bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.TU.870Challenges of Surgical Site Infections (SSIs) and Stoma
Authors: Ma Jennifer , Whitehouse Pauline , McFall Malcolm 
Published: October 2021

Abstract

Aims
Surgical site infection (SSI) is a costly health burden and is frequently observed in patients who undergo large bowel surgeries with stoma formation. The use of PICO has been associated with reduced rate of SSI and its use is encouraged by NICE.

Method
We identified patients who underwent elective or emergency large bowel surgeries, between 2014-2018, using the local database collected for national SSI surveillance. PICO order forms were cross-referenced with SSI database. Analysed data is presented as percentages, and variable testing is performed using Chi Square test.

Results
The overall rate of SSIs was 12.7%. 6.8% of the cohort developed an incisional SSI, while 5.9% developed an organ/space SSI. The presence of stoma had a significant impact in the rate of incisional SSI (10.3% v 4.2%; p = 0.000179). Amongst all patients with PICO dressing applied, stoma formation was associated with a higher rate of incisional SSI (15.2% vs 6.9%, p = 0.042).
28.7% patients with stoma formation had PICO applied. The use of PICO in this group of patients was associated with statistically significant improvement in the rate of incisional SSI (4.4% v 8.4%; p = 0.026) but not in the rate of organ/ space SSI (2.1% v 4.5%; p = 0.18). Similar findings were not observed when considering elective and emergency cases separately.

Conclusion
The risk of incisional SSIs is high in patients with stoma formation, even in those who had PICO dressing fitted. Tricky fitting of PICO dressing in the presence of stoma could be one hurdle in reducing SSIs.
EP.TU.883Improving diagnosis in all male patients admitted with right iliac fossa pain
Authors: Ballance Laura , Withers Chloe , Nair Dheepa , Galloway Simon 
Published: October 2021

Abstract

Background
Right iliac fossa pain is a common presenting complaint in males. Ultrasound is a cheap non-invasive investigation, yet results can be non-diagnostic. CT is becoming more accessible and available for patient assessment.

Aim
Our primary aim is to estimate how many unnecessary US scans are gained prior to CT imaging, thereby delaying surgery, increasing cost and increasing length of stay (LOS).

Method
We conducted a retrospective analysis of all male patients over the age of 16 admitted to a single unit with RIF pain over 12 months. Outcome and length of stay was recorded.

Results
162 male patients were admitted to a single University teaching hospital between 2017 and 2018. 33% (n = 53) of patients having an US scan require further imaging, 40% ( n = 21 ) of these had a surgical pathology, 80% (n = 17) of these requiring appendicectomy. Patients (n = 39) who had an initial CT scan subsequently requiring surgery length of LOS 3.6 days compared with US imaging with additional imaging requiring surgery ( n = 17) LOS 5.8 days.

Conclusion
Evaluation of practice of males over the age of 16 shows that US is frequently non diagnostic, requiring further investigation with CT or MRI. Imaging initially with CT scan aid diagnosis and decrease length of stay. An education steering committee of surgical trainees, consultants and radiographers has been created to adapt practice in our centre through continued education and training.
EP.TU.920Modified Surgical Heads-Up Charades – using gamification of surgical topics to enhance learning and make revision enjoyable and useful
Authors: Ahmad Manal , Law Sarah , Everett Samuel , Benton Kirsty , Bamford Richard , Hunter Ian 
Published: October 2021

Abstract

Introduction
Gamification has been shown to be successful in surgical education. Charades is an adaptable game and can be utilised as a form of peer learning and adjusted to various levels of knowledge incorporating fun, competition and team working.

Method
The project was piloted with a group of Third year medical students. Each player on a team had a short time frame to guess the maximum number of correct answers on the basis of what their colleagues would tell them about the given surgical term to gain points and win. Knowledge based assessments (KBA)were used to determine baseline knowledge and assess learning. A 5 point Likert scale was used to gain feedback from participants.

Result
100% agreed that they found this motivating and engaging, enjoyed this form of revision and would like to participate in this in future and that this helped them to identify gaps in their knowledge. Average scores from KBA’s increased from 52.5% to 86% based on new questions from session whilst the score from repeating the initial assessment increased by 10%.

