bluuebunny/crossref_metadata_2025_split huggingface dataset:
508 Conservative Management of Small Bowel Obstruction: A Local Experience
Authors: Gonzalez M , Aker M , Manjunath P , Mishra A , Ward N 
Published: May 2021

Abstract

Introduction
Post-operative intra-abdominal adhesions remain the leading cause of small bowel obstruction (SBO) representing one of the main diagnoses warranting emergency laparotomies. The National Audit in Small Bowel Obstruction advocates the use of water-soluble contrast agents (WSCA) as initial management of SBO. We aim to assess the role and outcomes of WSCA and its rate in successfully managing SBO non-operatively.

Method
We conducted a 2-year retrospective analysis including all patients admitted with adhesive SBO. Outcomes of patients who received WSCA were compared to those who hadn’t.

Results
118 patients were included, 27(23%) of which required immediate surgery while 91(77%) were initially managed conservatively. From the latter group, 53(58.2%) received WSCA whilst 38(41.8%) didn’t. Of the group that received WSCA, 36(39.5%) were successfully managed non-operatively, compared to 26(28.5%) that didn’t, this however lacked statistical significance. LOS didn’t differ between these two groups (5 days vs. 5.5 days, p = 0.805). 32% of the patients required eventual surgical intervention needing longer LOS regardless of receiving WSCA (6.6 days vs. 13.6 days p &lt; 0.001).

Conclusions
Adhesive SBO can be managed conservatively in up to two-thirds of patients. WSCA usage has a positive impact but needs further assessment in larger studies.
550 “No One Told Me About This Side of The Job!” A Novel Method for Teaching Senior Surgical Trainees
Authors: Metcalfe K , Pollard J , Thomas I 
Published: May 2021

Abstract

Introduction
Higher surgical training is specifically geared towards preparation for working as a Consultant, but trainees typically get limited exposure to Consultant level administration tasks. Whilst Consultants are familiar with these tasks, registrars are often naïve to this side of clinical practice and new Consultants find it takes up a significant proportion of their time. We developed an “office admin” simulation session as a method for gaining further non-technical skills in surgery.

Method
A simulation based on a real Consultant General Surgeon’s workload was created, which included actioning pathology reports, vetting referrals, and planning a theatre list. Trainees were given 40 minutes to work through the tasks before debriefing with an experienced simulation facilitator.

Results
Six general surgical trainees took part in the pilot. All found it ‘useful’ or ‘very useful’ and stated that it will help prepare them for the role of Consultant. All felt it would make a useful regular addition to the regional teaching programme.

Conclusions
This novel simulation was well received and demonstrated a useful method to practise these skills in preparing for the role of Consultant. We aim to develop the simulation package further so it can augment the regional speciality training.
28 Diagnosed vs Undiagnosed Chronic Obstructive Pulmonary Disease: Short and Long-term Impact on Coronary Artery Bypass Surgery
Authors: Gatta F , Haqzad Y , Loubani M 
Published: May 2021

Abstract

Introduction
This study sought to compare clinical outcomes among non-COPD, diagnosed COPD, and undiagnosed COPD patients, in CABG surgery.

Method
A single-centred retrospective study, from January 2010 to December 2019. Primary outcomes were post-operative complications, lenght of ITU admission and in-hospital staying. Secondary outcomes were re-intervention rate, in-hospital and long-term mortality.

Results
4020 patients were divided into: non-COPD – Group A (74.55% n = 2997), diagnosed COPD – Group B (14.78% n = 594), and undiagnosed COPD – Group C (10.67% n = 429). The rate of respiratory complications was noted in this order: Group B &gt; Group C &gt; Group A (p 0.00000002). Perioperative Acute Kidney Injury, wound complications, and in-hospital staying were higher in Group B (p 0.0004, p 0.03, and p 0.0009, respectively). Long-term mortality resulted greater in Group B and C (p 0.0004). No difference in long-term mortality was noted in relation to the expected FEV1% in Group B (p 0.29) and Group C (p 0.82).

