bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.WE.28Routine histopathology examination of the sleeved stomach after sleeve gastrectomy - significance and comparison with preoperative endoscopy
Authors: Omar Islam , Hafez Ahmed , Freear Josephine 
Published: October 2021

Abstract

Background
Sleeve gastrectomy (SG) is one of the most commonly performed bariatric procedures. However, the available literature on histological examination of the resected sleeved stomachs is widely inconsistent. This study aimed at assessing the histopathological findings after SG performed in our center compared to the routinely performed preoperative esophagogastroduodenoscopy (OGD) and the intraoperative findings.

Material and methods
We conducted a retrospective cohort study using the bariatric unit database of all patients who had SG procedures from June 2007 to December 2019.

Results
Out of the 620 SG performed, there were 219 patients with complete data, including preoperative OGD reports, operative notes, and postoperative histopathology reports. We found normal specimens in 43.83% (n = 96) and evidence of inflammation in 50.68% (n = 111) of cases. There were 10 (4.56%) specimens with evidence of inflammation and other lesions and two (0.91%) specimens with lesions only. Twenty-five patients had inflammation, and 10 had lesions on preoperative OGD with negative histopathology reports.

Conclusion
Routine histopathology examination after SG does not change the management, and preoperative OGD can detect inflammatory changes and lesions, which could have been missed with histology analysis only.
EP.WE.46Stentolith as an uncommon complication of loss to follow up after endoscopic biliary stenting
Authors: Ng Sherwin , Lam Mark , Gill Nina , Shamali Awad 
Published: October 2021

Abstract

Introduction
Endoscopic biliary stenting is a common procedure, with indications from malignant obstruction to benign stone disease. We discuss a patient who re-presented after endoscopic stenting having been lost to follow up, with a large ‘stentolith’ requiring open CBD exploration.

Case Presentation
A 56-year-old female presented in 2013 with obstructive jaundice and a 2-week history of abdominal pain. She was a smoker, but otherwise had no past medical, surgical, or relevant family history. After initial workup, ERCP with sphincterotomy and pigtail stent placement was performed with interval laparoscopic cholecystectomy in 2014. Post-operative follow up was not arranged, the patient subsequently re-presented in 2020 with fatigue. MRCP confirmed a proximal CBD stone and linear artefact. Open exploration facilitated removal of the stone-stent complex.

Discussion
Complications of stenting include cholangitis, stent occlusion and migration. Stenting for failed biliary stone extraction is considered a temporary measure, with removal or exchange at three months. However, patients may be lost to follow up and return with non-specific symptoms. A rare cause is de novo formation of a gallstone calculus encasing the stent, a phenomenon termed “stentolith”. Proposed pathophysiology is through promotion of bacterial proliferation by the stent, with biofilm formation and calcium bilirubinate precipitation. Variation in formation has been described, with plastic stents developing circumferential stones, due to potential space between the wall and stent.

Conclusion
This highlights the importance of robust inter-disciplinary working, careful patient follow up and implementation of a mandatory registry at all hospitals for stented patients.
EP.WE.47Cholecystectomy During COVID-19: A Single Centre Experience
Authors: Ghassemi Nader , Rathod Sneha , Salgaonkar Hrishikesh , Nnaji Martin , Athwal Tejinderjit , Cheruvu Chandra 
Published: October 2021

Abstract

Background
The COVID-19 pandemic has significantly impacted healthcare delivery globally with consequent restructuring of surgical services during the peak period and prioritisation of emergency and cancer surgery over elective operations.
We present outcomes for laparoscopic cholecystectomy during the peak period for COVID-19 in the UK and compare this with data for the same period in 2019

Methodology
This is a prospectively study. Analysis of collected data on patients who underwent laparoscopic cholecystectomy during the peak period for COVID-19 from 1st March 2020 – 30th June 2020 (study cohort) at the Royal Stoke University Hospital. Data from the same period in 2019 (control cohort) was compared and analysed.

