bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.WE.824Effect of bariatric surgery on gut permeability in humans: a systematic review
Authors: O'Brien James , Robertson Denise , Griffin Bruce , Rockall Timothy , Pring Chris 
Published: October 2021

Abstract

Aims
Altered intestinal permeability (“leaky gut”) is associated with obesity. Several mechanisms have been suggested to explain the harmful sequalae that follow permeability change such as inflammation, alteration to the microbiome and onset of insulin resistance. Studies describe bariatric surgery as having varying effects on intestinal permeability. We aim to summarise and review the literature.

Methods
A systematic review was performed using MEDLINE, EMBASE, and Scopus to identify studies in humans that investigated permeability change after bariatric surgery.

Results
5 studies were identified, all cohort. Heterogeneity precluded meta-analysis. All calculated permeability change following oral intake of different sugar solutions. Two studies described a reduction in gastroduodenal permeability post sleeve gastrectomy (SG), one from an increased baseline compared to lean controls. Two described an increase in small intestinal permeability after “malabsorptive” operations (biliopancreatic diversion and duodenal switch). Two found decreased small intestinal permeability at one month post Roux-en-Y gastric bypass and six months post SG. One including only SG had opposite findings of increased small intestinal permeability at 6 months. The only colonic change reported was increased permeability also 6 months post SG.

Conclusion
Research found both increased and decreased permeability of the small intestine. Two studies found reduced gastroduodenal permeability post operatively. Evidence regarding the effect of bariatric surgery on the permeability of the gastrointestinal tract and specifically the colon is limited and follow up, operation type and small numbers limit meaningful comparison. Further study into this crucial aspect of obesity both before and after surgery is needed.
EP.WE.844Two-week bowel cancer referrals during the COVID pandemic
Authors: Antakia Ramez , Popa-Nimigean Vladimir , Athisayaraj Thomas 
Published: October 2021

Abstract

Aims
The aims were to assess the impact of the COVID-19 pandemic on the waiting times for patients referred via the two-week pathway for suspected colorectal cancer. We also examined the use of Faecal Immunochemical Test (FIT) alongside the presenting complaints in triaging/prioritising patients for further imaging and/or endoscopic investigations appropriately.

Methods
A list of all patients referred via the two-week pathway to the West Suffolk Hospital for suspected colorectal cancers from 30/01/2020 to 19/07/2020 was compiled. The main four red flag symptoms were change in bowel habit (CIBH), anorectal bleeding, anaemia and weight loss. A subset of 235 patients were closely examined regarding their presenting complaints, FIT, imaging and endoscopy results with analysis of outcomes.

Results
127 male versus 108 female patients were included. 59.61% of patients who were eligible for the FIT test received one. Mean waiting time for FIT positive patients was 42.39 (95% CI) versus 61.10 (95% CI) for FIT negative patients. Patients with one or two red flags symptoms had a mean waiting time of 44.81 days (95% CI 35.79-53.82) and 47.91 days (95% CI 38.07-57.75) respectively. Patients with three red flag symptoms had a mean waiting time of 28.2 days (95% CI 17.94-38.39). There was a statistically significant difference in mean waiting time between patients having 1-2 symptoms and patients with three symptoms (p &lt; 0.005).

Conclusions
Despite delays during the COVID pandemic particularly for endoscopy, high risk and FIT positive patients were prioritised. Waiting times were still higher than advised national guidelines.
EP.WE.858Risk of Post-Operative COVID-19 Infection Following Breast Surgery
Authors: Akosile Catherine , Ravichandran Duraisamy , Knight Alexandra , James Ruth , Kirkpatrick Katharine 
Published: October 2021

Abstract

Aims
To study the risk of post-operative COVID-19 infection in patients undergoing breast surgery during the height of the pandemic in 2020.

Methods
We continued to perform surgery for breast cancers and other urgent breast conditions during the pandemic in a dedicated “Green” operating theatre in a COVID-19-free hospital. NHS guidance regarding staff and patient COVID-19 screening and patient self-isolation period changed frequently during the study period, and recommended guidance was followed. PPE was worn by theatre team. Patient records were subsequently reviewed for a positive COVID-19 swab or a COVID-19-related hospital admission within 8 weeks of surgery.

