bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.TH.210Our Take on Prophylactic Cholecytectomy in Patients Undergoing Bariatric Laparoscopic Roux En Y Gastric Bypass (Lrygb)
Authors: Virupaksha Suvi 
Published: October 2021

Abstract

Aim
The concept of prophylactic cholecystectomy in bariatric patients undergoing laparoscopic roux en y gastric bypass despite extensive discussion remains controversial. We aim to resolve this controversy by our observational study.

Method
Data extracted from our prospective Bariatric and theater database between 2012 and 2018 of patients having undergone roux en Y bypass and laparoscopic cholecytectomy in a retrospective manner. The primary endpoint was determining the incidence of laparoscopic cholecystectomy in bariatric bypass patients. The second endpoint of data analysis was to compare the outcomes between post laparoscopic roux en y gastric bypass and laparoscopic cholecystectomy in non bariatric.

Results
Incidence of laparoscopic cholecystectomy in 511 LRYGB patients was 19.17%. These were performed before (9.70%), after (7.20%) and concomitantly (2.15%). Ultrasound was done in 71.60% of patients of which 28.10% had evidence of Gallstones. MRCP was done in 1.56% for suspected CBD stone before LRYGB and 4.10% after LRYGB. Only 2(0.39%) patients required a laparoscopic assisted ERCP. Over all complications from Laparoscopic cholecytectomy performed after or concomitantly with LRYGB was similar to the non bariatric cohort.

Conclusion
We reported a low incidence of post and concomitant laparoscopic cholecystectomy There was no statistical deference in post operative complications from laparoscopic cholesystectomy between LRYGB and non bariatric population. To conclude there is no evidence support prophylactic cholecystectomy. However, a randomized controlled trial should be considered to support our conclusion.
EP.TH.311The 100 most influential Economic Analyses in medicine: a bibliometric and altmetric perspective
Authors: Eley Catherine , Gravell Wil , Powell Arfon , Lewis Wyn 
Published: October 2021

Abstract

Aims
Bibliometric and Altmetric evaluation identify the most cited publications which have historically shaped the development of Economic Analysis (EA).

Methods
Thomson Reuters Web of Science was used to identify EA’s 100 most cited articles (search terms “economic analys*”, “cost-effectiveness analys*”, “cost-benefit analys*” or “cost-utility analys*”, alongside “medic*” or “surg*”) which were examined by topic, journal, author, year, institution, and Altmetric Score (AS).

Results
Articles numbering 9,895 were returned: median citation number 293 (interquartile range (IQR) 240-539). JAMA contributed most articles (n = 17) and citations (9,106). The country and year with most articles were the USA (n = 60), and 2003 (n = 9) respectively. The most ubiquitous topic was health economic methodology (n = 57). AS ranged from zero to 237.00 (median 8.00, IQR 3.00-20.75). Citation Rate Index increased in parallel with AS before and after 2006 (m = 0.29, m = 0.24), and before and after 2010 (m = 0.27) but with a higher initial gain (constant difference 13.1 and 15.1 respectively).

Conclusion
The most cited articles described effective tools for economic analyses with Altmetric Scores becoming increasingly influential in promoting citations. This review provides a reading list of the most influential references in this arena, and a guide to what constitutes citable medical economic research.
EP.TH.335Through the Lens of a Pandemic: The Impact of COVID-19 on Breast Cancer
Authors: Ribbits Alexander , Subramanian Ash , Shah Elizabeth 
Published: October 2021

Abstract

Aims
On March 11th 2020 the UN accorded COVID-19 pandemic status. On March 15th, the Association of Breast Surgery released guidelines in light of the pandemic. Eight days later the UK government announced the first lockdown. GP referrals fell in April/May. The aim of this study is to review how COVID-19 affected breast cancer management.

Methods
This is a retrospective analysis of patients diagnosed with breast cancer attending their initial appointment between March 16th to September 18th (pandemic phase) and 1st January to 15th March(pre-pandemic). Primary outcomes were pandemic-related modification of treatment plans, and diagnosis of COVID-19 or related complications. Secondary outcomes were delay in presentation or advanced disease. B-Map-C and the CovidSurg Collaborative were used as Gold Standards.

