bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.TH.462Elective colorectal procedures: postoperative stay & outcomes
Authors: Kalaskar Shrinivas , Hanek Petr 
Published: October 2021

Abstract

Aim
This was a re-audit of (ACPGBI) Association of Coloproctology of Great Britain and Ireland guidelines for the management of colorectal cancers 3 rd Edition 2007.
“Surgeons should expect to achieve an overall anastomotic leak rate below 8% for anterior resections and below 4% for other types of resection. Surgeons should expect to achieve operative mortality of less than 7% for elective colorectal cancer surgery.”
To ensure that our Anastomotic Leak rates & Mortality rates are below the recommended standards.

Method
All elective colorectal surgeries from 01/01/2011 to 31/06/2012 from a busy colorectal the firm were included in study.
A thorough analysis & review of Discharge Summaries was done including type & number of elective colorectal surgeries, anastomotic Leak rate, 30 day mortality and readmission rate, average(Mean & median) postoperative stay and common postoperative complications were identified.
The reasons for delayed discharge identified.

Results
The anastomotic leak rate was 3.0% (2/65). Thirty-day mortality was 1.53%(1/65). The mean postoperative stay was 9.1days (Median 7 days).
Twenty postoperative complications were identified: 6 patients had ileus; 6 patients had minor wound infection; 2 patients had an anastomotic leak; 2 patients had stoma related complications; 2 post-op collections; 1 C-Diff infection & 1 Hospital-acquired Pneumonia.
The common reasons for delayed discharges were Social reasons, ileus, reoperations, inability to cope with a stoma and Hospital-Acquired Pneumonia.

Conclusions
Our anastomotic leak rates (3.0%) & 30-day mortality (1.53%) are well below recommended standards by ACPGBI.
Our median postoperative stay was below to National average (7days Vs 8days colonic cancer &10days rectal cancer).
EP.TH.589Comparison of Surgeon Gaze Behaviour Against Objective Skill Assessment in Open Inguinal Hernia Repair – A Pilot Study
Authors: Salazar Oliver , Erridge Simon , Beatty Jasmine Winter , Darzi Ara , Purkayastha Sanjay , Sodergren Mikael H 
Published: October 2021

Abstract

Aims
Technical skill is associated with improved postoperative outcomes. Adoption of a formalised high-stakes assessment of surgical skill is technically challenging and limited by the financial and human resources available. We aimed to assess the ability to adopt gaze behaviour analysis as an assessment of surgical skill within live open inguinal herniorrhaphy.

Methods
Surgeons’ gaze was measured with Tobii Pro eye-tracking Glasses 2 (Tobii AB). All grades of surgeons were included. Primary outcomes were dwell time (%) and fixation frequency (count/s), as markers of cognition, on areas of interest correlated to mean Objective Skill Assessment of Technical Skill score. Secondary outcomes assessed effort and concentration levels through maximum pupil diameter (mm) and rate of pupil change (mm/s) correlated to perceived workload (SURG-TLX). Three operative segments underwent analysis: mesh preparation, fixation and muscle closure. Spearman’s and Pearson’s correlation were performed with significance set at p &lt; 0.05.

Results
5 cases were analysed, totalling 270 minutes of video footage. All participants were senior surgical trainees and right-hand-dominant. The median number of hernia operations performed was 160 (range:100-500). The median ASA score of each patient participant was 2 (range:1-2). The median operation length was 45 mins (range:40-90 mins). There were no statistically significant primary outcomes from this pilot data (p &gt; 0.05).

Conclusions
This pilot study demonstrated the feasibility of recording gaze behaviours for comparison against formal skills assessment to determine the role of eye tracking in live high stakes technical skills assessment. A full study will now commence based on formal power calculation.
EP.TH.603Hypofractionated radiotherapy for resectable pancreatic ductal adenocarcinoma: a world first in response to COVID19
Authors: Spiers Harry VM , Thankamma Ajithkumar , Davies Susan , Duckworth Adam , Jah Asif , Liau Siong-Seng 
Published: October 2021

Abstract

Introduction
COVID-19 has challenged healthcare systems across the world, restricting resources for major hepato-pancreato-biliary resections. We report the experience of a unique temporising measure to overcome unavailability of upfront surgery, for select patients with resectable pancreatic ductal adenocarcinoma (rPDAC) during the pandemic.