Results
96 consecutive operations were performed by 4 consultants between April and August 2020. All but 14 were for breast carcinoma. Median age 56 (21-89). Median ASA grade 2 (1-3). 64 patients had negative preoperative COVID-19 swabs, others in the early stages were screened with chest X-ray or CT. 83% (n = 80) were done as day cases. Among breast cancer operations there were 17 mastectomies, bilateral in 2 cases. There was no cases of COVID-19 positivity or COVID-19-related hospital admission post-operatively.

Conclusions
Breast surgery, done mainly as day case, did not predispose patients to COVID-19 infection in the postoperative period when guidelines were followed. Concern about postoperative COVID-19 infection should not be a cause of surgical delay in any future waves, which can be potentially harmful to breast cancer patients.
EP.WE.1015Management of Boerhaave Syndrome
Authors: Florance Charlotte , Jones Katie , Singh Krishna 
Published: October 2021

Abstract

Aim
Boerhaave’s Syndrome is a rare and fatal condition, characterised by a distal oesophageal tear induced by an abrupt rise in intra-luminal pressure. Treatment remains controversial; we present a recent case and review relevant literature.

Methods
A retrospective analysis of case-notes was performed, and a literature review undertaken on PubMed.

Results
A 58-year-old male presented as an emergency with severe chest pain, having choked and vomited following the ingestion of steak. Computed tomograpy scan of the thorax demonstrated a large pneumomediastinum associated with an oesophageal perforation on the anterior wall and bilateral pleural effusions. A primary laparoscopic repair was performed with jejunostomy placement for feeding. The post-operative period was complicated by a prolonged stay on intensive care with sepsis secondary to mediastinitis. A contrast swallow performed eleven days post-surgery confirmed no persistent leak and the patient was discharged five days later.
Boerhaave’s syndrome accounts for 10% of oesophageal perforations and is typically associated with a history of overindulgence and vomiting. Stable patients with a contained disruption and minimal contamination, can be managed conservatively. Endoscopic therapies include clipping small perforations, self-expanding stents for larger defects, and endoluminal vacuum therapy. Operative interventions comprise primary repair, debridement and drainage of thoracic cavity, diversion operations and single stage resection with or without primary reconstruction.

Conclusion
Boerhaave’s Syndrome is associated with significant morbidity and mortality, but with early recognition and prompt intervention, patients can be successfully managed. Options include conservative, endoscopic and surgical, depending upon the site and size of the perforation.
EP.WE.1048Weight Regain After Sleeve Gastrectomy More Common in Male and Less Common in Super-Obese Patients - Results of an 18-Month Follow-up Study
Authors: Bodla Ahmed Salman , Abraham Jenny , Shah Neha , Menon Vinod 
Published: October 2021

Abstract

Aims
Long-term success of Sleeve Gastrectomy (SG) is undermined by weight regain (WR). Several procedure- and patient-specific factors have been proposed in previous studies. Here we look at 18-month follow-up post-SG to investigate WR and patient-specific variables influencing this.

Methods
A single-centre study involving retrospective analysis of a prospectively-maintained database. Inclusion criteria: Primary non-revisional SG patients with adequate follow-up data to assess WL/WR trends. Patients were divided into two subgroups based on their %EWL between 6-to-12 and 12-to-18 months: weight regainers (WR) and weight losers/maintainers (WL/M).

Results
Out of 338 SG cases between 2012-2017, 180 met inclusion criteria of which 18.3% were men and 45% were super-obese. All patients lost weight during first 6 months (mean %EWL 52.3%, P &lt; 0.0001). Between 6-to-12 months, 87.6% patients continued WL with a further mean %EWL of 10.35% (P &lt; 0.0001). Between 12-to-18 months, a drastic deceleration/reversal of WL progress was observed with an average of only 0.76% EWL (P = 0.84), with 42% of patients regaining weight in this period (mean EWG 6.8%). Male patients encountered significantly higher WR rate (OR 3.27, P = 0.003), whereas it was much less frequent in pre-operatively super-obese patients (OR 0.48, P = 0.036). Moreover, there was no difference in the 6-month %EWL between WR and WL/M subgroups (P = 0.62), thus negating the possibility of WL burn-out phenomenon.

