induction. In week two, Group A received training with the FRS curriculum and adjunctive VCT; Group B only received access to the FRS curriculum. In week three, the groups received the alternate intervention.

The primary outcome was measured using the validated R-OSAT score. This was collected post-intervention at time point 1(end of week two) and time point 2(end of week three).

Results

Participants attained higher mean proficiency scores with both the FRS curriculum and VCT, compared to the FRS curriculum alone. At timepoint 1, Group A achieved a greater mean proficiency score compared to Group B (44.80 vs 35.33, p=0.006). At timepoint 2, there was no significant difference in mean proficiency score in Group A from timepoint 1. In contrast, Group B, who received adjunctive VCT showed significant improvement in mean proficiency by 9.67points from timepoint 1 (95% CI 5.18–14.15, p=0.003).

Conclusion

VCT is an effective training adjunct to the FRS curriculum for learning basic robotic skills. With the steep learning curve in robotic surgery training, VCT offers interactive learning and can increase training effectiveness and accessibility.
SP7.6 The SUNRRISE Trial – Lessons learned from International Collaboration by Trainees
Authors:   SUNRRISE Study Group
Published: November 2022

Background

Trainee led collaborative research in surgery has become widely accepted and highly effective in the UK in the last decade. SUNRRISE is the first trainee led and delivered randomised controlled trial to run across the UK and Australia.

SUNRRISE is an international, multi-centre, trainee devised, led and delivered randomised controlled trial, funded by the NIHR (UK) and MRFF (Australia). It investigates whether a Single Use Negative Pressure Device (SUNPD) reduces the risk of surgical site infection within 30 days of an emergency laparotomy. We present lessons learned from running this study.

Methods

840 patients were 1:1 randomised between SUNPD (PICO7©, Smith and Nephew) and surgeon's choice at 12 centres in Australia and 22 centres in the UK between 2019 and 2021.

Results

International collaboration enabled the trial to continue when the pandemic threatened to stop it entirely.

We believe that this collaboration has benefited all stakeholders; research skills and knowledge have been successfully transferred to trainees, clinician researchers have become established and research professional staff have gained in experience and expertise in both Australia and the UK. Importantly, patients will benefit from more reliable and faster delivered results.

International RCT collaboration requires commitment, perseverance and an acceptance of setbacks, inconvenient working hours and misunderstandings which result from different systems, language and research environments.

Conclusion

International collaboration has made the trial more successful and increased the enjoyment and enthusiasm for the study. SUNRRISE has demonstrated the resilience and efficacy of multi-national, multi-centre trainee delivered RCTs.
SP7.7 Open Appendicectomy Confidence and Experience Study (OACES): a multicentre survey of UK non-consultant grade surgeons
Authors: Cheung Fang Yi , Bretherton Katherine , Wong Nicholas
Published: November 2022

Aims

Minimally invasive technique has eclipsed open in most cases, and reserved only when clinically necessary. However, surgeons must remain able to employ and deploy open technique at will with efficacy. This study aims to assess non-consultant grade surgeons’ confidence and experience to perform open appendicectomy.

Methods

Retrospective cohort study via digital survey consisting of 14 questions distributed to non-consultant grade surgeons in 3 UK deaneries and a professional surgery association.

Results

40 responses ranging from CT1 to ST8 surgeons below consultant totalling 431 cases. 55% respondents disagreed to strongly disagreed they felt confident to perform open appendicectomy independently. 32.5% respondents agreed to strongly agreed they were confident to convert from laparoscopic to open appendicectomy independently if required. Table 1 summarises open and laparoscopic appendicectomy quantitative experience.

Conclusion

Laparoscopic overwhelmingly exceeds open appendicectomy confidence and experience amongst the cohort of trainee surgeons. The majority have not assisted or performed open appendicectomy, and those that have constitute low single digit case numbers. This may translate into lower ability to perform open appendicectomy when required. The decline in open experience and confidence could continue increase as the minimally invasive uptrend continues. Programme directors and trainers should be aware of this phenomenon to safeguard training to mitigate lack of confidence and experience, as this could jeopardise future surgical patient care and safety.
SP7.8 The SUNRRISE Trial – Single Use Negative pRessure dressing for Reduction in Surgical site infection following Emergency laparotomy
Authors:   SUNRRISE Study Group,   Australian SUNRRISE Group,   NorthWest Research Collaborative,   West Midlands Research Collaborative
Published: November 2022

Background

Surgical Site Infections (SSI) are common after abdominal surgery, and more so after emergency laparotomy. Despite Single Use Negative Pressure Dressings (SUNPDs) having mixed evidence regarding effectiveness, they are recommended in the WHO SSI Prevention guidelines.

