bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.TH.342Using aboutmyop.org to measure quality of life using ePROMs in patients undergoing elective laparoscopic cholecystectomy – a feasibility study
Authors: Daliya Prita , Lobo Dileep , Parsons Simon 
Published: October 2021

Abstract

Introduction
The collection of Patient Reported Outcome Measures (PROMs) have many benefits for clinical practice. However, there are also many barriers that prevent it from becoming a part of routine clinical care. The aim of this study was to pilot the use of aboutmyop.org; a digital data-sharing platform, as a means to collecting electronic PROMs (ePROMs) and validate the ePROMs questionnaires used.

Method
Patients listed for elective laparoscopic cholecystectomy were asked to complete digital versions of the Otago gallstones Condition-Specific Questionnaire (CSQ), and the RAND 36-item health survey (SF36) on aboutmyop.org, pre- and post-operatively. In addition to ePROMs, patient demographics and 30-day clinical outcomes were recorded. An assessment of methodological quality of ePROM questionnaires was also performed.

Results
Pre-operative ePROMs were completed in 200 laparoscopic cholecystectomy patients. Despite participant drop out a significant improvement in quality of life was seen across all health domains post-operatively when compared to baseline pre-operative values for both disease-specific (emotional functioning; Pre-operative: 48.9, 30-days: 15.6, 3-months: 16.7, 6-months: 7.9, p &lt; 0.05) and generic (emotional well-being; Pre-operative: 60.1, 30-days: 73.7, 3-months: 74.3, 6-months: 73.5, p &lt; 0.05) PROMs. Methodological quality was assessed as good to excellent in both digital questionnaires used in the aboutymyop.org system.

Conclusion
The collection of ePROMs by a digital utility such as aboutymyop.org is possible with current technological advances. Although it may be an acceptable, and convenient process for patients, and a useful measure of quality of life trends for clinicians, further developmental work is necessary to improve accessibility for patients and reduce reporting bias.
EP.TH.359Improved Oesophagogastric Cancer Outcomes in Rural Patients
Authors: Griffin Fiona , Hunter Ross , Nanthakumaran Shayanthan , Ramsay George 
Published: October 2021

Abstract

Introduction
Despite advances in medical therapies and surgical techniques, oesophagogastric cancer survival remains low. Poorer cancer outcomes and survival for rural dwellers is well documented worldwide and has been an area of focus in Scotland since 2007, with changes to suspected cancer referral guidelines and a government report on delivering remote and rural healthcare.

Methods
A prospective, single-centre observation study was conducted utilising data from oesophago-gastric cancer MDT referrals and outcomes from January 2013 to December 2019. The Scottish Index of Multiple Deprivation 2020 tool provided a rurality code based on patient postcode at time of referral. Survival outcomes for urban and rural patients were compared across demographic factors, disease factors and stage at presentation.

Results
1046 patients were included in this study. The median age of presentation for urban and rural patients was 73.7 and 72.4 respectively. There was no significant difference between oesophageal versus gastric cancer presentations nor was there any difference between T, N or M stage at presentation between the groups. No difference was identified between those commenced on a radical therapy with other treatment plans. On Kaplan-Meier analysis there was a difference in survival between the groups favouring rural dwellers (p = 0.012).

Discussion
The difference in survival demonstrated here between urban and rural groups is not easily explained but may represent improvements to rural access to healthcare delivered as a result of policy change. This is an interesting finding and this study should be expanded to include performance status at time of referral.
EP.TH.421A Systematic Review of Early versus Late Closure of Loop Ileostomy
Authors: Aljorfi Ahmed , Alkhamis Abdulhameed 
Published: October 2021

Abstract

Aim
A Loop ileostomy is one of the most common techniques used in colorectal surgery, in order to protect either a downstream colorectal anastomosis or a coloanal anastomosis. However, it is a procedure that can cause a plethora of complications. Currently, there is no consensus regarding the optimal time for its reversal. Some studies suggested the early reversal of ileostomy procedure as a solution to reduce these complications. This study aims to review the available literature in order to ascertain the benefits behind early closure of loop ileostomy.

