bluuebunny/crossref_metadata_2025 huggingface dataset:
SP9.10 - The Sarcoma Hub and Spoke Diagnostic Service Can be Safely and Effectively Rolled-Out and Continued
Authors: Tjhin Yovita , Swe Thin Thin , Patell Naoroz , Pawa Nikhil
Published: September 2024

Aims

To understand the safety and effectiveness of the newly established Sarcoma Hub and Spoke Service (SHSS) in detecting malignancies through assessment of the performance of one Spoke Service in triaging lesions of concern.

Methods

Patients referred to our Diagnostic Service on the 2 week-wait pathway (2WW) and have had their lesion(s) of interest removed between an 18-month period were identified from our Hospital Information System. Data was collected for post-op histology, suspicion of diagnosis in the pre-op MDT, compatibility between the two, and whether patient was cleared from suspicion of malignancy before removal of the lesion.

Results

119 patients meeting the criteria were identified. 90 had been cleared of suspicion for malignancy prior to surgery. 83/90 of these had samples sent for histology, yielding 82 benign and 1 malignant (dermatofibrosarcoma protruberans) results. Of the 29 patients who had excision biopsy on the 2WW, 5/29 returned histology for risk of (e.g. possible sarcoma or atypical lipoma) or confirmed malignancies. 46/119 cases were discussed at our SHSS MDT and have both pre-op MDT diagnosis records and histology results; 37/46 of these were compatible – all correctly predicted benign pathologies. Where pre-op MDT diagnosis and histology were incompatible, 1/9 predicted benign diagnosis but returned malignant histology.

Conclusion

Our SHSS Diagnostic Service’s process of triaging lesions concerning for sarcoma, including our MDT and surgical excision biopsies, is accurate. Preliminary data shows that the Sarcoma Hub and Spoke Service is a safe way to aid in diagnosing or ruling out soft tissue sarcoma.
WP1.7 - A systematic review and a meta-analysis of randomised control trials of prophylactic ilioinguinal neurectomy versus ilioinguinal nerve preservation for open inguinal hernia repair
Authors: Singh Anurag , Khan Nida , Krasicka Dominika , Gulab Adil , Singh Krishna , Sajid Muhammad
Published: September 2024

Objective

The objective of this meta-analysis is to compare the outcomes of prophylactic ilioinguinal neurectomy versus ilioinguinal nerve preservation for open inguinal hernia repair.

Methods

Studies reporting the patient outcomes were selected from medical electronic databases and meta-analysis was conducted by following the guidelines of the Cochrane Collaboration using statistical software RevMan version 5.

Results

Seven studies on 1,333 patients reporting post-operative outcomes were included. In the random effect model analysis, the severe pain at the end of the follow-up period [odds ratio (OR) 0.45, 95%, CI (0.10, 2.08), Z = 1.03, p = 0.30] was similar in both the groups with high heterogeneity (Tau2 = 0.97; Chi2 = 4.45, df = 1 (P = 0.03; I2 = 78 %) among included studies. Hypoesthesia at 6-month follow-up period [odds ratio 1.00, 95%, CI (0.47, 2.15), Z = 0.00, p = 1.00] suggests comparable outcomes in both groups with no heterogeneity among the included studies. The absence of pain reported by patients at the 6-month follow-up period [odds ratio 0.96, 95%, CI (0.72, 1.27), Z = 0.28, P = 0.78] suggests comparable outcomes in both groups with no heterogeneity among the included studies.

Conclusion

Post-operative outcomes like chronic groin pain, hypoesthesia or no pain reported by patients were similar in both groups. There was a paucity of data, therefore a major multicentre randomised control trial is recommended to strengthen the findings of this meta-analysis.
WP1.12 - Unveiling Evidence Gaps in Emergency Umbilical Hernia Repair: A Scoping Review
Authors: Walshaw Josephine , Kuligowska Anna , Smart Neil J , Blencowe Natalie S , Lee Matthew J
Published: September 2024

Aim

Umbilical hernias may become acutely symptomatic, strangulated, or obstructed, necessitating emergency intervention. Robust evidence is required for high-quality care in this field. This scoping review aims to elucidate the existing evidence gaps in emergency care of umbilical hernias.

Methods

A systematic search of EMBASE, MEDLINE, and CENTRAL databases was conducted using a predefined strategy. Primary research reporting on any aspect of emergency umbilical hernia care and published in the English language were eligible for inclusion. Two independent authors screened abstracts and full texts, resolving disagreements through consensus or a third author. Data was charted according to core concepts addressed by each study and a narrative synthesis was performed.

Results

The search generated 299 abstracts, with 32 full texts assessed and 14 included in the final review. This encompassed 52,042 patients undergoing emergency umbilical hernia care. Studies were predominantly retrospective cohort designs (10/14), evenly distributed between single (6/14) and multi-centre (8/14), with only one randomised trial. Most multi-centre studies utilised national databases (7/8). Themes arising included risk profile (n=4), timing of surgery (n=4), investigations (n=1), repair method (n=8, 4 mesh vs suture; 4 laparoscopic vs open), and operative outcomes (n=11). Commonly reported outcomes were mortality (n=9), morbidity (n=7), and length of hospital stay (n=5).