Results
104 patients underwent a laparoscopic cholecystectomy during the peak period compared to 217 during the same period in 2019.
Median age in the study cohort was 51.5 years (15-84 years) and 52 years (19-91 years) in the control cohort (p = 0.49). Male to Female ratio was 1:2 in the study cohort and 1:2.2 in the control cohort (p = 0.67)
Emergency admissions constituted the majority of cases and there was no statistically significant difference between both groups (61.5% vs 61.8%, p = 0.49). Most cholecystectomies were for biliary colic (41.3% vs 35.5%) and cholecystitis (37.5% vs 43.8%), and there was no statistically significant difference between both groups (p = 0.31 and p = 0.29 respectively).

Conclusion
This study demonstrates that laparoscopic cholecystectomy was feasible and safe in patients with symptomatic gall bladder disease during the peak period for COVID-19 when compared to a historic cohort in 2019.
EP.WE.117Colovaginal fistula from neglected vaginal pessary; Fallouts from the COVID-19 pandemic
Authors: Tawfik Ahmed , Oyewole Bankole , Elzaafarany Ahmed , Gilbert Catherine , Campbell-Smith Tim 
Published: October 2021

Abstract
An 86 year old lady was admitted with a one week history of feeling unwell, polyuria, dysuria, urinary and faecal incontinence. She had previously been treated for recurrent UTIs by her GP. On examination she had suprapubic tenderness but no peritonism. Observations revealed tachycardia of 122bpm with a temperature of 36.3*C. Inflammatory markers were raised with a white cell count of 22.0x106/L and CRP 129 mg/L. Urine cultures grew Pseudomonas aeruginosa. She was managed for urosepsis with intravenous antibiotics.
Past medical history included vaginal pessary for uterine prolapse, congestive cardiac failure, hypertension, polymyalgia and osteoporosis.
She lived alone with no package of care.
On admission she improved with intravenous antibiotics however she had a perineal examination due to ongoing faecal and urinary incontinence and was noticed to be passing faeces per vaginam. A colo-vaginal fistula was suspected and she was reviewed by the gynaecologist who noted her pessary had been in-situ for up to a year and her routine appointment to have it changed was cancelled due to the COVID-19 pandemic.
An MRI Pelvic scan confirmed a 3x2cm rectovaginal fistula.
She was reviewed by the general surgery team and the decision was made for her to be defunctioned to prevent her episodes of recurrent UTIs and improve her quality of life. She successfully had a laparoscopic end colostomy with an uneventful post-operative period.
This case highlights the harms caused from the cancellation of appointments and demonstrates a rare cause of rectovaginal fistula.
EP.WE.213Short-term impact of COVID-19 on surgical services in a tertiary hospital
Authors: Hamer N , Brown A , Sharma V , Jha T , Garg D , Jha M 
Published: October 2021

Abstract

Aim
Since December 2019, SARS-CoV-2 has dramatically impacted the global landscape. One of the biggest challenges has been the additional strain put on healthcare systems. Although there are numerous studies on the effects of COVID-19 on intensive care beds and ventilator availability, there has been little exploration into the wider impacts of COVID-19 on the provision of other services. This study was designed to explore how COVID-19 has impacted surgical service provision at a large NHS hospital.

Methods
We compared the number and types of general surgical procedures carried out in a tertiary centre in the six months prior to the UK COVID-19 outbreak (September 2019-February 2020) and the six months after (March 2020-August 2020).

Results
We found that since March 2020 there has been a 70% decrease in the amount of operations taking place, with numbers dropping from a pre-COVID total of 1761 to a post-COVID total of 529. This mainly affected elective procedures with emergency surgeries remaining relatively constant (48 pre-COVID vs 44 post-COVID).

Conclusion
COVID-19 has caused a significant decrease in the number of surgeries being undertaken. This is due to a combination of factors including staffing issues, reduced investigative capacity, and national mandates on the cessation of non-urgent procedures. Although this mainly affected elective operations, it will have wider implications on future NHS workload and training. The knock on effects will inevitably result in a rise in delayed and emergency presentations with worse patient outcomes.
EP.WE.227YouTube as a source of patient information on elective surgery safety during the COVID-19 pandemic
Authors: Dawidziuk Aleksander , Gandhewar Rishikesh , Shah Kamal , Vemulapalli Kalyan 
Published: October 2021

Abstract

Aims
To evaluate the understandability, actionability and quality of perioperative patient information conveyed by YouTube videos covering safety of elective surgery during the COVID-19 pandemic.