Methods
Select patients with rPDAC who were assessed to be unsuitable for, or declined, upfront systemic chemotherapy, were considered for hypofractionated radiotherapy (hypoRT) as bridging therapy to Whipple’s pancreaticoduodenectomy.

Results
Three patients with EUS-biopsy confirmed rPDAC with no vascular involvement received 5 fractions of hypoRT followed by Whipple’s resection. Median patient age was 68 (range 63-77). All patients successfully completed hypoRT, with one case of transient grade 2 anorexia. Median interval from hypoRT to resection was 75 days (range 41-95 days), with median operative time including anaesthesia of 573 minutes (range 496-661 minutes). R0 resection was achieved in two cases, including one requiring portal vein resection. R1 resection was seen in one patient who required superior mesenteric vein resection. One patient experienced complication in the form of delayed gastric emptying. Median length of stay was 11 days (range 11-58 days). No patient experienced post-operative pancreatic fistula, and no patient has evidence of recurrence on 30-day follow up imaging.

Conclusion
This report provides initial experience for hypoRT in select patients with rPDAC prior to resection. Further work is required to quantify outcomes and long-term safety profile of this novel approach. The hypoRT programme allowed select patients to obtain treatment whilst awaiting availability of surgical resources.
Ep.Th.654Home Based Pre-Rehabilitation in Hepatic & Pancreatic Oncological Surgery- A Way Forward for Improved Patient Outcome
Authors: Ahmed Nauman , Obeidallah Rami , Subar Daren 
Published: October 2021

Abstract

Aims
To ascertain the impact of ‘’Cost effective home-based pre-rehabilitation’’ on post-operative outcomes in patients undergoing major hepatic and pancreatic oncological surgery.

Methods
In this non-randomized comparative study (2019-2021), we included 36 patients having pancreatic or hepatic malignancy. In group I, patients were signed up for home-based pre-rehabilitation program and dietary modification. Group II; included patients who did not have rehabilitation. The two groups were compared for post-operative outcomes (post-operative complications, length of ITU and hospital stay)

Results
Mean age was 69.05±9.68 years in group I and 67.50±8.75 years in group II (p-value 0.61). Open approach was used in 02 (11.0%) patients in group I and in 09 (50%) patients in group II (p-value 0.01). More patients in group II needed admission in intensive care unit (ICU); 18 (100%) versus 11 (61.1%) in group II (p-value 0.0003). The group I had shorter length of hospital stay as compared to Group II (p-value 0.0001). There was no significant difference in post-operative complications between the groups.

Conclusion
Home based pre-rehabilitation, has shown beneficial outcomes in terms of less requirement for ITU admission post operatively, shorter length of hospital stay and cost effective method of pre rehabilitation.
EP.TH.675Snapshot Audit of post ERCP surgical complications over three years at District General Hospital
Authors: Sarodaya Varun , Garg Arti 
Published: October 2021

Abstract

Aims
To determine the rates of Post ERCP (Endoscopic retrograde cholangiopancreatography) complications at District general hospital compared to standard derived from guidance issued by the European Society of Gastrointestinal Endoscopy (ESGE).

Method
We performed a retrospective data collection of all the patient who underwent ERCP between 01/01/2018 and 31/12/2020. Parameters like patient demographics, date of procedure, immediate post-procedure complications, A&E presentation within 7 days and 30-day mortality were considered.

Results
One hundred and fifty-three ERCPs were performed at our institution over this three year period. Eleven patients undergoing ERCP in this time interval developed surgical complications. Out of the 11 patients, 8 were females and 3 were males. The median age at ERCP was 63 Years. Of the 11 patients, 6 underwent MRCP and 5 had an Ultrasound scan before the procedure. Three patients had perforation (1.9%) out of which 1 required surgical intervention in theatre and 2 were managed conservatively. Out of the remaining, 4 (2.6%) developed acute cholecystitis and 2 (1.3%) were admitted with acute pancreatitis.