SUNRRISE is an international, multi-centre, trainee devised, led and delivered randomised controlled trial, funded by the NIHR (UK) and MRFF (Australia). It investigates whether a SUNPD reduces the risk of SSI within 30 days of emergency laparotomy.

Method

Patients were randomised between SUNPD (PICO7©, Smith and Nephew) and surgeon's preference of dressing. Patients were eligible if they underwent an emergency laparotomy with an incision of at least 5cm that was primarily closed at the end of the operation. SSI was assessed at day 5–10, via a patient diary while the patient was at home and at day 30–44 by a blinded, trained wound assessor.

Results

840 patients were randomised from 34 centres across the UK and Australia.

Intention to treat analysis showed no difference in SSI between the two groups (SUNPD-28%, Control-27%, p=0.75). There was also no difference in all secondary outcomes- length of stay (9 vs 11, p=0.14), hospital readmission for wound related complications (3% vs 3%, p-0.96, rates of wound related complications (19% vs 18%, p-0.79), pain (1.8 vs 1.8, p-0.61) and quality of life (SF-12 & EQ5D-5L).

Conclusion

SUNRRISE is a multicentre, assessor blinded, phase III RCT that provides robust evidence that single-use negative pressure dressings are not effective in reducing surgical site infections in patients undergoing an emergency laparotomy.
SP7.9 A systematic review and meta-analysis of potentially contaminated and contaminated abdominal wall hernias/defect repair using synthetic versus biological mesh
Authors: Imsirovic Anja , Baig Mirza K , Khan Mansoor , Singh Krishna K , Sains Parv , Sajid Muhammad S
Published: November 2022

Objective

The objective of this article is to evaluate the role of synthetic mesh versus biological mesh in repair of potentially contaminated and contaminated abdominal wall hernias/defects.

Method

Analysis was conducted according to PRISMA guidelines. Systematic search of medical databases like MEBASE, MEDLINE and pubmed was performed to find studies exclusively comparing the use of synthetic mesh versus biological mesh in repairing the potentially contaminated and contaminated complex abdominal wall hernia/defects. Standard medical electronic databases were searched with the help of local librarian and relevant published randomized controlled trials (RCT) were shortlisted according to the inclusion criteria. The analysis of the pooled data was done using RevMan statistical software.

Result

Three RCTs and 10 comparative studies on 1138 fulfilled the inclusion criteria. In the random effects model analysis, the use synthetic mesh for complex abdominal wall hernia/defect repair in contaminated or potentially contaminated zones reduce the risk of hernia recurrence [odds ratio 0.44, 95% CI (0.33–0.60), z= 5.37, p=0.00001] compared to implantation of biological mesh. Moreover, risk of surgical site infection was statistically higher [odds ratio 0.66, 95% CI (0.47–0.92), z=2.44, p=0.01] following the use of biological mesh. There was no heterogeneity (Tau2 = 0.10; Chi2= 16.15, df = 9 (p=0.06; I2 = 44%) among included studies.

Conclusion

Use of biological mesh for complex abdominal wall hernia/defect repair in potentially contaminated and contaminated situations failed to demonstrate any superiority over conventional synthetic mesh in both benchmark variables of surgical site infection and hernia recurrence.
SP7.12 Patient Initiated Follow-Up (PIFU)
Authors: Dholoo Farzan , Moore Emily , Dinneen Alex , Solan Matthew
Published: November 2022

Introduction

There is a drive within the National Health Service towards a more personalised approach to healthcare. Patient-centred care gives individuals more control over their mental and physical health. We have implemented a patient-initiated follow-up (PIFU) system, within our trust. This provides patients with autonomy for arranging follow-up appointments when needed and saves unnecessary routine reviews.

Methods

Two consultant surgeons have offered a ‘PIFU style’ follow-up. Selected patients seen in clinic were discharged but provided with a PIFU card. Patients returned this card if they needed to be seen again in clinic for the same complaint.