Conclusion

This scoping review demonstrates the paucity of high-quality data concerning emergency umbilical hernia care. The significant evidence gaps highlight a pressing need for randomised trials addressing timing and technical aspects of repair, incorporating patient-reported outcomes.
WP1.18 - A Surgical Post-Take Ward Round Checklist Proforma: A Prompt for Improved Documentation
Authors: Broadhurst Damian , Safi Mohannad , Abadi Porya Hasan , Masri Ahmad
Published: September 2024

Aims

Surgical ward rounds are often swift, therefore documentation of diagnostic and management decisions is frequently incomplete. The Royal College of Surgeons of Edinburgh (RCSEd) devised a ward round checklist toolkit to improve documentation of surgical post-take ward rounds.

Methods

We conducted a baseline audit of our district general hospital general surgery post-take ward round documentation, based on the RCSEd checklist. Documentation in each domain was recorded for each ward round entry for both pre and post intervention groups. Control patients were identified from the surgical take list across 7 different days in a month. The checklist toolkit was then adapted into a proforma for our institution and used on post-take ward rounds for a trial period of 7 days.

Results

40 patients were included in the pre-intervention group, 17 in the post intervention group. Following the introduction of the post take ward round proforma, documentation of most recent observations improved from 40% to 82%, admission blood results from 27.5% to 94%, and imaging results from 42% to 90%. Areas of existing good practice improved; history and examination findings were documented in 100% of patients, an improvement from 80% pre-intervention. Nil by mouth status was documented in 80% of cases, up from 50%, and IV fluid requirement in 58%, up from 10%.

Conclusions

A proforma for post take ward rounds improved documentation of key diagnostic and management information. As a result, we recommend a standardised approach to documentation to encourage consistency of recording key information in the patient record.
WP4.1 - Costs of acute appendicitis in COVID-19 pandemic period: a cohort study
Authors: Gok M A , Bughio M , Khan S , Mahajan L , Sadat M M , Khan U A , Riaz Komal
Published: September 2024

Aims

During COVID 19 pandemic, aerosol generating procedures were deemed high risk for patients & staff. NHS England set guidelines on appendicitis management, thus acute appendictomy rates were reduced. Aim of study is to assess cost implications of appendicitis management at a single centre.

Methods

Cohort study carried out from Mar'2020 to Jan'2024. Descriptive demography & post-operative outcomes were evaluated in appendicitis in COVID19, post-COVID19 appendicitis were controls. Costing calculated using the standardised NHS cost ledger for resources, procurement and services

Results

COVID (n = 306) Post COVID (n = 446) Interval (n = 45) Kruskal Wallis (p value) Age(yrs) 35.2 38.0 47.9 < 0.0005 Sex(M : F) 155 : 151 216 : 230 19 : 26 NS BMI(kg/m2) 25.4 25.8 26.5 NS GP 49 162 A & E 257 284 WCC(x109/L) 12.5 13.1 6.5 < 0.0001 CRP(mg/L) 67.2 70.9 3.4 < 0.0001 Conservative(n) 148 87 0 < 0.0001 Surgery(n) 158 359 45 < 0.0001 Open(n) 6 2 0 NS Lap(n) 300 444 45 < 0.0001 ASA(median) 2 1 2 NS Uncomplicated 178 170 42 < 0.0001 Complicated 128 276 3 < 0.0001 Clinical 0 21 USS scan 89 113 CT scan 334 312 Op time(mins) 72.8 75.9 74.4 NS LOS(days)(med) 2 2 0 < 0.0001 IP AB(days) 2 2 0 < 0.0001 Post-op AB(days) 5 3 0 < 0.0001 Appendix HPA(mm) Length 66.8 66.5 55.7 < 0.005 Diameter 11.5 11.1 9.9 NS Cost(£) 2160 4422 1046 < 0.0001

Conclusion

Clinically & radiologically grading of appendicitis (uncomplicated or complicated) has allowed safe conservative management (antibiotic therapy). Non surgical management is cheaper for index admission, but there are additional costs & workload.
WP4.4 - Is it appendicitis? Keeping it SIMPLE
Authors: Janjua Zia , Gourrege Anick , Lau Jiaying
Published: September 2024

Aims

Several appendicitis scoring systems have been described, criteria used for these are subjective leading to interobserver-bias. Existence of many scores instead of one suggests most of them are not clinically useful. We describe a SIMPLE score that is based on objective parameters as listed in Table 1.

Methods

A sample size for prospective evaluation was performed based on analysis of 118 patients of all ages with suspected appendicitis assessed at a University Hospital (area under ROC-curve of 0.7, null AUC 0.5, alpha 0.05, power 0.95). Each variable point weightage was calculated using multivariate analysis. ROC-analysis was used to define cut-offs for Leukocytes and CRP (GraphPad Prism-V9) as listed in Table -1. A SIMPLE-score was devised and prospectively validated.

Results

Table-1 SIMPLE-score Variable Odds ratio (95% CI) P-value Points Shift of abdominal pain 3.8 (1.3 – 12.1) 0.02 1 Impaired Oral intake 6.0 (1.5 – 31.5) 0.02 2 Mid-cycle 0.3 (0.0 – 2.1) 0.27 -1 Pyrexia of ≥37.5°C 2.5 (1.0 – 6.1) 0.04 1 Leukocytosis ≥10 5.5 (2.1 – 16.1) 0.00 2 Elevated CRP ≥9 4.0 (1.5 – 11.2) 0.01 2

SIMPLE score was calculated prospectively for 128 patients. Median age was 26.5 (range 4-85 years). Of these 62.5% (80) were females 37.5% (48) were males. A SIMPLE score of 2 or less was unlikely to be appendicitis (93.5% Negative Predictive Value), while a score of 3-6 was possibly appendicitis and a score of 7 or more was strongly associated with appendicitis (85% Positive Predictive Value).

