bluuebunny/crossref_metadata_2025_split huggingface dataset:
TP6.2.20 UK- single centre experience with the ElipseTM intragastric balloon; Early safety and effectiveness
Authors: Oyewole Bankole , Stefanova Irena , Sandhya Anu , Mangat Shannon , Monkhouse Simon 
Published: October 2021

Abstract

Introduction
The ElipseTM gastric balloon (EIGB) is an established outpatient, non-invasive, non-surgical device for weight-loss not requiring endoscopy nor sedation. This study reports the early safety and effectiveness from the largest and only reported UK cohort treated with the EIGB.

Methods
A retrospective study of 224 consecutive patients undergoing EIGB insertion between May 2018 and December 2020 was performed. EIGB placement involved swallowing of the ElipseTM capsule followed by a pre-inflation abdominal radiograph to confirm position. Inflation was performed with 550mls of sterile water followed by a post-inflation radiograph.
Patients had weekly follow-up to assess symptoms, weight-loss, time and route of balloon expulsion.

Results
224 patients underwent EIGB insertion during the study period; 39 patients were lost to follow-up. 185 patients (28 male and 157 female) were included in the final analysis with a mean age of 38.1 years. Mean study follow-up was 10 weeks, mean weight at insertion was 97.7 kg. Mean %Total Body Weight (TBW) loss was 6.5% at 4 weeks and 9% at last follow-up. 32 patients had 15.3 %TBW loss at 16 weeks follow-up. Frequently experienced symptoms during the first week were acid reflux, abdominal pain and bloating, nausea and vomiting. One patient had early expulsion at 8 weeks. Seven patients required early deflation due to severe symptoms (5), pancreatitis (1) and hyperinflation (1).

Conclusion
EIGB is a safe and effective method of weight loss. Longer follow-up studies in the UK population are required to assess overall patient outcomes and associated factors for weight loss.
TP7.2.4 Skin-to-gel is a safe and effective method to prevent patients sliding during minimally invasive colorectal surgery
Authors: Florance Charlotte , El-Dhuwaib Yesar , Miller Matthew 
Published: October 2021

Abstract

Aims
Minimally invasive colorectal surgery often requires manipulating the patient position to facilitate exposure of the surgical field, such as a steep Trendelenburg position. However, this exposes patients to risks of sliding on the operating table. Preventive interventions are available, such as bean bags; we explore our experiences of gel pads within a district general hospital.

Methods
A retrospective analysis was performed of all colorectal patients undergoing laparoscopic resections over the last ten years, identifying complications associated with the use of intra-operative gel pads (skin-to-gel) with no shoulder support.

Results
Over 500 patients have undergone laparoscopic colorectal resections during this time, all utilising pressure-relieving gel pads. Patients are placed skin-to-gel, lying on a single torso-length gel pad laid directly on the operating table mattress. Dependent upon the operative approach, the legs can be placed in stirrups or maintained supine on table extensions. There have been no DATIX recorded skin-tears, pressure or position-related injuries. The pads have also proven to prevent patient movement on the operating table, negating the use of shoulder supports when adopting the Trendelenburg position. On discussions with theatre staff, the Consultant body and interrogation of the DATIX database, there has only been one reported incidence of slipping when a patient was left on the slide sheet on top of the gel pad. They are relatively inexpensive, durable and easily maintained, proving a highly cost-effective piece of equipment.

Conclusion
Gel pads have proven to be highly effective in preventing both pressure-related injuries and patient movement during laparoscopic surgery.
TP7.2.10 The Un-abating Debate of using Drains following Colorectal Anastomosis: a systematic review
Authors: Hussain Mubashar 
Published: October 2021

Abstract

Aims
To study whether routine use of drains in colorectal surgery/anastomosis help reduce postoperative complications and whether has a selective role in high risk patients.

