bluuebunny/crossref_metadata_2025 huggingface dataset:
WP6.15 - A dedicated teaching programme in Colorectal Surgery: continuing education beyond medical school
Authors: Abishek Joshua , Massias Samuel , Tamanna Rezuana , McCarthy Deirdre , Bland Carol , Mallappa Sreelakshmi
Published: September 2024

Background

The UK Foundation Programme (UKFP) Curriculum illustrates the need for educational progression for doctors in their first two years of work. Although UKFP recommends use of departmental teaching for this, there is limited guidance on structured and learning-objective focussed training. We designed a colorectal surgery lecture series to create a reproducible teaching programme with defined learning outcomes.

Methods

We developed a 6-part lecture series aimed at FY1 doctors working in General Surgery at our Teaching Hospital. Teaching was in the form of 30-minute powerpoint presentations, with 15 minutes for questions, at weekly departmental teaching meetings. Lectures were delivered by FY2 doctors and members of colorectal multidisciplinary team (Enhanced Recovery CNS, Stoma Care CNS). Each session was supervised by a Colorectal Consultant. Feedback was obtained using a 10-point Likert scale questionnaire, assessing various domains.

Results

FY1 trainees indicated an increase in their knowledge with each lecture. Furthermore, the domains of relevance (mean score 9.53±0.80); teaching style (mean score 9.66±0.94); and audiovisual aid (mean score 9.68±0.70) were all rated highly. Lecture duration was rated as perfect length (mean score 5.86±1.80).

Conclusion

We have demonstrated that weekly departmental teaching can be utilised to enhance training for FY1 doctors within a challenging surgical subspecialty. Feedback revealed high satisfaction, facilitating improvement in knowledge and thus empowerment in undertaking clinical duties. Strengthened by this positive outcome work is in progress to introduce this format of structured teaching into departmental teaching meetings in all disciplines of medicine and surgery across our Trust.
ThP1.4 - Evidence-Based Perioperative Improvements in Microvascular Breast Free Flap Reconstruction: An Audit-Centric Evaluation & Retrospective Cohort Study
Authors: Yen Wai Jasmine May , Jasionowska Sara , Awad Laura , Walker Ciara , Langridge Benjamin , Nikkhah Dariush , Hamilton Stephen
Published: September 2024

Aim

This audit aimed to evaluate and improve the results of microvascular breast free flap reconstruction by implementing an enhanced perioperative care approach.

Method

All microvascular breast free flap reconstructions between June to August 2023 were included. Additionally, a three year retrospective review was conducted in adherence to ABS and the BAPRAS guidelines. Our team plans to introduce an evidenced-based modified Enhanced Recovery After Surgery (ERAS) protocol via MDT collaboration with a focus on pre-operative and post-operative care to improve postoperative outcomes.

Results

During June – August 2023, 22 flaps were performed with an average length of stay (LOS) of 5.47 days (target <3d). There were no unplanned readmissions, an 18% return to theatre (RTT) rate and a total complication rate of 18%. Over the past three years, out of 323 flaps, there was a 13% RTT rate with no unplanned readmissions. Suggested modifications to reduce length of stay include pre-surgical counselling and nutritional loading. Post-operatively, using a multi-modal opioid sparing analgesia (MOSA) regime, along with laxatives, early mobilisation and feeding has proven to enhance recovery. Pre-admission patient optimisation, VTE and perioperative antibiotic prophylaxis have been shown to reduce rates of flap failures and post-operative complications. Effective wound care, post-discharge support and physiotherapy are also crucial in accelerating recovery and preventing readmissions.

Conclusion

Implementing these ERAS modification to our current protocol is predicted to significantly improve post-operative recovery, thus improving surgical outcomes. This underscores the potential for continual improvement in patient care through an efficient evidence-based perioperative pathway.
ThP1.10 - Expression Pattern of Arginase In Tumour Tissue In Male Breast Cancer
Authors: Raj Nirmal , Huda Farhanul , Basu Somprakas , Khare Vidhu Shekhar , Amulya Kanmatha Reddy , Chowdhury Nilotpal
Published: September 2024

Aim

To study the expression pattern of arginase in tumor tissue of male breast cancer (MBC) by immunohistochemistry (IHC).

Methods

We retrospectively analysed the data of 21 MBC patients who were treated in our centre from January 2018 to March 2022. Immunohistochemical analysis of arginase expression was performed in tumor and lymph node tissue with primary arginase-1 antibody (1:300 dilution).

Results

The mean patient age was 57 years (33–81 years). 10 patients (48%) had metastatic disease at presentation, while early breast cancer (EBC) and locally advanced breast cancer (LABC) constituted 19% and 33%, respectively. Invasive ductal carcinoma was the predominant histology, with luminal being the major subtype. Modified radical mastectomy was done in 9 patients (43%), and palliative chemotherapy was given to all metastatic patients. IHC analysis revealed a lack of arginase expression in the tumor tissue even though it was expressed in the surrounding neutrophils.

Conclusion

Contrary to the majority of existing literature, ours was an IHC-based study, which provides a more accurate estimation of arginase expression at the cellular level. The lack of arginase expression obtained in our study may point towards the non-expression of the enzyme in MBC. This suggests that arginase is not a tissue biomarker in MBC. Taking other studies with protein expression into account, arginase should be treated, if necessary, only as a blood biomarker.
ThP1.12 - Axillary Node Clearance Following Positive Sentinel Node Biopsy: Is it Always Necessary?
Authors: Usoro Angel , Othman Sal , Reid Judith , Elgammal Suzanne
Published: September 2024

Aim

The study was carried out to determine what proportion of patients have residual disease on completion Axillary node clearance (ANC) following positive nodes on prior Sentinel node biopsy (SNB) and assess for correlation between possible predicting factors such as neoadjuvant chemotherapy and the absence of positive nodes at ANC.

