bluuebunny/crossref_metadata_2025 huggingface dataset:
ThP3.9 - Direct to PET-CT in oesophagogastric cancers: A pilot project at a tertiary upper gastrointestinal surgical referral centre
Authors: Ahmed Yazeed , Vaz Osborne , Jeffry Farah , Bektasoglu Ilyas , Khan Meshaal , Stockwell Robert , Shetty Vinutha
Published: September 2024

Background

Oesophageal cancer contributes to 18% of cancer mortalities worldwide. The aim of this pilot project was to offer direct positron emission tomography- computed tomography (PET-CT) imaging and observe any differences in time to investigation and treatment in the cohorts.

Methods

Patients referred with a diagnosis of oesophageal cancer between 1st January 2022 to 31st December 2022 were included. Data was collected from the electronic patient record and retrospective analysis was performed using Microsoft Excel.

Results

A total of 189 patients with OG cancer were included. There were 89 local and 100 network patients. Median age was 71[range 37 – 93]. Locally male female ratio was 52:37 and in the network 73:27 [“p” 0.03]. Of 35 patients who had direct PET-CT (A) 31(88%) were local and 4(12%) from the network. Among 115 patients who had a CT followed by PET scan (B) 29(25%) were local and 86 (75%) from the network [ “p” 0.00001]. Waiting times were 27 days for a PET-CT as compared to 32 days for PET after CT scan [ “p” 0.09]. Reports were available in a median 4 days in group A compared to 3.5 days in group B [ “p” 0.66]. In group A 12 (35%) had metastases with nodal metastases in 9(75%) and distant metastases in 3(25%).

Conclusion

Whilst direct to PET-CT improved patient experience there were no statistically significant differences in the time to investigations and treatment. Three patients with distant metastases offered direct PET-CT could have been diagnosed by CT.
ThP3.12 - Assessing Photo-documentation Compliance in Oesophago-Gastroduodenoscopy: A Review of Adherence to BSG and AUGIS Recommendations
Authors: Ali-Qazalbash Zeeshan M , Khopekar Faid Z , Khan Khurram S
Published: September 2024

Aim

In 2017, the British Gastroenterology Society (BSG) and the Association of Upper GI Surgeons of Great Britain and Ireland (ASGBI) issued a position statement outlining specific quality parameters for oesophago-gastroduodenoscopy (OGD), including photo-documentation of eight specified anatomical sites. This audit assesses the appropriate utilization of photo-documentation for diagnostic OGD.

Methods

A retrospective analysis of diagnostic OGD preformed in a single centre. General surgeons, gastroenterologist and nurse endoscopists performed OGDs. Patient with incomplete OGD or those carried out for therapeutic purposes were excluded. OGD report included photo-documentation was analysed.

Results

250 OGD were included; 54.8% were male and median age was 61 years. Indications for OGD were: 28% for nausea/vomiting, 26% for dysphagia, 22.4% for upper GI bleed, 12.4% for abdominal pain, 12% for anaemia, 11.2% for weight loss and 8.4% for dyspepsia.

62% of OGDs had photo-documentation: 9.6% upper oesophagus, 45.2% gastro-oesophageal junction, 36.8% fundus in retroflexion, 26% body of stomach, 8% incisura in retroflexion, 30.8% antrum, 17.2% duodenal bulb and 36% distal duodenum. Overall, 1.2% of OGDs had all eight anatomical sites photo-documented, all by the same endoscopist.

Conclusion

Robust photo-documentation plays a crucial role in ensuring both accurate clinical assessments and meeting medico-legal requirements. Our audit indicates that the current level of photo-documentation in OGD is less than optimal. Enhancing endoscopist education and raising awareness about recommended practices may lead to improved results. Further research is imperative to explore the underlying factors contributing to suboptimal photo-documentation, fostering a deeper understanding and facilitating targeted interventions for improvement.
ThP4.2 - Role of LiMAx in the Risk Assessment of Postoperative Outcomes in Patients undergoing Liver Resection: A Systematic Review and Meta-Regression Analysis
Authors: Patel Eashan , Joshi Anushri , Weston Chris , Clarke George , Hodson James , Dasari Bobby V M
Published: September 2024

Background

LiMAx is a novel test for assessing the metabolic capacity and dynamic function of the liver. The current review aims to investigate the predictive role of LiMAx for postoperative outcomes in patients undergoing liver resection.

Methods

A systematic review was conducted using EMBASE, Web of Science, Medline and Cochrane Library databases. Preoperative LiMAx values and various postoperative outcomes were extracted (e.g. mortality, post-hepatectomy liver failure). Pooled averages were calculated where appropriate. Postoperative complications in relation to the extent of resection and LiMAx values were the outcomes assessed.

Results

13 studies, comprising 1668 participants and 20 separate cohorts in total, were included. The meta-regression of preoperative LiMAx and postoperative outcomes yielded non-significant results (p>0.05). A second meta-regression highlighted significant correlations between extra major surgery rate and various outcomes (p<0.05), suggesting its confounding role in the first regression. A further analysis found a non-significant tendency for mortality to correlate with LiMAx as expected in patients undergoing minor resection.