Methods
YouTube search strategy was optimised using a combination of “COVID”, “safety”, and “surgery” terms. Each video was screened by two independent reviewers. The search was conducted on 9 January 2021. The understandability and actionability of videos were evaluated using validated Patient Education Materials Assessment Tool (PEMAT). Quality of perioperative patient information was determined with a novel 4-point checklist based on recommendations by the National Institute for Health and Care Excellence. The effect of video type on PEMAT and quality scores was assessed with Kruskal-Wallis Test. Scores were correlated with video metrics using Spearman's Rank.

Results
The primary search revealed 594 videos. After deduplication and exclusions, 108 materials were analysed. Majority of videos (n = 89) originated from the USA, with only 4 produced in the UK. Hospital-produced videos had the highest understandability scores [median (IQR): 83.33% (18.40%)] and patient testimonies the lowest [55.91% (33.24%)] (p=0.002). Hospital materials were also most actionable [2.25 (2.40)], with news reports scoring lowest [0.0 (0.8)] (p=0.049). Social distancing, preoperative COVID-19 testing, and wearing face masks were mentioned in 46, 41, and 48 videos respectively. Only 9 materials recommended self-isolation before surgery. There was no significant correlation between video metrics (e.g., length) and scores.

Conclusions
Short UK-specific videos should be created to outline accurate patient instructions for elective surgery during the COVID-19 pandemic and provide reassurance to help reduce the surgical backlog.
EP.WE.264How much are we spending on Botulinum Toxin A injections for functional Upper Gastrointestinal conditions?
Authors: Afzal Zeeshan , Sreedharan Loveena , Hasan Ibtisam , Corbett Gareth , Hardwick Richard 
Published: October 2021

Abstract
A number of Oesophagogastric (OG) conditions such as Achalasia, Gastroparesis, Oesophageal dysmotility (OD) and Pyloric dysfunction (PD) can be treated with Botulinum Toxin A (BTxA). The aim of our study was to assess the use and costs of Botulinum Toxin A endotherapy within a tertiary Oesophagogastric unit.
We performed a retrospective analysis of data collected over a 2-year period at a tertiary Oesophagogastric unit from November 2015 to November 2017.
We found 68 eligible patients with Achalasia, Gastroparesis, Oesophageal dysmotility, Pyloric dysfunction. The median number of treatment sessions were Achalasia 2 (1-3), Gastroparesis: 2 (1-9), Oesophageal dysmotility: 1 (1-5) and Pyloric dysfunction: 1.5 (1-3). The mean number of units of BTxA used per procedure (Unit) were Achalasia 200, Gastroparesis 170, Oesophageal dysmotility 190 and Pyloric dysfunction 270. A total of 126 vials containing 63000 units (£19530) were opened. 25520 units were used, and 37480 2. Vbn vcfunits were wasted (£11618) over 2 years. On average, 67% of each vial of Dysport was wasted.
The local annual wastage was £5810 per year, which roughly equates to a national wastage cost of £348,600 per year for these 4 OG conditions alone (assuming we serve population of around 1 million people and therefore multiplying by 60). An option for cost saving would be to consider using smaller volume vials to reduce wastage. We would recommend that guidelines are produced in order to standardise the optimal dose required and the vial sizes to stock for treatment of these conditions and avoid unnecessary expenditure.
EP.WE.334Value of including CT chest in the management of acute abdominal emergencies: Experience during first wave of COVID-19 pandemic at a District General Hospital
Authors: Patel Maitreyi , Jebamani Jennifer , Mohapatra Shrabani Das 
Published: October 2021

Abstract

Aims
The aim of this retrospective study was to assess the incidence of positive findings on CT chest in patients presenting with acute abdomen, who underwent CT thorax as part of the Intercollegiate General Surgical Guidance on COVID-19 during the first wave. To correlate CT chest findings with confirmed cases on RT-PCR; and to determine its influence on surgical management of abdominal emergencies.