Methods

Operation records of patients who had surgery for breast cancer were used to identify all patients who had Axillary node clearance done from 2020 to 2023. Patients who did not have SNB prior to ANC were excluded.

Results

Less than 45% of patients had residual disease on completion ANC. Data was evenly spread between ductal carcinoma and lobular carcinoma on biopsy. There was no significant correlation found between number of positive nodes found at SNB and positive nodes at ANC. More than 50% of patients who had neoadjuvant chemotherapy prior to procedure were node-negative on completion ANC.

Conclusion

Management of axillary disease post positive SNB remains debatable. Use of neoadjuvant chemotherapy may reduce the need for completion axillary node clearance.
ThP3.7 - Evaluating the Effectiveness of Internal Vetting for General Practitioners Referrals with Urgent Suspicion of Oesophago-Gastric Cancer
Authors: Agiotakis Stefanos , McDowall Neil , Khan Khurram S
Published: September 2024

Aim

The NHS faces substantial pressure on surgical clinic waiting times especially for urgent suspicion of cancer (USOC). This study audits the effectiveness of internal vetting process and the clinic waiting time for patients referred as USOC for oesophago-gastric cancer.

Methods

This was a retrospective cohort study of all consecutive USOC referrals with suspected oesophago-gastric cancer who had clinic appointment in a single surgical unit between April to September 2022. All patients who fulfilled the Scottish referral criteria for USOC were included. Patients demographics, the urgency of clinic slot utilised and waiting time to clinic were analysed. This study was registered with Clinical Quality Project (LanQIP 14749).

Results

275 patients were included; median age was 63 years (IQR 52-73) and 153 (55.6%) were female. 94 (34.2%) patients were appointed as USOC, 120 (43.6%) as urgent and 61 (22.2%) as routine clinic slot. Overall, the median time for clinic appointment was 42 days (IQR 31-63). The median time to clinic was 47, 42 and 21 days for USOC, urgent and routine clinic appointments, respectively. 21 (7.6%) patients did not attend clinic. Of the patients who attended the clinic, 200 (78.7%) had endoscopy requested.

Conclusions

Although General Practitioners made appropriate referrals, a noteworthy portion of patients were reassigned to urgent or routine clinic slots. Nevertheless, those downgraded in urgency received prompt clinic reviews. This can be attributed to the strategic use of less urgent slots, ensuring timely assessments for patients with urgent suspicion of oesophago-gastric cancer.
ThP3.8 - General Practitioner Compliance to Scottish Referral Guidelines for Urgent Suspicion of Oesophago-gastric Cancer
Authors: McDowall Neil , Agiotakis Stefanos , Khan Khurram S
Published: September 2024

Aim

The referral guidelines in Scotland stipulate that patients with urgent suspicion of cancer (USOC) should commence treatment within 62 days of diagnosis from the date of primary care referral. In this study, we assessed the adherence of general practitioners (GPs) to the Scottish Referral Guidelines for USOC.

Methods

This was a retrospective cohort study of all consecutive USOC referrals from GP who were given clinic appointment for Upper GI Surgeons in a single centre for suspected oesophago-gastric cancer between April to September 2022. Patient’s electronic case notes were analysed and the referral indication audited against the Scottish referral guidelines. This study was registered with Clinical Quality Project (LanQIP 14746).

Results

361 patients were identified, median age was 63 years (IQR 52-72) and 200 (55.4%) were female. Median Scottish Index of Multiple Deprivation was 4 (IQR 3-7). 138 (38.3%) were referred for dysphagia. 5 (1.4%) were vetted straight to the test and had endoscopy prior the clinic consultation.

275 (76.2%) of the GP referrals for USOC were compliant with the Scottish referral guidelines. Median time from the referral to the clinic consultation was 44 days (IQR 31-63). 35 (9.7%) of patients did not attend the clinic.

Conclusions

The criteria outlined in the Scottish referral guidelines for USOC provide clear parameters for clinic referrals. Our findings reveal that the majority of GP referrals align appropriately with the USOC criteria. Increasing education and awareness among GPs can further enhance compliance with these guidelines and reduce pressure on the clinic waiting time.
ThP3.10 - Initial experience with laparoscopic single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) in Class IV (BMI 50-60kg/m2) and Class V (BMI > 60 kg/m2) Obesity
Authors: Ahmed Awais , Lu Yanqiang , Davies Sian , Sharples Alistair , Rao Vittal , Marimuthu Kanagaraj , Salgaonkar Hrishikesh
Published: September 2024

Aims

Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a simplification of the duodenal switch (DS) in which alimentary limb is eliminated, and common channel is lengthened from 200 to 300 cm is gaining recognition as effective procedure in Class IV (BMI 50-60 kg/m2) and Class V (BMI >60 kg/m2) obesity. The aim of study is to discuss the surgical technique and analyse initial outcomes after introduction of SADI-S in our department for management of Class IV and Class V Obesity.

Methods

This is a retrospective cohort study of consecutive patients who underwent SADI-S at a tertiary level teaching hospital in NHS. Only patients who underwent single stage SADI-S procedure with minimal follow-up of 30 days were included in study. Patients who underwent Sleeve gastrectomy first, followed by duodenal switch in second stage as part of two-stage strategy were excluded.