Conclusions

SIMPLE score is objective, reliable, reproducible and indeed SIMPLE to use.
WP4.9 - Audit on writing outpatient clinic letters in the general surgery department at a tertiary care hospital
Authors: Singh Anurag , Toh Wei , Siby Jayas , Elzahed Nada , Fatima Anam , Sajid Muhammad , Khan Nida
Published: September 2024

Background

Clinic letters are crucial medical notes for a patient’s medical history and medico-legal purposes. We assessed the quality of clinic letters with the guidelines from the Academy of Medical Royal College suggested for writing a clinic letter.

Method

A retrospective collection of data was done from January – May 2023 and a total of 166 clinic letters were collected by independent authors and then analysed to avoid any bias in the collection.

Results

Multiple parameters were poorly documented and are mentioned in increasing order of missing data – Plan for patient/carer (37.5%), Care planning arrangements (44.6%), Complications (67.5%), Anaesthesia issues (89.4%), Allergies (94%), Diagnosis (94%), Time (99.4%), Preferred name (100%) and Personal identifiers (100%).

These findings were presented in the clinical governance meeting and to improve the quality of the clinic letters, we created a generic clinic letter including mandatory parameters suggested by the guidelines.

Conclusion

There were a few parameters missing from the analysed clinic letters. An adequate intervention after being discussed in the clinical governance meeting, in the form of a generic clinic letter has been introduced. A repeat cycle is planned in 3-5 months to assess the improvement in the quality.

There was a lack of documentation, which improved after the intervention advised by QIP. A teaching session for new junior doctors is planned at the induction session, to strengthen the importance of frailty documentation.
WP4.19 - The Emergency General Surgeon: what is their current operative role?
Authors: Wohlgemut Jared , Lee Matt , Peckham-Cooper Adam , Lockwood Sonia , Tierney Gillian , Moug Susan
Published: September 2024

Aims

Determine the current operative role of dedicated Emergency General Surgery (EGS) surgeons in the United Kingdom (UK) and the Republic of Ireland (ROI).

Methods

A live interactive online survey, designed and endorsed by ASGBI, was completed by attendees at two ASGBI conferences in 2023. The study was conducted according to CHERRIES and exempt from REC according to HRA. Consent was obtained from study participants, who were asked which surgeons usually perform the most common EGS operations in their hospital.

Results

The survey was completed by 156/371 eligible participants, of which 132 responses were analysed once duplicate responses (n=16), and non-UK/ROI respondents (n=8), were excluded. Participants included consultants (34%), surgical trainees (42%), and other doctors (23%), 61% were male and 39% were female, aged between 25 and 69.

The general surgeon on-call – or a dedicated EGS surgeon, where such service exists – operates on the majority of EGS pathology through an un-selected take. A surgeon with the relevant sub-specialty interest usually operates on emergency non-traumatic complex upper gastrointestinal or colorectal pathology. These include emergency colonic resections for cancer or inflammatory bowel disease, and operations for gastric volvulus, bariatric complications, and Boerhaaves. Acute cholecystectomy forms a major part of a dedicated EGS surgeon’s practice.

Conclusions

Dedicated EGS surgeons deliver a wide variety of operations, in addition to the peri-operative management of acute surgical patients. Future curriculum design and NHS workforce planning should reflect this service delivery pattern, should EGS become a recognised specialty interest.
WP6.10 - Factors Impacting Success in The Intercollegiate Membership of The Royal College of Surgeons Examinations
Authors: Small Sarah , McLaughlin Declan
Published: September 2024

Aims

We have witnessed within surgical training schools, that the attainment of the Intercollegiate Membership of the Royal College of Surgeons iMRCS examinations Part A and Part B continues to be one of the greatest challenges within core surgical training. This study aims to explore a trainee’s examination experience and factors influencing success and examination challenges.

Methods

A voluntary electronic survey including demographic factors, preparation specific approaches and adjuncts, challenges and barriers was sent to Northern Ireland core surgical trainees. Results were correlated with their examination outcomes. The results were collated using Microsoft excel software. Statistical analysis was completed using SPSS and thematic analysis of free text responses carried out.

Results

Twenty-seven trainees responded to the survey. The modal age category was 25-34 years with a male to female preponderance of 16 males to 11 females. English language was the first language of 60% of respondents. Statistical significance was demonstrated between age and first-time pass rate in the Part B. No statistical significance was demonstrated between first time pass rate and gender, English language, or background. Forty eight percent of those surveyed attributed personal attitude as a major contributor to success.

Conclusion

Those who undertook Part A closer to foundation training appeared to require fewer attempts to be successful in Part A, and the hours of preparation and study undertaken, correlated to feeling of preparedness. Part B success correlated to clinical experience.
WP6.16 - A comparison of post-rotation confidence levels over a year of surgical foundation year one doctors in a busy district general hospital
Authors: George Jayan , Savage Daniella , Brown Denise , Yeluri Sashidhar
Published: September 2024

Aims

Assess the confidence levels of foundation year one (FY1) doctors in managing surgical patients post-rotation. Identify areas where further support could be given to improve confidence levels.