Conclusions
In CABG surgery, patients with diagnosed COPD carry a prolonged in-hospital staying and greater peri-operative complications. Both diagnosed and undiagnosed COPD predispose to respiratory complications and higher long-term mortality rate. Consequently, undiagnosed COPD should be included in the EuroSCORE. Finally, the expected FEV1% appears not to correlate with long-term survival.
689 Silac (Sinus Laser-Assisted Closure) For Pilonidal Sinus: Our NHS Experience
Authors: Kalaskar S , Adamek J 
Published: May 2021

Abstract

Introduction
The accepted treatment of pilonidal disease still consists of surgical excision with primary wound closure. This treatment has complications such as excessive pain, delayed wound healing, and recurrence. We introduced this technique using a radial laser probe (SiLaCTM, Biolitec, Germany). Previous studies have shown encouraging results with respect to safety, patient satisfaction, and minimal recurrence rates.

Method
The pilot project was planned with the objectives to assess postoperative complications and reoperation rates. All operations were performed as day case procedures under general anaesthesia. We studied the data of our first 25patients operated with this technique between January 2019 and December 2019 using a prospective database and outpatient clinic follow up.

Results
The median follow up duration was 13 months. The initial success rate was 64%(16/25), reoperation was required in 32%(8/25) and one patient was lost to follow up. one patient returned with abscess formation in the postoperative period.

Conclusions
SiLaC is a safe and minimally invasive technique for the destruction of the pilonidal cyst and sinus. The success rate is modest, making this new therapy a minimally invasive option for the majority of the patients with pilonidal disease but it should be offered with caution.
711 Atypical Presentation of a Ruptured Thyroid Cyst
Authors: Sahib Y , Aziz M , Benamer M 
Published: May 2021

Abstract

Introduction
Thyroid cysts are a common finding with the bulk of cases being benign and approximately only 5% being malignant. The majority of these cysts are managed conservatively in the absence of malignancy or compressive symptoms.

Case

presentation

A middle-aged female patient presented with sudden onset anterior neck bruising but minimal specific symptomatology. On examination, the patient had bruising around the anterior neck and chest wall. CT and MRI scanning of the neck revealed the bruising was attributed to a ruptured thyroid cyst. On follow up, an ultrasound guided fine-needle aspirate revealed the histology to be inflammatory follicular thyroid tissue.

D

iscussion

The case demonstrated a rare presentation, given the lack of trauma in her history nor the presence of more sinister conditions as demonstrated by the fine-needle aspirate. Normally hemorrhage of thyroid cysts are due to trauma or abnormal thyroid vasculature. There are a few previous case reports of similar presentations where ruptured thyroid cysts led to life-threatening airway compromise requiring intubation. Early recognition of these thyroid cyst complications is crucial.

Conclusion

Neck and anterior chest wall hematoma can be a sign of thyroid cyst rupture/hemorrhage. It is important to recognize this sign to prevent life-threatening airway compromise.
743 Inflammatory Pseudotumor (IPT) Of the Liver, A Diagnostic Dilemma with Therapeutic Uncertainty in A cohort of Bangladeshi patients (Observational Cohort Study)
Authors: Rabbi H , Chowdhury A Q , Sarder M M , Islam R 
Published: May 2021

Abstract

Background
IPT a benign lesion seldom encountered in clinical practice. It’s mysterious in origin & remains ambiguous.Infection, stone,autoimmune disease,systemic inflammatory response,trauma,foreign body and neoplasm attributes to etiological factors.Advanced imaging modalities help in increased detection of focal liver lesion.

Aim

To analyze its clinical significance. 33 patients with focal liver lesions were evaluated and treated surgically as hepatic neoplasm consecutively from July 2013 to January 2020.

Method
Retrospective observational cohort study.

Results
14 male & 19 female were studied, mostly in 3rd decade of life. Clinically only 21% of them presented with fever.In 24 patients the lesions were located in left lobe of liver.The operative procedures were: wedge resection in 3 patients,limited resection in 5 patients,Left Hepatectomy 7 patients,Left lateral hepatic segmentectomy in 17 patients, right hepatectomy in 2 patients & central hepatectomy in 1 patient. 8patients required bilioenteric anastomosis as additional procedure.Histopathological study revealed Tuberculosis in 7 patients(21.21%),fungal granuloma in 3 patients, foreign body granuloma in 3 patients, Ductal calculi with abscess in 9 patients and idiopathic in 7 patients.