Conclusions
Different rates of WR in men and super-obese patients may indicate underlying behavioural and biological differences. More research is needed to investigate them in detail, having implications for revisional surgery and follow-up support.
EP.TH.104An interesting case of Post-ITU delirium
Authors: Bhat Srushti 
Published: October 2021

Abstract
A 75-year old golf-player underwent an open radical cystectomy for a grade 3 bladder carcinoma. His medical history was unremarkable. Post-operatively, he was admitted to the ITU for observation and transferred to the ward after 3 days. On the 5th day post-op, he developed sudden SOB, tachypnoea and hypotension. Blood gas analysis revealed T1 respiratory failure and lactate of 3.3. He was commenced on anticoagulants and a CTPA incidentally found multiple small pulmonary emboli- suspected to be chronic. He developed severe HAP and was transferred back to ITU. 10 days later after improvement he was stepped down. His oral intake had significantly reduced and his urine output was low. He was alert but ward nurses found him to be vacant and significantly confused after his second step down. A CXR was unremarkable. He reported hallucinations and was struggling with his memory. A week later, he was transferred to a community hospital for rehabilitation as his delirium was improving. In the community, he experienced ongoing confusion and hallucinations. Nurses noted hematochezia and jaundice and he was re-admitted with abdominal pain and pyrexia. His LFTs were severely deranged and he was initiated on antibiotics for possible cholangitis. USS abdomen, CT and MRCP revealed no obvious cause of obstruction. A probable diagnosis of viral hepatitis was made by the Gastroenterologist which spontaneously resolved. CT head for confusion screen revealed right frontal lobe ischaemia with severe gliosis- possibly post-operative. The psychiatric team reviewed the patient and he was diagnosed with post-ITU delirium.
EP.TH.208The need for speed: Reduced operative time in laparoscopic sleeve gastrectomy may reduce length of hospital stay
Authors: Lin Yi-Tzu Linda , Cheah Hock Ping , Wong Kenneth 
Published: October 2021

Abstract

Introduction
Length of stay (LOS) in laparoscopic sleeve gastrectomy (LSG) is affected by multiple factors, including gender, BMI &gt;50, comorbidities, socioeconomic status and increased operative time (OT). This study aimed to evaluate the effect of reduced OT on LOS.

Methods
Analysis was conducted using a prospective database in patients who underwent LSG by a single surgeon at a single institution from January 2015 to December 2019. Patients receiving other operations (e.g. adhesiolysis, cholecystectomy, para-oesophageal hiatal hernia repair or ventral hernia repair) during LSG were excluded. All the patients were divided into two groups: OT ≤ 60 minutes and OT &gt; 60 minutes. Patient demographics and outcome variables, including LOS, 30-day readmission, unexpected return to operating theatre, complications and mortality, were collected and analysed.

Results
A total of 1412 patients were included. In OT ≤ 60 minutes group (N = 804), the average LOS was 1.37 days and the average operative time was 51.31 minutes. In OT &gt; 60 minutes group (N = 608), the average LOS was 1.66 days and the average operative time was 77.95 minutes. OT ≤ 60 minutes group showed a statistically significant decrease in LOS compared to OT &gt; 60 minutes group (P-value &lt;0.0001). The 30-day readmission rate was 0.97%. Complications included one gastric leak (0.07%), one postoperative bleeding requiring reoperation (0.07%), three (0.21%) portal vein thrombosis, and no mortality.

Conclusion
Our study demonstrated that reduced OT (≤60 minutes) in LSG was associated with reduced LOS but without increase in complication rates and mortality. This has implications for economic considerations for both hospitals and patients, especially in self-funded payer models.
EP.TH.239Outcomes and Complications After Sleeve Gastrectomy
Authors: Asad Sima Al , Khan Shujhat 
Published: October 2021

Abstract

Aim
The sleeve gastrectomy (SG) is a popular bariatric procedure that has beneficial effects that go beyond that of simply reducing obesity. It also has positive effects on diabetes, dyslipidaemia, and hypertension.

Method
The literature search was carried out using Ovid MEDLINE and PubMed databases to search for keywords and MeSH terms including “bariatric surgery”, “sleeve gastrectomy”, “complications”, “hypertension”, “diabetes”, “dyslipidaemia”, “cardiovascular” and “obesity”.

Result
SG leads to improvement in hypertension, type 2 diabetes, increased HDL levels, and reduction in uraemia levels that were present even after 10 years. Approximately 56-59% of patients experience type 2 diabetes mellitus remission after a year following a SG operation, and the beneficial effects of the operation on diabetes continue long after a year, with 84-86% of patients noting remission after a 5-year period. Approximately 78.5% who undergo SG will see improvements in hypertension, whilst 67.1% will report resolution. On the other hand, complications include formation of strictures (0.7-4% in patients), haemorrhage (1.5% of patients), and leakage (1.5-2.4%). Additional complications include alteration to bile flow, disruption to microbiota, and disruption to vagus nerve activity.

