bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.FRI.274 Nasogastric decompression in small bowel obstruction
Authors: Ayeni Adewale , Rajebhosale Ramprasad , Ravi Prabhu , Thomas Pradeep 
Published: October 2021

Abstract

Aim
The aim of this study is to review the surgeon’s compliance and efficacy of nasogastric decompression in management of small bowel obstruction.

Method
This is a retrospective 6 months study from 1st January 2020 to 30th June 2020.

Results
73 patients were managed for SBO during this period. Adhesions (43.8%) was identified as the most common cause of small bowel obstruction followed by hernias (27.4%).
51 (70%) patients had nasogastric decompression planned on admission, although there was history of vomiting in 85% of patients at admission. Forty two patients (58%) had nasogastric decompression. Majority (71%) of these patients had NG inserted within 24 hours, only 2 of these patients had it inserted on admission.
Of the 44 patients managed conservatively for their SBO, 19 had NG decompression. Two patients died during admission (both managed with palliative intent).

Conclusion
The routine use of nasogastric decompression in SBO is still common despite the lack of randomized control trial. Its use is associated with an increase in duration of hospital stay. Although the optimal timing of placement of NG tube is not known, our study shows that placement within 6 hours of admission may shorten the duration of hospital stay.
EP.FRI.337 Active management of the open abdomen in non-trauma catastrophes, including use of negative pressure wound therapy, is associated with high primary fascial closure rates
Authors: Nair Dheepa , Banks Jessica , Guy Richard 
Published: October 2021

Abstract

Aims
Deliberate use of the open abdomen (OA) following emergency laparotomy (EL) may be life-saving in the non-trauma abdominal catastrophe (NTAC) and damage control surgery (DCS) can reduce the risk of abdominal compartment syndrome in compromised patients. Controversy exists over optimum management of the abdominal wall. An audit was undertaken of negative pressure wound therapy (NPWT) in OA patients.

Methods
All patients who underwent OA management of NTAC from 1st Jan 2019 to 31st Dec 2020 were identified. Data on patient demographics, indication for OA and clinical outcomes were analysed.

Results
Eighteen patients (median age 65.5 years; M:F9 each) underwent OA following EL. The indications were: bowel ischaemia (8), intra-abdominal sepsis (5), grossly distended bowel (3) and intra-abdominal haemorrhage (2). In all cases, ABTHERATM dressings (KCI/Acelity) were used. Mean ICU stay was 7.4 days (range 1-15) and mean hospital stay 33 days (range 2-61). Four patients died, 3 within 24 hours of initial EL. Relook laparotomy was performed within 48 hours in the remaining 15 patients; 3 patients required 2 relooks and 1 patient had three. Primary fascial closure (PFC) was achieved within five days in 13/14 (93%) survivors. Eight patients had SSIs with 2 intra-abdominal collections and all were treated conservatively. One patient developed an enterocutaneous fistula.

Conclusions
The use of commercially-available NPWT dressings in OA management is associated with high PFC rates within one week of initial EL. This practice is consistent with World Society of Emergency Surgery guidance recommending planned re-look laparotomy within 48 hours.
EP.FRI.368Impact of Covid 19 on Urgent Suspicion of GI Cancer Referral in a District General Hospital
Authors: Barman Sowrav , Ng Hwei Jene , Teo Serene , Blaney Eimear , Mansfield Olivia 
Published: October 2021

Abstract

Aim
Endoscopy services across United Kingdom were affected significantly since March 2020 due to Covid-19 pandemic. Services were reduced and were more selective. We aim to compare the impact on duration between referral to colonoscopy and the detection rate of pathology between February (pre- Covid) and August (Covid-impacted) 2020.

Methods
Data was analysed from a prospectively maintained database of patients referred for colonoscopy to Royal Alexandra Hospital, Scotland. Patients underwent colonoscopy in month of February and August 2020 were included. Bowel screening patients were excluded. Positive findings included diverticulosis, colitis, polyp and adenocarcinoma. P value of &lt; 0.05 was considered significant.