Results

During the study period 149 patients were discharged with a PIFU card. There were 1370 appointments (New and Follow-up) over the same period. Only 17% of PIFU patients (twenty-six) returned within six months. One hundred and twenty-three patients (83%) sought no further appointments. This reduced unnecessary, routine follow-up visits. If a greater proportion of patients were discharged in a timely fashion and offered a PIFU card, then outpatient clinic efficiency would be further improved.

Conclusion

The potential benefits of a PIFU system include: financial savings, patient autonomy, more clinic availability and fewer wasted GP appointments for re-referrals. Adopting a PIFU based system, helps to reduce service waiting times. PIFU is an important tool both for improving outpatient clinic efficiency and increasing patient autonomy. PIFU should be used widely, to help recovery after COVID-19.
SP8.1.3 Biliary tract disease and deprivation: a Scottish retrospective study
Authors: Dick Lachlan , Young Jamie
Published: November 2022

Introduction

Deprivation and poor health is a recognized association. However, the impact of deprivation on biliary disease is less understood. We aimed to determine the effect of deprivation on admission with biliary tract disease at a Scottish district general hospital.

Methods

Patients admitted with biliary tract disease were included from June 2016 to June 2019. Carstairs Deprivation scores were assigned to each patient by postcode with 5 being least deprived and 1 being most deprived. Statistical analysis was used to compare patient demographics, diagnoses, and outcomes.

Results

1116 patients were included. The majority (57.4%) were in decile 4. Only 2 patients were in decile 1 and so were excluded from the analysis. When comparing from decile 5 to 2, acute cholecystitis was more likely in patients with a lower decile (19.3 vs 23.1 vs 22.2 vs 28.4%, p=<0.05) however there was no difference when comparing age (63.3 vs 61.6 vs 62 vs 63 years, p=0.337), female gender (58 vs 60.7 vs 55.7 vs 56.7%, p=0.609) or mortality (0.6 vs 1.6, 1.3 vs 0.8%, p=0.687).

Conclusion

Whilst acute cholecystitis appears to be more prevalent in patients from the most deprived areas, there is no difference in demographics or outcomes when comparing them with those from the least deprived areas. Given the relatively affluent cohort in our study, future work should include a more balanced mix of patients across the deprivation spectrum.
SP8.1.4 Iatrogenic gallbladder perforation during laparoscopic cholecystectomy and outcomes: a systematic review and meta-analysis
Authors: Sams Emily , Evans Louis , Naguib Andrew , Hajibandeh Shahin , Hajibandeh Shahab
Published: November 2022

Aims

to compare the outcomes of iatrogenic gallbladder perforation versus no gallbladder perforation in patients undergoing laparoscopic cholecystectomy.

Methods

In compliance with PRISMA statement standards, electronic databases were searched to identify all studies comparing the outcomes of iatrogenic gallbladder perforation versus no gallbladder perforation in patients undergoing laparoscopic cholecystectomy. The outcome of interest included surgical site infection (SSI), postoperative collection, operative time and length of hospital stay. Random effects modelling was applied to calculate pooled outcome data. The certainty of evidence was assessed using GRADE system.

Results

A total of 5366 patients from 11 studies were included. Analysis of 5366 patients from 11 observational studies suggested that iatrogenic gallbladder perforation during laparoscopic cholecystectomy does not increase the risk of SSI (OR 1.48, 95% CI 0.57–3.86, P=0.42) and postoperative collection (RD 0.00, 95%CI -0.00–0.01, P=0.41) but may result in longer operative time (MD 10.28, 95% CI 7.40–13.16, P <0.00001) and length of hospital stay (MD 0.51, 95%CI 0.15–0.87, P=0.005). The results remained consistent through sensitivity analyses. The quality of available evidence was judged to be moderate and the GRADE certainty of the evidence was judged to be high.

Conclusions

Relatively robust evidence with high level of certainty suggests that iatrogenic gallbladder perforation during laparoscopic cholecystectomy may not increase the risk of SSI and postoperative collection but may result in longer operative time and length of hospital stay. Whether prompt retrieval of spilled stones, adequate peritoneal irrigation, and intraoperative use of prophylactic antibiotic contribute to the above findings remains unknown.
SP8.2.2 Neoadjuvant chemoradiotherapy (CRT) versus immediate surgery for resectable and borderline resectable pancreatic cancer: meta-analysis and trial sequential analysis of randomised controlled trials
Authors: Latif Sadia , Hajibandeh Shahin , Satyadas Thomas , Hajibandeh Shahab
Published: November 2022