Methods
The literature was searched for all studies that included a comparison between the outcomes of early and late closure of loop ileostomy in terms of morbidity, mortality, or quality of life, where available. Early closure of loop ileostomy is defined as closure less than three months and late as more than three months, in accordance with conventional literature. The resultant articles were filtered using our inclusion and exclusion criteria. Finally, the remaining articles were assessed for quality and their results were compared to one another in order to draw our conclusions.

Results
The results were slightly inclined toward early closure of loop ileostomy, despite the limitations of the studies reviewed.

Conclusion
There were limitations of the studies reviewed, including the heterogenicity of studies, selection bias, lack of clear definition of measured outcomes, and small sample size. Taking that into consideration, the results of early closure of loop ileostomies in the selected patients were promising and require further investigation.
EP.TH.494Preclinical feasibility of in situ isolated normothermic liver chemoperfusion
Authors: Clark Tamsyn , Ebeling Georg , Voyce Daniel , Bau Luca , Coussios Constantin , Friend Peter 
Published: October 2021

Abstract

Aims
Up to 85% of patients with liver metastases have inoperable hepatic tumour burden. Isolated liver perfusion involves vascular isolation of the liver in situ and regional delivery of chemotherapy, avoiding dose-limiting extra-hepatic toxicity. In this series, we develop a surgical protocol to demonstrate the feasibility of isolated normothermic liver perfusion (INLP) and investigate short-term safety and feasibility of delivering high-dose chemotherapy.

Methods
Laparotomy and complete, vascular isolation of the liver was performed on 55-65Kg pigs (n = 6). The hepatic artery (HA), portal vein (PV) and inferior vena cava were cannulated and liver NMP established. Veno-venous bypass maintained systemic circulation. High-dose doxorubicin was administered to the isolated liver, circulated for 1 hour and vascular reconnection performed. Physiological parameters were measured and doxorubicin quantified in blood, bile and tissue by high-performance liquid chromatography.

Results
INLP with doxorubicin delivery achieved physiological flow rates (PV 0.7L/min (0.6-0.9L/min); HA 0.3L/min (0.2-0.4L/min)) and pH (median 7.3 (7.24-7.38)), with a median lactate of 0.42mmol/L. Median peak AST and ALT were 1045 U/L and 47 U/L respectively. Doxorubicin decay was fitted with a 2-compartmental model; distribution half-life was 1.9 minutes and plasma Cmax was higher than if given systemically resulting in mean hepatic tissue levels of 26+/-11.6 µg/g. There was no leak during INLP and doxorubicin was undetectable in kidney or heart.

Conclusions
Surgical isolation and NMP of the liver in situ, with concurrent veno-venous bypass is feasible and enables high-dose drug delivery resulting in therapeutic tissue levels with no off-target toxicity. Further safety studies are required.
EP.TH.594Is Laparoscopic Common bile duct exploration feasible after failed ERCP?
Authors: Al-Ardah Mahmoud , Barnett Rebecca , Whewell Harriet , Boyce Tamsin , Rasheed Ashraf 
Published: October 2021

Abstract

Aims
Concomitant gallstones and common bile duct stones are a common problem with no consensus on the best management approach. Our aim is to review the outcomes of laparoscopic clearance of common bile duct stones after failed ERCP.

Methods
We retrospectively studied all cases that had a failed ERCP prior to surgery in 200 cases of laparoscopic cholecystectomy with common bile duct exploration performed between 2006 and 2019.

Results
Twenty-two patients underwent a laparoscopic common bile duct exploration after failed ERCP. Seventeen of these were before 2013. Eleven (50%) of these were after at least one failed attempt at clearance. In 8 patients (32%) the duct was not accessible (failed cannulation) due to a variety of reasons. Nine patients had large and impacted stones, two patients had Mirrizi syndrome with concomitant CBD stones, 2 had multiple stones and one a missed stone discovered intraoperatively.
CBD clearance was successful in 19 patients (88%), 8 were completed by a transcystic approach and 14 by a transcholedochal approach.
Post-operative length of stay was 12 (±10) days. 1 patient had an unplanned re-admission within 30 days. 1 patient required re-operation for bleeding. 3 patients developed recurrent stones and 1 developed a subsequent stricture. No mortalities were recorded.

