bluuebunny/crossref_metadata_2025_split huggingface dataset:
1630 Laparoscopic Repair of Linea Arcuata Hernia Presenting as Generalised Abdominal Pain - a Case Report
Authors: Sayers A , Ain Q , Thomas R , Laliotis A 
Published: October 2021

Abstract

Background
Arcuate line hernia (LAH) is an abnormal ascending herniation of intraperitoneal structures over the linea arcuate, between the rectus abdominus muscle and the posterior layer of its sheath. It is a rare clinical entity often associated with non-specific abdominal pain, posing a significant diagnostic challenge. The true prevalence is unknown, and diagnosis is almost always radiological.

Case Report
We report the case of a 57-year-old lady investigated extensively for frequent episodes of generalised abdominal pain. No palpable hernial defect or other pathology was identified on clinical examination. Subsequent computed tomography(CT) of the abdomen and pelvis revealed a 95 x 74 mm arcuate line hernia(LAH) anterior to the transversalis fascia, containing small bowel loops. She underwent an elective laparoscopic repair involving closure of the hernial defect with 2-0 knotless barbed sutures and reinforcement with a 20 x 15 cm underlay mesh. Postoperative recovery was uneventful, with complete resolution of her symptoms. One year after the repair there were no signs of recurrence.

Discussion
To our knowledge, only eleven prior cases of symptomatic LAH have been reported in the literature. There is no conclusive evidence regarding most appropriate diagnostic imaging, treatment approach and follow up regimen. Clinical diagnosis is difficult. Existing literature suggests use of CT scan as the primary imaging modality for diagnosis. The laparoscopic approach is safe, feasible and has certain advantages. This includes confirmation of diagnosis, excludes the presence of concomitant hernias and enables inspection of herniated viscera. Prosthetic mesh reinforcement is considered to minimise recurrence. Long term follow-up of these patients is required
1664 A rare case of Stenotrophomas maltophilia affecting an ACL Endobutton: A Case Report and Review of the literature
Authors: Adewusi M , Roy K , Joshi Y 
Published: October 2021

Abstract

Background
Stenotrophomas maltophilia (SM) is a ubiquitous opportunistic gram-negative bacillus known to cause hospital acquired infections, commonly in immunosuppressed individuals. However, occurrence of this microorganism is rarely reported in the musculoskeletal system. We report a case of a young healthy man with recurrent knee swelling caused by SM. This organism has been reported to form biofilms over orthopaedic implants, with increased resistance to antibiotic therapy, making it difficult to eradicate once established.

Case Report
A 34-year-old man with psoriasis and asthma presented with right knee swelling and pain, and no history of preceding trauma or fever. He has a past surgical history of anterior cruciate ligament tear and underwent reconstruction with an endobutton two years prior, and a lateral meniscal repair treated in the previous year. At presentation, he was apyrexial and was noted to have a moderate right knee effusion. Initial radiographic imaging identified a large joint effusion with no obvious evidence of bone destruction, laboratory studies also showed a raised white cell count of 11.4 *10^9/L, C-reactive protein of 54mg/L and aspiration cultures were negative. He subsequently underwent numerous washouts, and removal of endobutton with open synovial biopsy which showed SM. The organism was sensitive to cotrimoxazole. The patient had appropriate antibiotics with resolution of symptoms, however he still presented with recurrence.

Conclusions
The persistence of SM despite intervention makes it difficult to treat. Although a rare organism, surgeons should consider it as a differential in recurring knee effusion with orthopaedic implants, and institute early and appropriate management for best outcomes.
1669 Ureterosciatic Hernia: A Case Report and Review of the Literature
Authors: Woo C A , Quraishi M K 
Published: October 2021

Abstract

Aim
Ureterosciatic hernia (USH) is an extremely unusual condition, with presentations ranging from asymptomatic, to flank pain, renal failure, septic shock and even obstructive uropathy. Due to its rarity, there are no recommendations on the treatment of USH. We therefore carried out a systemic review of published literature on its management.