Methods
A systematic search of electronic database performed using PubMed, Embase, and Cochrane Central database. Clinical literature from 1988 to 2018 was reviewed including randomized, non-randomized controlled studies, meta-analysis and systematic reviews for routine use of drain versus no usage of drain at index surgery & compared for clinical benefits. Terms used for search were ‘colorectal’, ‘rectal’, ‘colonic’ surgery/anastomosis’ and drain. Main outcome: anastomotic leak whilst secondary outcome were to study collections, re-surgical intervention, wound infection, DVT/PE, chest complications & mortality. Case reports and small cohort studies (&lt;25 patients) were excluded.

Results
2243 patients were included from 14 RCTs, 2 meta-analysis and 3 systematic reviews. 1178 patients in the drain group and 1065 patients in the no drain group. Using Chi square test, data analysis demonstrated no statistically significant differences between the two groups (drains Versus no drains) for anastomotic leakage, P &gt;0.35; re-operation, P &gt;0.41, wound infection, P &gt;0.41; DVT/PE, P &gt; 1.1; chest complications, P &gt; 0.51 and mortality, P &gt;0.48.

Conclusions
Routine use of drains in colorectal surgery/anastomosis does not confer significant benefit in reducing postoperative complications.
However, selective use of drains in the high risk patients for anastomotic leak may have a role but warrants more studies.
TP7.2.12 Robotic versus laparoscopic inguinal hernia repair: a systematic review
Authors: Imsirovic Anja , Bagga Rahul , Khan Mansoor , Singh Krishna , Sains Parv , Sajid Muhammad S 
Published: October 2021

Abstract

Aims
Robotic inguinal hernia repair (RIHR) is considered to improve surgical outcomes in patients undergoing inguinal hernia surgery. The objective is to present a systematic review of RIHR compared to laparoscopic repair (LIHR).

Methods
A systematic review of comparative studies until January 2021 published on Embase, Medline, PubMed, PubMed Central and Cochrane databases reporting the surgical outcomes in patients undergoing RIHR versus LIHR was performed.

Results
A total of 12565 patients in 10 comparative studies were included. In the random effects model analysis using the statistical software Review Manager, statistically the RIHR prolonged the duration of operation (Standardized mean difference (SMD), 3.33; z = 5.84; P = 0.00001) but the length of stay (SMD, -0.8; z = 0.66; P = 0.51) and post-operative pain score (SMD, -0.47; z = 1.19; P = 0.24) were similar in both groups. In addition, the recurrence rate was similar in both groups (p = 0.92). The incidence of post-operative complications (OR 1.67; 95% CI, 1.14, 2.45; z = 2.64; P = 0.008) and chronic groin pain (OR 2.14; 95% CI, 0.97, 4.72; z = 1.88; P = 0.06) was higher in RIHR group.

Conclusion
RIHR is feasible and safe, but the duration of operation is significantly longer with equivocal other variables such as stay and pain score. There was higher incidence of post-operative morbidity and chronic groin pain as well. Major multi-center randomized controlled trial is mandatory to assess the long terms outcomes and cost effectiveness before the routine use of RIHR.
TP7.2.17 Are there any predictable trends in the pattern of two week referrals for suspected gastrointestinal cancers?
Authors: Hussain Adiba , Dharni Akash , Sayed Rehma , Saleh Ahmed , Eltilib Ibrahim , Saha Arin 
Published: October 2021

Abstract

Aims
Patients with suspected cancer are referred to secondary care on the “two week wait” pathway. Investigation and management of these patients is resource intensive and puts a significant strain on services. We aim to determine if there are predictable trends in quantity of referrals or cancer detection rates (conversion rates) for suspected upper and lower gastrointestinal cancers. Identifying such trends could guide future resource allocation and provision of services.

Methods
Two week wait referrals to upper and lower gastrointestinal clinics between 2015 and 2019 were included. The number of referrals and conversion rates were analysed on monthly, quarterly and annual basis.

Results
Upper GI total referrals: 1094 in 2015 vs 1357 in 2019. Lower GI total referrals: 1827 in 2015 vs. 3278 in 2019. Upper GI conversion rates: 8.8% in 2015 vs. 8.36% in 2019. Lower GI conversion rates: 6.47% in 2015 vs. 4.07% in 2019. There were no identifiable significant trends in referral numbers or conversion rates when analysed on a monthly and quarterly basis.