Results
39 patients were in the pandemic phase and 45 in the pre-pandemic. 3/39(7.69%) and 14/45(31%) had surgery delayed. There were no COVID diagnoses. In-situ cancers were held on a deferred list until local guidelines changed. 2 patients had interim endocrine therapy. 9/39 underwent chemotherapy, of which 4 were neoadjuvant. 2/39 patients presented late to their GP, of which one had widespread metastases. 9/39(23.08%) were lymph node positive. In the pre-pandemic group, 6/45(13.3%) were lymph node positive, 2/45(4.4%) had distant metastases.

Conclusions
This study shows that breast surgery can be safely carried out during this pandemic and treatment postponement should be avoided as the pandemic continues. It remains to be seen if delayed treatments during 2020 will impact on local relapse and overall survival rates.
EP.TH.444Long-term recurrence and complication rates in patients with self gripping mesh hernia repair
Authors: Elnaggar Mahmoud , Verdiyeva Gunay , Thamaran Nisha Rajesh , Fafemi Oladapo , Munteanu Alexandru 
Published: October 2021

Abstract

Aim
Assessment of long term complications of self gripping mesh used in different types of hernia repair procedures more than 4 years ago aiming to compare the results with sutured prolene mesh with regards to safety and efficacy.

Methods
70 patients (3 emergency & 67 elective) ventral hernia repair procedures, done in 2016 using self gripping mesh, were followed for recurrence and complications on the long term.

Results
There were 2 right (6.45%) and 1 left (3.44%) inguinal hernia recurrences. There were no cases of chronic groin pain or foreign body sensation. As compared to the meta-analysis of postoperative pain using non-sutured or sutured single-layer open mesh repair for inguinal hernia, where 19 studies including 4531 patients analysed recurrence, no significant difference was found in recurrence rates between the 2 mesh repair groups after 1 year of follow-up. With regards to the incidence of chronic pain at 12 months, there was no significant difference between Self gripping and suture fixation.

Conclusions
The self-gripping mesh in this study has better results as compared with a sutured mesh regarding the incidence of chronic postoperative inguinal pain and foreign body sensation.
Recurrence rates are comparable to most studies, however, long-term results still are based on relatively small patients numbers.
EP.TH.528The Accuracy of the Multi-slice detector CT Scan (MDCT) in staging borderline resectable periampullary carcinoma
Authors: Noureldin Khaled , Mahmoud Afsheen , Panamarenko Ben , Shalaby Ahmed 
Published: October 2021

Abstract

Objectives
Assess MDCT accuracy in staging cancers periampullary cancers.

Introduction
Periampullary malignancies are highly aggressive with poor outcomes. Surgery is the only curative option. It is crucial to define the patients who can advantage from a Whipple’s resection and who can avoid.

Methodology and Results
RCT investigated randomly 28 patients over 15 months. The patients were sub-divided into 2 groups. Group A, we relied mainly on the MDCT for preoperative staging, while in Group B staging laparoscopy was added before the abdominal exploration. Sensitivity of the MDCT and its accuracy were 100% in defining the signs of irresectability. For borderline staging, the accuracy of the scan was 62.5% and 71%, in groups A and B. The Overall accuracy of MDCT was 75%. It decreased to 68.1% for borderline lesions. The addition of staging laparoscopy to the diagnostic work up, increased the accuracy to 92.5%. The camera test was able to see occult findings which were missed in the images. liver Mets and malignant peritoneal fluid were localized in 18% and 9% respectively. 3 cases in group A and one in group B underwent unnecessary laparotomy. Thus, the false negative incidences were 21% and 7% in group A and B, with overall incidence 14.2%.

Conclusion
MDCT is highly sensitive and specific with high stage periampullary cancers. These parameters drop in border tumors with reduced accuracy in detecting the degree of vascular abutment and distant-occult findings. Addition of other adjuncts to decrease the rate of un-indicated laparotomy is advised.
EP.TH.664Breast lump recurrence - malignancy or iatrogenic disease process?
Authors: Fox Katherine , Khan Lucy 
Published: October 2021

Abstract

Backgound
Fibromatosis is a rare disease, accounting for 0.2% of breast tumours and 3% of soft tissue tumours. Due to its rarity there is a lack of multi centre trials and therefore evidence and guidance on the best treatment options. Likewise, many clinicians are unfamiliar with how to best manage these patients, even in specialist centres.