Conclusions
IPT of liver represents a rare entity usually mistaken as malignant lesion.Despite the low prevalence, it often creates a diagnostic dilemma resulting into therapeutic uncertainty.
768 The Role of MRI Texture Analysis in Predicting Outcomes in Locally Advanced Rectal Cancer After Chemoradiotherapy
Authors: Alrahawy M , Aker M , Zeinaldin A , Arulampalam T 
Published: May 2021

Abstract

Background
Locally advanced rectal cancer (LARC) is treated by neoadjuvant chemoradiotherapy(NCRT) followed by surgery after restaging by magnetic resonance imaging(MRI). Texture analysis(TA) is a novel imaging biomarker that can assess heterogeneity in MRIs. This study hypothesizes that TA has the ability to predict the complete response(CR), survival, local recurrence, and distant metastasis.

Method
This is a retrospective analysis of all patients diagnosed with LARC who received NCRT and who have had MRI scans. Six parameters were systematically extracted from Textural histograms of post-treatment scans. Correlation between TA and CR was tested. These parameters were then examined to determine their ability in predicting local recurrence, distant metastases, and survival by means of Kaplan-Meier survival curves and log-rank tests.

Results
Four out of the six parameters extracted significantly identified CR. Utilising the same cut-off values across all parameters, three parameters significantly predicted local recurrence: Entropy(p = 0.033), mean of positive pixels(MPP)(p = 0.045), and Skewness(p = 0.018). Four parameters significantly predicted distant metastases: SD(p = 0.015), entropy(p = 0.017), MPP(p = 0.005), and skewness (p &lt; 0.001). Four texture parameters significantly predicted survival: SD(p = 0.002), entropy(p = 0.001), MPP(p &lt; 0.001), and skewness(p = 0.017).

Conclusions
MRI textural features are potentially significant imaging biomarkers in predicting survival, local recurrence, or liver metastases in LARC.
837 The Identification of Gaze Behaviour and Physiological Markers Associated With Making An Error During Laparoscopic Cholecystectomy
Authors: Ashraf H , Sodergren M , Mylonas G , Darzi A 
Published: May 2021

Abstract

Introduction
Adverse surgical events remain at an unacceptably high level despite multiple global safety initiatives being introduced. As yet, however there is no conclusive evidence to identify whether physiological markers can be used to predict whether a surgeon will make an error

Method
Surgeons were asked to complete a simulated laparoscopic cholecystectomy task while physiological metrics and gaze behaviour was tracked. LightGBM and CatBoost were used to predict the physiological metric most useful in predicting whether a surgeon was about to make an error. The binary task used a boolean value of “does an error occur in the next 5 seconds” as the dependent variable, while the multiclass task classified the severity of error (0, 1, 2, 3).

Results
Autocorrelation with lag (eventually calculated with a lag of timestep 2) measured the tendency of this timeseries to correlate with itself. The degree of correlation, or lack of correlation, and sudden changes in correlation over time were gleaned from this feature.

Conclusions
Skin conductance was most likely to successfully predict impending error. However when gaze features were added, overall model performance improved by 6.4%. The potential for reduction in surgical error rate and improvement in patient safety are important factors to consider.
875 Use of Oriented Priors Through Magnetic Tractography (MAGNET) In Deliniation Of Meyer's Loop and Correlation with Visual Field Deficit In Temporal Lobe Epilepsy (TLE) Surgery: A Pilot Study
Authors: Bhatia S , Shastin D , Tax C , Parker G , Shwartz S , Hamandi K , Gray W , Jones D , Chamberland M 
Published: May 2021

Abstract

Introduction
Pre-operative white matter tract reconstruction of the Meyer’s loop (ML) of the optic radiation using diffusion MRI (tractography) can be used to prevent post-operative visual-field deficit. Due to its complex anatomy, precise reconstruction of the ML is challenging and often underestimated. Previous work has suggested that an innovative tractography technique using oriented priors called MAGNET better approximates reconstruction to reported histological prosections. This proof-of-context study validates the MAGNET methodology in predicting visual-field deficits in patients undergoing TLE surgery.

Method
Diffusion MRI datasets were used to reconstruct pre-operative ML using MAGNET in five patients. These were overlaid on post-operative T2-MRI series demonstrating the surgically resected area to measure overlap between resection and reconstructed ML. A correlation with post-operative visual-field defects was established.

Results
There was no evidence of visual field deficit in the cases where there was no overlap between the reconstructed ML and the resected region. In the cases with overlap with reconstructed ML and resection, there was visual deficit found. There was no correlation between proportion of resected ML and visual deficit.