Results
Total number of patients included was 97 (55 in February, 42 in August). Median age was 61 and 69 years respectively. Mean duration from referral to colonoscopy were 4 weeks in February and 7 weeks in August. qFIT test were found raised in 50.9% in February and 57.1% in August with positive findings of 47.3% in February and 66.7% in August. 46.4% in February and 16.7% in August had raised qFIT but normal findings (p &lt; 0.05). Two high grade dysplasia polyps and two adenocarcinomas were identified in February, none found in August.

Conclusion
Covid-19 pandemic has disrupted the endoscopic services prolonging the duration from referral to colonoscopy. qFIT test is more heavily relied to prioritise urgent colonoscopies resulting in more positive findings on colonoscopy. Cancer detection rate has reduced which is a consistent finding as the UK national endoscopy study. Massive efforts are needed to restore endoscopy services.
EP.FRI.464 Application of the Oakland score to a real world lower GI bleeding patient population
Authors: McKenzie Emily , Bradley Nicholas , Kynaston James , Torpey Greig 
Published: October 2021

Abstract

Aims
Lower GI bleeding (LGIB) is a significant burden on healthcare resources with an estimated 21120 UK annual admissions. The Oakland score was developed in 2017 and allows patients to be triaged based on clinical and laboratory parameters to predict safe discharge; an Oakland score &lt;8 predicts safe discharge with a 98.4% sensitivity. We aim to describe our experience at applying this scoring system to our practice.

Methods
This retrospective single centre study included 25 consecutive emergency LGIB referrals to a busy district general hospital. Oakland score was retrospectively calculated from case notes and clinical outcomes followed up.

Results
The average age of the patient group was 72.8 years, 56% were male. 64% of our patients were referred from ED with the remainder from GP. Mean Oakland score was 16.68. 40% of patients were on anti-platelets or a DOAC. The average length of stay was 2.56 days. 76% of these patients did not receive a blood transfusion and 73% did not undergo any imaging or endoscopy while an inpatient. Only 5 of the patients were sent home directly from the surgical assessment unit.

Conclusions
Our preliminary real world experience suggests that routine use of the Oakland score will allow for safe rationalisation of inpatient services. Further prospective data collection is required to validate this approach. Our data represents only patients admitted to hospital, therefore the low-scoring patient population is not represented; these patients will be included in prospective analysis.
EP.FRI.472Building the ‘LIEGS’ way – Establishing an ambulatory Rapid Access Theatre Service for those patients with acute surgical pathology requiring operative management
Authors: Amtul Nasira , Ahmad Aman , Mutyavaviri Lindsay , Peckham-Cooper Adam , Toogood Giles , Smith Andrew 
Published: October 2021

Abstract

Aim
LTHT is the largest acute surgical unit in the UK and has seen an annual 11% increase in attendances with often 90 patients assessed daily. 40% patients present with acute biliary pathology but despite this there has been no dedicated operating list for this cohort of patients. Rapid Access Theatre (RAT) lists were created to manage these patients. We report our early results.

Method
In October 2020 the trust appointed four EGS Consultants forming a dedicated acute general surgical service. Emphasis was placed on creating ambulatory pathways and those patients safe to be managed at home but requiring surgical intervention are placed on a day case RAT list. COVID-19 has restricted the broad use of this service for all emergency admissions but biliary pathology continues to be amenable to these pathways. Data was collected retrospectively using in-house coding and electronic patient database systems.

Results
34 day case laparoscopic cholecystectomies were performed in the first 10 weeks. Mean age was 44(17-67) with a male:female ratio of 1:1. Mean wait time from clinical review to theatre was 11(3-23) days. 1 patient required overnight admission but there were no readmissions and no reported complications at 30 days.

Conclusion
Despite isolation restrictions resulting from COVID-19, the service has allowed patients to be assessed and treated in a timely, safe fashion. The new service has resulted in significant reductions in bed stays and improved patient experiences. Financial savings have been clearly delineated and as such expansion of the model is underway.
EP.FRI.476 Routine group and save sampling prior to elective laparoscopic colorectal cancer resection – Is it necessary?
Authors: Yang Peiming 
Published: October 2021

Abstract

Introduction
Laparoscopic colorectal cancer resection (LCCS) has been shown to reduce blood loss when compared to open surgery. There are no national guidelines regarding need for pre-operative group and save(G&S) sampling in LCCS patients. Our study aims to assess the necessity of G&S samples through identifying rates of post-operative transfusion following LCCS.