Methods

August 2022, December 2022 and April 2023 cohorts were surveyed following the end of their four-month rotation. Ten questions used Likert scales (1 to 5: not at all confident to very confident) to assess general surgical patient management. One question focused on education methods and one was an open question. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results

100% (10/10) August 2022 cohort, 38% (3/8) December 2022 and 80% (8/10) April 2023 cohort completed the survey.

Modal post-rotation confidence levels were mostly four and five across all cohorts.

August 2022 and December 2022 cohorts had a modal value of three for confidence in speaking with a patient’s family when a patient was dying.

August 2022 cohort had a modal value of three for confidence in speaking to a patient when their condition was unknown.

Common concerns of FY1 doctors were managing a deteriorating patient and being unable to contact a senior.

Most FY1 doctors felt that case-based discussion would be the preferred method to increase understanding of general surgery.

Conclusions

Confidence levels were high post-rotation and increased throughout the year. This could suggest that FY1 doctors are receiving a good understanding of general surgery by the end of their rotation. Further work needs to be done to target improvement in areas of lower confidence.
WP7.2 - The Role of a Frailty Team to improve Perioperative Care for ELLSA Patients
Authors: McCulloch Alison , Watson Hannah , Richmond Victoria , McCleary Andrew , Sturrock Claire , Martin Paul
Published: September 2024

Aim

Frailty assessment amongst emergency laparotomy patients is essential. The 8th NELA report highlighted that only 31.8% of patients who were frail and over 65 years received geriatrician input. Within our organisation, patients who undergo emergency laparotomy are included in the Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA). The consultant geriatrician led Surgical Acute Frailty Team (SAFT) works collaboratively with the emergency general surgery team and ELLSA specialist nurse to review ELLSA patients within our hospital. Our aim was to establish outcomes of ELLSA patients reviewed by SAFT.

Methods

Data collected routinely via Redcap as part of our organisation’s ELLSA was reviewed. All ELLSA patients aged ≥65 years admitted between November 2022 and November 2023 were included. Data included frailty assessment, discharge destination and 30 day mortality.

Results

152 patients aged ≥ 65 years underwent operative intervention as defined by ELLSA. 100% of patients had a documented Clinical Frailty Scale (CFS) score. 72 patients (47.4%) had a pre-operative frailty review. 68.4% of patients had their initial frailty assessment by a consultant geriatrician. 19.7% of patients were reviewed by frailty ANPs or clinical fellow. Only 7.9% of patients required care support on discharge. 30 day mortality was 17.1%.

Conclusions

Embedding a dedicated frailty team within our general surgery wards has been incredibly successful; frailty assessment is significantly above that of the 8th NELA report. The majority of ELLSA patients aged ≥65 years are discharged home independently. Collaborative working and early identification of frailty in ELLSA patients is essential to improve patient outcomes.
WP8.6 - Improved confidence levels with the introduction of a junior doctor led surgical handbook for first rotation foundation year one doctors
Authors: George Jayan , Brown Denise , Savage Daniella , Yeluri Sashidhar
Published: September 2024

Aims

Assess the confidence levels of general surgical foundation year one (FY1) doctors in managing patients at the start of their rotation in August 2022 and August 2023. Assess the impact of a surgical handbook on confidence levels at the start of the rotation.

Methods

Cohort one (August 2022) were asked to reflect on their confidence before their surgical placements. Cohort two (August 2023) were surveyed at the start of their rotation. A surgical handbook was given to cohort two pre-rotation. Ten questions used Likert scales (1 to 5: not at all confident to very confident). One question on education methods and one was an open question. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results

100% (10/10) cohort one and 100% (12/12) cohort two completed the survey. 83% (10/12) of cohort two had read the surgical handbook pre-rotation. 100% (10/10) who read the guide found it useful.

Modal confidence scores were higher across all 10 questions in cohort two in comparison to cohort one.

The lowest confidence levels in both cohorts were in speaking to a dying patient’s family.

The majority of FY1 doctors would prefer case-based discussions as their preferred method of learning.

A common concern of FY1 doctors was a lack of senior support.

Conclusions

Confidence levels were higher pre-rotation with the cohort that received the surgical handbook. Targeted case-based discussions may support increasing confidence through the rotation
ThP4.4 - Is it always just a Whipple? A not insignificant number of patients require a concomitant procedure at the time of pancreatoduodenectomy
Authors: Abdelmohsin Omar A M , Russell Thomas B , Labib Peter L ,   RAW Study Collaborators, Aroori Somaiah
Published: September 2024

Background

Some patients may need to undergo an additional procedure at the time of their pancreatoduodenectomy (PD). This study aimed to investigate the proportion of patients that this includes and to describe the additional procedures that these patients undergo.

Methods

Data were extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study (29 centres from eight countries, n=1484). The group that underwent a concomitant procedure was compared to the group that did not (chi-squared test).

Results

Out of 1484 PD patients, 79 (5.3%) underwent a concomitant procedure (seven excluded due to missing data). This was most commonly: right hemicolectomy (14, 17.7%), liver excision biopsy (12, 15.2%), appendicectomy (11, 13.9%), adhesiolysis (6, 11.4%), cholangioscopy (5, 6.3%), incisional/ventral hernia repair (5, 6.3%), diagnostic laparoscopy (5, 6.3%) and splenectomy (5, 6.3%). When those who underwent an additional procedure were compared to those who did not, length of stay (both 13 days, p=0.7), as well as rates of return to theatre (7.6% vs 4.9%, p=0.3), 90-day mortality (5.1% vs 3.6%, p=0.5) and five-year survival (38.0% vs 31.5%) did not differ significantly. However, 30-day readmission was significantly higher among those who underwent a concomitant procedure (16.4% vs 8.7%, p=0.02).