Conclusion

In this review, there was no statistical correlation between LiMAx values and post-hepatectomy outcomes. The LiMAx test was relatively more helpful in predicting mortality in patients undergoing minor resection; this was likely confounded by selection bias in the low quality studies. Larger multi-centre studies with standardised reporting of outcomes are required.
ThP5.11 - Reducing Gallstone Related Patient Episodes Through Index Admission Management: A Multicentre Retrospective Study
Authors: Curry Heather , Nassar Ahmad H M , Khan Khurram S
Published: September 2024

Aim

Gallstones represent a significant portion of acute general surgical admissions, with widespread management practices across the UK. Our objective was to assess the effects of implementing proactive management strategies for symptomatic gallstones and their complications on admissions related to gallstone.

Methods

A retrospective multicentre study of three acute general surgical units within a single health board with similar population coverage between 2014 and 2018. In site A, the standard of care was definitive management of gallstone disease in the index admission; whereas in site B & C this was not the case. All gallstone related presentations were included. The data was extracted from the health board coding data. Number of biliary related admissions compared between the three sites.

Results

3,790 episodes were identified. Biliary colic was the most common (54.9%) reason for presentation followed by acute cholecystitis (22.7%), acute pancreatitis (16.2%) and ascending cholangitis (6.2%).

For biliary colic: site A had 361 presentations, site B had 853 presentations and site C had 867 presentations. The occurrences of more than one admission were 22.7%, 36.3%, and 42.3% for Site A, B, and C, respectively.

Overall, site A had 796 biliary presentations; compared to 1497 each at site B and C.

Conclusion

Implementing definitive surgical interventions during the index admission for biliary-related cases offers a substantial reduction in re-admission rates, leading to an overall decrease in hospital attendance. This not only yields significant cost benefits for the health board but also enhances the quality of life for patients.
ThP5.12 - Safety of emergency laparoscopic cholecystectomy in the treatment of gall stone disease: A single centre observational study from a District General Hospital
Authors: Sukumaran Sreekanth Nedumparambil , Thomas Pradeep , Narayanasamy Sangara Narayanan
Published: September 2024

Aim

To evaluate the safety of emergency laparoscopic cholecystectomy in the treatment of gallstone disease.

Methods

This was a retrospective, single-centre observational study of 267 patients who were admitted with abdominal pain due to a gallstone related pathology during June 2021 to June 2022. The parameters studied were age, gender, duration of symptoms, previous admissions, investigations, imaging, conservative or surgical treatment, emergency surgery or elective interval surgery, utilisation of dedicated "hot gallbladder list", re-admissions, and re-operations.

Results

Out of the 267 patients, 163 were female and 104 were male. The median age was 61 with the age ranging from 20 to 96. The median duration of symptoms was 2 days before admission. First-time admissions were 226 and re-admissions were 41. Ultrasound, CT and MRI were done on 188, 123 and 64 patients respectively. 178 patients were diagnosed to have acute calculous cholecystitis, 51 patients had acute gallstone pancreatitis and 38 had biliary colic due to lithiasis. 172 patients were treated with surgery of which 104 were operated on during the same admission, 20 in readmission and 48 as an interval elective surgery. Of the 124 emergency operations, 37 were performed on the dedicated "hot gallbladder list" and 87 were performed on the emergency CEPOD list. 2 patients were re-operated due to post-operative complications. 95 patients were managed conservatively.

Conclusions

Emergency laparoscopic cholecystectomy is a safe option when performed by experienced surgeons. A dedicated "hot gall bladder list" provides a safe and effective way to reduce the disease burden.
ThP6.1 - Revisiting outcomes of laparoscopic cholecystectomy in an elderly population
Authors: Thompson Luke , Gao Neng , Fultang Joshua , Maruthachalam Karthik , Apollos Jeyakumar
Published: September 2024

Aims

Laparoscopic cholecystectomy in the elderly patient is a challenging operation with variable outcomes. We evaluate the outcome of patients who underwent laparoscopic cholecystectomy in a hospital that serves a large ageing population.

Methods

Retrospective analysis of 53 patients over the age of 70 years who underwent cholecystectomy between January and December 2023. Outcomes were compared between elective vs emergency procedures, indications, age groups (70-74, 75-79, 80-84, 85+) and Charlson comorbidity index (CCI).

Results

The mean age was 77±4.9 years, and the mean CCI was 4±1. Of 53 procedures performed, 30.2% (n=16) were emergency and 69.8% (n=37) were elective. 6.3% (n=1) was converted to open. 11.3% (n=6) of patients underwent Rendezvous ERCP. Emergency patients had increased length of stay (LOS) (5.1±2.8 vs 1.6±4.1, p=0.04). The indication for surgery was noted to have a significant influence on LOS (p=0.003), however, age groups and CCI did not influence LOS. Non-biliary complications occurred in 13.2% (n=7) of patients. 7.5% (n=4) of patients had readmission within 30 days. 3.75% (n=2) had retained CBD stone and underwent postoperative ERCP. No significant differences between age groups in relation to complications were identified.

Conclusions

Emergency cholecystectomy in patients over the age of 70 is associated with a longer LOS. Rates of complications are not influenced by age or CCI. Laparoscopic Cholecystectomy can be safely offered to a diverse elderly population.
ThP6.4 - Psoas Sarcopaenia as a Predictor of Mortality in Patients Over 65 with PR Bleeding: A Retrospective Case Controlled Study
Authors: Cunningham Brian , McConnell Megan , Daly Aisling , Kilkenny Jane , Rice Paul , McElvanna Kevin
Published: September 2024

Aims

Sarcopaenia has been examined as a predictor for functional baseline and frailty in surgical patients and may predict mortality. The hypothesis of this study is that sarcopaenia is associated with increased risk of death after per rectal (PR) bleeding.