Results

Total 14 patients, 2 (14.2%) males and 12 (85.8%) females were included in study. The median pre-op BMI was 56.1 (51.95-69) kg/M2 and median Pre-op weight was 149.2 (121.8 – 163.2) kg. 9 pts had diabetes, 11 pts OSA on CPAP, 8 pts HTN, 6 pts fibromyalgia etc. 1 patient had sleeve staple-line bleed which was managed conservatively with fluids and blood transfusion. No re-operations, mortality or re-admissions were recorded. Median length of stay was 2 days.

Conclusion

SADI-S is a promising surgery in Class IV and Class V obesity patients with low postoperative morbidity. The postoperative recovery and protocol is similar to standard procedure like sleeve gastrectomy and Roux-Y-gastric bypass.
ThP3.15 - Trends in ERCP in a new city teaching hospital; is there a learning curve for a unit?
Authors: McNickle Luke , Wohlgemut Jared , Glen Paul
Published: September 2024

Aims

Describe trends in volume, demographics, and complications over time for endoscopic retrograde cholangiopancreatography (ERCP) in a new endoscopy unit.

Methods

Prospective recording of all ERCPs in a new city teaching hospital commenced when the unit opened in 2015. This registry recorded patient demographics, indications, procedural data and complications. We analysed annual trends over time using linear regression.

Results

4504 ERCPs were performed during the study period (1/6/15-31/5/23), with a female predominance of 58%. Median age (70 years, interquartile range 59-80) was unchanged over the study period, however the proportion under 30 years had decreased over time (4%-1%, slope -0.93, p=0.042). Total number of procedures per year has decreased over time (peak 628 in 2016, falling to 438 in 2022). The proportion performed for stone disease has fallen over the study period (80%-71%, slope -0.07, p=<0.001). Though not a statistically significant difference, the rate of ERCP pancreatitis has had a clinically significant decrease over time (5.4%-3.9%, slope -0.033, p=0.32).

Conclusion

A number of changes in practice have occurred since three units were merged into one unit. We routinely give diclofenac and IV fluids post-procedure. We now preferentially treat younger stone patients with laparoscopic cholecystectomy and common bile duct exploration. This results in an evolving use of contemporary ERCP with an older patient cohort with an increased indication of cancer and other reasons and fewer total numbers. These factors will contribute to a lower incidence of pancreatitis post-procedure but cannot discount a learning curve effect for a new unit.
ThP5.14 - Assessing Adherence and Cost Implications of NICE Guidelines for Intravenous compared to Oral paracetamol use after Resuming Oral Diet Following Liver and Pancreas Resections
Authors: Aziz Tariq , Rehman Zak , Mukhtar Talha , Froghi Farid , Kotelis Nikolaos
Published: September 2024

Aim

For post-operative pain management NICE recommends not to offer intravenous paracetamol unless the person cannot take oral medicine [NG180] 1.6.6. Despite this recommendation, many patients continue to receive intravenous paracetamol whilst on oral diet. This audit aims to assess the adherence and cost implications of NICE guidelines for switching from IV to oral paracetamol once oral diet resumes following liver and pancreas resections.

Method

Data for 176 patients undergoing major liver or pancreas resections at the Royal Free Hospital London (January 2022 to October 2023) was collected retrospectively. This included the number of IV and oral paracetamol doses, resumption of oral diet post-operatively, and the total number of IV paracetamol doses whilst oral diet resumed. Costings for IV and oral paracetamol were established, and the total cost was calculated per patient. After a departmental presentation, the audit cycle was completed.

Result

The analysis of the initial dataset disclosed that 69% of patients were administered IV paracetamol while on an oral diet, incurring a cost of £9412/100 patients, in contrast to £18.5 for oral paracetamol. Following the intervention, there was a noteworthy enhancement in adherence to guidelines, reducing the average days of IV paracetamol administration after resuming oral diet from 4.08 days pre-intervention to 2.06 days post-intervention.

Conclusion

This improved adherence showed almost 50% cost reduction compared to first audit. In addition to this we can also expect early patient mobilization, enhanced recovery, and prompt discharges. This audit provides valuable insight into optimizing postoperative pain management strategies and resource utilization.
ThP6.7 - Early assessment by a specalist geriatric team reduces length of stay in unplanned surgical admissions
Authors: Ramdin Ashling , Rothnie Alex , Hamza Mohamed , Satar Iman , Cross Jason , Thin Katie , Mamidanna Ravi
Published: September 2024

Intro

A comprehensive geriatric assessment (CGA) performed by the Perioperative medicine for Older People undergoing Surgery (POPS) team has been shown to reduce length of stay(LOS) for unplanned hospital admissions in the older population. This study investigates whether timing of POPS review reduces LOS for older adults admitted under the acute general surgical team.

Methods

We performed a single centre, prospective study of all older adult patients (aged 65 or above) admitted acutely to the general surgical team between August 2022 and September 2023. Timing of POPS review and LOS was calculated, and Mann Whitney-U test was performed.

Results

Three hundred and nine patients were identified. Of these, 207 patients were reviewed by POPS within 48 hours (early) and 151 of these patients were reviewed within 24 hours (very early) of admission. There was a statistically significant difference (p<0.001) in LOS between those who were assessed by POPS within 48 hours [Median 5 days (IQR 3,9)] versus those beyond 48 hours [Median 9 days (IQR 6,19)]. Very early POPS review (less than 24 hours) resulted in a statistically significant reduction in length of stay compared to POPS review between 24 and 48 hours [Median 5 days (IQR 2,8) versus 6 days (IQR3,9)] p<0.02.