Conclusion
Charades is an effective tool for identifying knowledge gaps and developing knowledge base in surgical education and supports the use for gamification as a learning tool.
EP.FRI.4 Cholecystostomy presents as a viable option in acute biliary sepsis during the COVID-19 pandemic
Authors: Gunn Christopher , O'Connor Adam , Alam Imran 
Published: October 2021

Abstract

Aim
To audit and evaluate gallstone related admissions during the COVID-19 pandemic and assess cholecystostomy as an interim and potentially life-saving measure in acute biliary sepsis

Methods
Patients attending with gallstone disease related complaints from January to September 2020 were assessed, along with data collection on ‘hot’ gallbladder operations, elective cholecystectomies and cholecystostomies performed. Data was assessed on a month by month basis

Results
There were 306 gallstone related acute admissions in this audit time period. August had the highest number of admissions with 42 (14%) and March the lowest with 21 (7%). Despite 15 hot cholecystectomies (94%) being performed from January to March, only 1 was performed from April to September (6%). 116 elective cholecystectomies were performed during the time period, with 94 (81%) occurring from January to March. 15 cholecystostomies (9 radiologically, 6 surgically) were performed in the period, with 12 (80%) occurring from March onwards. All cholecystostomy patients have been subsequently listed for laparoscopic cholecystectomy.

Conclusions
This study demonstrates a drop in elective surgery from March 2020 onwards consistent with the COVID-19 pandemic peak. Furthermore, acute admissions related to gallstones decreased over a similar timeframe. Cholecystostomy proved itself to be a viable and potentially life-saving option in dealing with acute biliary sepsis during the COVID-19 pandemic
EP.FRI.82 Using NCEPOD guidelines to develop an evidence based pathway for acute bowel obstruction
Authors: Bierrum William , Bashkirova Varvara , Jones Thomas 
Published: October 2021

Abstract
Bowel obstruction is a common presentation and poses a significant challenge for clinicians. This condition is associated with a high level of mortality and morbidity. The aim of this project was to assess the clinical pathway for patients presenting with bowel obstruction and improve the overall care they received. This was achieved using guidance from the 2020 NCEPOD report looking at bowel obstruction management. Best practice guidelines from the NCEPOD report were used to assess aspects of patient care such as the time to senior review, assessment of nutrition/fluid status and risk of mortality/morbidity assessment. This identified areas where the standard of care was good, such as the majority of patients being assessed by a consultant within 14 hours. However, it also identified areas such as hydration and nutritional status assessment, documentation of ceilings of care/treatment escalation plans and calculation of risk of mortality and morbidity, which required improvement. An admission checklist and nutritional scoring sheet was created to help prompt clerking doctors when admitting patients with acute bowel obstruction. All cases of bowel obstruction were then prospectively audited over a 2 month period to assess the impact of these changes. The findings were presented at the departmental meetings to increase clinician awareness. Following the audit period, local guidelines were amended to incorporate the NCEPOD recommendations, specific pathways were also made for adhesive small bowel obstruction and malignant large bowel obstruction due to the specific requirements of these conditions.
EP.FRI.90 Should laparoscopy be performed before or after appendicectomy in females of reproductive age with a clinical diagnosis of appendicitis?
Authors: Scott Charles , Lambert Anthony 
Published: October 2021

Abstract

Introduction
Females of reproductive age with a clinical diagnosis of appendicitis may undergo laparoscopy prior to appendicectomy. This paper advocates laparoscopy after appendicectomy only if the appendix is macroscopically normal in this patient group.

Method
A cohort of patients under the care of a single general surgeon is reported. If the appendix was macroscopically normal a laparoscopic port was inserted through the right iliac fossa incision. This single port was used for laparoscopic assessment of the pelvic organs.

Results
Fourteen females of reproductive age underwent laparoscopy following a macroscopically normal open appendicectomy. No additional laparoscopic ports were required. A benign dermoid ovarian cyst was identified in a 14 year-old which was electively excised following further investigation by a gynaecologist. Two ruptured simple ovarian cysts were also identified. There were no complications reported in this patient group.