Methods

Patients over 65 who were admitted between January 2017 and December 2022, having had an episode of PR bleeding, that underwent cross sectional imaging were identified from the Southern health and social care trust database. Cross sectional imaging was accessed via PACS and total psoas area (TPA) calculated at the third lumbar vertebra by a radiology trainee and validated by a consultant radiologist. Clinical, mortality and demographic data was obtained from Northern Ireland Electronic Care Record (NIECR). Psoas muscle index (PMI) was then calculated by TPA and standardising for height in mm2/m2. Sarcopaenia was defined as PMI male < 545 mm2/m2 female < 385 mm2/m2.

Results

77 Patients were included in this study. Patients were excluded based on the ability to standardise TPA for height. 27% (n 21) of patients were identified as sarcopaenic, 66% (n 14) of these patients have died. The median PMI showed differences between female mortality (490.44 mm2/m2) and non-mortality (559.49 mm2/m2) groups. Male patients also showed lower median PMI between mortality (599.79 mm2/m2) and non-mortality (643.05 mm2/m2 ) groups.

Conclusions

Sarcopaenia as a predictor for frailty is an important risk factor for all-cause mortality in PR bleeding. Cross-sectional imaging provides an opportunity to quantify risk as well as investigate aetiology for PR bleeding. Although radiation risk and cost effectiveness may limit use, it should be considered when imaging is available.
ThP6.14 - The Diagnostic Utility of C-Reactive Protein in Acute Appendicitis
Authors: Khalid Hammaad , Boyle Abbey , Iqbal Rizwan , Gokhale Jay , Bhogal Rayna , Mahmood Hijab , Amjad Wasif , Mohammed Mohammed I , Jassal Arun , Ayub Navyan
Published: September 2024

Aim

This study sought to determine the value of C-Reactive Protein (CRP) as a diagnostic marker in acute appendicitis.

Methods

All patients > 18 years presenting to the surgical assessment unit with acute appendicitis in 2022 were retrospectively identified. Data including patient demographics, admission CRP, CT results and operative findings were analysed.

Results

This study identified 130 patients with a median age of 35 years. Operative management was undertaken in 85% of patients (n=110) and conservative in 15% (n=20). Of these, four required conversion to operative management. No significant difference in CRP was identified between conservative and operative management. CT was performed in 84% of patients. Of these, 98% (n=107) were suggestive of acute appendicitis - 85% uncomplicated (n=91) and 15% (n=16) complicated. CRP was significantly higher in patients with CT- diagnosed complicated appendicitis (p<0.001). Operative assessment demonstrated 76 patients (58%) with uncomplicated and 38 (29%) with complicated appendicitis, with CRP significantly elevated in complicated appendicitis (median 119.5 vs 21, p<0.001). A CRP cut-off of 96mg/L showed reasonable predictive value of complicated appendicitis (sensitivity=61%, specificity=88%) with AUC value of 0.76 (95%CI: 0.66-0.87). CRP also showed value as a predictor of perforation and abscess (AUC=0.79 (95%CI: 0.67-0.90) and 0.76 (95%CI: 0.63-0.89) respectively. Optimal CRP cut off for perforation was 84mg/L (sensitivity=73%, specificity=88%) and 96mg/L (sensitivity=73%, specificity=81%) for abscess. CRP was not significantly elevated in necrotic or gangrenous appendicitis.

Conclusions

CRP levels correlate with appendicitis severity in both CT and operative assessment and may be a useful predictor of perforation and abscess formation.
ThP7.9 - Enhancing Access to Psychological Support for Major Trauma Patients: A Comprehensive Approach
Authors: Nightingale Katie , Knight Chris , Dawson Matthew , McCarthy Eilis , Smith Stella
Published: September 2024

Introduction

One in three major trauma (MT) patients experience acute stress disorder (ASD) following physical trauma. Patients experiencing ASD are at increased risk of developing longer-term mental health conditions, including PTSD, which can impede physical recovery. Early identification of these patients and timely psychological interventions, reduce the impact of long-term mental health conditions. Access to specialist psychology services is therefore imperative for holistic patient recovery.

Methods

Referral rates to a Major Trauma Psychology service were collected for MT patients (Injury Severity Score ≥9) admitted October to December 2022. Following this, a prompt for healthcare professionals to offer the psychology service was added to the Tertiary Trauma Survey (TTS) proforma in March 2023. The TTS is a top-to-toe examination conducted within 24 hours of admission to ensure all injuries have been identified. Educational sessions were delivered to MT healthcare professionals to support their discussions with patients and a patient information leaflet was designed. Data collection was then repeated April to June 2023.

Results

Prior to these interventions, 14.18% of MT patients were referred to the psychology service with a median time from admission to referral of 4 days.

Following the interventions, 31% of patients were referred to the service, with a median time from admission to referral of 1 day.

Conclusion

Raising awareness of the importance of providing early and focused psychological support improved the rate and speed of referral to the psychology service. Earlier intervention in patients with psychological distress following trauma can reduce long-term mental health conditions and promote active recovery.
ThP8.3 - From red coded report to Fistula salvage in 2 weeks
Authors: Anton Jeny , Freedman Ben , De Figueiredo Fatima , Gambhir Raghvinder Pal Singh
Published: September 2024

Aim

Fistulas and grafts are life line for patients with End stage renal disease (ESRD). However, they frequently fail, and early intervention is recommended to prevent loss of access. The present study aimed to establish waiting times between identification of significant stenosis/thrombus on duplex scan to intervention.