Conclusions
The number of two week wait referrals for suspected cancers has shown a sustained year on year increase. Conversion rates for the time period have remained somewhat static and in some cases decreased. Our data shows no evidence of any spikes or troughs in demand related to the time of year. Should demand continue to rise at the current rate then alternate modes of assessment such as telephone assessment clinic or a straight to test approach may become more widespread.
TP8.1.10 Factors predicting residual disease on re-excision after breast conserving surgery
Authors: Simpson Duncan , Allan Jennifer , McFall Brendan 
Published: October 2021

Abstract

Introduction
Breast conserving surgery is the standard of care for early breast cancer, however in a quarter of patients, satisfactory margins are not achieved, usually leading to re-excision. Residual disease is found in less than half of these re-excisions, leading to increased morbidity,poorer cosmesis and increased cost with no oncological benefit. Our study aimed to identify a group of patients with unsatisfactory margins but a low risk of residual disease, who may be able to avoid re-excision.

Methods
All patients from our unit undergoing re-excision for unsatisfactory margins after breast conserving surgery between January 2013 and October 2019 were identified. Pathological factors predicting residual disease were investigated using univariable and multivariable analysis.

Results
220 patients were included. 90 (41%) had residual disease in the re-excision specimen. Residual disease was more likely in those having mastectomy than cavity shaves (61% vs 32%, p &lt; 0.0001). Residual disease increased in a linear fashion with number of involved margins and with increasing tumour size. Tumour size &lt;20mm (p = 0.045), a pathological to radiological tumour size ratio less than 1.5 (p &lt; 0.0001) and disease-free cavity shaves taken at initial surgery (p = 0.041) were all significant predictors of a low chance of residual disease on multivariable analysis. Patients with all three factors had a 14% chance of residual disease.

Conclusions
More than half of patients undergo unnecessary re-excision, and patients with small, radiologically obvious tumours are less likely to have residual disease. The decision on re-excision should include these factors in addition to the margin status.
TP8.2.2 Surgical Escape Rooms: A Novel Approach to identifying and addressing Resilience and Academic Buoyancy
Authors: Ahmad Manal , Law Sarah , Hester Ben , Hunter Ian , Bamford Richard 
Published: October 2021

Abstract

Introduction
Traditional Simulation is useful practice for real life scenarios whilst Surgical Escape Rooms (ER) assess other elements. Resilience contributes to physical and emotional wellbeing as well as the development of coping strategies. Consistent short-term Academic Buoyancy levels can have an impact on long-term levels of Resilience.

Method
Two groups of 4th year medical students were given the validated Brief Resilience Scale (BRS) and the Academic Buoyancy Scale (ABS) before and after. The first group completed the Surgical ER whilst the second group completed a Surgical Simulation. During the ER session, participants were assessed by multiple, independent assessors on 4 parameters - participation, objective display of frustration/stress, interaction with the team and definitive decisions taken. These were then correlated with their initial self-assessments scores.

Result
The ER group ABS Scores improved (3.45 to 3.8; Range 0-4) whilst BRS scores decreased (4.5 to 3.9; Range 0-5). The Simulation group ABS scores decreased (3.4 to 2.9) whilst BRS scores improved (2.9 to 3.2). Scores became more polarised across all groups. Participants who scored low on the BRS/ABS displayed lower levels of participation, team interaction and fewer definitive actions taken but also displayed fewer indicators of overt stress in comparison to their higher scoring counterparts.

Conclusion
Escape Rooms are useful in challenging individuals to improve problem solving skills and encourage lateral thinking. It would be useful to incorporate ER’s in the early stages of training to build confidence and reduce the immediate negative impact of Simulation at later stages.
TP8.2.11 Impact of surgical training on long-term patient outcomes in sleeve gastrectomy
Authors: Ghosh Aishwarya , Lo Christina , Reddy Marcus , Khan Omar 
Published: October 2021

Abstract

Aims
Although few studies have examined the impact of surgical training on early postoperative outcomes in bariatric surgery, there is limited data on longer-term outcomes in trainee-performed cases. Our aim was to evaluate the effect of surgical training on weight loss outcomes following laparoscopic sleeve gastrectomy (LSG).