Conclusions

POPS review within 48 hours reduces length of stay for older patients who have had an acute general surgical admission. Furthermore, this data suggests that very early POPS review (within 24 hours) is associated with a shorter hospital admission. Further research into this will help service planning.
ThP6.16 - Small bowel obstruction (SBO) in NELA patients: A cohort study
Authors: Gok M A , Bughio M , Yim S , Khan S , Sadat M M , Khan U A , Zaidi Marium
Published: September 2024

Aims

SBO is characterized as mechanical or functional obstruction of intestines, accounting for 15% of acute abdomens & 50% (NASBO 2017) of emergency laparotomies each year in the UK. Aim of study is to assess the surgical management of SBO amongst NELA patients at a single centre.

Methods

Cohort study carried out from Jan’2014 to Jan’2023. Descriptive demography & post-operative outcomes were evaluated for SBO NELA patients. Other non SBO NELA patient were controls.

Results

SBO NELA(n = 560) Non SBO NELA(n = 306) Mann Whitney U(p value) Age(yrs) 68.7 65.7 < 0.005 Sex(M:F) 235 : 325 157 : 149 BMI 25.5 26.0 NS ASA 3 3 NS Op time(mins) 112.1 133.0 < 0.0001 ITU stay(n) 229 171 ITU stay(days) ± ± LOS(days) 11 16 < 0.0001 Lap(n) 176 60 Open(n) 384 246 Lactate(mmol/L) 2.0 ± 0.1 2.3 ± 0.2 NS WCC(x109/L) 12.4 ± 0.2 12.4 ± 0.4 NS CRP(mg/L) 62.2 ± 3.9 90.6 ± 5.9 < 0.0001 Physiol score 21.9 ± 0.3 23.5 ± 0.5 < 0.05 Op score 15.4 ± 0.2 19.5 ± 0.3 < 0.0001 Pre possum score 10.4 ± 0.8 21.0 ± 1.7 < 0.0001 PP mortality score 7.3 ± 0.5 9.7 ± 1.1 NS PP morbidity score 60.7 ± 1.4 75.6 ± 1.7 < 0.0001 Adhesions(n) 277 Hernias(n) 48 Other(n) 235 SB resection(n) 115

Conclusion

Early radiological diagnosis & management is essential in SBO including nutritional support. Surgery is indicated in SBO where there is potential perforation, strangulation & failed conservative managements. SBO was treated laparoscopically in 31.4% of cases, adhesions (49.4%) was most causes, SB resection was undertaken in 20.5 % cases. Other causes include hernias, FB (gallstones), tumours, intussusception & volvulus.
ThP7.11 - Does Hypoalbuminaemia Increase the Risk of Surgical Site Infection in Neck of Femur Fracture Patients? A Systematic Review and Meta-analysis
Authors: Mostafa Omar Ezzat Saber , Al-Allaf Omar , Tahir Muaaz , Hossain Fahad , Blackwell John
Published: September 2024

Aim

Serum albumin plays an important role in physiological and inflammatory haemostasis; low serum levels are linked with an increased incidence of surgical site infections (SSI). Although this has been demonstrated in spinal and elective arthroplasty surgeries, there is a paucity of evidence with regard to the effect of low preoperative serum albumin on rates of SSI following surgery for adult patients suffering from traumatic, acute hip fractures.

Method

A systematic review was conducted using the PRISMA guidelines. Four databases were searched for randomised controlled trials, cohort and case-controlled studies. The risk of bias was assessed using the Newcastle-Ottawa Score (NOS). Data was collected and pooled using RevMan Web Software. Results were reported as Odds Ratio (OR) with 95% Confidence Intervals (CI) and statistical significance of p <0.05. An Inverse-Variance model was used in meta-analysis.

Results

Six retrospective studies (five cohorts, one case-control) with a total of 43,059 patients were included. 45.3% (n=19,496) had low serum albumin (<3.5 g/dL). Hypoalbuminemia was associated with a significantly higher risk of any form of SSI (OR 1.25, p=0.008) and deep SSI (OR 1.76, p=0.05). There was no statistical significance between hypoalbuminemia and the incidence of superficial SSI (OR 1.06, p=0.77). Organ-space SSI was associated with hypoalbuminemia, albeit only one study reported this with poor statistical significance (OR 8.74, p<0.054).

Conclusion

Hypoalbuminemia increases the risks of most forms of surgical site infections; superficial and deep infections. There is a weak conclusion to draw between incidence of deep-space organ infections and low serum albumin.
FP1.7 - Colorectal Anastomotic leaks after malignant resections: A cohort study
Authors: Gok M A , Bughio M , Mathiewson N O M , Aris R , Sadat M M , Khan U A
Published: September 2024

Aims

Colorectal anastomotic leaks (AL) is serious complication in restorative colorectal cancer surgery, reported incidence of <10%. AL can adversely affect long term survival. Aim of study is to assess management of colorectal anastomotic leaks at a single centre.