Methods
Retrospective study of all patients who underwent LCCS between 1st January 2019 and 31st December 2019.

Results
Of 102 surgical procedures, 42 right hemicolectomy, 21 anterior resection, 19 sigmoid colectomy, 12 left hemicolectomy, and 8 APER. The median age was 67(range 56-86) years. All received two valid G&S samples. 13 cases were converted.
The median pre-operative haemoglobin was 127g/L, and median post-operative haemoglobin was 114g/L. The median blood loss was &lt;100mls. Only 4(3.9%) patients required post-operative transfusion, 3 of whom were converted due to intra-operative bleeding. The fourth case had decreased haemoglobin post-operatively without need for return to theatre. A significant difference was evident in pre-operative haemoglobin level in patients who needed transfusion compared to those who did not (P = 0.031).
A total of 9 units were transfused. Twenty-one pre-operative cross-matched units were not used.

Conclusion
Evidently, blood transfusion is most likely required in open conversion cases due to intra-operative blood loss, as well as in patients with low pre-operative haemoglobin. A patient specific approach to assessing requirement for pre-operative G&S in elective LCCS patients is required to improve cost-effectiveness, particularly taking into account those with normal pre-operative haemoglobin.
EP.FRI.580 Negative appendectomy rates at a district regional hospital
Authors: Al-Azzawi Marwa 
Published: October 2021

Abstract

Aim
Emergency appendectomy is one of the most common emergency procedures done. Negative appendectomy rates vary and the aim was to identify the rate of it at a DGH.

Method
Appendectomy cases at a small regional hospital were during a 2-year period (2017-2018) were included. Elective and interval appendectomies were excluded. Histopathology findings were noted.

Results
78 patient had an emergency appendectomy, of which 87% (n = 68) had it done laparoscopically.
Normal appendix on pathology was found in 13.8% (n = 12) of the removed appendices. They were all removed laprascopically. The majority were females (n = 11) compared to males (n = 1). 58% of the normal appendix (n = 7) were identified as a macroscopically normal appendix. 36% of the females were mid-cycle (n = 4). The mean WBC on admission was 9.5 (4.8-13.6 x109/L) . All of the females had a transabdominal USS as initial investigation but was inconclusive.

Conclusion
Negative appendectomy rates are still high in female patients, whether doing further scans such as TVUSS or CTAP might reduce the risks of getting a negative appendectomy, needs to be discussed and tailored to each case, as the majority are young patients in the reproductive age group.
EP.FRI.596 A Tale of Two Ultrasounds
Authors: Blenkharn Christopher , Anwar Baseerat , Rao Praveen , Islam Jawad Ul 
Published: October 2021

Abstract

Background
Testicular torsion is a common cause of acute testicular pain, which requires immediate investigation and treatment. We describe a unique presentation of testicular torsion, which required the operating surgeon to assess the viability of a clinically dead testis through surgical manipulation, 16 hours after onset of pain.

Case Report
A 19 year old male presented with a 12 hour history of pain and swelling in the left scrotum. Examination revealed the left testes was hard, swollen and tender with a palpable spermatic cord. Clinical diagnosis of testicular mass or epididymo-orchitis was suggested and scrotal ultrasound was organised. This reported no blood flow in the left testis, and so torsion was suspected. Patient was taken immediately to theatre. Examination was performed under general anaesthetic, which revealed a hard, swollen testis, with no torsion clinically. Midline scrotal incision was made. On visual examination, left testis was black and hard, but there was no obvious torsion in the cord. However, during manipulation, the testis softened and started to change colour, eventually becoming dusky. A small incision into the testis showed bright red blood, and the decision was made to replace the testis and fix both testes. The patient made an excellent recovery post-operatively. Repeat ultrasound showed return of testicular vascularity.