Method
The systemic review was completed using three search terms: “uretero sciatic hernia”, “ureterosciatic hernia” and “ureteric sciatic hernia” on Healthcare Databases Advanced Search, producing 224 potential papers. This was narrowed down to 42 papers after using the PRISMA guidelines. All selected papers included a case report of USH, as well as the investigation and management in English only.

Result
We report a case of an 85-year-old female who was investigated for weight lost with Computed Tomography(CT), which showed an incidental finding of USH. She was managed conservatively after she denied any symptoms and had no hydronephrosis. Abdominal pain was the most common presentation of USH(64%), whilst only 9.5% were found incidentally. 79% of all patients had a CT scan which showed the pathognomonic “curlicue” sign. 55% of all patients had hydronephrosis. Half of all patients had surgical intervention, from open repair to laparoscopic to robotic(9.5% of all management)with no known mortality. Conservatively management(16.6%) was reserved for asymptomatic/poor surgical candidates, and were more likely to be followed up compared to surgical patients(55.5%vs47.6%).

Conclusions
Our case is of an incidental USH managed conservatively, with a literature review emphasising similarities to our case and the different management options.
188 Right Hemicolectomy with End-To-Side Circular Stapled Ileo-Colic Anastomosis: Evaluation of Outcomes in A Series Of 55 Consecutive Patients
Authors: Angamuthu N , Froghi F , Shah S , Mirnezami R , Knowles J 
Published: October 2021

Abstract

Background
Stapled ileo-colic anastomosis is a well-established alternative to hand-sewn anastomosis after right hemicolectomy. A side-to-side configuration (SSA) is the option commonly practiced. This study describes our experience using a less well described technique, using an end-to-side circular stapled ileo-colic anastomosis (ESSA).

Method
Consecutive adult patients undergoing a right or extended- right hemicolectomy with ESSA for colonic cancer between July 2013 and March 2020 were included. Perioperative outcomes including anastomotic leak and anastomotic bleeding were extracted from a prospectively maintained institutional database. The Clavien-Dindo classification was used to stratify post-operative complications. Data are presented in medians and IQR.

Results
Right hemicolectomy with circular stapled ESSA ileo-colic anastomosis was performed in 55 consecutive patients (M:F 26:29) by a single surgeon at a tertiary referral centre. Over half of patients (54.5%, 30/55) were in the 8th and 9th decades of age with a median BMI of 26.5 (IQR:24-30.7). Median postoperative length of stay was 6 days (IQR:4-8) and the overall morbidity rate was 34.5% (19/55). Anastomotic leak and anastomotic bleeding were seen in 5.45% (3/55) and 3.64% (2/55), respectively. None of the patients with leak or bleeding needed a re-operation.

Conclusions
In comparison to the widely used SSA type of ileo-colic anastomosis, the ESSA configuration using a circular stapling device is a viable option for restoring bowel continuity after right colonic resections with comparable results. Potential advantages of this approach include avoidance of cross stapling and improved ileo-colic anatomical fidelity.
269 Outcomes of Modified Karydakis Flap in The Surgical Management of Sacrococcygeal Pilonidal Disease: A Single Surgeon’s Experience
Authors: Alam F , Farooq D , Theofilis A , Wooler H , Payne R 
Published: October 2021

Abstract

Aim
To determine the incidence of post-operative complications of patients with sacrococcygeal pilonidal disease who were treated with the Modified Karydakis flap with a specific management bundle. Primary outcomes assessed included the post-operative incidence of seroma, haematoma, SSI, deep SSI, wound dehiscence, re-admissions, return to theatre and flap necrosis. Secondary outcome evaluated was recurrence at 6 months follow up.

Method
It was a retrospective analysis of a single surgeon’s (FA’s) practice results of Modified Karydakis flaps on patients with sacrococcygeal pilonidal disease who were managed according to a specific protocol (fig. 1). Data was collected between June 2017 and June 2020. 96 patients were analysed, of which 9 were excluded as they only had excision without closure. Pre, per and post-operative management of the remaining 87 patients was according to a standardised protocol (fig. 1). Data was collected from patient’s notes and from prospectively and retrospectively maintained patient data bases (Theatre System, Medway).