Methods
Data was prospectively collated on patients undergoing primary LSG at a Quaternary Bariatric London teaching Hospital between 2016-2017. Inclusion criteria was BMI≥35. Exclusion criteria were BMI&lt;35 or &gt; 60, planned HDU admission and LSG with concomitant hiatus hernia repair. Operative time, length of stay, complications and longer-term excess weight loss was recorded with outcomes of consultant and trainee cases compared.

Results
76 LSG patients were included; 44 performed by consultants, 32 by trainees. There was no difference in age, gender, pre-operative weight, BMI and number of obesity-related comorbidities between groups.
Operative time (trainee105±10.0 vs consultant91±18.1 mins) and length of stay (trainee2.6±0.4 vs consultant2.8±0.9 days) were similar between groups. There were 3 complications in the trainee group (intra-abdominal collection requiring drainage, wound infection, hypokalaemia); and 2 with consultants (wound infection, intra-operative bleeding with ICU admission).
Excess Weight Loss (%) at 2years was 55.9%±7.5% for trainee cases and 52.4%±6.7% for consultants(p = 0.49).
Excess Weight Loss (%) at 3.5years was 54.9%±9.9% for trainee cases and 50.7%±9.9% for consultants(p = 0.54).

Conclusion
Outcomes in trainee-performed LSG are comparable to those performed by consultants. Surgical training in a high-volume teaching hospital does not appear to have detrimental effect on patient outcomes following LSG.
TP8.2.13 Impact of peer-delivered tuition/feedback on appointment to UK Higher Surgical Training
Authors: Joy Melvin , Choong Wen Ling , Madurska Marta , Tang Benjie , Ip Brian 
Published: October 2021

Abstract

Aims
In the UK, Core Surgical Trainees (or equivalent) undergo a rigorous National Selection (NS) process to secure a ST3 Training Post in General/Vascular Surgery. Despite decrease in competition ratio from 3:1 in 2012 to 1.48:1 in 2017, many applicants were unable to secure ST3 Training Posts. We hypothesise this is due to applicant performance anxiety rather than lack of clinical experience. We designed a 2-day structured course to address the applicant’s confidence levels in preparing for NS.

Methods
This is a prospective observational study following 27 delegates who completed a 2-day course delivered by surgical consultants and trainees; consisting of didactic lectures and interactive practice with a 1:1 faculty:delegate ratio. A specific mentor was nominated to oversee the delegate’s progress throughout and post course. Personalised feedback was given by the entire faculty throughout the course. Delegates were asked to complete evaluation forms to track their perceived confidence levels of success at NS at different timeframes, measured by a visual analogue scale. Paired t -test was performed to compare the mean confidence level pre- and post- course.

Results
Evaluation forms were received from all (n = 27) delegates. Self-reported confidence increased significantly for all domains except Professional Communication. 23 (85%) participants were successful at interviews post course. There was no statistically significant difference between UK and non-UK graduates, first time and not-first-time applicants.

Conclusions
Peer-delivered teaching, practice and feedback as a structured interview practice course significantly improves applicants’ confidence levels which translates to higher success rate at National Selection.
TP9.1.4Use of a modified Delphi process to develop research priorities in Major Trauma
Authors: McElroy Luke , McGillivray J , Wilson Michael 
Published: October 2021

Abstract

Aims
Delphi methodology can be used to develop consensus opinion amongst a group of stakeholders. This can be used to prioritise clinically relevant, patient centred research questions to guide future funding allocations. The aim of our study was to identify key future research priorities pertaining to the management of major trauma in the UK.