Conclusions
This pilot demonstrates that MAGNET accurately reconstructs ML in pre-surgical TLE cases compared to standard tractography techniques and can be used to augment neurosurgical planning and resection.
923 Accuracy of Assessment in Hand Trauma; Pre COVID-19 Face to Face Assessment Compared to Virtual Assessment During COVID-19 Lockdown
Authors: Westley S , Creasy H , Mistry R 
Published: May 2021

Abstract

Introduction
The Queen Victoria Hospital (QVH) was designated a cancer and trauma hub during the COVID-19 pandemic. With this, a new virtual hand trauma clinic was set up.
We assess accuracy of assessment within this virtual set-up with comparison to pre COVID-19 face-to-face assessment.

Method
Two weeks of clinic sessions during and pre lockdown were analysed. Initial assessment was compared with the patient's operation note.

Results
In the pre COVID-19 two-week period 129 face-to-face appointments were analysed. Of 99 patients that required surgery 77 (78%) had an accurate assessment. 6 were overestimated, 12 were underestimated.
189 patients were seen over two weeks during lockdown via telephone or video call. Accuracy of assessment increased with seniority of the clinician. Of 126 patients that required an operation 109 (87%) had an accurate assessment; all structures injured were correctly predicted. 12 were overestimated, 5 had their injury underestimated.

Conclusions
The new virtual clinic allowed patients to be remotely assessed during lockdown, reducing footfall and unnecessary journeys.
We found that virtual clinic assessments are accurate, and no patient underwent an unnecessary procedure. Using a telephone call plus photo gave similar accuracy as a video call.
Virtual assessment was more accurate than face-to-face assessment.
38 Adapting an Emergency General Surgery Service in Response to the COVID-19 Pandemic
Authors: Hickland P , Clements J , Convie L , McKay D , McElvanna K 
Published: May 2021

Abstract

Introduction
In response to the COVID-19 pandemic, our emergency general surgery (EGS) service established an enhanced ambulatory service and undertook non-operative management of selected pathologies. This study compares the activity of our service before and after these changes.

Method
Patients referred by the emergency department were prospectively identified over a four-week period beginning from the date of reconfiguration (COVID) and compared to patients retrospectively identified from the same period the previous year (Pre-COVID) and followed up for 30 days. Data was extracted from handover documents and electronic care records.

Results
There were 281 and 283 patients during the Pre-COVID and COVID periods, respectively. Rates of admission decreased (78.1% to 41.7%) whilst there were increased rates of ambulation (7.1% to 17.3%) and discharge (6% to 22.6%). Duration of admission decreased (6.9 to 4.8 days), and there were fewer operative and endoscopic interventions (78 to 40). There were increased ambulatory investigations (11 to 39), telephone reviews (0 to 39), and use of early CT to facilitate discharge (5% to 34.7%). There were no differences in 30-day readmission or mortality in any group.

Conclusions
Restructuring of our EGS service in response to COVID-19 facilitated an increased use of ambulatory services and imaging, whilst maintaining patient safety.
107 COVID 19 - Developing A Second Brain for Axillary Conservation During the Pandemic By Extrapolating Evidence On Technical Trends Of Sentinel Node Staging Of Axilla Into A Streamlined Recommendation
Authors: Arif T , Absar M S 
Published: May 2021

Abstract

Introduction
Axillary conservation is the way forward after game changing trials like ACOSOG Z0011, surrogate trials like IBCSG,AMAROS, ALMANAC, on-going POSNOC, and newbie ATNEC have decreased the need to fiddle with the axilla. Current standard is the utilisation of double technique with radioisotope and blue dye to decrease false negative rates for true sentinel node retrieval.

Method
Literature search on the topic in the last two decades.

Results
The search yielded 197 publications which were subjected to a meticulous review.

Conclusions
Single agent radioisotope is recommended in palpable and good biology breast tumours. Use of single agent blue dye can be standardised in axillary tail tumours. It is also recommended when isotope mapping is logistically not feasible or during pandemics like COVID 19 where looming infrastructure challenges are prevalent. Dual agent technique should be considered in previously treated breast and axilla, neoadjuvant chemotherapy cohort, bad tumour biology, high BMI and macromastia groups for true nodal retrieval. Optimal number of nodes taken out should not be more than three (n = 3). Lower axillary sampling of not more than 3 nodes is recommended for troubleshooting. Magnetic tracing can be used as an adjunct to either single agent (RI/BD) technique when there is failure to localise the sentinel node.
141 The COVID-19 Pandemic: A Disproportionate Impact on Pregnant Surgical Trainees?
Authors: Pendegast H 
Published: May 2021

Abstract

Introduction
Despite increases in the female surgical trainee workforce over the last decade male trainees still dominate the surgical specialties. It is well recognised that there is strong gender disparity in surgery. The wider challenges further experienced by pregnant surgical trainees are also well documented.