Conclusion
The incidence of complications post ERCP is roughly 10%, with a reported mortality of around 1%. Incidence of post ERCP complication at the UK district hospital was marginally higher than the standard set by ESGE guidelines. Determining incidence is difficult and the study had various shortcoming like small sample size, patient variation in selection for ERCP, inherent bias. Despite limitations, we aim to take various measures to improve our practise and meet the national standards set by ESGE.
EP.TH.697The great mimic of mesenteric cyst - an interesting case report of mucinous adenocarcinoma of the ovary
Authors: Lowe Katherine , Dhaif Ahmed , Gumber Ashutosh , Pareek Raju , Allam Mohammed , Elsapagh Khaled 
Published: October 2021

Abstract

Aims
A mesenteric cyst, rare intra-abdominal pathology, poses a clinical challenge due to lack of pathognomonic symptoms, variability in presentation and location. We present an interesting case with a significant diagnostic dilemma; a suspected benign ovarian cyst invading the mesentery on repeat imaging and laparoscopy is questioned for mesenteric in origin.

Methods
A 77-year-old female presented with a 6-year history of abdominal mass. She had multiple radiological scans which reported it as a simple cyst, but the origin could not be defined. She had repeated aspirations with benign cytology. They cyst developed septations, filled-up rapidly, became an abdominal cyst from the pelvis. A careful decision was taken for surgery. The procedure undertook with general surgeons and gynaecologists with a possibility of the mesenteric cyst. During laparotomy, the cyst was found extending from pelvis and base of mesentery up to the diaphragm densely adhered to sigmoid colon. The cyst was completely excised with hysterectomy and oophorectomy.

Results
The patient recovered well from surgery. Post-operatively, histopathology confirmed Figo IC2 Grade 2 mucinous adenocarcinoma of the ovary with an expansive growth pattern. She is awaiting further treatment with chemotherapy after discussion in the Gynaecology MDT.

Conclusion
This case emphasises the importance of having an insight into the question of established diagnosis in the face of a changing clinical picture. Also, it highlights the need for understanding the mesenteric cyst. Early exploration can prevent diagnostic delays and further treatment.
EP.TH.714Adult Spontaneous Choledochal Cyst Rupture: A Case Report of a Rare Presentation
Authors: AlSaleh Khaled , Wani Mahmood , Almudawah Yasmin , Alotaibi Ahad 
Published: October 2021

Abstract

Background
Choledochal cysts are uncommon congenital biliary duct dilatation involving either intra-hepatic, extra-hepatic ducts or both. The presentation varies among pediatric age groups compared to adults, in which pediatrics present mostly with jaundice whereas adults present with abdominal pain. It carries high-risk complications and related malignancy depending on the type of cyst. There were few reported cases of spontaneous rupture of choledochal cyst in adults.

Case Description
A 35-year-old female, medically and surgically free. Presented to Emergency Department with recurrent episodes of non-bilious vomiting for three weeks, managed conservatively. One day later, she presented with generalized abdominal pain with persistent vomiting. The patient mentioned a history of chronic abdominal pain for 6 years. On examination, the abdomen was tender all over with signs of peritonitis. A Computed Tomography scan revealed a septated intra-hepatic duct cyst measuring 9 x 11 cm. Therefore, she was taken to the operating room for exploratory laparoscopy, washout was done and drains were inserted. Afterward, Endoscopic Retrograde Cholangio-Pancreatography with sphincterotomy and stenting performed. Six weeks later, she underwent elective left hepatectomy and histopathology confirmed the choledochal cyst. She had an uneventful postoperative course with two weeks follow up with no complications.

Conclusion
Ruptured choledochal cyst is a rare presentation and high clinical suspicion is warranted in adult patients who present with a surgical abdomen along with a history of chronic abdominal pain. This case report represents the importance of conservative treatment before the definitive operation, to allow resolution of the peritonitis and lower the consequences.
EP.TH.770Upgrading the level of evidence regarding Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy: Meta-analysis of randomised controlled trials
Authors: Hajibandeh Shahin , Hajibandeh Shahab , Mankotia Rajnish , Peravali Rajeev 
Published: October 2021

Abstract

Objectives
To evaluate comparative outcomes of intracorporeal (ICA) and extracorporeal (ECA) anastomosis in laparoscopic right hemicolectomy.

Methods
We conducted a systematic search of electronic databases and bibliographic reference lists. We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases. Overall perioperative morbidity, anastomotic leak, surgical site infection (SSI), paralytic ileus, bleeding, postoperative pain within 5 days, conversion to an open procedure, length of incision and procedure time were the evaluated outcome parameters.