Methods
A three-phased modified Delphi process was undertaken. Phase 1 involved the submission of research questions by members of the trauma community using an online survey (Phase 1). Phases 2 and 3 involved two consecutive rounds of prioritisation after questions were subdivided into 6 subcategories: Brain Injury, Rehabilitation, Trauma in Older People, Prehospital, Interventional, and Miscellaneous (Phases 2 and 3). Cut-off points were agreed by consensus among the steering subcommittees. This established a final prioritised list of research questions.

Results
201 questions across all were submitted by 65 stakeholders in phase 1. After analysis and with consensus achieved, 186 questions were taken forward for prioritisation in phase 2 with 114 included in phase 3. 56 prioritised major trauma research questions across the 6 categories were identified with a clear focus on long-term patient outcomes.

Conclusions
Consensus from within the major trauma community has identified 56 key research questions across 6 categories. Dissemination of these questions to funding bodies to allow for the development of high-quality research is now required. There is a clear indication for targeted multi-centric multi-disciplinary research in major trauma.
TP9.1.5Optimizing Patient Outcomes and Improving Organization Efficiency through Enhanced Management of Low Back Ache and Sciatica
Authors: Peri Harish , Harvitkar Rafique Umer , Ansari Khursheed 
Published: October 2021

Abstract

Aim
This study was undertaken to tackle the rising incidence of Low Back Ache and Sciatica in a primary care government setup, which had contributed to a disabled and diminished workforce. The aim being improving patient outcomes by implementing changes in the current management protocol (measured against the standard NICE guidelines by an initial clinical audit)

Method
Two Plan-Do-Study-Act (PDSA) cycles were implemented post an initial clinical audit among 59 patients of the institution. Data was collected using self-made questionnaires and then analyzed. Re-audits were done to measure the outcome against a set standard.

Results
20-30% (n = 12-18) of patients were aware of their risk category, understood various treatment modalities and use of orthotics in the initial clinical audit. 56% (n = 33), 73% (n = 43), 88% (n = 51) of the patients were absent from work or had diminished work output, were offered imaging and were put on medication respectively. 10% of the patients were offered psychological counselling. Post implementation of changes from the first PDSA cycle, the set target of 90% was achieved in most of the categories. Further, 24% (n = 14) of patients reported that they were still apprehensive about their condition. A second PDSA cycle was undertaken and post implementation of changes, the set standard of 10% or less patients being apprehensive was noted.

Conclusions
Increased awareness among patients through means of regular educational sessions, psychological counselling, updated management protocols have led to healthier patients, less absence from duty and improved work output thereby increasing the organizational efficiency as a whole.
TP9.2.18Are delays to diagnosis and treatment associated with reduced survival in oesophageal cancer?
Authors: Magnoli Matteo , Murgitroyd Ellen , Lamb Peter J , Skipworth Richard JE 
Published: October 2021

Abstract

Aims
Oesophageal cancer has low survival rates due to diagnosis commonly occurring in advanced stages. We performed a systematic review of delays to diagnosis and treatment in oesophageal cancer, and the impact of delay on clinical outcome.

Methods
A systematic review of Pubmed, Embase and Cochrane Library was carried out using the following search terms: (esophageal cancer) AND ((time) OR (diagnosis)) AND ((delay) OR (wait)). 821 results in English were retrieved and independently reviewed by two researchers. Studies were included if they were randomised controlled trials (RCT), meta-analyses or observational studies, and assessed delay in relation to at least one clinical outcome or TNM stage at diagnosis.

Results
15277 patients across 12 studies were included. 10/12 studies were retrospective, and there were no RCT. Heterogeneity existed amongst the studies in defining delay and outcomes (morbidity = 1/12, mortality = 2/12, disease-free = 2/12 or overall survival = 5/12, TNM stage = 6/12).
No studies demonstrated that reduced delay improved clinical outcome. Longer patient delay correlated with presence of malnutrition in one study but did not result in reduced survival.

Conclusions
Systematic review of published literature did not demonstrate a relationship between diagnosis/treatment delay and patient outcome in oesophageal cancer. Multi-centre prospective studies/RCTs are required to identify the impact of delay and the optimal timing of treatment.