Methods
A retrospective observational study of adult emergency surgical referrals (excluding trauma) for acute abdomen over a ten week period was performed. COVID changes on CT Chest were categorized as per the BSTI CT reporting criteria. Patient demographics, COVID RT-PCR, management and outcome were recorded. Statistical analysis was performed using Microsoft Excel with p value significant at ≤ 0.05.

Results
Of the 160 patients included, only 111(69.38%) had COVID RT-PCR. Of 24 (15%) patients with CT chest features of COVID, 45.83% demonstrated classic/probable CT features of COVID of which 36.36% had positive RT PCR. 54.17% had indeterminate pattern and none tested positive for COVID. There was a significant association between positive CT abdomen with normal CT chest findings (p = 0.03). Of 25 (15.63%) patients with normal CT abdomen, 7(28%) had CT features of COVID. Only 43(34.4%) patients needed surgical intervention of which 18.6% had COVID changes on CT, confirmed by positive RT PCR in 12.5%.

Conclusions
CT chest as an additional investigation modality in acute abdomen had clinically helped in triaging of patients to appropriate specialties but did not influence emergency surgical management.
EP.WE.372Has COVID-19 affected the attention surgical papers are receiving?
Authors: Baker Megan , Hanton Alice , Perin Giordano , Lumley Emma , Mahendran Ashuvini , Saha Arin 
Published: October 2021

Abstract

Aim
Unsurprisingly, much of the medical profession has focussed on treating covid-19 over the past year often to the detriment of other pathologies. Engagement with academic literature may follow a similar trend; this paper used standard social media attention and citations metrices to assess whether the pandemic has affected engagement with surgical literature.

Method
Twitter Mentions and Mendeley Readers Data were retrieved for all papers published in Annals of Surgery, BJS and JAMASurgery between January 2019 and October 2020. The non-parametric Mann-Whitney U test was used to compare Twitter Mentions and Mendeley Readers for COVID surgical vs non-COVID surgical publications (in 2020) and all surgical papers published before and after the advent of COVID-19. A control database of all papers published in NEJM, BMJ and Lancet over the same period of time was also created.

Results
There was no difference in Twitter mentions between COVID-19 and non-COVID-19 papers (p-value 0.604); however there were significantly more Mendeley readers of COVID-19 papers than non-COVID-19 papers in 2020 (55 vs 5 median readers, p &lt; 0.001). Surgical papers published in 2020 received significantly fewer Twitter mentions than those published in 2019 (15.5 vs 27, p &lt; 0.001).
Analysis of the non-surgical control dataset revealed the opposite trend; papers published in 2020 received significantly more attention than those published in 2019 (39 vs 30 median Twitter citations, p &lt; 0.001).

Conclusion
Surgical papers published during the COVID-19 pandemic received significantly fewer social media mentions. Such reduced visibility has the potential to affect future citation metrics and dissemination of surgical knowledge
EP.WE.548The prevalence iron deficiency anaemia in patients with oesophago-gastric cancer
Authors: McCollum Catherine , Khan Khurram , Chuntamongkol Rongkagorn , Forshaw Matthew 
Published: October 2021

Abstract

Aims
Blood loss from the gastrointestinal tract is the most common cause of iron deficiency anaemia (IDA) in adult men and post-menopausal women. Up to 10% of patients with IDA have underlying gastrointestinal cancer. The aim of this study was to investigate prevalence of IDA in patients with oesophago-gastric cancer.

Methods
A retrospective cohort study of all newly diagnosed oesophago-gastric cancers (adenocarcinoma and squamous cell carcinoma) and high grade dysplasia discussed at tertiary multi-disciplinary team meeting between October 2019 and September 2020. Electronic case notes and blood profile at presentation, including ferritin and serum iron level, were analysed. Patients who did not have blood profile within three months of presentation were excluded.