Methods

Cohort study was carried out from Jan2008 to Jan2024. Descriptive demography and post-operative outcomes were evaluated for AL, non-leaks recruited as controls

Results

A L (n = 66) Non Leaks (n = 1644) Mann Whitney U test (p value) Age(yrs) 67.8 70.5 <0.05 Sex(M:F) 41 : 25 915 : 729 NS ASA(median) 2 2 NS BMI(kg/m2) 27.3 26.5 NS Emerg : Elec(n) 7 : 59 355 : 1289 <0.05 Lap : Open(n) 31 : 35 927 : 717 <0.0001 LN harvest(n) 16 17 NS Leaks Rx Type A (antibiotics) 29 Type B (drainage) 10 Type C (surgery) 27 Days to Leak(Med) 6 Leak day Day 6 WCC(10x9/L) 14.1 9.4 <0.001 CRP(mg/L) 226.5 118.1 <0.0001 Op time(mins) 178.3 174.9 NS LOS(days) 14.5 < 0.0001 Complication(n) Ileus 14 260 NS HAP 7 178 NS Anaemia(transfusion) 1 52 NS Wound infections 5 150 NS Collections 31 65 <0.0001 Sepsis 13 73 <0.05 Mortality(n) 30 day 1 57 NS 60 day 2 82 NS 90 day 3 95 NS Survival rates(%) 1st year 88.7 86.0 5th year 79.7 68.8 Logrank 10th year 72.0 60.7 p=NS 15th year 67.7 57.8

Conclusion

AL occurred in 3.8 % all colorectal cancer resections, 40.9 % requiring surgery (type C-1.6 %). AL associated with rise in WCC & CRP, but early radiological diagnosis is essential. Despite prolonged hospitalization, there was no reduced survival.
FP1.9 - Evaluating outcomes of multi-visceral resections for locally advanced colorectal cancer
Authors: O’Connell Elizabeth , Javed Ahsan , Wyatt James , Choi Marcus
Published: September 2024

Introduction

Multi-visceral resection for colorectal cancer invading into adjacent organs is often difficult and involves serious complications. The aim of this study is to evaluate the short- and long-term outcomes of patients undergoing multi visceral and beyond TME (total mesorectal excision) resections for locally advanced CRC.

Methods

Patients undergoing elective surgery for advanced or recurrent CRC between October 2018 and October 2023 were identified. Demographic and clinical data were recorded, and outcomes analysed. Primary outcome was R0 resection rate and post-operative complication rate.

Results

Thirty-three patients (51.5% male, 48.5% female) were included, with a median age of 66.8 years (IQR 38-82) and median BMI was 26.7 kg/m2 (13.8-50). Majority of patients (n = 29, 87.8%) had surgery for primary, locally advanced CRC and most were referred from external Trusts (n=25, 75.7%).

Thirteen patients (39.3 %) had robotic resections, one case was completed laparoscopically, and the remaining were open procedures (n= 19, 57.5%). Seventeen individuals had previous abdominal surgeries with no differences between open (8/20 = 40%) and robotic approach (9/13 = 69.2%) (p=0.207). Median LOS in open and robotic groups were 16 and 10 days respectively (p=0.047). There was no post-operative mortality. Proportion of CD I-II complications was 9/33 (27.3%) and CD III-IV 18/33 (54.5%). R0 resections rate was 63.6 % and eight patients (24.2%) developed recurrence during the follow up period (median = 47.6 months).

Conclusions

An aggressive surgical approach as part of a multimodal strategy affords the best prospect for long-term survival in selected patients. Robotic multi-visceral resection for locally advanced CRC is a safe and feasible, minimally invasive approach in selected cases.
FP1.11 - An audit of post colonoscopy Colorectal cancers within a Northern Ireland Health and Social Care Trust
Authors: Stevenson Sarah , Clements Jake , Coulson Rachael , Johnston Dorothy , McElvanna Kevin , Neill Adrian
Published: September 2024

Background

Post colonoscopy colorectal cancer (PCCRC) is defined as colorectal cancer found within 48 months of a colonoscopy in which no cancer was found. The British Society of Gastroenterology (BSG) proposes PCCRC rates as a key quality indicator of colonoscopy. Rates documented vary between 2-8%, with higher rates shown in Inflammatory Bowel disease (IBD). The English National Post Colonoscopy Colorectal Audit was established after recommendations from the World Endoscopy Organisation (WEO). We aim to establish the rates of PCCRC within this Health and Social Care Trust (HSCT).

Method

All CRCs diagnosed in our HSCT between January 2021 to December 2022 were retrospectively reviewed. Our definition for a PCCRC was one diagnosed between 0-48months after a colonoscopy. Information included whether the colonoscopy was complete, quality of bowel preparation, lesions detected, if resection of lesion was complete and if IBD was present.

Results

In this timeframe 524 CRCs were diagnosed in this HSCT, with 33(6.3%) having had a colonoscopy within the previous 48 months. Of the 33 PCCRCs, 21(63.6%) had a complete colonoscopy, 22(66.6%) had at least fair/satisfactory bowel preparation, 24(72.7%) had a lesion detected and 3(9%) had a prior diagnosis of IBD. Of those who had a lesion detected (n=24), 13(54%) had a complete resection and 10(41.6%) had a biopsy only or incomplete resection.

Conclusions

Our PCCRC detection rate is in keeping with previous published literature. Further analysis of the 33 cases should provide information on how we can reduce future PCCRCs.
FP2.3 - Is the Oakland score a reliable tool for safe discharge in lower gastrointestinal bleed patients?
Authors: Whiteway James , Yim Ho Yu Stephanie , Leong Ka Tung Natalie , Shah Ankur
Published: September 2024

Aim

There are no NICE guidelines regarding safe discharge of patients with lower gastrointestinal bleeds (LGIB). The aim of this study was to investigate the effectiveness and safety of the Oakland score, as suggested by the British Society of Gastroenterology guidelines, in patients presenting with LGIB at William Harvey hospital.