Conclusions
Laparoscopic common bile duct exploration is feasible and safe as a secondary procedure after failed ERCP. New technologies and advancements in surgical techniques will continue to improve success and morbidity.
EP.TH.602Exploring decision-making of healthcare professionals in patients with benign large non-pedunculated colonic polyps (BLNPCP) virtually using combined focus group and nominal group technique
Authors: Wheldon L , Morgan J , Lee MJ , Riley S , Brown SR , Wyld L 
Published: October 2021

Abstract

Aim
We aimed to elicit key factors that influence healthcare professional decision-making when deciding treatment for BLNPCP.

Background
Benign large non-pedunculated colonic polyps (BLNPCP) may harbour covert malignancy and opinions differ about the optimal treatment modality. There are several options available, including endoscopic mucosal resection, endoscopic submucosal resection, combined endoscopic laparoscopic surgery and surgical resection. Despite widespread availability of endoscopic resection techniques, there are high rates of surgery in the UK.

Methods
Three focus groups of healthcare professionals, comprised of either consultant colorectal surgeons, nurse endoscopists and consultant gastroenterologists, were conducted virtually utilising the Nominal Group Technique. Meetings were recorded and transcribed verbatim. Themes were devolved using the framework approach for qualitative analysis. A priority-ranked list of factors influencing healthcare professional decision-making in this setting was generated.

Results
Five main themes were identified as influencing decision-making: Shared decision making (patient preference, informed consent); Patient factors (co-morbidity, age, life-expectancy); Polyp factors (Location, size, morphology, risk of cancer); Healthcare professionals (skill-set, personal preference); System factors (techniques availability locally, regional referral networks). Nominal Group Technique generated 55 items across the three focus groups. Nurses and gastroentologists ranked patient factors (particularly drug history and tolerance of procedure) and shared decision making (patient preference) more highly then surgeons. Surgeons placed greater emphasis on polyp factors particularly location and the risk of submucosal invasive carcinoma.

Conclusion
Decision making is complex and multifactorial. These results support the benefits of complex polyp MDTs and patient involvement in the decision-making. The complexity of decision-making may underpin wide variation in practice.
EP.TH.625Consenting for a Bedside Procedure: A Prospective Observational Analysis of Consenting Practice in the Surgical Emergency Admissions Unit of a District General Hospital
Authors: Mishra Shashwat , Davis Heather , Balakumar Charannya , Shrestha Ashish 
Published: October 2021

Abstract

Aims
Consent is necessary to enable patient autonomy and essential to providing good clinical care. Recent case law has grown around consent and practice guidance has evolved. This was a prospective, observational study consisting of two cycles. It investigated the quality of consent for bedside incision and drainage (I&D) procedures performed in the surgical emergency admissions unit (SEAU) at a district general hospital compared with GMC guidance.

Methods
A prospective analysis of consent documentation was performed from August to September 2020. Data was gathered for quality of consent including risk and benefit discussions, local anaesthetic used, operation note documentation and procedure discussion. We communicated these results at a departmental level, increased awareness of available consent forms and placed them in more accessible locations. Data to see the benefit of these interventions were gathered from November 2020 to January 2021.

Results
In cycle one, of 20 cases (n = 20), 5.0% had written consent documentation, and 75.0% had verbal consent documentation. 20.0% of cases had no consent documented. Following interventions, of 14 cases (n = 14), 57.1% of cases had written consent documentation, and 7.14% had verbal consent documentation. 35.0% of cases had no consent documented.

Conclusion
This study highlighted a deviation from GMC guidance. Interventions have shown to increase the proportion of cases with written consent. Overall cases with no written evidence of consent remain high and further work is required to increase compliance. We aim to refine the interventions we have implemented in order to promote the highest quality of consent documentation.
EP.TH.640Outcomes in Elective and Emergency Laparoscopic Cholecystectomies in a District General Hospital
Authors: Nur Ahmed , Agrawal Aditya 
Published: October 2021

Abstract

Aims
To evaluate early perioperative outcomes following emergency and elective laparoscopic cholecystectomies in a district general hospital against the national average.