Aims

To compare resection and survival outcomes of CRT and immediate surgery in patients with resectable and borderline resectable pancreatic cancer

Methods

In compliance with PRISMA statement standards, electronic databases were searched to identify all randomised controlled trials (RCTs) investigating outcomes of neoadjuvant CRT versus immediate surgery in patients with resectable and borderline resectable pancreatic cancer. Two treatment strategies were compared using direct comparison meta-analysis model. Random effects modelling was applied to calculate pooled outcome data. The risks of Type1 or Type2 error in the meta-analysis model were assessed using trial sequential analysis (TSA) model. The certainty of evidence was assessed using GRADE system.

Results

400 patients from 4 RCTs were included. When resectable and borderline resectable diseases were analysed together, neoadjuvant CRT resulted in higher R0 resection rate (RR: 1.55, P=0.004), longer overall survival (MD: 3.75, P=0.009) but lower overall resection rate (RR: 0.83, P=0.008). When resectable and borderline resectable diseases were analysed separately, neoadjuvant CRT improved R0 resection rate (RR: 3.72, P=0.004) and overall survival (MD: 6.64, P=0.004) in patients with borderline resectable pancreatic cancer but it did not improve R0 resection rate (RR: 1.18, P=0.13) and overall survival (MD: 0.94, P=0.57) in patients with resectable pancreatic cancer.

Conclusions

Evidence from RCTs suggests that neoadjuvant CRT improves R0 resection rate and overall survival in patients with borderline resectable pancreatic cancer but not in patients with resectable pancreatic cancer. Nevertheless, the best available evidence does not include the contemporary chemotherapy regimens; therefore, more definite conclusions would depend on the results of future RCTs.
SP8.2.3 Serial CRP in post operative elective general surgery patients: analysis of usage and value
Authors: Abdelrahman Shadi , Shahzadi-Sohail Rabbiya , Singh Priya , Khan Amir
Published: November 2022

Aims

The aim of this project is to investigate the current practice in measuring C-reactive protein (CRP) in the post-operative patients in elective general surgery, to determine the current trends in using it and its potential value in detecting post operative complications.

Methods

A retrospective analysis of a 100 consecutive patients admitted for elective general surgery between January and July 2021 was conducted. This included analysis of patient demographics and post-operative interventions including return to theatres and interventional radiology. The CRP levels of the patients who required interventions were compared against those who did not.

Results

40 males; 60 females with a mean age of 61.1 years were included, 11% of these patients had post-operative interventions. This analysis showed CRP values were measured routinely post operatively for at least 5 days in 91% of patients. There was a rise in CRP in all patients in the early post-operative period (first three days). If CRP continued to rise after this, it was more associated with a need for post-operative interventions.

Conclusions

There is no diagnostic value for measuring CRP in the first three days of the post operative period, as it will always show a rise in that period. Continued rise after day 3 may indicate post operative complications. Setting up pre-determined blood tests profiles for elective surgical patients may help save time, effort and resources.
SP8.2.4 Mindfulness-based Cognitive Therapy (MBCT) reduces symptoms in patients with chronic visceral pain, and is associated with the alteration of pain-evoked neural activity and resting functional connectivity in the descending pain modulatory system
Authors: Waldman Sarah , Wanigasekera Vishvarani , Henrich Julia , Martin Maryanne , Gjelsvik Bergljot , Tracey Irene
Published: November 2022

Aims

Chronic visceral pain can cause repeated presentations to surgical services. Cognitive therapies show promise but are not often considered in the surgical setting. This study aims to assess the efficacy and mechanisms of MBCT-IBS, a mindfulness-based cognitive intervention for irritable bowel syndrome (IBS).

Methods

Fifteen women with IBS underwent a 6-week MBCT-IBS training course. Before and after this they completed validated questionnaires on symptoms, and functional MRI brain scans during thermal pain and at rest.

Results

MBCT-IBS led to improved symptoms (p<0.05). Increased temperatures were required to achieve 5/10 pain ratings (mean 1.21°C, p<0.001), indicating reduced pain sensitivity. Neuroimaging showed that MBCT-IBS led to altered pain responses in the anterior cingulate, the prefrontal cortex, the amygdala and the precuneus (Z>2.3, p<0.05). In the left dorsolateral prefrontal cortex (dlPFC) this correlated with reduced pain severity scores (rs(11)=-0.614, p=0.025). Altered functional connectivity was seen between the right dlPFC and multiple regions involved in emotional and sensory aspects of pain processing, including the amygdala. There was also altered connectivity between the amygdala and sensorimotor cortices (Z>2.3, p<0.05).