Methods

In this study we looked at all red coded reports in 2022 to establish their waiting time from red report to a radiological or surgical intervention.

We have a traffic light system where patients with fistulas with no stenosis and good volume flow (VF) over >600ml/min are labelled green, labelled amber when there is a <50% stenosis or minor thrombus with VF still around/above 600 ml/min. Red where there is significant stenosis/thrombus.

Results

291 patients were identified, 178 patients with significant >50% stenosis/thrombus in fistula, 82 patients with occluded fistulas, 15 patients with significant inflow +/-outflow stenosis/occlusion, 16 patients with e.g. very high VF fistulas/pseudoaneurysms/small vein size +/- <600ml/min VF (maturing fistulas). As a result of red report, 9% of patients received a new fistula and 57% of patients received an intervention to salvage their existing fistula. Interventions included 112 fistuloplasty/venoplasty, 43 surgical thromb ectomy procedures. 58% of patients received an intervention within the first 2 weeks with 3.6% of patients receiving intervention on the same day as red coded report. 34% of patents however did not receive any intervention.

Conclusion

There is room for further improvement to salvage more fistulas, though 60% of patients did have an intervention within 2 weeks.
FP2.7 - Results of Lower Rectum Cancer Treatment
Authors: Lamara Abdelhak , Nini Badreddine
Published: September 2024

Objective

The objective of this study is to evaluate oncological outcomes, specifically, the rate of locoregional recurrences in lower third rectum cancers treated with concurrent radio-chemotherapy and radical surgery.

Methods

Locoregional and metastatic recurrences were analyzed based on the initial tumor stage, response to neoadjuvant treatment, and the type of surgery. We utilized the biomedical statistics software SPSS24 and Microsoft Excel. Statistical analysis was performed using the chi-square test, with the calculation of the P-value (Pearson's test).

Results

During the period from 2000 to December 2021, 638 consecutive resections for lower third rectum cancer were conducted. One hundred and sixty-one patients (25.23%) underwent abdominoperineal amputation (AAP), while 477 (74.76%) underwent conservative surgery. There were 389 men and 249 women, with an average age of 51 years (ranging from 20 to 88). Thirty of our patients were classified as T1, 163 as T2, 420 as T3, and 25 as T4. One hundred and thirty-five patients (21%) received preoperative radiotherapy, and four hundred and eighty-six (76%) underwent concurrent preoperative radio-chemotherapy. Two hundred and six patients (43%) had an ultralow colorectal anastomosis, and 252 (52.8%) had a coloanal anastomosis. Local resection was performed in nineteen patients. The mortality rate was 0.78%, and the morbidity rate was 34%, including twenty-seven anastomotic fistulas (5.6%). Forty-one local recurrences were observed (6.4%).

Conclusion

During surgery for lower rectal cancer, the surgeon's primary concern is to achieve a valid oncological resection, preserve sphincter function, and ensure patients a recurrence-free survival.
FP2.11 - Management of Acute Sigmoid Volvulus – a 10-year retrospective review
Authors: Seager Eden , Philip Ken , Hutton Michael , Griffith David
Published: September 2024

Aims

This study aims to review the management and outcomes of acute sigmoid volvulus within our Trust.

Methods

This was a retrospective study conducted at our NHS Trust. All adult patients presenting with SV between January 2012 and January 2022 were included. Data was collected from electronic patient records. Admission data included management (conservative only, CM, emergency surgery, ES, or planned surgery, PS), episode number, and 30-day mortality. Surgical data included ASA grade, complication rates, and bowel continuity rates.

Results

219 patients (54.8% male, median age 72yrs) presented with acute SV. 87.2% patients were managed conservatively at index presentation, 44% of whom experienced recurrent SV. 27.4% patients received surgical management during follow-up (18.3% ES, 9.1% PS), none of whom experienced recurrence following surgery. The rate of ES increased linearly with total number of episodes, from 11% at index presentation to 25% at ≥5 episodes.

30-day mortality was 13.4% in the CM group, 15% in the ES group, and 0% in the PS group. Post-operative complication rate was 42.5% in the ES group and 5% in the PS group. Bowel continuity was achieved in 22.5% of ES patients and 60% of PS patients.

Discussion

Conservative management of SV was associated with a significant recurrence rate in our cohort. Repeat admissions were associated with an increasing incidence of ES, which was associated with worse outcomes compared with PS. We recommend all patients are considered for planned surgical intervention at index presentation to reduce recurrence and minimise the rate of emergency intervention.
FP3.9 - Loop ileostomy reversal in anterior resection: A single centre cohort Study
Authors: Gok M A , Bughio M , Aris R , Mahajan L , Sadat M M , Khan U A
Published: September 2024

Aims

Defunctioning loop ileostomy is commonly undertaken in <40% of anterior resections especially mid and low rectal cancer resections. Loop ileostomy allows early enteral nutrition and rehabilitation and reduces the impact of post operative ileus, anastomotic leaks and pelvic sepsis complications Closure of loop ileostomy is usually advocated after 3 months of the index malignant colorectal resection. The aim of this study was to assess the reversal intervals and delays in ileostomy reversal.