Conclusion

In our multicentre study of PD outcomes, 5.3% of patients underwent an additional procedure at the time of their Whipple. These patients more commonly had an unplanned return to theatre.
ThP4.9 - The role of preoperative nutritional assessment in postoperative outcomes of hepato-pancreato-biliary patients: A bicenter prospective observational study
Authors: Frountzas Maximos , Sotirakis Demosthenis , Karanikki Eva , Tsikrikou Iliana , Schizas Dimitrios , Toutouzas Konstantinos
Published: September 2024

Aims

Preoperative nutritional status of patients who undergo surgery due to hepato-pancreato-biliary (HPB) cancer has been considered as a prognostic factor of their postoperative course. The aim of the present study was to investigate the association of preoperative nutritional assessment with the postoperative morbidity and mortality in such patients.

Methods

Patients undergoing surgery due to HPB cancer from March 2022 until March 2023 at two university surgical departments were included in the present study. Patients’ demographics and postoperative parameters, such as complications’ severity according to Clavien-Dindo classification and mortality, along with malignancy stage were reported. Preoperative nutritional assessment was conducted according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and the Controlling Nutritional Status (CONUT) score. The present study was registered in ClinicalTrials.gov (NCT05795374).

Results

The present study included 66 patients with a mean age of 63 ± 12 years old. The high risk of malnutrition according to the GLIM criteria was associated with major (Clavien-Dindo≥3) postoperative complications (74% vs 32%, p=0.026) and increased 30-day mortality (80% vs 23%, p=0.021). Moreover, malnutrition according to the CONUT tool was correlated to increased 30-day mortality (66% vs 45%, p=0.016).

Conclusions

Preoperative malnutrition seems to be associated with higher rates of postoperative mortality and major morbidity in patients undergoing surgery due to HPB cancer.
ThP4.13 - To drain or not to drain?! Selective Abdominal Drainage Reduces Morbidity and Re-interventions in Laparoscopic Cholecystectomy and Bile Duct Exploration
Authors: Hayyawi Israa , Al-Shaye Ahmad , Omran Asmaa , Nassar Ahmad
Published: September 2024

Aims

To evaluate the indications and benefits of sub-hepatic drainage after laparoscopic cholecystectomy(LC) and bile duct exploration (LCBDE).

Methods

Utilisation of drains in a prospective database of LC and LCBDE was reviewed. The occurrence of postcholecystectomy bile leakage (PCBL) and abdominal collections was analysed.

Results

52.5 % of 6140 patients had drains. PCBL occurred in 43 (1.3%). 20 leaks had choledochotomy LCBDE; 16 before drain removal (10 settling spontaneously, 3 requiring ERCP, 3 relaparoscopy). All 4 occurring after drain removal required percutaneous drains (PCD) or ERCPs. 12 leaks had transcystic explorations; 10 before drain removal (8 settling spontaneously, 1 ERCP, 1 PCD) and 2 after drain removal (1 settled, 1 needed ERCP). 11 PCBLs had LC only; 9 still had drains (6 settled, 1 PCD, 1 ERCP, 1 relaparoscopy) and 2 after drain removal needing relaparoscopy and ERCP. Drains allowed early detection and spontaneous resolution in 24 patients (55.8%) and early detection and intervention prevented serious morbidity in 11 (25.6%). 7 of 8 PCBLs after drain removal required reintervention.

2915 (47.5%) had no drains. 6 had PCBL (0.2%); 5 needing multiple reinterventions; 3 PCD, 2 ERCPs and 3 relaparoscopies.

Drains caused complications in six patients (0.18%); one retracted into the abdomen needing relaparoscopy, two drain site infections and 3 had significant pain disappearing when drains were removed.

Collections other than PCBL occurred in 19 patients; 8 with drains and 11 after drain removal. They were treated conservatively (9), by PCD (8) or relaparoscopy (2).

Conclusions

Careful selective abdominal drainage after advanced biliary surgery allows early detection of collections, minimising morbidity and reintervention.
ThP5.1 - The Influence of the COVID-19 Pandemic on the Complexity of Laparoscopic Cholecystectomy
Authors: Zubair Farhan , Di Rollo Domenic , Nassar Ahmad H M , Khan Khurram S
Published: September 2024

Aim

The operative difficulty of Laparoscopic Cholecystectomy (LC) varies widely. This can affect the operative time, complications, post-operative course and ultimately patient outcomes. The COVID-19 pandemic caused substantial delays in the definitive management of gallstone disease. The aim of the present study was to compare the intraoperative difficulty grading of post COVID-19 pandemic LCs with previously published data.

Methods

This comparative study analyses a prospectively maintained database of all LCs performed by two biliary surgeons in a single centre between August 2022 to January 2024. Clinical and intra-operative findings including operative difficulty grading using the Nassar scale were recorded. This data was then compared to the previously published data from a single surgeon spanning 29 years (n=5,391).