Conclusions
Laparoscopy following a macroscopically normal open appendicectomy allows assessment of the pelvic organs in females of reproductive age and reduces the number of ports required during surgery.
EP.FRI.98 Perioperative blood glucose monitoring and handover in Post-Laparotomy Diabetic patients admitted to Intensive Care
Authors: Chang David , Tan Joni , Liu Keri , Mohsan Mallick 
Published: October 2021

Abstract

Aim
To identify the percentage of diabetic laparotomy patients admitted to ITU who had a pre-operative blood glucose check, and the frequency of post-operative blood glucose checks in the immediate 24 hours post-operatively, with any association with 30 day mortality

Method
We identified diabetic post-laparotomy patients admitted to a large tertiary hospital ICU, identifying handover between medical and critical care teams and perioperative blood glucose monitoring up to the first 24 hours of ICU admission post-operatively using both physical and electronic notes.

Results
We identified 79 diabetic laparotomy patients admitted to ICU of which 49.3% (39/79) did not have diabetes recorded as a comorbidity in nursing handover charts. We found that 27.8% of these patients did not have an intra-day pre-operative blood glucose recorded and that frequency of post-operative glucose monitoring in the first 24 hours ranged from 0.5 to 10 hourly. ITU monitoring charts could only be found for 69 of the 79 patients, out of which 40.7% of patients had at least one hyperglycaemic episode while 11.6% of patients had a hypoglycaemic episode. We found no correlation between incidences of hyperglycaemia and hypoglycemia or handover with 30 day mortality (13.9%).

Conclusion
72.2 percent of post laparotomy diabetic patients admitted to ICU have a preoperative blood glucose recorded, with considerable variance in blood glucose monitoring frequency 24 hours post-laparotomy from half hourly to 10 hours between blood glucose monitoring but we found no association between hyperglycaemic and hypoglycaemic events in the first 24 hours post-laparotomy with 30 day mortality.
EP.FRI.154 Could Antiangiogenic Drugs be the Solution to Tendon Injury? A Literature Review on the use of Antiangiogenic Drugs for Tendon Regeneration
Authors: Kirchhoff Chris 
Published: October 2021

Abstract

Background
Tendinopathy accounts for more than half of reported musculoskeletal injuries worldwide. The subsequent healing process results in a disorganised tendon structure secondary to neovascularisation, forming a bulky tendon with overall reduced strength. Current treatment options remain controversial as re-rupture rates following surgical intervention are high. It has been proposed that the use of anti-vascular endothelial growth factors could improve tendon healing.

Methods
This literature review employed a systematic approach. The search strategy incorporated an adjusted PICO format and PRISMA flow diagram. Search findings were critically appraised using the CASP tool checklist. Identified studies investigated the effect of injectable anti-angiogenic drugs on tendon healing.

Results
Three final studies were identified. Tempfer et al. showed a reduction in cross sectional tendon area in the intervention group (5.6mm²+1.8), comparatively to the control group (9.1mm² +2.0), and increased tendon strength in the intervention group (47.7N+6.41) comparatively to the control group(32.41N+9.23). Dallaudiere (2014) et al. showed reduced cross-sectional area in the intervention group (0.95mm²+0.01) compared with the control group (0.75mm²+0.01). Dallaudiere (2013) et al. also showed reduced cross sectional areas in the intervention group (1.10mm²+0.01) compared with the control group (1.11mm²+0.03).

Conclusion
All studies supported the use of anti-angiogenic drugs to support tendon healing. The use of injectable anti-angiogenic drugs may potentially serve in conjunction with surgical intervention or as an alternative minimally invasive intervention to improve tendon rehabilitation. This review recommends that further randomised control studies will be needed to strengthen the current evidence.
EP.FRI.159 Crohn’s terminal ileal perforation peri partum; a case report and review of the literature
Authors: Tokidis Evripidis , Malcolm Francesca , White Timothy 
Published: October 2021

Abstract

Introduction
Surgical care of complicated Crohn’s disease (CD) during pregnancy is often a clinicodiagnostic conundrum. We present a case of a 26 year old with active CD and subsequent terminal ileal (TI) perforation diagnosed post-partum.

