bluuebunny/crossref_metadata_2025_split huggingface dataset:
717 Roux-En-Y Versus Single Loop Reconstruction in Pancreaticoduodenectomy: A Systematic Review and Meta-Analysis
Authors: Mobarak S , Tarazi M , Davé M , Varley R , Stott M , Baltatzis M , Satyadas T 
Published: October 2021

Abstract

Aim
Post-operative pancreatic fistula (POPF) and delayed gastric emptying (DGE) both remain problematic complications following pancreaticoduodenectomy. This systematic review and meta-analysis evaluates whether Roux-en-Y compared to a single loop reconstruction in pancreaticoduodenectomy significantly reduces rates of these complications.

Method
A systematic review and meta-analysis were conducted according to the PRISMA guidelines by screening EMBASE, MEDLINE/PubMed, CENTRAL and bibliographic reference lists for comparative studies meeting the predetermined inclusion criteria. Post-operative outcome measures included: POPF, DGE, bile leak, operating time, blood loss, need for transfusion, wound infection, intra-abdominal collection, post-pancreatectomy haemorrhage, overall morbidity, re-operation, overall mortality, hospital length of stay. Pooled odds ratios or mean differences with 95% confidence intervals were calculated using either fixed- or random-effects models.

Results
Fourteen studies were identified including four randomized controlled trials (RCTs) and 10 observational studies reporting a total of 2 031 patients. Data synthesis showed no statistically significant difference between the two groups in any of the outcome measures except operating time, which was longer in those undergoing Roux-en-Y reconstruction.

Conclusions
Roux-en-Y is not superior to single loop reconstruction in pancreaticoduodenectomy but may prolong operating time. Future high-quality randomized studies with appropriate study design and sample size power calculation may be required to further validate this conclusion.
821 Comparative Effectiveness of Interventions to Reduce Ileus After Colorectal Surgery: A Network Meta-Analysis
Authors: Ashcroft J , Singh A A , Ramachandran B , Habeeb A , Hudson V , Meyer J , Simillis C , Davies R J 
Published: October 2021

Abstract

Aim
Several treatment strategies for post-operative ileus have been evaluated in randomised controlled trials. This network meta-analysis aimed to explore the relative effectiveness of these different therapies on their impact on ileus outcome measures.

Method
A systematic review was conducted to identify randomised controlled trials reported up to 23rd April 2020. Indirect comparisons of all regimens were simultaneously compared using random-effects network meta-analysis.

Results
A total of 48 randomised controlled trials, reporting any combination of five different outcome measures of time to flatus, stool, and solid diet tolerance, or nasogastric tube post-operative insertion, or length of stay following colorectal surgery were identified. In this network meta-analysis, early feeding was ranked first for time to solid diet tolerance (Mean Difference (hours) -58.845 CrI (-73.414, -43.150; rank 1 p = 0.960) and length of hospital stay (Mean Difference (hours) -2.326; CrI -3.510, -1.184; rank 1 p = 0.465) with high probability of first rank in the remainder of measures. Epidural analgesia was ranked first for time to flatus (Mean Difference (hours) -18.882; CrI -33.673, -3.435; rank 1 p = 0.286) and time to stool (Mean Difference (hours) -26.054; 95% CrI -66.417, 15.645; rank 1 p = 0.268).

Conclusions
This network meta-analysis identified early feeding as the most efficacious therapeutic to reduce post-operative ileus in patients undergoing colorectal surgery. High quality studies of the efficacious therapeutics to reduce ileus following colorectal surgery highlighted in this review are required with established core outcome measures of gastrointestinal mobility.
62 Evaluation of Laparoscopic Cholecystectomy with the help of AI-Video Analytics Platform
Authors: Gendia A , Korambayil S , Cota A , Finlay I , Clarke M , Al-Ardah M , Clark J 
Published: October 2021

Abstract

Aim
This report aims to evaluate the use of an AI video analytics platform in laparoscopic cholecystectomy (LC) based on the achievement of the critical view of safety (CVS) and to assess its ability to correctly comment on CVS.

Method
Touch surgery video platform, an AI-video based analytic tool, was screened for laparoscopic cholecystectomy in our institute and analysed from April 2019 till October 2020. Data collected by the AI included identification of the critical view of safety and time needed to achieve CVS. A reviewer graded the LC according to Nasser grading and evaluated the ability of AI to identify the CVS.

Results
66 LC were included from our video database. CVS was achieved in only 56% (37/66) in all LC videos included. Mean time spent to attend CVS from start of dissection of Calot’s triangle 16.8 (±13.6) mins. 26 (39.4%) LCs were Nasser grade 2 and 20 (30.3%) each were grade 1 and grade 3. There was no significant difference between number of CVS obtained between all grades. Time spent to achieve CVS from dissecting Calot’s triangle were the longest in grade 3 LCs (28.4±17.4 mins) with significant difference between all 3 grades. Finally, the platform correctly commented on CVS in 92.4% of the all LC videos.

Conclusions
AI video analytics can provide a useful tool to assess laparoscopic cholecystectomies and the critical view of safety. Additionally, more studies should explore the use of the platfrom and integrate the results with the clinical outcomes.
326 Resorbable Composite Materials for Fracture Fixation
Authors: Baljer B , Melo P , German M , Dalgarno K 
Published: October 2021

Abstract

Introduction
Titanium-based fracture fixation devices often necessitate removal in the maxillofacial region. Resorbable composite implants negate the need for a revision operation; however, concurrent devices either possess a prolonged degradation profile or bioactivity, resulting in undesirable bone deposition. To that end, a novel, fast-resorbing, non-bioactive composite material is proposed, which still possesses an osteoinductive potential, thereby aiding fracture healing.