Conclusion
This case showcases the importance of considering salvage in patients who have presented even after the generally accepted 6-8 hour time window. It also highlights the value of an experienced surgeon’s judgement in unusual presentations and with unexpected events intraoperatively.
EP.FRI.616 Novel Technique of Gastrojejunostomy Tube Insertion to Control Retracted Proximal Stoma
Authors: Allen Neill , McBride Rachael , Wallace William , Lyndsay Richard 
Published: October 2021

Abstract

Introduction
Extensive small bowel resection for ischaemia can require formation of a proximal jejunostomy. Depending on length of remaining jejunum, a major potential complication is stoma retraction with resultant peritonitis, intra-abdominal sepsis and enterocutaneous fistula formation.
We describe a case using a novel technique of inserting a retrograde gastrojejunostomy tube to gain control of an acutely retracted stoma in a 61 year old patient who developed an enterocutaneous fistula shortly after major resection due to ischaemia.

Method
Under fluoroscopic guidance, the retracted proximal limb of the jejunostomy was cannulated antegradely by guide wire. A gastro-jejunostomy tube was inserted retrograde over the guide wire and the tip placed within the stomach. The proximal tube fenestrations were sited within the duodenum and the balloon was inflated to limit enteric content spilling into the peritoneal cavity.

Conclusion
This technique enabled drainage of gastroduodenal fluid, minimised spillage into the peritoneal cavity, reduced fistula output and controlled sepsis. This allowed time for nutritional optimisation, better glycaemic control and endovascular revascularisation in preparation for restoration of intestinal continuity at an appropriate time.
This method offered a useful alternative to surgery, in a patient for whom emergency re-exploration of the abdomen would carry significant risk of morbidity or mortality.
EP.FRI.692 Gender differences in the age and outcomes of appendicectomy patients
Authors: Al-Azzawi Yassir , Khan Khurram , Miller Gillian , Lowrie Joanna , Thomas Rachel , Macdonald Andrew 
Published: October 2021

Abstract

Aims
Appendicectomy is one of the commonest emergency General Surgical operations performed. However, there exists minimal published literature exploring whether there are differences between males and females undergoing appendicectomy. This study aimed to investigate the demographics, pre-operative investigation, intra-operative findings and clinical outcomes between both genders having an emergency appendicectomy.

Methods
A multicentre retrospective cohort study of all patients who had an emergency appendicectomy within four UK hospitals between September 2019 and November 2020. Electronic records were interrogated and patients dichotomised by gender and the results compared.

Results
559 emergency appendicectomies (315 (56.4%) male and 244 (43.6%) female patients) were included. Males undergoing appendicectomy were younger (median age: 33 vs 41 years, p &lt; 0.001). American Society of Anaesthesiologists classification was equally matched. Whilst no difference in mean white cell or neutrophil count was identified, C-reactive protein was lower (mean 108 vs 137, p = 0.001) and bilirubin higher (mean 21 vs 15, p &lt; 0.001) in male patients pre-operatively. Pre-operative imaging was performed more often in females: ultrasound (16.0 vs 1.3%, p &lt; 0.001) and CT scan (69.3 vs 60.3%, p = 0.029). Male patients underwent more open surgery (13.7 vs 8.2%, p = 0.043). The intra-operative severity of appendicitis was equally matched. No differences in overall hospital length of stay (median 3 vs 3 days, p = 0.183), post-operative complication rates or 30-day readmission rates were identified.

Conclusions
This study demonstrates that differences exist between males and females who have emergency appendicectomy in terms of age, use of pre-operative imaging and operative approach, however, clinical outcomes are similar.
EP.FRI.749 Facial augmentation surgery: Perception vs. Reality
Authors: Saber Kashan , Mumtaz Shadaab , Oikonomou Chrysavgi 
Published: October 2021

Abstract

Background
In recent years, aesthetic surgeries have gained significant momentum. A recent audit identified that more than 28,000 cosmetic surgeries were performed in the United Kingdom (UK) in 2018.1. We present an unfortunate case of morbid complications related to the use of malar implant for cosmesis.