Methods

This is a cohort study carried out since January 2008 to December 2023 at a single centre. Descriptive demography & surgical outcomes were evaluated for all Anterior Resections with loop ileostomy. All anterior resections without covering loop ileostomy carried out since 2008 were recruited as controls.

Results

AR loop ileostomy (n = 152) AR no stoma (n = 297) Mann Whitney U (p test) Age(yrs) 67.0 ± 0.8 68.4 ± 0.7 NS Sex(M:F) 96 : 56 180 : 117 NS ASA(median) 2 2 NS BMI 26.5 ± 0.4 27.2 ± 0.3 NS Lap : Open(n) 94 : 58 220 : 77 < 0.05 Op time(mins) (index op) 256.3 ± 6.8 219.2 ± 4.7 < 0.0001 LOS(days)(index op) 10 ± 4.5 6 ± 3 Reversal (n) 111 Days to reversal 262 ± 102 Reverse op time(mins) 84.3 ± 4.9 LOS reversal(days) 6 ± 3.5

Conclusion

Delays in loop ileostomy reversal in our intuition were due to: progressive CRC disease diagnosis, adjuvant treatments, patient frailty/death, patient choice, delays in anastomotic integrity checks, & theatre availability. To avoid delay, reversal should be planned at time of defunctioning loop ileostomy.
FP3.13 - Acute Complicated Diverticulitis: Colorectal Cancer in Disguise? Five Years of Follow-up Practice at a 600-bed Hospital
Authors: Jones Benjamin , Watt David
Published: September 2024

Aims

Complicated diverticular disease is associated with colonic neoplasia rates of 7.8% to 10.9%. ACPGBI guidelines recommend optical or virtual colonoscopy six weeks following an attack of acute complicated diverticulitis unless performed within the preceding two years. It has been posited that flexible sigmoidoscopy may be sufficient to rule out malignancy given that diverticulitis predominantly affects the sigmoid colon. Five years of practice at a 600-bed hospital was audited to the ACPGBI standard and malignancy rates and locations investigated.

Methods

All emergency admissions coded for acute complicated diverticulitis from January 2017 to December 2022 were included. Patient electronic records were reviewed retrospectively for demographic data, operation notes, as well as radiology, endoscopy and histology reports.

Results

A total of 197 patients were included in the study period. 97 cases underwent emergency or semi-elective resection within one year. 8 patients had colonic visualisation in the two years prior to their attack, leaving 92 cases in whom colonic visualisation was indicated. 44 patients had colonoscopy, 22 had flexible sigmoidoscopy, 2 had CT colonography and 24 had no further imaging. 7 malignancies were identified, 5 from resection specimens and 2 from endoscopy. All tumours were in sigmoid colon.

Conclusions

The ACPGBI standard was met in 50% (46/92) of cases. If flexible sigmoidoscopy were deemed acceptable this would increase to 74% (68/92). Malignancy was identified in 4% (7/197) of cases. All malignancies were in the range of flexible sigmoidoscopy, suggesting full colonoscopy may be superfluous. Less extensive endoscopy may reduce procedure duration, bowel preparation and patient discomfort.
FP4.9 - Adherence to post Colonic polypectomy surveillance guidelines
Authors: Khattak Muhammad Ali , Waheed Aimen , Demetriou George , Bedford Matthew
Published: September 2024

Aims

The British Society of Gastroenterology updated its guidelines in 2020 regarding polyps follow-up following colonoscopy. The surveillance depends on type, size, number, and histology criteria. Our aim was to assess adherence of our hospital's endoscopy department to these new guidelines.

Methods

A retrospective analysis of all consecutive adult patients who underwent colonoscopy were included between January and March 2022 at our hospital. Data were collected and analyzed on excel. The endoscopy report was identified from MediLogik-EMS.Histology from PICS system. Demographics including the specialty of endoscopist was also included. Non-parametric data were expressed in their Median and IQR.

Results

Out of the 108 patients examined 50/108 (49%) were found to have polyps and were included in the analysis. F: M =1:2, median age 64 with IQR 18.5(59-77.5). Tubular adenoma was found in 58%, hyperplastic polyps in 12%, sessile serrated polyps in 10%, tubulovillous adenoma in 8%, adenocarcinoma in 8%, and inflammatory polyps in 4%. Histopathology revealed tubular adenoma with LGD in 58%, inflammatory polyps in 16%, adenocarcinoma in 8%. Polyps were removed using cold biopsy in 58% and hot snare in 38%. BSG guidelines were followed in 92% (46/50). The reason for not adherence was either histologically incomplete excision, requiring a site check within 2-6 months which was not performed in6%(3)or high-risk features requiring 3 yearly surveillance colonoscopy follow-ups not requested in 2%(1).

Conclusion

There is high adherence to the guidelines but still not 100%. Our aim is to achieve 100% adherence in the re-audit.
FP4.13 - Intravenous morphine negatively affects length of stay following minimally invasive colorectal surgery
Authors: Moolamannil Mathew , Rajaratnam Kanapathi , Bevan Katharine , Georgiades Fanos
Published: September 2024

Aim

Investigate the impact of intravenous (IV) morphine administered as patient controlled analgesia (PCA) following minimally invasive colorectal resections.

Method

Demographic, peri-operative and follow-up data from a prospectively maintained database were collected for all laparoscopic and robotic assisted colorectal procedures carried out at our centre.