Conclusions

MBCT-IBS was an effective treatment for IBS. The fact that there was altered activity in and connectivity between key parts of the descending endogenous pain modulatory system suggests that MBCT-IBS may be an effective intervention for patients with dysfunctional pain pathways in whom the pathological cause for their pain is unclear. It is non-invasive and inexpensive, and has the potential to reduce the incidence of unnecessary surgical intervention in patients with chronic visceral pain.
SP8.2.5 Weekend Presentation to Emergency Surgical Units Results in Delayed Ultrasound Diagnosis and More Hospital Visits
Authors: Abdul-Hamid Sawsan , Sian Tanvir , Ning Lee Rachel Xue , Ng Oliver , Bharathan Balamurali
Published: November 2022

Aims

The principles of same day emergency care (SDEC) have been around early assessment, access to point of care testing and criteria led discharge. Supplementing clinical and biochemical assessment with ultrasound (USS) may not always achieve a diagnosis but still facilitates SDEC. Our 5-day SDEC USS service aims to achieve these objectives with only limited dedicated slots over the weekend and holidays. We present the results from our service, focusing on differences in outcomes in those who present on weekdays versus weekends.

Methods

Retrospective analysis of 558 patients who had USS between 2.2.21 and 12.4.21. Days from presentation to scan, number of re-presentations, and need for admission were compared.

Results

402 patients presented in the weekday and 156 at the weekend. The proportion of patients having same day USS was higher for the weekday group (65% vs 26%; χ2 p < .001). The number of days to scanning was higher for weekend presenters (1.15 vs 0.38; Mann-Whitney p<0.001). There was no difference in admission rate on index presentation (weekday = 36% vs weekend = 37%; χ2 p = 0.74), however, the average number of total attendances during the study period was higher in those with an index presentation on a weekend (1.74 vs 1.55; Mann-Whitney p=.007).

Conclusions

Patients presenting at weekends have longer waits for USS, delaying diagnosis and discharge. Whilst admission rates on index presentation are not affected, access to SDEC USS at the weekend would allow for same-day discharge and fewer visits to hospital for patients.
SP8.2.7 Is “Hot” Laparoscopic Cholecystectomy in patients with high BMI a safe option? - Outcomes of Emergency Laparoscopic Cholecystectomy in obese vs non-obese patients
Authors: Bezzaa Sabrina , Patel Reeya , Boven Carine , Gerogiannis Ioannis
Published: November 2022

Aim

NICE guidelines currently recommend offering patients presenting with acute cholecystitis a laparoscopic cholecystectomy within 1 week of diagnosis. We compared peri-operative outcomes for patients undergoing emergency laparoscopic cholecystectomy with a BMI of <30 kg/m2 (Group 1) and ≥30 kg/m2 (Group 2).

Methods

A retrospective review of patients undergoing an emergency laparoscopic cholecystectomy at a District General Hospital between January 2018 and November 2020.

Results

159 patients were included. Group 1 had 97 patients (BMI range 18.8–29.9 kg/m2, age range 27–82 years, 56 females: 41 males). Group 2 had 62 patients (BMI range 30–56.3 kg/m2, age range 19–88 years, 38 females: 24 males).

ASA breakdown was 1(25.8%), 2(64.9%) and 3(9.3%) for Group 1 and 2(71%) and 3(29%) for Group 2. Indications for surgery included biliary colic, acute cholecystitis and gallstone pancreatitis. Operating surgeons had training in both Upper GI and Bariatric surgery.

There were no significant differences between Group 1 and Group 2 for anaesthetic time (minutes, 32.74 vs 32.50 p=0.91), operative time (minutes, 95.82 vs 93.67 p=0.75), total length of stay (days, 6.15 vs 5.17 p=0.30) or readmission rate within 30 days (22.68% vs 19.35% p=0.62). 4 patients in each group had acute complications during the index admission.