Conclusion
Complications from SG are uncommon but can be severe, and the involved mechanisms are only partially revealed. However, optimisation of risk factors in the months leading up to the operation can significantly improve outcomes in patients. This involves an early implementation of a healthy lifestyle including advising patients to exercise more regularly and adopt a low fat, low salt diet, limiting alcohol, and cessation of smoking.
EP.TH.243Western Australian Multicentre review of management of the axilla in breast cancer patients receiving neoadjuvant chemotherapy
Authors: MacConnell Suanne , Ballal Helen , Singh Vineeta , Saunders Christobel 
Published: October 2021

Abstract

Aim
De-escalation of treatment in early breast cancer is proposed to reduce morbidity to patients without compromising oncological outcomes. Use of SNB as gold standard in clinically node negative patients is an example of successful implementation. In patients receiving upfront chemotherapy, axillary management is more complex. We reviewed the axillary management of patients undergoing neoadjuvant chemotherapy (NAC) to assess nodal response.

Method
The MDT records of two centres were reviewed between January 2015 and May 2019 to identify patients receiving NAC. Clinical records were reviewed to collect demographics, radiological and clinicopathological results as well as follow up data.

Results
185 patients were identified as suitable, median age 49 (21-79). 49% were clinically node negative on presentation. 32% underwent a SNB prior to NAC; this decreased over the study period from 40.5% to 20.5%. Of the cN0 patients, 24% were upstaged to node positive disease at final surgery. None of these achieved a pCR in the breast. 18% of cN0 patients went straight to ALND, 50% were YpN0. 42% of cN1 patients achieved ypN0. 58% down-staged to ypN0 also achieved pCR in the breast. Only 1 patient with residual disease in axilla achieved pCR in the breast.

Conclusion
Use of pre-NAC SNB is declining with low rates of upfront ALND in cN0 patients. There is a 42% rate of down-staging axillary disease with NAC. Patients are unlikely to have nodal response without pCR in the breast. There is likely to be a role for targeted axillary dissection in carefully selected patients.
EP.TH.322Should a concurrent sentinel node biopsy be performed when the preoperative histopathological category of B5c in a breast cancer biopsy is identified?
Authors: Clark Dominic , Jenkins Stephanie 
Published: October 2021

Abstract

Aim
To assess the management of sentinel lymph node biopsy (SLNB) in patients with a pre-operative B5c histopathological diagnosis.

Method
A retrospective study of the decision for SLNB in 31 breast cancer patients with B5c biopsy and their final histology were reviewed between 2009-2019. Factors that determine concurrent SLNB (size of mass lesion &gt; 1cm/increasing size, DCIS &gt; 4cm, recurrence and abnormal lymph nodes on ultrasound) were assessed.

Results
15 patients (48%) with invasive disease and 7 patients (23%) with non-invasive disease had concurrent SLNB, whilst 9 (29%) patients with non-invasive disease did not receive concurrent SLNB and no patient (0%) with invasive disease failed to receive concurrent SLNB. Using the above inclusion and exclusion criteria 21 of 31 (68%) patients would have been managed correctly whilst 5 (16%) would of had unnecessary surgery and 5 (16%) would have required a second operation.

Discussion
In this study, 48% of patients with concurrent SLNB were identified as invasive and avoided a second operation. Although 23% of patients underwent unnecessary SNLB, no invasive disease SLNBs were missed. Solely using inclusion and exclusion criteria would not have improved results. This suggests that there must be other factors involved in correctly managing these patients.

Conclusion
Discussions with the patient about risk benefits of SLN complications vs repeat surgery, and patient comorbidity, in addition to radiological characteristics, may assist management decisions.
EP.TH.336Surgeons' Knowledge Of Characteristics of Mesh Used in Groin Hernia Repair- A Cross Sectional Survey
Authors: Patel Maitreyi , Kirmani Naveed 
Published: October 2021

Abstract

Aims
We aim to assess the surgeons’ awareness of mesh characteristics by way of an online survey.

Methods
A cross sectional survey of surgeons routinely performing groin hernia repairs was conducted across five NHS hospitals using an online questionnaire. Surgeon’s experience in groin hernia repair was taken in account. The data was analyzed using Microsoft Excel. Descriptive statistics was used.