Methods

Patients with LGIB who presented to A&E or inpatient referral from January to December 2023 were included in this retrospective study. Data was extracted from patient’s Sunrise documentation. The Oakland score for each patient was calculated. Those with a score of ≤8 were deemed safe for discharge; those with a higher score were deemed unsuitable. Patients’ admission, safe discharges and adverse outcomes, such as representation, blood transfusion, or further intervention, were investigated. The area under the receiver-operating characteristic curve (AUROC) for the Oakland score and adverse outcome was calculated.

Results

123 patients were included. A total of 144 presentations to hospital, 29 had an Oakland score ≤8; 17 (58.6%) cases were safely discharged, 8 (27.6%) admitted and 4 (13.8%) represented. 115 had a score >8; 37 (32.2%) were safely discharged, 72 (62.6%) admitted and 41 (35.7%) experienced at least one adverse outcome. The AUROC for safe discharge was 0.84.

Conclusion

The Oakland score seems to be a safe and reliable tool for identifying LGIB patients who could be safely discharged home without hospital intervention. However, further research is required to assess whether a score >8 could be used as many higher risk patients did not experience adverse outcomes.
FP3.3 - Sensitivity of Faecal Immunochemical Testing
Authors: Karim Seiver , Moolamannil Mathew , Kumarakulasingam Priyanga , Bevan Katharine
Published: September 2024

Aim

The use of faecal immunochemical testing (FIT) in the diagnosis of colorectal cancers (CRC) has become a routinely utilised and reliable investigation. In the symptomatic population, FIT may identify those patients who require urgent colorectal investigation. It is also commonly used as a triaging tool in bowel cancer screening.

In this study we sought to assess the sensitivity of FIT in detecting CRC in our centre.

Method

Patients with histologically confirmed CRC were identified from a data set gathered from the hospital colorectal specialist services between January 2021 to January 2022. Thereafter, the hospital electronic systems were used to retrospectively gather the value of FIT tests for each CRC patient found.

Results

From 407 patients with CRC identified, only 256 patients who we successfully managed to obtain their pre diagnosis FIT result were included. From those, 235 patients were FIT positive and 21 patients had a false negative result. Therefore, this suggests a FIT sensitivity of 91.79%.

Furthermore, we identified 14 patients who had a repeat FIT preformed. From which, one patient who was originally fit negative had a positive result on the repeat test.

Conclusion

While faecal immunochemical testing is highly sensitive and a useful screening tool, it's important to remember that it is not always accurate. Therefore if a patient has convincing history or symptoms, we should keep a high index of suspicion and investigate further. It also remains to be seen if the use of double FIT will help increase the sensitivity of detecting CRC.
FP3.15 - Are non-colorectal surgeons more likely to make a stoma in an emergency right hemicolectomy for cancer?
Authors: Campbell Tim , Mandal Piya , Bisheet George , Fernandes Roland
Published: September 2024

Introduction

Right sided colonic cancers can often cause bowel obstruction and present as an emergency. The decision to perform an anastomois following a right hemicolectomy resection is frequently multifactorial. There is controversy as to whether colorectal cancers should be operated on by non-colorectal surgeons in the emergency setting. This study explores whether there are differences in stoma formation rates between colorectal and non-colorectal surgeons in the context of emergency right hemicolectomy operations performed for malignancy.

Methods

A retrospective study was conducted at a 3 site Trust in South East England between 2017 and 2022. Theatre and Infoflex Cancer records were used to obtain patients who had undergone an open right hemicolectomy for malignancy and their operating surgeon.

Results

There were 281 patients included in the study, in a 152:129 female:male ratio. The mean age was 68 (34-86 IQR). 13% (37/281) of operations were conducted by Upper Gastro-intestinal Surgeons. 54% (20/37) of these patients had stoma formation as part of their operation. 47% (115/244) of operations undertaken by colorectal surgeons also had stoma formation. There was no significant difference between the stoma formation between colorectal and non-colorectal surgeons (p=0.108)

Conclusion

The study shows that although the decision to form a stoma following a right hemicolectomy multifactorial and is dependent on a wealth of patient and operative factors, there is no statistical difference between colorectal and non-colorectal surgeons in the emergency setting.
FP5.2 - Skills-fade pilot study, inclusion of Return to Training Trainees in the ST3 General Surgical Bootcamp
Authors: Richards Eleanor , Clarke Rory
Published: September 2024

Aims

The concept of skills fade after time out of training is well recognised but there is a paucity of objective assessment of this in returning trainees. We sought to assess the utility of inclusion of returning trainees in a bootcamp by measuring performance and confidence.

Methods

In this pragmatic pilot study 8 General Surgery trainees returning from time out were offered a place on the ST3 Bootcamp of whom 3 agreed to participate. These trainees had been out of programme for a medical education fellowship, non-clinical research and parental leave respectively. Trainees received a 3 day period of intensive reskilling, covering open and laparoscopic skills, proctology, endoscopy, ward round managing the OP list and stressful environment. Their confidence and competence were assessed pre and post Bootcamp completion.

Results

Returning trainee confidence improved across the board. Trainees fed back that they found the open and laparoscopic simulation sessions most useful. All trainees objectively improved in laparoscopic skills although not in open skills or endoscopy and proctoscopy. The pressure of being assessed may have affected these finding or this may reflect a need for consistency of faculty and a more robust method of objectively assessing competence.