Conclusion

Emergency laparoscopic cholecystectomy for patients with a BMI ≥30 kg/m2 has similar peri-operative outcomes when compared to patients with a BMI <30 kg/ m2 and is safe to be performed in a District General Hospital by operating surgeons with an interest in Upper GI and Bariatric surgery.
SP8.2.8 Resection and primary anastomosis is safe in selected patients with perforated diverticulitis; a cohort study
Authors: Dowdeswell Megan , Chang Jessica , Rajalingam Viswa , Wolos Maria , McCloud Joe , Cheetham Mark
Published: November 2022

Aims

Historically, the preferred procedure for perforated diverticular disease is Hartmann's procedure (HP). Although reliably achieving source control, it's associated with a high rate of post-operative complications and a stoma which often becomes permanent. We reviewed our experience of patients undergoing HP vs primary anastomosis (PA) for perforated diverticulitis.

Methods

All patients undergoing emergency resectional surgery for perforated diverticulitis between March 2015 and Jan 2021 were identified from the Hospital Episode Statistics (HES) data. Demographics were collected and the patient groups were case matched for age and Charleson Comorbidity Index (CCI), Computed Tomography (CT) appearance and intraoperative contamination data. Post-operative morbidity/mortality data was compared.

Results

105 patients were included. 15 patients had PA (without diversion) and 90 HP.

In the PA cohort were 10 males, median age 52 (range 27–76). There were no anastomotic leaks. 30-day morbidities were superficial wound dehiscence (1) and early incisional hernia (1). Median post-operative stay was 9 days (range 5–25).

HP control group (age below 76, Charlson score 10 and below, Hinchey 1–3 intraoperatively). Included 58 patients, 26 males, median age 60.5 (range 30–76). Median post-operative stay was 10.5 days (range 5–227). 2 patients required re-operation. 5 patients developed wound infections. At the time of the study 18 patients have undergone reversal, 6 are on active waiting-list for reversal.

There was a single 30-day mortality (post-discharge).

Conclusion

We have shown that PA is safe in selected cohort of patients and have identified that over 50% of patients undergoing HP could have been considered for PA.
SP9.1.2 Investigating the association between trust case volume and perioperative outcomes in colorectal cancer surgery
Authors: Al-Zubaidy Mustafa , Al-Hasani Aos , Hamakarim Tatiana
Published: November 2022

Background

Whilst current colorectal cancer care pathways operate by referral to local hospitals, there has been a recent drive to centralise cancer services to improve patient outcomes. Centralisation will inevitably increase trust case volume and the existing literature is inconclusive regarding a possible volume-outcome association. This study aims to investigate the association between case volume and unplanned readmission or unplanned return to theatre (URTT) rates in patients undergoing colorectal surgery across England and Wales.

Methods

A retrospective analysis was conducted of 14028 patients across 135 trusts using the 2020 NBOCA dataset. Primary outcome measures were 30-day unplanned readmission and 30-day URTT rates. Trusts were dichotomised into low or high-volume sites. Statistical analysis used Spearman's ρ correlation, Mann-Whitney U and Student T-test.

Results

11.2% (2.30–24.5) and 8.31% (0.00–23.3) of 14028 patients underwent an unplanned readmission and URTT respectively. There was no significant correlation between the number of cases and 30-day unplanned readmission (r=0.0628, 95%CI: -0.112–0.234, p=0.469), with no significant difference between low and high-volume trusts (p=0.432). Similarly, no significant correlation was found between the number of cases and 30-day URTT rate (r=-0.0848, 95%CI: -0.255–0.0904, p=0.328), with no significant difference between low and high-volume trusts (p=0.285).

Conclusions

No association was discovered between volume and unplanned readmission or URTT in this cohort. Increasing volume among trusts who demonstrate favourable outcomes, rather than indiscriminately increasing volume may be beneficial. This study increases our understanding of volume-outcome relationships, however further prospective studies at a national level into other outcomes should be conducted to rule out centralisation.
SP9.1.4 Performance and Cost-Effectiveness of a Virtual Consultation Clinic for 2-Week-Wait Colorectal Cancer Referrals – A Response to the Covid-19 Pandemic
Authors: Davidson Christopher , Conlon Sinead , Al-Fagih Othman , Khan Nauwab , Cheetham Drostan , Patel Vanash
Published: November 2022

Aims

Measure performance and cost effectiveness of a Virtual Consultation (VC) clinic, compared to face-to-face (FF) clinic, for 2-week-wait (2WW) colorectal cancer (CRC) referrals, which did not meet the criteria for nurse-led Telephone Assessment Service.