Methods
We present the case of a patient presenting with a suspicious breast lump, diagnosed as fibromatosis. Literature search enabled review of current trends and opinions in the management of such patients.

Results
We discuss the case of a 70 year old patient with a right breast lump, presenting 3 years following wide local excision and radiotherapy for DCIS. Imaging and examination were suspicious for malignancy. Biopsy demonstrated fibromatosis, for which the patient is currently being managed with active observation.

Discussion and Conclusion
Desmoid tumours of the breast are a rare but important differential in patients presenting with a breast lump. The aetiology remains poorly understood but they have been linked to genetic conditions, and trauma. As with this case, trauma may be iatrogenic in the form of surgery or radiotherapy. Due to the destructive nature of fibromatosis, the current trend in the management of these patients advocates wide local excision where possible. However, there is a high recurrence rate. There has been some success with medical therapies such as NSAIDs and tyrosine kinase inhibitors. These may be viable options in patients in whom surgery is not suitable.
EP.TH.670Antibiotic Prophylaxis Use In Paediatric Robotic-Assisted Laparoscopic Pyeloplasty: A Systematic Review
Authors: Schaffer Sierra , O'Neill Parker 
Published: October 2021

Abstract

Aim
A systematic review was conducted to evaluate the current evidence for prophylactic antibiotic use in paediatric robotic-assisted laparoscopic pyeloplasty (RALP). As pyeloplasties are ‘clean contaminated’ procedures, prophylactic antibiotics are recommended, however, recent evidence suggests that antibiotics may be unnecessary. Prophylactic antibiotics are often either under or over prescribed in paediatric surgery, which increases the risk of developing antibiotic resistance. In general, minimally invasive surgery is associated with less postoperative infections, however, it is not yet clear how RALP compares with other approaches. Recent reviews have indicated prophylactic antibiotics may not decrease postoperative infections, however, there are no clear guidelines.

Methods
A systematic review was conducted of the following electronic databases: Pubmed, Medline Ovid, The Cochrane Library, TRIP Database, NICE Evidence Search, and EMBASE. The search terms used were: paediatric, pyeloplasty, robotic, antibiotic and were used as keywords as well as in combination as MeSH terms.

Results
Forty-one articles were retrieved, and after screening for relevance and redundancy, 2 articles remained including a total of 315 pyeloplasties. Prophylactic antibiotics did not reduce the incidence of postoperative UTIs in RALP.

Conclusion
Prophylactic antibiotics for RALP is not associated with lower rates of UTIs and therefore, may be reserved for patients with risk factors. However, due to the limited data and confounding factors, further research is required to optimise antibiotic stewardship and infection prevention.
EP.TH.729Spontaneous Complete Regression of Sacroma: A Case Report And Review of Literature
Authors: Ravindran Sharanya , Westbroek David , Kryjak Zibigniew 
Published: October 2021

Abstract

Spontaneous complete regression (SR) of cancer is complete or partial disappearance of the cancer without any treatment which is very rare(1).

Case Report
58 year old female, with a palpable right breast lump from the chest wall at 7o clock position. It was 25mm in size, axillae demonstrated no LAD. Imaging was performed which showed a suspicious lesion with malignant features,core biopsy done. It showed pleomorphic spindled and epitheloid cells. Immunohistochemistry was negative for AE1/AE3,MNF116,CK19,CK7,P63,CK14,CK5/6 was diagnosed as sarcoma with a possibility of phyllodes tumour. Plan was made in MDT to discuss in regional sarcoma meeting and staging CT which was normal.
Sarcoma MDT recommended surgery, planned for wide local excision. On the day of surgery patient came for wire localisation, however no tumor noted on imaging and patient also confirmed the same. Patient had CT and MRI which revealed no abnormalities. This was discussed in local and central MDT, advised imaging after 3 and 6 months.

Discussion
Spontaneous regression of breast sarcoma in Pub med yielded no cases. This process has not been clearly explained yet. Several mechanisms have been suggested for spontaneous regression, including immune modulation, withdrawal of carcinogens, infection, apoptosis, antiangiogenic and maturation mechanisms gene therapy, vaccine-mediated mechanisms among many.