Results

Our cohort included 38 colorectal resections completed with the DaVinci Xi (Intuitive Surgical, USA) robotic platform and 57 consecutive laparoscopic colorectal resections. 7 patients were excluded due to incomplete data. 51/88 (57.9%) of patients underwent a left sided resection and 24/88 (27.3%) had a stoma formed. We observed a median IV morphine dose of 15.5mg (IQR 15.5-43.5mg) and we sub-divided the cohort into those who received >15 mg of IV morphine and <15mg of morphine via PCA. Patients who received <15mg IV morphine were older (median age 75 Vs 67 years; p<0.001). There was no statistical difference in the body mass index, ASA grade, total operative time, or type of minimally invasive resection. The median length of stay was 4 days for the <15mg IV Morphine cases compared to 5 in the >15mg IV Morphine group (p<0.001). As expected, there was a quicker time to first flatus in the <15mg IV Morphine group (median 2 days Vs 3 days; p<0.001) and a shorter time to opening bowels (median 3 days Vs 4 days; p=0.003). There was no statistically significant difference in post-operative complications between the two groups.

Conclusions

Reducing postoperative IV Morphine dosing following minimally invasive colorectal resections may lead to prompter recovery.
FP5.14 - Enhancing Patient Communication in Surgical Care: an Audit of Practice at a DGH
Authors: Dinarvand Daniel , Thiruchelvam Tharanya , Kassem Mohamed , Kerans George , Ratnasingham Kumaran
Published: September 2024

Aims

This audit aimed to evaluate current communication standards at a DGH (based on inpatient feedback) and assess the alignment with NICE Guidelines for improving the experience of care in adult NHS-services. The standards assessed included: providing clear information on diagnosis, oral and written communication, and communication in the presence of family or next of kin.

Methods

Inpatient feedback on surgical wards was collected to assess guideline adherence, with a pre-intervention survey designed to assess opinions before implementing an intervention. Two assessment cycles were conducted, with 12 responses in Cycle 1 (1-15 Nov 2023) and 13 responses in Cycle 2 (16-30 Nov 2023). The intervention included providing clear written information on imaging results and ongoing plans, and encouraging patients to use an information sheet throughout their admission, which could also be relayed to family members.

Results

Pre-intervention data revealed a diverse age distribution, predominantly in the 55-64 age group. Understanding of diagnosis varied pre-intervention but showed improvements post-intervention. Post-intervention, the majority (n=9) felt the information was appropriately pitched. Thirteen respondents received accessible information, finding the universally distributed information sheet helpful. A written response highlighted its utility in explaining clinical information to families. Healthcare professionals received improved 'clarity' and 'helpfulness' ratings post intervention, indicating positive outcomes.

Conclusions

Effective communication is integral to exceptional patient care. This audit underscores the potential to enhance patient understanding, alleviate concerns, and improve communication in surgical settings. The intervention, a simple information sheet, proved effective and emphasised the need for accessible, clear and standardised patient communication.
FP5.15 - Who’s in the club? Higher General Surgical Trainees and Trainers perceptions of who and what comprises multidisciplinary team working
Authors: Johnston Judith , Quinton Naomi
Published: September 2024

Aim

To explore who Higher General Surgical Trainees (HST) and Trainers perceive as being members of Multidisciplinary teams.

To explore what HST and Trainers perceive to be a MDT meeting.

Methods

Following ethical approval, virtual semi structured interviews were conducted with 8 HST and 4 Trainers within one deanery. These interviews were then evaluated using reflexive thematic analysis.

Results

The majority of those interviewed expressed the dichotomy of the professionals involved in day-to-day care patient compared specific meeting relating to disease processed. While most recognised the former as a definition, when specifically discussing MDT, all referred to meetings. This duality was particularly pertinent in discussion of assessment of MDT as a Capability in Practice (CiP). Junior HSTs self-assessed using day-to day MDT but Senior HSTs and Trainers regarded the meeting as the arena for assessment. Despite participants working in different general surgical specialities with benign components, all perceived cancer MDT meetings to be the ‘true’ or most relevant definition. However, there was a consensus that the definition of MDT is evolving. When elucidating members of cancer MDTs, every participant named all clinical and support staff that routinely attend, but Trainers did not reference their HST.

Conclusion

Despite an evolution of MDT definition to include benign meetings such a pelvic floor or day-to-day working, there is a persistence among General Surgical Trainers and trainees to interpret MDT as purely cancer meeting. This can cause confusion in assessment of MDT as a CiP.
FP6.1 - Core Surgical Training in Northern Ireland: Regional Compliance with Quality Indicators
Authors: Lockhart Jessica , Phillips Sally-Anne
Published: September 2024

Aims

Standards for training programmes are set by the GMC, with the Joint Committee for Surgical Training developing a curriculum and quality indicators (QIs) specific to Core Surgical Training. To ensure local training fits within these guidelines, placement quality is evaluated by NIMDTA, using specialty specific surveys sent to all Core Trainees in the region.

Methods

A survey, related to their current post, was sent to all Core Trainees in Northern Ireland. The responses were collated and cross-referenced against the 14 generic QIs for Core Surgery in order to assess compliance with published standards.

Results

Response rate from trainees was 70%. Compliance with the quality indicators was generally poor; 24% of trainees reported receiving the recommended 2 hours per week of formal teaching, 59% were able to complete a quality improvement project, 83% of trainees completed a learning agreement within the recommended 6 weeks from post commencement, 21% reported adequate exposure to simulation training and only 11% reported attending the expected one or more MDT meetings per week.