Results

149 patients were included; the median age was 56 years (IQR 45-66). 88 (51.1%) were female. 71 (47.7%) LC’s were completed as part of an emergency admission. The median Scottish Index of Multiple Deprivation was 5 (IQR 3-7). 45 (30.2%) underwent LC alone, 63 (42.2%) also received an operative cholangiography and 41 (27.5%) underwent common bile duct exploration. Grade 1 LC (4.8% vs 33.2%, p<0.001) were significantly less prevalent than grade 4 LC (37.4% vs 14.2%, p<0.001) in the post pandemic period when compared to the previous published data.

Conclusion

The present study suggests that LCs are more challenging post pandemic. The contributing factors are likely diverse, but extended waiting times and multiple emergency admissions leading to delays in definitive management are presumed to play significant role. Urgent attention is warranted to establish biliary pathways that guarantee timely and definitive management of gallstones for patients.
ThP5.5 - Outcomes Of Laparoscopic Common Bile Duct Exploration And Laparoscopic Cholecystectomy; A Single Centre Review From A District General Hospital In Northern Ireland
Authors: Winter Jonny , Ainley Paul , Gudyma Jaroslaw , Eltayeb Omer
Published: September 2024

Aim

Laparoscopic cholecystectomy with laparoscopic common bile duct exploration is a one-stage therapeutic option for patients presenting with choledocholithiasis. This is a review of outcomes for patients who underwent this procedure in a district general hospital setting in Northern Ireland over a two-year period.

Method

This is a retrospective review of prospectively collected data concerning all patients who underwent laparoscopic cholecystectomy and laparoscopic common bile duct exploration between October 2021 and October 2023. Data were reviewed to include pre-operative liver function, pre-operative imaging, rate of conversion to open procedure, length of stay, and readmission rate due to complications.

Results

106 patients were included in the review. The average length of stay was 2.7 days (with a median of 1 day) and readmission rate was 7.5%. 87.7% of patients had deranged liver function tests on the morning of surgery, and 100% had proven choledocholithiasis on cross-sectional imaging prior to proceeding to theatre. Only two patients required conversion to open cholecystectomy. No patients developed postoperative pancreatitis. The complication rate was 11.3%, with most complications being of Clavien-Dindo Grade I or II.

Conclusions

Laparoscopic common bile duct exploration at the time of laparoscopic cholecystectomy represents a safe and effective method for management of choledocholithiasis. It can be considered as an alternative to endoscopic retrograde cholangiopancreatography as a therapeutic option in an appropriately selected patient group.
ThP5.8 - Familial hepatocellular carcinoma: a model for studying preventive and therapeutic measures
Authors: Weledji Elroy
Published: September 2024

Aims

Limited attention has been given to the role of primary genetic factors in hepatocellular carcinoma (HCC) especially as familial clusters of HCC are mostly described in areas of endemic hepatitis B virus (HBV) infection. The aim of the study was to review the literature on familial hepatocellular carcinoma (FHCC) and give evidence to suggest that FHCC may be a good model for studying preventive and therapeutic measures for HCC

Methods

Electronic searches of the Medline (PubMed) data base were performed to identify original published case studies on familial HCC.

Results

16 case studies on FHCC were reported between 1965-2016. Even in the presence of HBV infection, FHCC seemed statistically unlikely to occur by chance. Genetic contributions may explain healthy and unhealthy HBsAg carriers, the male sex being predominantly affected, and HBV being directly oncogenic and causing HCC in the absence of cirrhosis in the younger patients. The highest risk of HCC occurs when a hereditary component is acting in concert with environmental factors such as HBV infection through epigenomic alterations. A family history of HCC increases the risk of FHCC independently of hepatitis due to a multifactorial inheritance including DICER 1 germline mutation and altered liver zonation. Epigenetic studies on monozygotic twins with HCC will identify the susceptible loci which can be used therapeuticallym. FHCC is a prognostic factor for improved survival in early resectable tumours with no/minimal cirrhosis.

Conclusions

HCC lacks a strong hereditary component but HCC-prone families of the familial type may provide a powerful model for studying preventive and therapeutic measures.
ThP6.3 - Is routine histopathological analysis required following cholecystectomy?
Authors: Mohanraj Gearry , Tibude Ameya , Gajdhar Aniq , Madhok Brijesh
Published: September 2024

Aims

To identify incidental gall bladder cancers (IGBC) in elective cholecystectomy specimen. Preoperative presentations were observed to see if a selective approach can be adopted when requesting histopathological examination (HPE) following elective cholecystectomy.

Methods

Retrospective data was gathered for all patients undergoing cholecystectomy in 2022 at a single university teaching hospital. Histology reports and preoperative presentations were analysed. The total sample size was 505.

Results

Within the 505 patients, six operations did not occur, and five other patients underwent pancreaticojejunostomy. In the remaining 494 patients who underwent successful cholecystectomy 130 were males. Two (0.4%) patients were found to have IGBC (poorly differentiated adenocarcinoma). Both were females aged 57 and 75 years with grossly thickened gall bladder at operation. One patient underwent portal lymphadenectomy and segmental liver resection whilst the other patient was commenced on palliative chemotherapy.