Methods

2WW CRC referrals were triaged by a colorectal surgeon to either a doctor-led VC or FF clinic. Demographics, referral indications, and primary outcome measures (time to clinic/results; investigation type; cancer detection rate) were compared pre-pandemic (November 2019–January 2020) and during the pandemic (May–June 2021).

Results

158 (pre-pandemic) and 160 (pandemic) consecutive patients were analysed, with no difference in age (74 vs. 75 years, p=0.936). During the pandemic, patients were referred with an increased number of positive FIT tests (29 vs. 13%, p<0.001), were more likely to have computerised tomography (65 vs. 45%, p=0.003), had a longer time from referral to clinic assessment (10 vs. 8 days, p=0.002), but were informed of results more promptly (59 vs. 138 days, p<0.001) than pre-pandemic patients. During the pandemic patients were assessed earlier via VC than FF clinics (9 vs. 11 days, p=0.049). There were no significant differences in cancer detection rate pre or during the pandemic (12 vs. 8%, p=0.187), or between VC and FF clinic during the pandemic (6 vs. 12%, p=0.294). Cost effective analysis showed £15,000 per annum saving with doctor-led VC clinic.

Conclusion

Virtual consultation for 2WW CRC referrals may improve efficiency without compromising the cancer detection rate, as well as reducing risk of Covid-19 transmission and being more cost effective.
SP9.1.5 Occult appendix pathology in patients undergoing colorectal cancer resection suggests a role for appendectomy at left colon or rectal cancer resection
Authors: Ravi Prabhu , Di Fabio Francesco , Khan Kashuf , Abduelraheim Abu , Arnold Steve , Moran Brendan
Published: November 2022

Aims

There is epidemiological evidence suggesting that the incidence of appendicular neoplasms is increasing. The purpose of this study is to assess the incidence of appendix neoplasms in patients undergoing colorectal cancer resection in a unit where standard of care is appendectomy, with consent, when left colon or rectal cancer resection is performed.

Methods

This is a retrospective single-centre study on a prospectively collected data base of 718 consecutive patients undergoing colorectal cancer resection between January 2015 and June 2021. The primary outcome was the proportion of histologically abnormal appendix specimens at incidental appendectomy. Secondary outcome was complications from incidental appendectomy.

Results

Overall, 222/718(31%) patients had previous appendectomy. The remaining 496 comprised 169/496 (34%) who had a right-/extended-right hemicolectomy or sub-total colectomy which incorporates appendectomy, and 327/496(66%) who had left-sided resection (left-hemicolectomy, anterior resection or abdomino-perineal excision) with incidental appendectomy.

At definitive histology, 454(92%) had a normal appendix, 13(2.6%) had inflammatory appendix pathology, 17(3.4%) had a hyperplastic/serrated polyp and 12(2.4%) had an appendix neoplasm, which included 5 carcinoids and 7 low-grade appendiceal mucinous neoplasms (LAMN).

In the 327 patients who had incidental appendectomy, 7(2.1%) had a neoplasm (4 carcinoid and 3 LAMN). There were no complications attributable to appendectomy.

Conclusion

Patients undergoing left sided colorectal cancer surgery with an appendix in situ should be counselled on the benefits of co-incidental appendectomy to treat the small proportion with synchronous neoplasms and inflammation and eradicate the risk of metachronous appendicitis or a subsequent appendix tumour.
SP9.1.6 Save the scope - a 3-year analysis of follow-up methods for acute diverticulitis and the incidence of colorectal malignancy
Authors: Gurowich Louise , Hollyman Marianne
Published: November 2022

Aims

Previously, guidelines for the management of diverticular disease have recommended endoscopic evaluation following acute diverticulitis to exclude colorectal cancer (CRC). However, 2021 ACPGBI consensus guidelines recognised the sensitivity of modern CT scanning and low incidence of CRC, and suggested no routine re-imaging in CT-proven uncomplicated disease.

Methods

Patient were identified presenting between 2017–2019 at a single centre. Records were retrospectively reviewed to evaluate the incidence of CRC at a minimum of 18-month follow up in this patient group. Secondary outcomes included the imaging method requested, operative management, and complications following endoscopy.