Results
We identified 4 randomised controlled trials reporting a total of 399 patients evaluating outcomes of ICA (n = 199) and ECA (n = 200) in laparoscopic right hemicolectomy. The ICA was associated with significantly shorter length of incision (MD:-1.82, P &lt; 0.00001), lower postoperative pain score on day 2 (MD:-0.69, P = 0.0007), day 3 (MD:-0.80, P = 0.02), day 4 (MD:-0.83, P = 0.01) and day 5 (MD:-0.49, P &lt; 0.00001) when compared to ECA. Moreover, it was associated with significantly shorter length of hospital stay (MD:-0.27, p = 0.03). However, there was no significant difference in overall perioperative morbidity (RR:0.79, P = 0.47), anastomotic leak (RR:1.29, P = 0.65), SSI (RR:0.61, P = 0.42), bleeding (RR:0.70, P = 0.71), ileus (RR:0.60, P = 0.45), conversion to open (RD:-0.02, P = 0.45), number of harvested lymph nodes (MD:0.82, p = 0.06), and procedure time (MD:16.04, p = 0.06) between two groups.

Conclusions
The meta-analysis of level 1 evidence demonstrated that ICA and ECA have comparable perioperative outcomes in laparoscopic right colectomy although the former may be associated with less postoperative pain probably due to shorter incision length. Future research may provide stronger evidence in favour of an intervention.
EP.TH.893Virtual Clinic follow-up in Laparoscopic Fundoplication Surgery
Authors: Ji Chenchen , Mitchell Benjamin , Tan Christine , Toh Simon 
Published: October 2021

Abstract

Aims
There are clinical and financial incentives to reduce follow-up NHS clinics after elective surgery. 55% of our laparoscopic anti-reflux procedures are day-cases procedures. To reduce consultant clinic workload and unnecessary face-to-face patient reviews, we introduced a laparoscopic surgical care practitioner (LSCP) based Virtual Clinic.

Methods
Patients were telephoned on day 1 and 5 to ensure they were managing their diet without significant post-operative symptoms.
This was followed by a Virtual Clinic follow-up at 6-8 weeks, using a universal list of questions and template, and an electronic letter with outcomes recorded.
149 patients underwent laparoscopic fundoplication surgery from September 2016 – May 2018. All follow-up clinics, both virtual and face-to-face, were recorded electronically. These were reviewed, data collected and analysed.

Results
Between September 2016 – May 2018, 149 patients had laparoscopic fundoplication surgery at our trust with the following clinic outcomes:

Conclusions
Our LSCP Virtual Clinics discharged 50 out of 149 (33%) patients with no need for face-to-face clinic time, and no detriment to patient care. Those requiring further follow-up were patients who had difficulty managing dietary changes, or experiencing symptoms like dysphagia, often needing physical review and further investigations. Furthermore, patients have expressed high satisfaction with this service. Virtual clinic follow-up is safe, patient-friendly, and reduces both clinical and financial load on NHS outpatient clinics.
EP.TH.961Meta-analysis of Spinal Anaesthesia Versus General Anaesthesia During Laparoscopic Total Extraperitoneal Repair of Inguinal Hernia
Authors: Hajibandeh Shahin , Hajibandeh Shahab , Mobarak Shahd , Mobarak Dham , Satyadas Thomas 
Published: October 2021

Abstract

Objectives
To evaluate comparative outcomes of spinal anaesthesia (SA) and general anaesthesia (GA) during laparoscopic total extraperitoneal (TEP) repair of inguinal hernia.

Methods
We systematically searched MEDLINE; EMBASE; CINAHL; CENTRAL, and bibliographic reference lists. Post-operative pain assessed by visual analogue scale (VAS), individual and overall perioperative morbidity, procedure time and time taken to normal activities, were the outcome parameters. Combined overall effect sizes were calculated using fixed-effect or random-effects models.