Case
A 26 year old with known CD presented with abdominal pain at 24 weeks pregnant to Obstetrics. Surgical opinion was sought due to increasing abdominal pain; MRI was performed and found active TI CD but no free gas. Within 24 hours the patient prematurely delivered. Immediately post-partum the patient reported worsening pain with notable peritonism on examination. Urgent CT abdomen was arranged demonstrating free aim secondary to TI perforation. The patient underwent laparotomy. Intraoperatively there was 4 quadrant peritonitis, confined TI loops behind the gravid uterus and TI perforations. Following drainage of the intrabdominal sepsis, a ileo-caecal resection was performed with end ileostomy and colonic mucous fistula formation. Post-operative recovery was uneventful and the patient was discharged 5 days later.

Discussion
There is a paucity of evidence describing manifestations of CD during pregnancy. Meta-analysis has shown a correlation of active CD and adverse perinatal outcome. The specific complication of TI perforation is a rare sequelae of CD; documented in less than 5% of cases. TI perforation during pregnancy has been described in only a handful of case reports.

Conclusion
This case report illustrates diagnostic challenges faced in the investigation and management of active CD in pregnant patients. It also highlights the importance of dynamic reassessment and the collaborative efforts of the multidisciplinary team.
EP.FRI.241 Negative appendicectomy rate and role of biomarkers in predicting the severity of acute appendicitis
Authors: So Cher Pin , Bradley Nicholas , Crumley Andrew B C , Wilson Michael Samuel James 
Published: October 2021

Abstract

Aim
Acute appendicitis is the most common general surgical emergency. A recent consensus study has proposed a 10% negative appendicectomy rate. We aimed to determine the negative appendicectomy rate in our centre whilst evaluating the role of biomarkers in predicting the severity of appendicitis.

Methods
A single-centre retrospective analysis of consecutive laparoscopic appendicectomies from 2019-2020 was performed. Patients were categorised by severity using AAST grading system. Kruskal-Wallis test was used to compare biomarkers levels (WCC, CRP, bilirubin, neutrophil:lymphocyte ratio (NLR) and platelet:lymphocyte ratio (PLR)). T-test, ROC curve and Fisher’s exact test were used to differentiate between perforated and non-perforated appendicitis and negative appendicectomy rate. WCC ≥11, CRP ≥50, bilirubin ≥21, NLR ≥6.4 and PLR ≥153 were the cut-off values. Negative appendicitis was defined as normal appendix at histopathological analysis.

Results
224 patients were included; mean age 33.7 years, 57.1% were male. 17 patients (7.6%) had negative appendicectomy. CRP, NLR, bilirubin and PLR increase with AAST score (P &lt; 0.001). WCC ≥11 (p &lt; 0.001) and NLR ≥6.4 (p = 0.007) predicted acute appendicitis.
WCC (p = 0.018), CRP (p &lt; 0.001), bilirubin (p &lt; 0.001), NLR (p &lt; 0.001), PLR (p = 0.002) were predictive for appendiceal perforation.

Conclusion
7.6% negative appendicectomy rate in our centre is below the recommended standard of 10% and lower than other centres. In our centre, raised WCC and NLR were predictive of acute appendicitis. WCC, CRP, bilirubin, NLR and PLR may be used to distinguish between perforated and non-perforated appendicitis. Our results add to the conflicting body of evidence relating to biomarkers and the severity of appendicitis.
EP.FRI.344 Training in remote and austere emergency surgery - Is it UK relevant or Medical tourism?
Authors: Murgitroyd Ellen 
Published: October 2021

Abstract

Aims
Military surgical trainees from ST4 were deployed to Afghanistan. They gained extensive experience of surgical trauma. The placement no longer exists, and the type of deployment has moved from fully equipped, multi-disciplinary team scenario to small team, remote and austere.
With increasing specialisation and advancing technology how do surgeons prepare for remote and austere surgery with resource-limited decision making? One consideration is an out-of-programme experience in a developing nation. This needs to be balanced with the impression of “medical tourism.