Conclusions

We found very low incidence of IGBC following routine elective cholecystectomy. This is particularly rare in young patients (< 50 years) found to have a thin-walled gallbladder on ultrasound examination or at laparoscopy. Hence routine HPE following elective cholecystectomy does not seem necessary. We recommend requesting HPE if any mucosal abnormality is identified on inspecting the specimen after removal or if the gallbladder is thick-walled at laparoscopy or preoperative imaging, or patient is over 50 years of age. In the absence of level 1 evidence, such a pragmatic approach appears safe, cost-effective, and offers good use of valuable resources.
ThP6.9 - Endoluminal vacuum-assisted closure (EndoVAC) therapy in spontaneous duodenal perforation: a novel approach to an undertreated problem
Authors: Roberts Geoffrey , Sienes Alexa
Published: September 2024

Introduction

Duodenal perforation is a rare but critical condition, with management ranging from conservative to surgical depending on timing of presentation, patient status, and clinician preference. In recent years, minimally invasive techniques have been emerging alternatives for their safety and efficacy. Notably, there have been cases promoting endoluminal vacuum-assisted closure (EndoVAC) therapy as a viable alternative for use among patients with iatrogenic oesophageal perforations. To our knowledge, there has been no reported use of this novel approach specifically in spontaneous duodenal perforations.

Case presentation

A 55-year-old female with no history of trauma, surgery, NSAID use, or gastrointestinal conditions presented with epigastric pain and vomiting. A CT scan revealed a contained duodenal perforation at the D2/3 junction, accompanied by a complex retroperitoneal collection unsuitable for imaging-guided drainage. Initial management was conservative with intravenous hydration, antibiotics, proton pump inhibitors, and nasogastric tube decompression. She underwent oesophagoduodenoscopy and EndoVAC therapy resulting in complete resolution of collection and a small diverticulum on repeat CT.

Discussion

Current standard of care for duodenal perforations would be conservative management, though this carries the risk of deterioration due to biliopancreatic leakage and slow resolution of sepsis. Surgical management, when needed, is often technically challenging with high morbidity. EndoVAC gives the benefit of providing targeted drainage and negative pressure therapy to the site of perforation, reducing ongoing contamination, and promoting wound granulation.

Conclusion

EndoVAC therapy offers a minimally invasive alternative to treatment of duodenal perforations and has the potential for broader application in specialist and tertiary healthcare settings.
ThP6.15 - 1, 3, and 5-year mortality following emergency laparotomy, can the National Emergency Laparotomy Audit (NELA) or the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) risk calculators predict it? – a retrospective, multi-center, observational, cohort study
Authors: Moscalu Andrei , Timofeiov Sergiu , Perumal Mohit , Sinclair Martin
Published: September 2024

Background

Emergency laparotomy (EL) comprises a high-risk group of surgical procedures, associated with a significantly increased risk of death in the following 5 years. EL are performed on a heterogeneous population, of which at least 50% are ≥ 70 years old. Accurate preoperative risk prediction is vital for planning care, patient shared decision, and improving outcomes. To date, no prediction tool can reliably estimate long-term outcomes, including mortality, following an EL.

Methods

This is a multicenter, retrospective, observational, cohort study that investigated the correlation between actual mortality at 1, 3, and 5 years and predicted 30-day mortality (30-dm) using NELA and ACS-NSQIP risk prediction tools, following EL, in adults aged ≥18, over 2 years, in two UK centers. The sample size was calculated at 385 cases. GraphPad-Prism 10.1.1. was used for statistical analysis.

Results

626 cases were analyzed. The male/female ratio was 0.85, age 70 years (55;78); BMI 24.94kg/m² (22;29); preoperative lactate 1.7 mmol/L (1.2;2.6), clinical frailty score 3 (2;4); and Charlson Comorbidity Index 4(2;5) (all data is expressed as median+IQR). The 1, 3, and 5-year survival were 76%, 67%, and 61%, respectively. A perfect positive correlation between NELA and ACS-NSQIP 30-dm and the 1-year actual mortality was found (R²=1). At 3 years only NELA correlated positively to actual mortality (R²=0.23, p<0.05). The 5-year mortality correlated positively with both predictors - NELA: R²=0.61, p<0.001; ACS-NSQIP: R²=0.31, p< 0.05.

Conclusion

Both NELA and ACS-NSQIP risk calculators can predict mortality at 1,3 and 5 years after an emergency laparotomy, with NELA expressing a stronger correlation.
ThP7.4 - Splenic trauma in the West of Scotland: a seven year analysis of management and outcomes
Authors: Mapara Rahee , Cole Elaine , Schyma Barry
Published: September 2024

Aim

To evaluate admission characteristics and management of traumatic splenic injuries in the region over a seven-year period and investigate differences in clinical outcomes.

Methods

Data was obtained from the Scottish Trauma Audit Group (STAG). Retrospective cohort analysis was performed of adult patients who sustained splenic injuries between 2015 and 2022 and received operative (OM), embolization (EM) or conservative management (CM) at a multiple-site single NHS trust in the West of Scotland. Primary outcome was all-cause inpatient mortality, secondary outcomes was length of stay (LOS).

Results

129 patients were included. Majority of patients were male (73.6%, n=95). A third (34.1%) underwent OM (n=44), 4.7% underwent EM (n=6) and 61.2% (n=79) were managed conservatively. Median age was highest in the EM group at 61 years, versus 35 and 40 years in OM and CM groups (p=0.039). OM group patients had the highest median admission lactate (3.0) and median H+ ions (48.5) versus the CM group with a median lactate of 2.0 (p=0.050) and H+ of 45.9 (p=0.010). CM failed in 4.8% (n = 4) and required either OM or EM. Overall mortality was 3.9%, and exclusively observed in the CM group. Longest median LOS was observed in the EM group (17 days), versus 10 and 9 days in OM and CM groups (p=0.207).