Results
We identified 5 studies enrolling 1,518 patients (2,134 hernia) evaluating outcomes of laparoscopic TEP repair under SA (n = 1,277 patients, 1,877 hernia) or GA (n = 241 patients, 257 hernia). SA was associated with significantly lower post-operative pain assessed by VAS at 12 hours (MD: - 0.32, P &lt; 0.0001) and shorter time to normal activities (MD: -0.30, P = 0.002) compared to GA. However, it significantly increased risk of urinary retention (OR:4.02, P = 0.01), hypotension (OR:3.97, P = 0.004), headache (OR:7.65, P = 0.003), and procedure time (MD: 3.82, P = 0.004) There was no significant difference in VAS at 24 hours (MD:0.06, P = 0.34), seroma (OR:1.54, P = 0.26), wound infection (OR:1.03, P = 0.94), and vomiting (OR:0.84, P = 0.66) between two groups. There was a non-significant decrease in overall morbidity in favour GA (OR:1.84, P = 0.17) which became significant following sensitivity analysis (OR:2.59, P = 0.01).

Conclusions
Although TEP inguinal hernia repair under SA may reduce pain in early postoperative period, it seems to be associated with increased postoperative morbidity and longer procedure time. It may be an appropriate anaesthetic modality in selected patients who are considered high risk for GA. Higher level of evidence is needed.
EP.TH.1029Surgery for retained gallstones: A single centre experience
Authors: Gok M A , Ftaieh F , Shams O , Ward S J , Khan U A 
Published: October 2021

Abstract

Aims
Lost spilled gallstones during laparoscopic cholecystectomy is a rare inadvertent complication results in recurrent delayed sepsis. Diagnosis is made via retrospective review of operative notes. 2 cases of retained gallstones were removed surgically, following several years after the initial laparoscopic cholecystectomy.

Conclusion
2 cases presented with delayed symptoms of abdominal pain, sepsis with intra-abdominal collections. Intra-abdominal abscesses treated with percutaneous USS guided drainage & antibiotics. Abscesses arise in right subphrenic space, right anterior abdominal wall & iliacus as a result of gallstone migration. Diagnosis of “spilled lost gallstones” was delayed until confirmation of retained gallstones on radiological imaging. Combination of USS, CT and MRI scan enabled to detect retained gallstones (radiolucent or radio-opaque) within an abscess cavity.
Multi-disciplinary approach allowed a more concerted management i.e. diagnosis of retained gallstones & planning surgical exploration for retained gallstones.
Ultimately, abscesses should be drained (percutaneously or surgically), and retained stones should be removed. Ideally this is done via minimally invasive techniques, but open surgery is often required. Use of laparoscopy enables exploration of the peritoneal cavity and any abscess cavity. This exploration will extract any fragment of gallstone that could be a nidus for continuous infection.
EP.TH.1043Outcomes of liver resections by trainee surgeons versus consultant surgeon – a single centre experience
Authors: Thiyagarajan Umasankar Mathuram , Al-Mohammad Alaa , Goh Stephanie , Liau Siong-Seng , Huguet Emmanuel , Jah Asif 
Published: October 2021

Abstract

Introduction
Liver resection is a most effective treatment for patients with operable primary or secondary cancer deposits. The role of trainee as a lead surgeon versus consultant surgeon performing liver resections and its impact on surgical outcomes had never been reported.

Methods and Materials
This study was aimed to assess the liver resection outcomes including operative time, acute kidney injury (AKI), bile leak, sepsis, mortality and hospital readmission within 3 months. A total of 320 liver resections from Addenbookes Hospital at Cambridge between 2015 to 2017 were included in this study.
All liver resections were performed under supervision of the consultant surgeon who is either scrubbed or unscrubbed in theatre. Trainee surgeons have performed 116 of 320 as lead surgeon and the consultant surgeons performed the remaining 204.

Results
The mean operative time was 413±129 versus 383±118 (P = 0.41) minutes in trainee surgeons and consultant surgeons respectively. The incidence of postoperative AKI were similar in between the groups (5/116 versus 11/204;P=0.79). Although the bile leak was numerically high in the trainee group, did not reach statistical difference (13/116 versus 12/204;P=0.12); similar results noted in the incidence of sepsis too (3/116 versus 4/204;P=070). Mortality, hospital readmission at 3 months were (1/204 versus 1/116;P=1) and (2/116 versus 4/204;P=1) respectively. No significant difference was observed.

Conclusion
Liver resections performed by the trainee surgeons under supervision appeared to be safe without increasing the operative time, morbidity, mortality and hospital readmission at 90 days. Further multicentre prospective study with long-term follow up is recommended.