Results

Of 486 admissions in 461 patients, 168 (35%) had CT-proven complicated disease, 225 (46%) had uncomplicated, and 93 (19%) had no imaging. 281 (59%) had follow-up investigations requested; 126 CT colonoscopy (CTC) and 150 endoscopic. 133 investigations were performed in patients with uncomplicated diverticulitis.

Only 6 patients (1%) were diagnosed with CRC; 2 at endoscopy, and 4 by histology from colorectal resections during emergency admission; all had CT-proven complicated diverticulitis. No malignancy was identified in patients with uncomplicated diverticulitis.

Secondary outcomes identified that 26 (24%) flexible sigmoidoscopies were poorly tolerated, necessitating further imaging.

Conclusions

At our centre, there was little consensus on whether patients had follow-up imaging following acute diverticulitis, and what modality was used. We identified no CRC in patients with CT-proven uncomplicated disease, with 133 potentially unnecessary investigations performed in this group. We recommend use of CTC or endoscopy following acute CT-proven complicated diverticulitis in line with ACPGBI guidelines, avoiding follow-up in uncomplicated disease.
SP9.2.1 Postoperative outcomes in patients undergoing Total Pelvic Clearance for locally advanced Primary and Recurrent Rectal Cancer: A Systematic Review to assess Perioperative Mortality, Rate of R0 Resection and 5Year Overall Mortality
Authors: Khan Rehan , Selvasekar Chelliah , Jamshed Nayer , Sahu Ankit
Published: November 2022

Introduction

The outcomes of complex surgical procedures such as Total pelvic clearance (TPC) have improved due to advances in technology, improvements in surgical technique and experience. Majority of Reviews include older studies diluting the benefits and outcomes. Secondly, very few studies mention all important outcomes in one leading to non-uniformity in reporting of data. Lastly, there was further need of updating the previous reviews, the last one published a decade earlier, hence, the review of Perioperative Mortality, rates of R0 resection and 5-year overall survival were carried out in patients undergoing TPC for primary or recurrent rectal cancer in a systematic manner.

Methods

Literature searches were performed in three databases: MEDLINE, PUBMED and Cochrane Library. Each study was evaluated with regards to its design and statistical methodology. The quality assessment of studies was carried out in this review as per the SIGN grading system. Publication bias was assessed by drawing funnel plots for each outcome. Each outcome was further analysed by creating Forrest plot using fixed effect model.

Results

A total of 1632 articles were identified through electronic databases. A total of 21 articles were finally included which met the inclusion and exclusion criteria. Out of 963 resections carried out, perioperative mortality was 3.4%. Overall R0 rection rates were 72.4%. Out of total 374 patients, overall, 5-year survival rate was 42%.

Conclusion

TPC is safe in experienced hands at specialist centres experienced in dealing with such cases with acceptable outcomes outlined above.
SP10.1.3 Can We Justify Routine Group & Screen Testing Prior to Appendicectomies? - A Single Centre Analysis
Authors: Deb Rita , Deb Gita , Pore Naresh , Sheth Hemant , Raje Durgesh
Published: November 2022

Aim

Numerous sources have suggested that routine preoperative Group & Screen (G&S) testing prior to cholecystectomies 1–4, breast surgery 5 and gynaecological procedures including Caesarean sections 6 may be unnecessary because perioperative blood transfusion incidence remains low.

This project aimed to understand whether routine pre-appendicectomy G&S testing can be justified by analysing blood transfusion incidence for appendicectomies completed at our hospital. To further comment on their relevance to clinical practice, we also aimed to investigate any potential delay to surgery that G&S tests may pose, and their cost implications.

Method

For all appendicectomies undertaken at our hospital from 2018 to 2021 (n = 257), we noted if the patient received a blood transfusion anytime during their admission. The date and time of G&S sample collection and of the surgery were recorded, including any documentation of delays to surgery.

Results

0% of appendicectomies between 2018–2021 required a blood transfusion during the admission. On average, 3.9% of appendicectomies per year were delayed due to preoperative G&S testing with an average delay to surgery of 78.71 minutes.

The total cost of G&S tests undertaken for appendicectomy patients between 2018–2021 was £5768.03.

Conclusion

It is difficult to justify routine pre-appendicectomy G&S testing when our data suggests such a low risk of blood loss necessitating transfusion, and that these tests delay treatment. This may warrant pre-appendicectomy risk stratification to streamline G&S testing. Additionally, should an emergency occur, uncrossmatched blood is readily accessible and poses minimal risk to patients7.