Methods
A retrospective audit was carried out on consecutive Laparoscopic Cholecystectomies performed between January 2020 and June 2018. All indications were included. Demographics and base data included; age, gender, ASA grade, type of surgery (Emergency/Elective), number of symptomatic days preoperatively, preoperative bloods, preoperative ERCP, operative findings, postoperative complications and length of stay. Data was gathered from physical and electronic patient records.

Results
166 laparoscopic cholecystectomies were included in the audit. Of the 166 included patients, 48 were male and 118 were female. Mean age at time of operation was 53.4 years. 106 of the laparoscopic cholecystectomies were carried out as Elective cases and 60 were performed as Emergencies. 100% of cases were performed laparoscopically, with 3 cases requiring conversion to open intraoperatively. Postoperatively, 5 patients had post-op pneumonia. There were 3 documented cases of bile leak with 1 patient requiring ERCP as a result. There were 2 cases of wound infection requiring re-admission. Other documented complications included; umbilical port sit abscess requiring incision and drainage, collection in the gallbladder fossa, small bowel injury and a post-op drop in Haemoglobin requiring transfusion.

Conclusions
Outcomes in this cohort of patients undergoing laparoscopic cholecystectomies are comparable to national data. The focus of further evaluation from this cohort should be to compare outcomes between Emergency and Elective Laparoscopic Cholecystectomies, with Emergency cases further stratified according to the number of symptomatic days preoperatively.
EP.TH.649Identifying Factors Associated with Readmissions after acute biliary admission. Can it help prioritising patients in COVID recovery plans?
Authors: White Annabelle , Refalo Andrew , Widlund Hedda. , Knight William , Ebied Husam 
Published: October 2021

Abstract

Aim
We conducted a retrospective analysis of readmissions after Acute admission with biliary pathology managed conservatively under the Surgical Team in a teaching London Hospital from 01/03/2019-29/02/2020

Methods
We obtained records of patients admitted with Acute Cholecystitis, Biliary Colic, Cholelithiasis, Choledocholithiasis and Gallstone Pancreatitis from the Audit Department between 01/03/2019-29/02/2020, and analysed these regarding patient demographics, comorbidities, duration of index admission, method of diagnosis and management and identified patients’ readmissions
Differences in readmission rates based on before mentioned characteristics were studied.

Results
157 patients presented between 01/03/2019-29/02/2020, 76 acute cholecystitis, 22 Biliary Colic, 24 Gallstone Pancreatitis, 6 Ascending Cholangitis and 29 Choledocholithiasis
The highest representation rate was for patients with choledocholithiasis (41.3%) followed by Acute Cholecystitis (31.5%), 3 patients required cholecystostomies.
Baseline characteristics and differences in these characteristics based on occurrence of readmission were studied.
45-60 age group, increasing comorbidity, and biliary obstruction were all associated with increased risk of readmission.

Conclusion
Readmissions is a substantial burden on the health care services and patient’s safety and QoL
We propose adherence to the NICE/BSG Guidelines for management of Acute Biliary Disease, to alleviate this pressure which is already sometimes challenging due to the logistics and resources and would be more challenging with the COVID situation and limited emergency and elective theatre availability so the group at high risk of readmission should be prioritised in the recovery plans.
EP.TH.652Use of the Proceed Ventral Patch (PVP) Mesh for Small to Medium sized defects in Ventral Hernia Repair over 10 years – Simple, Safe and Secure
Authors: Krishnamoorthy Ashwin , Tan LamChin 
Published: October 2021

Abstract

Aims
The Proceed Ventral Patch (PVP) has been in use since the late 2000s and is a self-expanding lightweight mesh patch comprised of multiple layers of absorbable and non-absorbable materials including polypropylene and polydioxanone. It is intended for use in all ventral hernias. We report our single-centre experience of using the mesh with primary outcomes being recurrence and reoperation for recurrence, readmission within 21 days for post-operative complications and discharge as day-case.

Methods
Retrospective review of case notes from 54 patients who were operated between October 2010 and November 2020 was undertaken. Patient characteristics were of a 2.1: 1 Male:Female ratio with a median age of 56 years old. 3 epigastric hernias and 51 paraumbilical hernias were repaired using either a 4.3cm or 6.4cm Proceed Ventral Patch. The size of the hernia defect ranged from 0.5cm to 4cm with a median defect size of 2cm for the 54 patients.