Results
Primary outcomes:
Secondary outcome:

Conclusions
Good surgical results can be obtained with Modified Karadakis flap, provided meticulous surgical technique is applied. Placement of a suction drain for a minimum of 72 hours reduces incidence of post-operative haematoma and seroma formation. Three post-operative doses of broad-spectrum intravenous antibiotics followed by 5 days of oral antibiotics helps reduce post-operative infections.
386 Is the Routine Histopathology of Haemorrhoidectomy Specimens Cost Effective?
Authors: Ng G S 
Published: October 2021

Abstract

Introduction
The necessity for routine histopathologic evaluation of hemorrhoidectomy specimens has been controversial, yet it is commonplace in many hospitals. The cost effectiveness was analysed in a regional hospital in Queensland. Our secondary aim was to also determine the incidence of unexpected abnormality in haemorrhoidectomy specimens.

Method
This is a retrospective study between March 21st 2012 – April 30th 2020 in a regional hospital in Queensland, and approved by the Health Service Human Research Ethics Committee as a low risk research project. We used Operating Room Management Information System (ORMIS) to obtain a total number of 122 haemorrhoidectomies. The cost of histopathological analysis of a haemorrhoidectomy specimen is AUD$174.65.

Results
We found that 122 haemorrhoidectomies were performed over the study period. Of these, 66.39% (n = 81) haemorrhoidectomy specimens were sent for routine histopathology. 84.4% (n = 103) were done via the Milligan-Morgan technique. There was intra-operative suspicion of abnormality in 2 cases; histology showed no dysplasia. In total, no specimens had any evidence of dysplasia or neoplasia.

Conclusions
Routine pathological evaluation of hemorrhoidectomy specimens is not useful and is expensive, as unsuspected anal carcinoma is a rare occurrence and was not demonstrable in the study period. However, a careful pre-operative examination should be performed as unsuspected carcinoma of the anus diagnosed solely by microscopic analysis has been described in the literature. Any suspicious areas should be sent for microscopic evaluation. At a cost of AUD$174.65 per specimen, approximately AUD$1,768.33 could have been saved per annum, or AUD$14,146.65 in 8 years.
429 Preoperative Risk Assessment In Elective Colorectal Patients
Authors: Cernei C , Grossman R , Bodger O , Williams J , Pritchard C , Goede A 
Published: October 2021

Abstract

Introduction
Cardiopulmonary Exercise Testing (CPET) and the Colorectal Physiology and Operative Severity Score (CR-POSSUM) are increasingly used in colorectal surgical practice to risk-stratify patients preoperatively and for planning level 2 HDU or ITU admission. This study aims to generate a simple, objective pre-operative risk assessment model to complement clinical judgement, and to determine objectively for whom CPET is necessary in colorectal pre-assessment.

Method
A retrospective cohort study was conducted. Demographic and perioperative data were gathered, and CR-POSSUM score was determined retrospectively. Mortality at 12 months was considered the primary outcome with readmissions up to 12 months as secondary outcomes. Statistical analysis used Binary Logistic Regression, and odds ratios were reported with confidence intervals. A new combined pre-operative risk assessment model with the most significant individual predictors was constructed.

Results
Some 167 elective patients were included in the final analysis. Half of patients had planned HDU admissions. The all-cause mortality at 90 days was 3.5% and at 12 months was 11%. Readmission rate at 30 days was 10%, with a further 11.3% at 90 days postoperatively. The ASA, Physiology Score and Operative Severity Scores correlated with mortality rates (p &lt; 0.05). Current diagnostic performance using CPET vs. the combined model identified 48% and 35% ‘high risk’ patients with 83.3% and 56.5% vs 94.4% and 76.1% sensitivity and specificity, respectively. The model draws its predictive power mainly from the CR-POSSUM.