Conclusion

Mortality from splenic injury in the region is low. Patients who were shocked on admission were more likely to be managed operatively. Few patients were managed with embolisation, but this cohort had a significantly longer LOS.
ThP7.5 - District General Hospital Management of Chest Trauma in Frail Adults: A Need for National Guidelines for Frailty in General Surgery
Authors: Yao Siliang , Coombes Zara , Okocha Michael , Gaskell Natalie
Published: September 2024

Annually, 16,000 adults face chest trauma, with blunt injuries in the elderly leading to high mortality rates. In TARN Chest trauma ranks as the second deadliest trauma in older adults, following head injuries. There's significant inconsistency, nationally, in the General Surgical management of these patients.

Aims

This study evaluates outcomes at a DGH to establish a basis for national guidelines

Methods

Single centre retrospective review of patients over the age of 65 presenting with chest trauma from Jan 2022 to Jan 2023.

Results

114 Patients were included. Median age was 81 with a male predominance of 57.9%. Mortality was 17/109 (15.6%). Mechanisms of injury were fall from standing height (71.9%), fall from height >2m (18.8%) and RTA 9.3%. Median Rib fractures sustained were 4 (range 0 - >10). 51.8% of the patients had an associated pleural injury, 14 patients required a drain. 70 (61.4%) had isolated chest injuries, 29 (25.4%) had one other injured body region and 15 (13.2%) had three or more injured body regions. Median STUMBL score was 25 (9 – 52), 42.6% had a score of ≥ 27. 16.4% of patients were vulnerable and 51% were frail. Median Charlson co-morbidity index was 5 (range 2-11). 39% of patients had timely Geriatric review during admission and 14% were not referred.

Conclusion

DGH General Surgery teams admit high volumes of frail patients with chest trauma. Nationally there is an absence of general surgery chest trauma guidance (BOASTs now archived). These patients are complex requiring early support from Geriatricians to guide the goals of care. Careful consideration should be given to referral pathways, MDT and priorities of care.
ThP7.7 - Investigating Trauma Patient Undertriage in Riyadh's Prehospital System
Authors: Khan Lubna , Aldarsouni Fayez , Alsubaie Norah
Published: September 2024

Aims

This study aims to analyze the extent of prehospital undertriage by assessing the transfer rates of critically ill trauma patients to non-trauma centers in Riyadh, Saudi Arabia.

Methods

We analyzed 102,895 incident reports from 50 prehospital dispatch centers in Riyadh using data from the Saudi Red Crescent Authority between January 2021 and March 2023. Inclusion criteria comprised all adult trauma cases classified under red criteria. We mapped regional distribution and delineated trauma center service areas reachable within specific timeframes using QGIS. Dispatch centers were grouped based on these service areas to evaluate undertriage. Data analysis was performed using SPSS 26 and R statistics.

Results

Approximately a third of the red criteria cases (n=5105/17983, 28.8%) were undertriaged to a non-trauma center primarily involving blunt traumatic injuries (n=3316, 65%) and, to a lesser degree, penetrating injuries (n=1604, 31.4%). Undertriage rates were higher in the 45- and 60-minute service areas (n=930/2917, 31.9% and n=20/45, 44.4%, respectively), particularly in the east (n=2013/5105, 39.4%) and north (n=1522/5105, 29.8%). Nearly a third of undertriaged cases (n=1601/5105, 31.4%) experienced delays, ranging from 4.5% to 66.8% across dispatch centers. The highest undertriage rates were observed in specific dispatch centers, such as Alkharj and Alamana, located in the 30- and 45-minute service areas, respectively.

Conclusions

The study reveals higher undertriage rates in areas farther from trauma centers, indicating a greater likelihood of non-trauma center transfers. To enhance access to trauma care for critically ill patients, there is a need for infrastructure expansion and stricter implementation of triaging protocols. Further research should investigate the impact of non-trauma center transfers on mortality in the region.
ThP7.17 - Improving completeness of operative notes for laparoscopic appendicectomy
Authors: Ahmad Awais , Fernando John , Gull Sadaf
Published: September 2024

Aim

This study aimed to compare the quality of laparoscopic appendicectomy operation notes in the emergency setting to 'Get It Right First Time' (GIRFT) guidelines. To evaluate the effect of the teaching session and operative note checklist in improving the completion rate of operation notes for laparoscopic appendicectomy.

Method

Retrospective analysis of 19 consecutive operation notes of patients undergoing emergency laparoscopic appendicectomy. Prospective data was then collected on 15 consecutive appendicectomy operation notes post-intervention. 34 recommendations based on GIRFT recommendations 'Best practice for laparoscopic appendicectomy documentation' were used to audit laparoscopic appendicectomy operation notes. Documentation was reviewed by two independent reviewers and scores were given based on GIRFT recommendations. Student's T-test was used to calculate the significance of overall scores and Chi-Squared to calculate the difference between individual categories.

Results

Mean completeness of operation notes improved from the first cycle (58.5%) to the second cycle (85.5%, P<0.001). There was a significant improvement in documentation of patient positioning (P=0.001), skin preparation (0.035), diagnostic findings (P<0.001), health of caecum (P<0.036), extraction port (P=0.01) and follow-up plan (P=0.03).

Conclusion

There were many domains of the GIRFT recommendations not addressed prior to this audit. Teaching sessions and checklist distribution lead to a significant improvement in overall completeness of the operation note. Movement towards digitised templates should be made to further comply with guidelines.