Results
There were no intraoperative complications. Two patients (0.04%) underwent laparoscopic reoperation for recurrence. Only one (0.02%) patient was readmitted within 21 days for a wound abscess which was drained and treated with a VAC dressing with satisfactory healing. The operations were split between nine different surgeons of varying expertise from ST5 level to Consultant level.

Conclusions
Ventral hernia repair with PVP is intuitive to learn and has low recurrence/complication rates.
EP.TH.717Triple tumour: A myriad of serial incidental findings in a patient presenting with Gallstone pancreatitis
Authors: Boyle Cameron , Lowe Katherine , Dhaif Ahmed , Hassan Adeeb , Shalli Kawan , Gumber Ashutosh 
Published: October 2021

Abstract

Aim
To present a rare incidental synchronous triple tumours - colonic adenocarcinoma, endometroid ovarian adenocarcinoma and benign Brenner tumour in a patient admitted with acute gallstone pancreatitis.

Methods
A 75-year-old female presented with epigastric pain. Blood-tests and USS abdomen confirmed gallstones and pancreatitis. She was treated conservatively. USS also showed incidental pelvic mass which was further characterised by CT and MR scans. These scans confirmed heterogeneous lobulated mass in the left adnexa. CT scan also picked-up incidental mass in transverse colon, which was confirmed as cancer by colonoscopy. She was offered therapeutic resection after discussion in Colorectal and Gynaecology MDT. Intra-operatively, transverse colonic tumour was invading into the proximal ileum. Laprascopic surgery concluded with extended right hemicolectomy, small bowel resection-anastomosis, omentectomy, total abdominal hysterectomy and bilateral salpingo-oophorectomy.

Results
The patient had gradual recovery without any complications. Histopathology showed T4N2 poorly differentiated adenocarcinoma of colonic mass, FIGO grade 1 stage 1c endometrioid adenocarcinoma of left ovary and benign brenner tumour of right ovary. Post-operative MDT did not offer adjuvant-therapy due to slow recovery and fraility. So far, two-years of follow-up did not show any recurrence.

Conclusion
This report adds to the limited literature of triple synchronous tumours, including rare Brenner accounting for 5% of benign ovarian tumours and endometrioid ovarian tumour with an incidence of 4 -7%. Multi-disciplinary approach and combined surgery can achieve a desirable outcome in such complex cases. It is crucial to identify the primary status of the tumours as it will guide the adjuvant treatment.
EP.TH.772Meta-analysis of laparoscopic mesh rectopexy versus posterior sutured rectopexy for management of complete rectal prolapse
Authors: Hajibandeh Shahin , Hajibandeh Shahab 
Published: October 2021

Abstract

Objectives
To evaluate comparative outcomes of laparoscopic mesh rectopexy (LMR) and laparoscopic posterior sutured rectopexy (LPSR) in patients with rectal prolapse

Methods
We conducted a systematic search of electronic databases and bibliographic reference lists with application of a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits. Recurrence, Cleveland Clinic Incontinence Score (CCIS), Cleveland Clinic Constipation Score (CCCS), surgical site infections, procedure time, and length of hospital stay were the evaluated outcome measures.

Results
We identified 5 comparative studies reporting a total of 307 patients evaluating outcomes of LMR (n = 160) or LPSR (n = 147) in patients with rectal prolapse. LMR was associated with significantly lower recurrence rate (OR:0.28, P = 0.009) but longer procedure time (MD:23.93, P &lt; 0.0001) compared to LPSR. However, there was no significant difference in CCIS (MD:-1.02, P = 0.50), CCCS (MD:-1.54, P = 0.47), surgical site infection (OR:1.48, P = 0.71), and length of hospital stay (MD:-1.54, P = 0.47) between two groups. No mesh erosion was reported in any of the included studies at maximum follow-up point. Sub-group analyses with respect to ventral mesh rectopexy, posterior mesh rectopexy, randomised studies and adult patients were consistent with the main analysis.

Conclusions
LMR seems to be associated with lower recurrence but longer procedure time compared to LPSR. Although no mesh related complications have been reported by the included studies, no definitive conclusions can be made considering that the included studies were inadequately powered for such outcome. Future high quality randomised studies with adequate sample size are required.