Results
A total of 349 patients were identified, 12 were excluded due to missing data. 226 (67.1%) were male and the mean age was 69.7 ± 11.7 years. 260 (77.2%) were referred from primary care. After initial investigations, 256 (76.0%) were oesophageal cancer, 248 (73.6%) were adenocarcinoma, and 134 (39.8%) were metastatic at presentation. 128 (38.0%) patients were anaemic: 30 (23.4%) microcytic, 88 (68.8%) normocytic and 10 (7.8%) macrocytic. 98 (76.6%) anaemic patients had ferritin and/or iron levels checked. Analysis of these identified 63 (49.2%) patients with bloods consistent with IDA: 22 (34.9%) microcytic, 40 (63.5%) normocytic, and 1 (1.6%) macrocytic.

Conclusions
This study confirms that while there is high prevalence of anaemia in patients presenting with oesophagi-gastric cancer, IDA was diagnosed in only half of these. The predominant form of anaemia identified in these patients is normocytic.
EP.WE.567Regional anaesthesia for infra-inguinal revascularisation in patients with symptomatic peripheral arterial disease
Authors: Tait Sophie , McGillivray Kay , McKenna Roisin , Hussey Keith 
Published: October 2021

Abstract

Introduction
General anaesthesia is considered to be an aerosol generating procedure. The global Covid-19 pandemic has resulted in review of practice to reduce risk to both patients and health care workers. The outcome of regional anaesthesia (RA) for infra-inguinal arterial reconstruction in patients with symptomatic occlusive atherosclerotic has been explored and compared with patients managed with general anaesthesia (GA).

Methods
Patients undergoing infra-inguinal revascularisation between 2019-2020 were identified from a prospectively maintained administrative theatre dataset. Case-linkage was used to complete the dataset. Specific end points included to critical care admission and peri-operative mortality.

Results
There were 204 patients identified (46 RA and 158 GA). The mean age of patients in both groups was 67-years and procedures were commonly performed in male patients (although the male:female ratio was higher in the RA group 2.8:1 than in the GA group 1.4:1). More patients in the RA had intervention for chronic limb threatening ischaemia (80% versus 59%). The interventions performed were comparable in both groups. The mean length of procedure was less in the RA group (142-minutes versus 160-minutes). No patients in the RA required admission to critical care (10 patients managed with GA required admission to critical care). The 30-day mortality was comparable in the RA and GA groups (2.2% and 1.9% respectively).

Conclusions
Regional anaesthesia would appear to be feasible for patients undergoing infra-inguinal arterial reconstruction with a reduction in operating time and critical care admission without increased peri-operative risk.
EP.WE.641Spectrum of Right Iliac Fossa Pain Presentation and Management During the First COVID-19 Lockdown: A Single Institution Experience
Authors: Bodla Ahmed Salman , Ndegbu Chinedu 
Published: October 2021

Abstract

Aims
Acute surgical presentations and management approaches have witnessed a changing pattern occasioned by COVID-19 pandemic and attendant lockdown. We report the spectrum of right iliac fossa (RIF) pain referrals and management trend within an acute surgical unit before and during the National lockdown.

Methods
A retrospective review of all patients referred to the acute surgical unit with RIF pain before and during first National lockdown was undertaken. Patients managed during these periods were segregated into Pre-Lockdown (January-2020) and Lockdown (April/May-2020) cohorts. Relevant data were obtained from patients’ electronic medical records and main outcome measures compared between both arms were definitive diagnosis, rate of acute appendicitis, diagnostic imaging modality utilised, management approach and post-operative 30-day complications.

Results
RIF pain referrals were fewer (17% vs. 23%, P = 0.045) but more likely to be related to acute appendicitis during the lockdown (52% vs. 28%, P = 0.002). However, the risk of presenting with complicated appendicitis did not alter significantly (26% vs. 19%, RR = 1.34, P = 0.56). Diagnostic imaging was increasingly deployed (for RIF pain: 91% vs. 74%, P = 0.07; for appendicitis: 77% vs. 42%, P = 0.007) especially computerised tomography scan (45% vs. 31%). Increased adoption of conservative approach in the management of acute appendicitis was significant (61% vs 23%, RR 2.65, P = 0.01) although other outcomes such as length of stay, post-operative complication and 30-day re-presentation rates were comparable to pre-lockdown phase.

Conclusion
Fewer RIF pain but more likelihood of acute appendicitis, increased use of radiological imaging and conservative approach to management reflect an evolving pattern during the lockdown phase.