Methods
A charity-funded experienced UK general surgeon was needed in an Eastern Province hospital, Rwanda. This provided opportunity for a registrar to assist. “Give back” was by assisting in the training of Rwandan doctors and establishing a stand-alone surgical service.

Results
The workload included resource-constrained operative and non-operative management of significant trauma (including head injuries and burns), general surgery, vascular, urology and gynaecology disease in all age groups. 114 operations in 29 working days, Non-operative management decisions were the most challenging, resulting in immersive trauma and emergency surgery experience.
The surgery involved unusual operations and creative clinical and technical thinking. There was a significant amount of trauma, most presenting very late, creating management complexities due to infection risk.

Conclusions
The role of remote and austere surgery is applicable to UK trainees, in particular military trainees, those who wish to work in remote and austere environments and for real life critical thinking exposure that could apply to resource limitation or delay-to-surgery in mass casualty situations.
EP.FRI.398 Diverticular Disease Patient Presenting with Acute Abdominal Pain, Guidelines and Management
Authors: Elnaggar Mahmoud , Bukhary Syed Zain , Fafemi Oladapo , Saber Moustafa 
Published: October 2021

Abstract

Aim
Diverticular disease of the sigmoid colon is a common condition in Western society, 10-25% will develop an acute episode of diverticulitis, Since Hinchey’s traditional classification for perforated diverticulitis in 1978, several modifications and new grading systems have been presented to display a more contemporary overview of the disease

Methods
100 patients diagnosed with acute diverticulitis admitted to the surgical unit in NMUH starting from 1/1/2019 (the first 100 patients were chosen - they attended over a period of 6 months) Data were checked for all patients from the patients' notes and electronic hospital systems for as compared to the: “Acute Diverticulitis Management Algorithm”, provided on the NMUH intranet since April 2015.

Results
10% of patients Had pain and tenderness in an abdominal quadrant other than left iliac fossa. Standard investigations including WCC, CRP & erect chest radiograph were done to all patients. 84% of patients were diagnosed with CT scan while the rest were diagnosed clinically. 96% of patients had colonoscopy appointments while 4% had CT colonography appointments. There was no mention of Hinchey grade, despite cases were managed according to this classification.

Conclusions
There was a good degree of commitment to the management algorithm in some parts, like blood tests and antibiotic prescription, however other parts were not adhered to like the Hinchey's classification documentation for each case. There is a need for more clinical and management related classification system of acute diverticulitis, some classifications were proposed.
EP.FRI.450 Gastrograffin use in Non-Adhesional Small bowel Obstruction
Authors: Hughes Rebecca , Ali Oroog , O'Loughlin Paul 
Published: October 2021

Abstract

Aims
Use of Gastrograffin (GG) radio-opaque contrast has been documented in the management of adhesional small bowel obstruction. It is not widely used in other causes of small bowel obstruction. The aim of this study was to assess the effectiveness of GG use in non-adhesive small bowel obstructions.

Methods
A retrospective review of patients who had GG administered following CT confirmed small bowel obstruction (SBO) over 2-year period was conducted. Demographics, cause of SBO and outcomes were recorded. The primary outcome was resolution of SBO with GG.

Results
80 patients received GG for management of radiologically confirmed small bowel obstruction. The mean age was 62.7 years +/- 14.64 (SD) and M:F ratio was 1:1. The causes of small bowel obstruction included adhesions (n = 37, 46%), hernias (n = 17, 21%), progression of known cancer (n = 3, 4%). 18% (n = 15) had no clear cause of SBO on CT. In the adhesion group, GG resolved SBO in n = 27 (73%) of patients. In the hernia group 7 (41%) were incisional hernias and 7 (41%) were parastomal hernias. GG was given to both groups and the obstruction resolved in n = 6 (86%) and n = 4 (57%) of cases respectively.

Conclusions
This study shows the effective use of GG in hernia related SBO where there is no absolute indication for surgery. GG might be suitable for incisional and parastomal hernias as a bridge to resolving acute SBO allowing a delayed repair with complex techniques.