Method
NHS digital data on the surgical workforce and the Royal College of Obstetricians and Gynaecologists COVID-19 guidance for pregnant healthcare workers was reviewed.

Results
Women account for 27% of the surgical workforce and the average time taken to complete training is longer for female trainees. Current guidelines for pregnant healthcare workers advise strict social distancing measures up to 28 weeks gestation with avoidance of high-risk areas including operating theatres. A non-patient facing role is advised from 28 weeks onward.

Conclusions
The COVID-19 pandemic has created additional barriers for women in surgery. Restrictions for pregnant trainees, whilst vital for their wellbeing, has denied access to some essential training opportunities necessary for progression. It will likely further isolate them from the workforce and hinder their advancement into senior roles where they are already underrepresented. Although it is recognised that surgical training in general has been impacted by COVID-19 there is an argument that this disproportionately affects pregnant trainees.
147 A Meta-Analysis Comparing the Diagnostic Accuracy of Initial RT-PCR And CT Scan in Suspected COVID-19 Patients
Authors: Siddiqui S , Mair M , Hussain M , Das S 
Published: May 2021

Abstract

Introduction
Reverse transcriptase Polymerase chain reaction(RT-PCR) is considered as the gold standard diagnostic test for COVID-19 infection. It’s accuracy has been doubted and subsequently had effects on planning, performing operations causing. Research has suggested the use of Computed Tomography Scan instead. In this study we performed a meta-analysis comparing the diagnostic accuracy of CT compared to RTPCR.

Method
Our systematic review and meta-analysis were undertaken as per PRISMA guidelines. The methodological quality of each included study was assessed using the QUADAS-2 tool on RevMan 5.3. We performed data analyses using Stata version 12.

Results
Sensitivity estimates for CT scan ranged from 0.69 to 1.00 and for RT-PCR varied ranging from 0.47 to 1.00. The pooled estimate of sensitivity for CT was 0.95 (95% CI – 0.88-0.98) and specificity was 0.31 (95% CI – 0.035-0.84). It was found that specificity of initial RT-PCR(100%) was higher than CT(31%). With respect to sensitivity, CT(95%) was superior to RT-PCR(91%) p (0.000)

Conclusions
Sensitivity of CT is significantly higher than RT-PCR for detecting COVID-19 infection, however as CT findings are not specific. Since CT scans are readily available, protocols can be developed to utilise it to minimalize delay in planning surgery.
167 The Experience and Outcomes of Elective Urgent and Cancer Surgery in A District General Hospital in The United Kingdom During Covid-19 Pandemic
Authors: Tam A , Elhadi M , Ong C T , Bhat A , Akhtar M 
Published: May 2021

Abstract

Background
Many urgent and elective surgeries were postponed to cope with the Coronavirus disease (COVID-19) pandemic, with latest data found a substantial postoperative mortality risk (25·6%, 18.9%) after emergency and elective surgery, respectively.
Our institution was one of the first trust to offer essential elective surgery using a “COVID-free” designated site during the start of the pandemic.
The aim of this study is to analyse the clinical outcomes of patients who underwent essential elective procedures during the virus outbreak in the UK.

Method
Retrospective analysis of outcomes all patients who had undergone urgent elective and cancer surgery, from 30th March 2020 to 21st May 2020, using an implemented “Super Green Pathway”.
The primary endpoints were 30 days mortality and COVID related morbidities, and the secondary endpoints were surgical related complications and oncological outcomes.

Results
92 patients (Male:45%; Female:55%) across 5 surgical specialties were identified. There was no record of mortality in our cohort. Only 1 patient was tested positive for SARS-CoV-2, 18 days after the initial operation without any pulmonary complications.

Conclusions
It is possible to mitigate the high mortality risk of postoperative complications associated with COVID-19, with no delay to essential surgeries for cancer patients, thus delivering safe practice during the pandemic.