Conclusions
Current practice at the study centre produces outcomes above the national average. The process can be improved whilst focusing resources further using the combined model.
533 Diverticular Disease and Diet: Are We Doing Enough?
Authors: Jamshad F , Al-Zubaidy R , Ahmed R , Singhal T 
Published: October 2021

Abstract

Introduction
Diverticular disease (DD) is a major burden on healthcare systems globally, especially in the western world. DD accounts for the second most common indication for elective colorectal resections, with each resection costing the NHS a minimum of £5000. Since dietary advice is an integral part of the management of DD, we aim to investigate the proportion of patients that receive documented dietary advice or guidance on their stay in hospital.

Method
A list of all admissions related to DD from June to November 2019 was obtained from the HIPE Department in Princess Royal University Hospital. Our Electronic patient record system was used to extract information regarding patient demographics, length of stay in hospital and the presence of documented evidence that dietary advice was given to patients.

Results
A total of 57 patients were admitted due to DD over a six-month period in 2019. 41 were female and 16 were male. They had a mean age of 67.1 and an average length of stay of 6.3 days. 12 of the 57 (21%) had some form of surgery either as an emergency or electively after discharge. Only 15 (26%) received dietary advice of which only 9 were referred to a dietician.

Conclusions
DD is a major contributor to surgical admissions requiring both elective and emergency surgery. It is largely a preventable disease; hence health care staff should take more initiative to highlight the importance of lifestyle modification to patients whenever the opportunity arises, with the target to benefit public health and free healthcare resources.
804 The Role of Kono-S Anastomosis and Mesenteric Resection in Reducing Recurrence After Surgery for Crohn’s Disease: A Systematic Review
Authors: Alshantti A 
Published: October 2021

Abstract

Aim
Recurrence after surgery for Crohn’s disease is common. Anastomotic configuration may influence recurrence and the mesentery may be key.The Kono-S anastomosis and radical mesenteric excision have been proposed as methods of reducing recurrence. We analysed the literature pertaining to these novel techniques.

Method
We searched MEDLINE, Embase and the Cochrane Library for, studies evaluating Kono-S anastomosis and/or radical mesenteric excision in Crohn’s disease. We assessed methodological quality and risk of bias using the Cochrane tool for randomized controlled trials and the JBI tool for nonrandomized trials. A narrative synthesis was used to summarize the findings.

Results
Nine studies (896 patients) were identified. Apart from one randomized controlled trial with a low risk of bias the overall level of evidence was poor (Grade IV). The Kono-S anastomosis was associated with a lower incidence of endoscopic and surgical recurrence (0%–3.4% vs 15%–24.4% respectively). Complications, particularly anastomotic leak rate, were also lower (1.8% vs 9.3% respectively). Evidence from a single poor-quality study suggested that mesenteric excision may reduce surgical recurrence rates compared with mesentery preservation.

Conclusions
The existing literature suggests that the Kono-S anastomosis is safe and may reduce endoscopic and surgical recurrence, but level of evidence is mainly poor. One element of the Kono-S technique, preservation of the mesentery, may be detrimental to recurrence. Further, higher quality, studies are required to investigate these techniques. Such studies should consider the impact of the degree of mesenteric resection in addition to the anastomosis on disease recurrence.
869 Colorectal Cancer Referral Pathways: Impact of First Months of COVID-19
Authors: Spyropoulou L E , Li M , Curley D , Martin E , Wynn G , Doulias T 
Published: October 2021

Abstract

Introduction
Whilst daily living has adapted to the “new normal” during Covid-19, colorectal cancer pathways are yet to be revised to reflect this transformation. Government advice to stay at home, hospital avoidance and reduced healthcare access, may be masking a significant proportion of population at risk. We aim to identify changes in colorectal cancer target pathways.

Method
All cancer referrals during the initial Covid-19 period were retrospectively analysed, recording type and date of first clinic and investigation, MDT discussion and decision to treat dates. A comparison was made with referral and treatment data from the same referral period in 2019.

Results
338 referrals were received during March-April 2020, compared to 542 in 2019, indicating a 37.6% decrease. A high proportion of patients were reviewed by telephone clinic (63.4%) rather than face-to-face (23.8%), representing a significant shift in practice. An increasing number of patients were initially investigated by CT(40.2%) instead of endoscopy (37.8%). 51(15.5%) patients were not investigated, with COVID-19 being the commonest reason. 25 patients were diagnosed with colorectal cancer, of which 8(32.0%) breached the investigation and 13(52.0%) the treatment date, both usually postponed due to the pandemic. There was a 66.7% reduction in surgical management compared to 2019.