Conclusion

Inclusion of RTT trainees in surgical bootcamp improves confidence and enhances their return. Simulation should be included in a return to training programme. If objective assessment is used to evaluate their progress then this should be with predefined criteria or computer software to ensure that the evaluation is unbiased.
FP5.5 - Simulated Abdominal Wall - a valuable educational tool for Abdominal Wall Reconstruction and Small Bite closure techniques.
Authors: Smith Olivia , Ritchie Coral , Aylward Kathryn , Green Susie , Chintapatla Srinivas , Chitsabesan Praminthra , Chua WeiYing
Published: September 2024

Background

Incisional hernia is a common complication following laparotomy (31.8% at 2 years, HART collaborative, 2022) and this may require complicated reconstructive techniques. Studies suggest that poor closure technique contributes to incisional hernia formation. Junior trainees are often left to close the abdominal wall. European and American guidelines have suggested closing the abdomen with the "small bites technique".

Simulated training has gained traction. Reduction in theatre training hours necessitates simulated training.

This study aims to:generate a synthetic model that anatomically represents the layers of the abdominal wall.use this model as a simulated training tool for general surgical and plastic surgical trainees who are often left to close the abdominal wall in laparotomy cases / abdominal wall reconstruction.use this model to teach reconstructive abdominal wall repair techniques.

Methods

2021: literature search and research. Theatre observation of complex abdominal wall procedures and techniques. Cadaveric lab attendance at Leeds University.

2022: prototype - first model produced from medial grade silicone.

2022: amendments - alterations to the prototype.

2023: accreditation and delivery - Small Bites Course delivered and accredited by RCS Edinburgh.

Results

86% of course attendees found the abdominal wall models "as realistic as possible". Attendees felt more confident to perform small bites closure and simple abdominal wall reconstruction. Total cost saving per model compared with competitors = £1109.50.

Conclusions

Our simulated abdominal wall model has proved to be realistic and cost effective. It is an ethical and improved way to train junior surgeons in the small-bites technique and some elements of abdominal wall reconstruction. These models have been implemented on training courses for surgical trainees within the deanery.
Retracted: FP5.8 - Bridging the Trust Divide: How Medical AI Outperforms yet Battles to Win Public Confidence - A Study Conducted Among 74 UK Residents
Authors: Misro Aswini
Published: September 2024

This article has been retracted. Please see: https://doi.org/10.1093/bjs/znaf039
FP6.13 - A Quality improvement project to reduce the number of readmissions to surgical assessment unit (SAU) in East Sussex hospitals (ESHT) following laparoscopic cholecystectomy
Authors: Ali Elmurtada Ahmed , Jenner Deborah , Al-Robaei Basim
Published: September 2024

Aim

This is a QI project aiming to reduce the number of readmissions following laparoscopic cholecystectomy in ESHT from the current rate of 8.1% to the UK national average rate of 5%. This proposal followed an audit I conducted previously. About two-thirds of those readmissions occurred on day one following discharge, half of them due to pain, and almost 90% of them discharged without any intervention needing only reassurance, pain control, and analgesia.

Methods

Problem identified, SMART objectives followed, which means our intervention is: specific, measurable, achievable, relevant, and time specified.

Set up a process map showing areas where intervention is desirable/beneficial. These include time allowed for consent, preoperative assessment clinic, and postoperative discharge information.

Then a driver diagram is drawn to indicate the primary and secondary drivers we need to tackle in order to achieve our goal. In summary, the proposed changes include allowing more time in clinic for patients to explain procedure and consent, junior doctors and nurses’ education, resources, and provision of leaflets and websites for information.

Identification of stakeholders including managers, anaesthetists’ nurses, and patients, and dealing with them according to their influence and interest. PDSA (plan do study and act) cycle, TQM (total quality management), SPC (statistical process control), and lean methodology were implemented.

Conclusion

This project is aimed primarily at reducing readmissions numbers to SAU following laparoscopic cholecystectomy from 8.1% to 5% within a year. Areas in the process map were identified to achieve this objective,

and since about 90% of patients were discharged without any intervention, we believe this should be achievable.
FP7.5 - 90- day mortality rate post emergency laparotomy for frail and sarcopenic patients
Authors: Ng Hwei Jene , Quasim Tara , Moug Susan
Published: September 2024

Aims

High mortality and morbidity rate post emergency laparotomy (EmLap) has been well documented in frail or sarcopenic patients. Although frailty and sarcopenia can be present concurrently, they can also occur independently. We aim to explore the relationship between 90- day mortality, frailty and sarcopenia.

Methods

Prospectively collected data from EmLap patients age ≥40 years between May 2022 to July 2023 including 3 months follow-up from a district hospital was analysed. Clinical Frailty Scale was used to assess frailty with score >4 as frail. Total psoas index (TPI) [TPI=total L3 psoas area on CT (cm2)/ patient’s height (m2)] was measured on pre-operative CT to assess sarcopenia, stratified according to gender with lowest quartile as sarcopenic. Logistic regression was performed and p-value of <0.05 was considered significant.

Results

150 patients were recruited, 55% were female and median age was 69 years. The overall 90- day mortality rate was 13.3%. Frailty was present in 10% and 90-day mortality rate was 13.0% (OR 1.00, p= 1.000) while 23.6% were sarcopenic and 90- day mortality rate was 25.7% (OR 3.21, p= 0.0197). 4% were both frail and sarcopenic with 90- day mortality rate of 33.3% (OR 3.50, p= 0.1648).