Conclusions

The level of adherence to the QIs for core surgery in Northern Ireland could be significantly improved. Despite some themes achieving a majority response in line with the QIs, overall alignment is poor. Subsequently we have developed key recommendations for focused improvement in the local Core Training programme in NI in an effort to better align our training with the JCST QI framework. A further survey will be conducted to assess the effect of these recommendations on compliance with JCST QIs.
FP6.6 - Diagnosing the improvements required for enhancing the medical student ward round bedside teaching experience utilising a cohort of surgical teaching fellows
Authors: Tokeisham Karim , Alnabhan Ahmad , Khera Goldie
Published: September 2024

Aim

After previously having mixed student feedback as a learning experience, our UK medical school have embedded a cohort of dedicated surgical teaching fellows into acute surgical ward rounds. Since this has happened, we aimed to further improve traditional Surgical Ward Round Bedside Teaching methods.

Method

Post event, retrospective, optional questionnaire formed of 5 Questions evaluated by a Likert scale and 2 open ended Questions. Presented to year 3, UK undergraduate medical students.

Results

20 complete responses received. The majority of students strongly agreed that Surgical Ward Round Bedside Teaching sessions with dedicated fellows present were effective in enhancing clinical knowledge and skills.

90% strongly agreed that teaching fellows were engaging and approachable during Surgical Ward Round Bedside Teaching. Also 90% strongly agreed that they felt comfortable asking questions and seeking clarification during Surgical Ward Round Bedside Teaching sessions.

However, only 60% strongly agreed that Surgical Ward Round Bedside Teaching sessions were well-organized and focused on relevant surgical/clinical cases.

When asked ‘How could the bedside/Ward Round teaching sessions be improved?’ – Responses revolved around suggesting teaching in smaller groups, reminding wards/departments to expect students/clinical fellows, providing online resources or hand-outs before teaching, identifying teaching session objectives, and spend more time on history taking and examination sessions

Conclusions

The introduction of surgical teaching fellows has had a positive impact on the student Surgical Ward Round Bedside Teaching experience. There is still room for future refinement however and further enhancement strategies are in progress.
FP7.4 - Interval appendicectomy: A single centre cohort Study
Authors: Gok M A , Bughio M , Yim S , Aris R , Akhmal Y , Khan U A , Riaz Komal
Published: September 2024

Aims

Interval appendicectomy occurs at a rate of < 15 %. It is recommended in non operative appendicitis (complicated appendicitis, appendix mass) to reduce recurrence. Acute appendicectomy rate was reduced in Covid 19 pandemic era, as aerosol generating procedures were deemed high risk. Interval appendicectomy can be offered after 6 weeks dependent on pre-requisite interval colorectal screening (colonoscopy or CT scan) prior to surgery. Aim of study is to assess the interval appendectomy at a single centre.

Methods

Cohort study carried out from Mar'2020 to Dec'2023. Descriptive demography & post-operative outcomes were evaluated for interval appendicectomy, and acute appendicectomy were used as controls.

Results

Interval appendicectomy (n = 45) Appendicectomy (n = 515) Mann Whitney U (p test) Age(yrs) 47.9 35.8 < 0.0001 Sex(M:F) 19 : 26 251 : 264 NS ASA(median) 2 1 NS BMI 26.5 25.5 NS WCC(x109/L) 6.5 13.2 < 0.0001 CRP(mg/L) 3.4 66.3 < 0.0001 Laparoscopic 45 507 Op time(mins) 74.4 74.9 NS Appendix length(mm) 55.7 66.6 < 0.0001 Appendix diameter(mm) 9.9 11.2 NS LOS(days) 0 2 < 0.0001 AB use(days) In-patient 0 ± 0.5 2 ± 1 < 0.0001 Post-op 0 ± 0 0 ± 2.5 Cost(£) 1046 4269 < 0.0005

Conclusion

Interval appendicectomy is a safe and cost effective option in the management of appendix mass. Interval appendectomy allows resolution of acute appendicitis resulting in fewer intraoperative & postoperative complications. It reduces the chance of bowel resection & can be done as a day case procedure. However interval appendicectomy my require work-up prior to surgery.
FP8.3 - Reducing Waste with Remanufactured Harmonic Devices
Authors: Gordon Caitlin , Gardner Shona , Beniwal Abhijeet , Pullyblank Anne
Published: September 2024

The NHS produces an estimated 590,000 tonnes of waste per annum and disposable harmonic scalpels are costly both financially and environmentally. The average cost of a new harmonic device nationally is £460. Remanufactured harmonic devices are not only recommended by the Intercollegiate Green Theatre Checklist and NHS England but also the Department of Health Med Tech Strategy.

North Bristol NHS Trust has engaged with the initiative from Vanguard to reduce clinical waste as well as utilise remanufactured harmonic devices. Initially the project began in January 2023 with collecting used devices only, but this was followed by the rollout and use of remanufactured devices within colorectal surgery in May 2023. The initiative has resulted in a reduction of clinical waste produced as well as a significant cost saving. 56 devices used so far in colorectal surgery have saved £12,880 and the estimated CO2 saving is 97 kilograms. There have been no incidents regarding the use of remanufactured devices or concerns raised. The project’s success has resulted in recent expansion into gynaecological surgery where the first remanufactured devices are in use.