Conclusion
This is the first case of SA of primary breast sarcoma to our knowledge and our main aim to present this case is due to its rarity.
EP.TH.915An Audit of BAUS Guidelines and Complications of Suprapubic Catheter Insertion
Authors: Malik Salim , Dermanis Alexander , Kalejaiye Odunayo , Dowson Christopher 
Published: October 2021

Abstract

Introduction
The National Patient Safety Agency (NPSA) noted between September 2005 to June 2009, 259 incidents relating to suprapubic catheter (SPC) insertion were reported. 9 of these were bowel perforations. BAUS produced guidelines for SPC insertion which included recommending open or ultrasound guided insertion of SPCs in patients with previous lower abdominal surgery. The aim of this audit was to assess compliance with BAUS guidelines and complications following SPC insertion.

Methods
All patients who had a SPC inserted in theatre at this District General Hospital (DGH) between October 2012 to October 2019 were identified. Patient demographics, ASA grade, co-morbidities, previous abdominal surgery and complications were recorded.

Results
A total of 154 patients (59.1% male; 40.3% female) were identified. Mean age was 65 and mode ASA was 3. 21 (13.6%) of patients had previous lower abdominal surgery. Of these 2 (10%) had ultrasound guided insertion, 3 (14%) were open, 11 (52%) had cystoscopy guided insertion alone and for 5 (24%) the method was unknown. 4 (2.6%) of patients had a bowel injury following SPC insertion.

Discussion
At this DGH there was poor compliance with BAUS guidelines with a significant number of patients with lower abdominal surgery not having open or ultrasound guided insertion of SPC. 2.6% of patients had a bowel injury, however none of these had previous lower abdominal surgery. For these patients BAUS guidelines were adhered to, but bowel injury was not prevented. We therefore recommend the consideration of image guided insertion of SPCs in all patients where possible.
EP.TH.1046Probing the cost variation in Laparoscopic Cholecystectomy using PLICS
Authors: Hossain Tanvir , Ahmed Nauman , Menon Achyuth 
Published: October 2021

Abstract

Aims
This pilot study followed the introduction of PLICS (Patient-Level Information and Costing Systems) in our trust. Data for for Q2 2018 was probed to understand cost variation in procedures and to plan how to utilize this system.

Methods
Elective laparoscopic cholecystectomy data was extracted, providing costing for each procedure across a number of domains. We established a system to assess the domains with the most variation. We calculated the coefficient of variation (CV) for each domain. CV &gt; 1 was seen as high variation and these domains were probed further to identify causes.

Results
Domains identified to be of notable variation (CV &gt; 1) were length of stay, pathology test costs, drugs administered, medical staffing costs and pharmacy costs. Domains such as interest costs and device costs appeared to be arbitrary and directed our feedback on how to improve the system.

Conclusion
We identified variation of costs due to dispensation of drugs unrelated to laparoscopic cholecystectomy which can be easily addressed. Staffing cost variation provided data to drive theatre utilization strategies. Improvements in data capture such as device costs per procedure are imperative to evaluate and change practice for further cost efficiencies.

Key statement
PLICS is a powerful system to probe procedure costs, variation and drive efficiency. Our combined clinical and management team collaborated to understand the data. To use PLICS to the best advantage the data must be accurate, truly recorded at the patient level and be subject to regular scrutiny.
Moy.03Evaluation of the Basket in Catheter Technique for Transcystic Bile Duct Exploration and Suspected Ductal Stones
Authors: Nassar Ahmad , Qandeel Haitham , Khan Khurram , Nj Hwei , Hasanat Subreen , Ashour Haneen 
Published: October 2021

Abstract

Aims
The ‘Basket-in-catheter’ (BIC) technique facilitates laparoscopic transcystic ductal exploration (LTCE) and increases its success rate, being easier and safer than inserting the basket alone. This study evaluates the benefits in confirmed and suspected ductal stones.

Methods
Prospective preoperative, operative and postoperative data on consecutive single session ductal explorations was collected over 28 years and analysed. BIC became our default technique for the transcystic approach to confirmed or suspected bile duct stones.

Results
741 of 1225 (60.5%) attempted LTCE were performed using retrieval baskets without dilating the cystic duct (CD). BIC was used in 646 (87.2%). Of 386 (52.1%) patients undergoing successful stone retrieval 62.7% had clinical and radiological risk factors for ductal stones and 92.0% had positive intraoperative cholangiography. 355 (47.9%) patients had preoperative or operative risk factors for CBD stones and equivocal cholangiography in 25%. Basket trawling was negative and repeat cholangiography confirmed resolution of abnormalities. Choledochoscopy was utilised in 484/1225 (39.5%), either primarily or when blind trawling failed to extract stones. Retained stones occurred in 7 patients, six requiring ERCP. Bile leakage occurred in 6 patients. There were two open conversions, no biliary injuries and no mortality. Post-operative pancreatitis occurred in 7 and recurrent stones in 8 patients.