Case Presentation
A 63-year-old Caucasian female presented to the Emergency department with sepsis related to a large painful, tender swelling of the right side of the face. There was discharge of pus from two cutaneous sinuses with additional ectropion/chemosis of the right eye. An orocutaneous communication due to infection/migration of the implant was also noted. The patient reported a history of bilateral malar implants placement three years ago. The patient initially required emergency drainage & subsequent removal of the infected malar implant.

Discussion
Malar implants provide suitable volume enhancement providing structural and aesthetic benefits including the ‘high cheek bone’ appearance. It is generally considered to be a safe surgical technique with multiple approaches possible to insert the implant. including transoral approach). Spadafora (1971) & Hinderer (1972) first described the use of malar implants for facial augmentation.2,3 Rayess et al.(2017) conducted a 10 year review of complications related to facial implants & noted that 75% of complications related to malar implants were due to infection with 38% of these implants needing removal.4

Conclusion
There is a surge in presentations of complications related to cosmetic facial surgery and knowledge of these adverse effects is essential to appropriately manage these patients & their concerns.
EP.FRI.792 Laparoscopic port positioning in paediatric appendicectomy - a closed loop audit
Authors: Stefanova Irena , O'Brien James , Pencavel Timothy 
Published: October 2021

Abstract

Aims
Laparoscopic appendicectomy is the most common laparoscopic procedure performed in children, typically with a suprapubic (SP) left-hand port position. This has been associated with bladder injury. Pre-operative bladder emptying can reduce the risk of this complication. The aim of this study was to evaluate compliance with local policy mandating left iliac fossa port placement (LIFPP) rather than SP. We assessed the rate of LIFPP before and after an educational intervention, and also audited if voiding status was included as part of the paediatric WHO checklist.

Methods
Retrospective data was collected before and after implementation of education, for 50 consecutive patients aged &lt;16 years undergoing laparoscopic appendicectomy. The education programme targeted operating department practitioners, paediatric nurses and surgeons, and included seminars and regular dissemination of the local protocol. Data analysis was performed using GraphPad Prism.

Results
Patients were evenly distributed by gender with 94% above the age of 10. Mean age was 13.8 years. There was a statistically significant improvement in compliance with LIFPP, from 72% to 100% (p &lt; 0.0001) after introduction of improved education, as well as significantly improved documentation of pre-operative voiding status from 12% to 40% (p = 0.0026). The rate of catheterisation intra-operatively was reduced from 20% to 8% (p = 0.1478).

Conclusions
Improved education has led to a significantly increased compliance with local port placement policy. Documentation of pre-operative voiding status has been included in the paediatric WHO checklist ‘SIGN IN’ section locally.
EP.FRI.815 Hartmann’s at 100: Relevant or Redundant?
Authors: Frakas Nicholas , Conroy Michael , Harris Holly , Kenny Ross , Baig Mirza 
Published: October 2021

Abstract

Introduction
Henri Albert Hartmann first described resection of the rectosigmoid colon and exteriorization of the bowel with a colostomy in 1921. As we approach the centenary anniversary of Hartmann’s procedure we feel it is the appropriate time to discuss this significant surgical advancement and its relevance in modern day surgery.

Methods
We provide a contemporary overview of the literature, highlighting various aspects of the Hartmann’s procedure applicable to both today’s clinical practice and that of tomorrow.

Results
Hartmann’s procedure was initially performed for colorectal carcinoma in 1921. One hundred years on, the Hartmann’s procedure remains a safe and effective option in select patients with colorectal cancer and at high risk of anastomotic failure. In recent years, the majority of Hartmann’s procedures have been performed for benign disease and the majority of these cases are in the emergency setting. As hospital admissions with acute diverticulitis continue to rise steeply, the importance of the Hartmann’s procedure in the field of surgery continues. Hartmann’s procedure has adapted as surgery has advanced. Hartmann’s is now performed both laparoscopically and robotically with good postoperative outcomes.

Conclusions
In 1921, few would have predicted how modern day medicine and surgery is today. Hartmann’s procedure has survived the surgical test of time, and its key principles remain the same. As we look to the future, it is unlikely that it’s role will be lost to surgical advances, but to alternative management modalities in disease prevention.