Conclusions
Two-week wait pathways are strained in the era of Covid-19. As the fight against the global pandemic continues, patients are mostly seen virtually and receive non-gold standard investigation. With fewer patient presentations and elective surgeries, it is important to continue colorectal cancer surveillance and timely treatment, considering possible alternative pathways.
1029 Evaluation of Significant Polyp and Early Colorectal Cancer (SPECC) MDT In A District General Hospital
Authors: Pereira I , Kulkarni N , Dalton M , Azhar A 
Published: October 2021

Abstract

Aim
There is an increase in the number of complex SPECC cases presented at colorectal MDT meetings with a wide variation in the treatments offered to patients, many of whom undergo high-risk and life-changing surgical resection. This study aimed to evaluate the detection, diagnosis and treatment of early colorectal cancer since the introduction of a SPECC MDT.

Method
This was a retrospective audit of 108 patients, from the SPECC MDT database from January 2014 to December 2019. Primary outcome assessed the recognition of lesions using endoscopy and radiological evaluation to assess depth of invasion and lymph node involvement. Secondary outcomes included definite treatment, pathological reporting and recurrence.

Results
Overall, mean age of 72, 79% had one or more significant co-morbidity. Clinical presentation; 61 asymptomatic, 46 symptomatic and 31 referred from the national bowel cancer-screening programme. All patients (n = 108) had endoscopic assessment the lesions were, 53% sessile and 47% pedunculated; 78% of the lesions were found in the rectum. We observed surgical management in 31 cases, endoscopic in 28, chemo-radiotherapy in 12 and 3 cases were palliative. However, 17 (n = 108) underwent failed endoscopic resection and required surgical intervention. Recurrence was observed in 17.6% of cases and mortality in 4%.

Conclusions
Pathological reports provide a definitive answer to questions of malignancy but SPECC can be challenging in all areas. A specialist MDT allows for appropriate assessment and treatment of lesions and leads to better patient outcomes.
1057 Outcome Reporting Following Rectopexy Requires Standardisation for Reproducibility and Transparent Outcome Analysis
Authors: Wa Katolo H , Fleming C , Wilkinson G , Brannigan A 
Published: October 2021

Abstract

Aim
Rectopexy is a surgical procedure commonly used to correct rectal prolapse. Several studies have investigated different approaches (abdominal, perineal) and techniques (open, laparoscopic, robotic) in this field however reporting outcomes vary significantly among studies impeding comparison of techniques. We aimed to comprehensively analyse primary outcome reporting methods following rectopexy in published literature.

Method
A systematic search was performed in keeping with PRISMA guidelines and search protocol registered with PROSPERO. Published databases were searched using the following terms: “rectopexy”, “abdominal rectopexy” and “rectopexy outcomes”. Randomised controlled trials, comparative and non-comparative prospective and retrospective studies published between 1992 and 2019 were included for analysis. Review articles, letters, editorials, abstracts, and non-English language studies were excluded. A narrative description of outcomes was reported.

Results
A total of 1089 articles were screened, and 32 articles were identified as suitable for inclusion, reporting on 1780 patients who underwent rectopexy surgery. Over 30 unique methods of reporting outcomes were recorded, with the most common being the rate of recurrence (n = 15), Cleveland Clinic Faecal Incontinence score (CCIS) (n = 11), and customised symptom questionnaires (n = 10). Many studies recognised the impact of symptoms of rectal prolapse on patients’ quality of life (QoL) however, few utilised standardised quality of life scores to evaluate the outcome of the procedures.

Conclusions
As surgical technique evolves in rectopexy, incorporating minimally invasive surgery and robotic surgery, it is important that outcome reporting is standardised to facilitate transparent comparison. Improving patient QoL is the mainstay of surgical intervention and it is important that QoL outcome measures are incorporated.