Conclusions
The BIC technique achieves successful LTCE without CD dilatation in 40%, reducing the need for choledochoscopy and choledochotomy. It facilitates safe and speedy CBD trawling when stones are suspected due to preoperative or operative risk factors or equivocal cholangiography and helps surgeons acquire and consolidate ductal exploration skills.
BJS.05Stage Migration in Newly Diagnosed Oesophago-gastric Cancer during the first wave of COVID-19 Pandemic
Authors: Khan Khurram , Chuntamongkol Rongkagorn , McCollum Catherine , Gall Lewis , Forshaw Matthew 
Published: October 2021

Abstract

Aims
Covid-19 has significantly disrupted elective and emergency health care provision including cancer care within the UK. The aim of the study was to investigate the impact of the pandemic on the staging of oesophago-gastric cancers at presentation, determine the time delay in performing gastroscopy and the multidisciplinary team (MDT) treatment outcomes.

Methods
A retrospective cohort study of all newly diagnosed oesophago-gastric cancers (adenocarcinoma and squamous cell carcinoma) in a single regional MDT was performed between 1st October 2019 and 30th September 2020. Electronic records were interrogated and patients dichotomised into two groups with those presenting before the introduction of the UK national lockdown of 23rd March 2020 compared to those presenting post-lockdown.

Results
349 new oesophago-gastric cancer patients were discussed in the MDT (192 pre-lockdown versus 157 post-lockdown). Demographics were evenly matched between the two groups. More patients presented as an emergency admission post-lockdown (28.0% vs 12.5%, p &lt; 0.001). Median waiting time for gastroscopy was longer post-lockdown (23 vs 14 days, p = 0.035). Metastatic disease at presentation was more frequent post-lockdown (47.8% vs 33.3%, p = 0.008). Overall, more patients had a palliative rather than curative treatment intent post-lockdown (71.3% vs 57.8%, p = 0.005).

Conclusions
The Covid-19 pandemic has had a significant negative effect on the stage of oesophago-gastric cancers at presentation. This has translated into more patients receiving palliative treatment and ultimately having a poorer prognosis. This study highlights the importance of maintaining cancer services during Covid-19 pandemic.
EP.TU.6The Impact of Disability on Performance in the Intercollegiate Membership of the Royal College of Surgeons examination (MRCS)
Authors: Ellis Ricky , Brennan Peter , Cleland Jennifer , Lee Amanda , Scrimgeour Duncan 
Published: October 2021

Abstract

Aims
The number of medical students and doctors with disabilities is increasing, however there is a paucity of data on the performance of doctors with registered disabilities in the postgraduate environment. To address this gap in knowledge, we assessed the impact of disabilities on performance in the MRCS.

Methods
All UK medical graduates who had attempted MRCS Part A (n = 9,597) and Part B (n = 4,562) between 2007-2017 with linked disability data in the UK Medical Education Database (https://www.ukmed.ac.uk) were included. Univariate analysis identified associations with MRCS performance and logistic regression models identified independent predictors of success.

Results
Candidates with registered disabilities had lower MRCS Part A pass rates (46.3% vs 59.8% respectively (p &lt; 0.001)) but similar Part B pass rates (68.2% vs 70.9% (p = 0.339). They were nearly twice as likely to fail Part A (odds ratio 0.55 [95% Confidence Interval 0.46-0.64]). When prior academic attainment (A-Levels and medical school performance) was taken into account, there was no statistically significant difference in the likelihood of success at MRCS (p &gt; 0.05). MRCS pass rates were similar for candidates with specific learning difficulties and those with other registered disabilities p &gt; 0.05).

Conclusions
This is the first study to assess the impact of disability status and type on performance at a postgraduate medical examination. It appears that candidates with registered disabilities perform less well in formal, written examinations generally. Our data indicate that the MRCS itself is fair for candidates with registered disabilities and that the current testing accommodations enable performance unrestricted by disability.