Based on previous harmonic device usage within NBT of 618 per annum, projected savings of using remanufactured devices are likely to reach £71,070 and half a tonne of CO2 in the next year. This represents a significant financial and environmental initiative to continue the drive to reduce disposable waste within surgical theatres.
FP8.8 - LumenEye XI rigid digital rectoscope in the assessment of anorectal symptoms: a sustainable substitute for outpatient flexible sigmoidoscopy?
Authors: Attard Nathalie , Fava Leanne , Pace Gillian , Diacono Emily , Camilleri-Brennan John
Published: September 2024

Aims

To evaluate the acceptability, safety and diagnostic yield of the LumenEye XI in the assessment of anorectal symptoms.

Methods

Consecutive patients with anorectal symptoms, referred to the colorectal unit by their general practitioner, had a full clinical assessment followed by endoscopic examination using the LumenEye XI by a consultant colorectal surgeon.

Results

59 consecutive patients,16 being male, were examined. The median age was 59 years (range 27-90). The main reported presenting complaints were rectal bleeding (n = 18, 21.4%), proctalgia (n = 10, 15.5 %), faecal incontinence (n=12, 14.3%), obstructive defaecation (n=7, 8.3%), anorectal swelling (n = 7, 8.3%), and mucous discharge (n = 2, 2.4%). The main findings were haemorrhoids (n= 18, 22.5%), rectal prolapse and rectocoele (n=14, 17.5%), and inflammatory conditions (proctitis, anal fistula, pouchitis) (n=4, 5%). One patient was diagnosed with rectal cancer. 19 patients (23.75%) had normal findings. 13 patients (22%) were referred for further investigations. Out of the 18 patients with rectal bleeding, 16 had a definitive diagnosis made with LumenEye. The diagnoses in patients with rectal bleeding were haemorrhoids (n=15, 53.6%), inflammation (n=4, 14.3%), prolapse (n=2, 7.1%), and ulceration (n=1, 3.6%). No cause could be identified in 2 of these patients.

The rectosigmoid junction was visualised in all patients who had an intact rectum (57 out of 59 patients). All patients tolerated the procedure well, with no complications.

Conclusions

LumenEye XI is safe and well accepted by patients with good diagnostic accuracy. It therefore offers a potential solution to helping to relieve the endoscopy burden and enable cost savings by reducing the number of outpatient flexible sigmoidoscopies.
FP8.11 - Surgical Site Infection Post-operation (gowning vs not gowning): A District General Hospital Experience
Authors: Ong Chon Sum , Lala Anil
Published: September 2024

Aims

Increasing evidence shows that surgical site infection (SSI) does not differ significantly between main operation theatre and field sterility for many surgical procedures. This audit aimed to assess the rate of surgical site infection (comparing the operating surgeon using a disposable gown vs not using one) for emergency/elective skin procedures like uncomplicated incision and drainage of abscess, excision of lipoma, sebaceous cyst, and pilonidal sinus.

Methods

The electronic database was used to collect data (September-October 2023) on the type of surgery performed, number of theatre staff scrubbed in. Poster displays and informal education were used to raise awareness of theatre wastage (November 2023). All were advised to wear an apron, mask, sterile gloves, and field sterility only for uncomplicated cases. Data was recollected (December 2023-January 2024).

Results

54 cases were performed in September and October 2023. All theatre staff scrubbed in and 160 gowns were used. 5/54 (9.3%) returned with wound infection and managed with antibiotics. The median of the number of days in which the patients returned post-operatively is 7 days. 24 cases were performed from December 2023-January 2024. Theatre staff in 5/24 cases did not scrub in and none of these patients returned with wound infection. Out of the other 17/24 cases, 5/17 (29.4%) returned with wound infection.

Conclusions

With the limitation of small sample size and multi-factorial aetiology of wound infection, surgeons who did not gown up had no increased risk of wound infection. The higher monetary and environmental costs of complete gowning without improvement of patients’ care are unjustifiable.
EP58 - Gangrenous appendicitis in an incarcerated femoral hernia: A rare case of De Garengeot Hernia
Authors: Hamadziripi Millicent , Saeed Munir
Published: September 2024

Aims

To present a rare case of gangrenous appendicitis within an incarcerated femoral hernia, discussing its clinical background and highlighting the challenges in its diagnosis and surgical management.

Methods

We detail a 74-year-old female with a painful, non-reducible groin mass. A CT abdomen pelvis revealed a right femoral hernia with acute reactive inflammatory changes, with no comment made on the appendix (Figure 1 and 2). Emergency open femoral hernioplasty and laparoscopic appendectomy were performed.

Results

Intraoperatively, a femoral hernia with a gangrenous appendicitis were identified. The appendix was reduced into the abdominal cavity to allow for better evaluation of its base. A laparoscopic appendectomy was performed after identifying the healthy base (Figure 3), followed by a femoral hernioplasty.

This case sheds light on the rarity not only of the De Garengeot hernia which is defined by the presence of the vermiform appendix within the femoral hernia sac, but also even rarer the finding of a gangrenous appendix within the sac, with a reported incidence from 0.08-0.13% in cases of acute appendicitis. The case emphasizes the importance of considering an acute appendicitis and its complications within a femoral hernia as a differential diagnosis of painful groin masses with raised inflammatory markers.

Conclusion

Given the scarcity of literature on the surgical management of acute appendicitis in De Garengeot hernias, this case contributes valuable insights. The absence of established guidelines underscores the need for further exploration of optimal surgical strategies in such cases. Our report aims to enhance awareness of this rare presentation and facilitate future discussions on its management.