Results
37 surgeons responded to the survey.6 surgeons had more than 20 years of experience. 8 (21.62%) performed &gt;50 hernia repairs annually. When compared with years of experience, knowledge of material was 100% with &gt;10 years experience. Knowledge of tensile strength was 50% in those with &gt; 20 years experience, while 83% of respondents with &gt;20 years experience were aware of the weight and pore size of the mesh they used. In comparison with the number of groin hernia repairs done annually, all respondents performing &gt;50 repairs knew the material they used. Amongst these respondents, knowledge of tensile strength, weight and pore size was 38%, 75% and 63% respectively.

Conclusions
Our study suggests that the level of knowledge regarding mesh is inadequate among surgeons, falling short of the minimum expected of surgeons performing groin hernia repair.
EP.TH.341Creating and testing the online multimedia platform aboutmyop.org
Authors: Daliya Prita , Lobo Dileep , Parsons Simon 
Published: October 2021

Abstract

Introduction
The value of patient focused registries and the use of patient reported outcomes is well documented. However, despite the availability of technological advances the use of multimedia interfaces with patient interaction and real time digitalised data collection has yet to become routine practice. As a modern-day solution, aboutmyop.org was developed as a patient-facing website to improve patient-clinician communication and information sharing. The aim of this study was to pilot the platform in routine clinical care, to identify acceptability, strength and weaknesses.

Method
Patients identified with symptomatic gallstones and referred for consideration for elective laparoscopic cholecystectomy were invited to use aboutmyop.org by postal invitation. Patient demographics, and information on patient recruitment were collected prospectively.

Results
The process of approvals to implement and integrate aboutmyop.org with NHS systems took over 18 months. Due to difficulties with onboarding, 349 (38.9%) of the 898 eligible patients registered, and fewer continued to participate post-operatively (7 days: 46.5%, 30-days: 30.5%, 3-months: 27%, 6-months: 19%). Participants were significantly younger than non-participants (47.6 vs. 51.8 years, p &lt; 0.05), but were otherwise equally matched for gender and comorbidities. Despite system and implementation issues, participants were accepting and supportive of aboutmyop.org.

Conclusion
The aboutmyop.org system demonstrates a method to improve information accessibility for patients, and a novel method for data-sharing between patients and clinicians. Despite difficulties with system access, users demonstrated a willingness to engage in virtual recruitment and digital surveys. Subsequent improvements in access to a aboutmyop.org should help to facilitate long-term patient engagement and quantify real world benefits.
EP.TH.447Simultaneous repair of bilateral Inguinal hernia under Local Anaesthetic - is it feasible?
Authors: Athisayaraj T , Olugbemi J , Sebastian B , Coveney E 
Published: October 2021

Abstract

Introduction
Local Anaesthetic repair of unilateral Inguinal hernia is well reported in the literature, as a safe, well tolerated and effective operation. However, there is not much literature on simultaneous repair of bilateral inguinal hernias under local anaesthetic. We are reporting our experience with simultaneous repair of bilateral inguinal hernias under local anaesthetic.

Methods
We did a retrospective analysis of prospectively collected data of patients, who had bilateral inguinal hernia repaired under local anaesthetic over a period of 2009 - 2019, looking at the patient demographics, patient reported pain score, operating time, volume of local anaesthetic used, patient satisfaction and complication rates.All the patients had Lichtenstein's hernioplasty. The LA mixture was made up of 30ml 0.5% Bupivacaine with adrenaline, 20 ml 2% Lignocaine with adrenaline, 50 ml of 0.9% Saline and 6 ml of 8.6% Sodium Bicarbonate. All these surgeries were performed on a day case basis.

Results
There were 24 patients, who underwent local anaesthetic repair of bilateral inguinal hernias, 22 Males and 2 Females. Age range was 35 - 81 years. The BMI varied from 18 - 30, with a mean of 24. The average operating time was 66.8 minutes (38 - 120 minutes, median 60 min). The mean pain score was 24, on a 0-100 scale. Patient satisfaction scores varied from 50-100 (Median 90, Mean 88.1)

Conclusion
We conclude that successful simultaneous repair of bilateral inguinal hernia under local anaesthetic is feasible, with a low level of patient discomfort, high satisfaction rate and using safe quantities of local anaesthetic