Conclusion

The 90-day mortality rate is higher when frailty and sarcopenia are both present in EmLap patients. Early evaluation of frailty and/ or sarcopenia in emergency setting is crucial to improve EmLap outcomes and aid shared decision making.
FP7.13 - Is There A Difference In Anastomotic Leak Rates Requiring Re-Operation Following Emergency Right Hemicolectomy Between Colorectal And Non-Colorectal Surgeons?
Authors: Mandal Piya , Campbell Timothy , Bisheet George , Fernandes Roland
Published: September 2024

Aim

Right sided colonic cancers can often obstruct and present as an emergency. The decision to perform an anastomosis following the right hemicolectomy resection is often multifactorial. This study explores whether there are differences in leak rates between colorectal and non-colorectal surgeons in the context of emergency right hemicolectomy operations performed for malignancy.

Methods

A retrospective study was conducted at a 3-site Trust in South-East England between 2017 and 2022. Theatre and Infoflex Cancer records were used to obtain patients who had undergone an open right hemicolectomy for malignancy and their operating surgeon. Discharge summaries and clinic letters were then used to ascertain return to theatre for an anastomotic leak.

Results

There were 281 patients who had undergone an emergency right hemicolectomy in this time interval. There was a 152:129 female:male ratio. 17 out of 37 patients had an anastomosis undertaken by an Upper Gastrointestinal Surgeon. 2 out of the 17 (12%) had an anastomotic leak. 129 out of 244 had an anastomosis undertaken by a Colorectal Surgeon. 17 of the 129 (13%) had an anastomotic leak. There was no significant difference between the leak rates between colorectal and non-colorectal surgeons (p=0.888).

Conclusion

The study shows that there is no statistical difference in right hemicolectomy anastomotic leak rates between colorectal and non-colorectal surgeons in the emergency setting.
EP 632 - Management of chest trauma in a District General Hospital - Audit of current practice
Authors: Willis Kelly , Fitz-Gerald Alice , Ali Saqib
Published: September 2024

This abstract was published in Volume 110, Supplement 10, December 2023 ASGBI Emergency General Surgery Symposium. 1st November 2023. Glasgow, UK, and can be accessed at https://academic.oup.com/bjs/article/110/Supplement_10/znad388.012/7455140
EP65 - Case Series of 45 Preterm Neonates with Surgical Necrotizing Enterocolitis
Authors: Duric Bea
Published: September 2024

Aim

The objective of this study was to determine if the timing of surgery from the onset of necrotising enterocolitis (NEC) diagnosis affects clinical outcomes in preterm neonates.

Methods

We enrolled 45 preterm neonates who were transferred to the Evelina Children’s Hospital for surgical management of NEC between 2015 and 2018. Neonates had an established diagnosis of NEC as per Bell’s staging criteria. Surgical indications were: pneumoperitoneum, failure to improve despite medical management, shock, peritonitis, abdominal mass or loops, and unresolving intestinal obstruction.

Results

Average time from NEC onset to surgery was 4.2 days (±9.04) for all neonates, with an average of 5.72 days (±11.42) for neonates with pneumoperitoneum and 2.05 days (±3.22) for neonates without pneumoperitoneum (p=0.09). 26 neonates (57.7%) presented with pneumoperitoneum. Time of NEC onset to surgery was inversely correlated to mortality and directly correlated to postoperative parenteral nutrition at 28 days, although neither were significant (p=0.392 and p=0.744, respectively). 6 neonates (13%) developed short gut postoperatively.

Conclusions

Although pneumoperitoneum is the most reliable indication for surgery, timing to operation took longer for those neonates than those without pneumoperitoneum. Longer timing to surgery was associated with lower mortality and slightly higher odds of requiring parenteral nutrition postoperatively, although not statistically significant. Though preliminary evidence suggests worse clinical outcomes for neonates with sooner surgery, more trials with larger sample sizes are needed to see if this is statistically significant.
EP169 - Volume Replacement Perforator Flaps: Introducing a New Service to a DGH Oncoplastic Surgical Unit
Authors: Allan Jennifer , McIlmunn Colin , Diggin Padraig , Skelly Brendan
Published: September 2024

Aims

Oncoplastic breast conserving surgery (BCS) has developed to facilitate adequate oncological resection whilst maintaining cosmesis. Volume replacement surgery allows immediate reconstruction with transposition of autologous tissue. One approach is the use of chest wall perforator flaps (CWPF). This increases access for patients to enhanced oncoplastic techniques facilitating BCS, in the setting of larger tumour size, reducing the mastectomy rate in our unit.

Our aim was to analyse a series of patients undergoing CWPF in our DGH and determine whether oncological outcomes were comparable to traditional breast conserving surgery.

Methods

Patients undergoing CWPF reconstruction were identified using theatre records for a period of 12 months (Jan-Dec2023). Data was collected including patient demographics, histopathological findings and post-operative course and treatments.

Results

A total of seven patients were identified with median age 48 . Range of tumour sizes: 17mm-51mm. All were performed in the immediate setting with all undergoing SLNB. 3/7 required further surgery in the form of re-excision of margins. One patient developed a seroma, requiring aspiration once without further complication. Patient satisfaction is anecdotally high; however, this has not been quantified.

Conclusions

The utilisation of CWPF within our DGH has shown satisfactory outcomes. Performing these in the immediate setting means some patients have required re-excision of margins and replacement of flaps (similar to local figures for WLE without volume replacement) without impacting patient satisfaction. We advocate that CWPF significantly increases the options available as routine practice for suitable patients. OBCS is possible within the DGH without compromising oncological treatments or cosmesis.