Method
Three bioglasses were available (NCL1-3) as filler material. NCL2 was selected and different concentrations (5%; 20%) were added to reinforce medical grade poly(lactic-co- glycolide) (PLGA). The final compression moulded samples underwent material characterisation and an 8-week degradation assay.

Results
No significant difference was found between the cytotoxicity of the glasses and both the positive (apatite wollastonite) and negative (absence of glass) controls in relation to mesenchymal stem cells or osteoblasts. pH and weight change analyses showed an increased rate of degradation with an increase in glass concentration. Although reinforcement with NCL2 did not increase the mechanical properties of the polymer, no significant difference was present between the mechanical properties of the composites, and, as made, both 5% and 20% composites had flexural strengths of 13MPa±5, which did not decrease significantly during degradation.

Conclusions
NCL1-3 are non-toxic in the context of fracture healing. The PLGA/NCL2 composite is not suitable for fracture fixation as produced currently, due to increased polymer degradation and lower mechanical properties. However, 20% compositions are recommended for future research, as they would hypothetically provide a superior osteoinductive response without significantly lowering the mechanical properties of the composite.
1244 The TAL Suction Retractor: A Simple Technique for Visualising the Transverse Acetabular Ligament (TAL) During Total Hip Replacement (THR) Surgery
Authors: Murphy B , Pollock R , Ramchurn S , Hurson C 
Published: October 2021

Abstract

Introduction
The transverse acetabular ligament (TAL) is an anatomical landmark that is of particular use during primary total hip replacements (THR). Visualisation is important to aid the orientation of the acetabular cup and it is a structure that can be identified in virtually every primary hip replacement surgery. We introduce a simple technique to facilitate this.

Method
A thoracic suction catheter is taped to the distal end of a blunt Hohmann’s retractor with two steristrips wrapping around the catheter and retractor leaving approximately 1-1.5cm of retractor exposed. Our preference is for a thoracic suction catheter with side holes and a proximal end which allows direct connection with the tip of the Yankauer suction. The blunt Hohmann’s retractor is used as the inferior acetabular retractor in the usual way, placed inferior to the transverse acetabular ligament, resting on the posterior ischial surface. The catheter suction tip should lie just under the TAL, in the most dependant point of the wound.

Results
The TAL suction catheter can be used continuously or intermittently to facilitate visualisation of the TAL during reaming, trialling, and acetabular cup placement. The TAL suction retractor provides suction in the most dependant point of the surgical wound, preventing unnecessary movement and facilitates a clutter-free surgical field leading to more streamlined and efficient surgery with potential reduced operative times.

Conclusions
The transverse acetabular ligament (TAL) suction retractor is a simple improvised surgical tool that makes it easier to visualise the TAL during acetabular preparation in total hip replacements.
500 The Four Year Clinical and Economic Impact of an Extended Screening Program for Developmental Dysplasia of the Hip in Cardiff and Vale University Health Board
Authors: Poacher A , Froud J , Marsh L , Carpenter C 
Published: October 2021

Abstract

Aim
Early detection of DDH is associated with the increased success of non-surgical treatment. Therefore, Cardiff and Vale Health Board (CAVUHB) implemented an extended screening program for Developmental dysplasia of the Hip (DDH) to improve neonatal public health within the population.

Method
A 4-year prospective case-control study of all patients born between 01/01/2016-31/12/2019 (n = 21843) who underwent ultrasonographic screening for DDH in CAVUHB. Ultrasounds were graded using Graf’s classification, with treatment outcomes determined by patient’s records and costings based on NHS tariffs.

Results
Screening of those with risk factors diagnosed 49% of treated DDH cases. Screening for risk factors cost CAVUHB £175,000 per annum, with a cost per favourable outcome of £12351. The mean cost of DDH treatment of a late presenting patient was £23,782, incurring a cost reduction of 48%. Cost-effectiveness and positive predictive value (PPV) of calcaneovalgus malformations, oligohydramnios, and plagiocephaly demonstrating PPV similar to that of primary risk factors. Calcaneovalgus malformations demonstrated significantly higher PPV than primary risk factors for DDH (p &lt; 0.05).

Conclusions
CAVUHB cost-effectively reduced morbidity and surgical mortality within the neonatal population, as a result of its extended screening program for DDH. The novel findings of prevalence and predictive value of secondary risk factors as a marker of treatable DDH are significant, as currently they are not included in the national new-born and infant physical examination (NIPE) guidance. High predictive value with low population prevalence indicates that these are cost reducing and clinically valuable markers of disease that could provide value if within a national screening program.
1466 Closed Incision Negative Pressure Wound Therapy reduces Surgical Site Infection following Emergency Laparotomy: A Propensity Matched NELA Registry Study
Authors: Blyth U , Chung J N C , Ali O , Hawthornthwaite E , Watkinson T , Harji D , Griffiths B 
Published: October 2021

Abstract

Background
Surgical site infection (SSI) contributes to a significant proportion of post-operative morbidity in people undergoing emergency surgery. Prophylactic closed incision negative pressure therapy (CINPT) has been shown to reduce SSI rates in patients undergoing elective laparotomy however there is limited evidence for their use in the emergency setting. This study aimed to determine whether prophylactic CINPT provides comparable SSI rate to SSD for midline incision following emergency laparotomy.

Method
A registry-based, prospective cohort study was undertaken using data from National Emergency Laparotomy Audit (NELA) database at our centre. The primary outcome measure was SSI as defined by the Centers for Disease Control (CDC) criteria. Secondary outcomes included 30-day post-operative morbidity and grade using Clavien-Dindo (CD) classification and the Comprehensive Complication Index, length of stay, 30-day mortality and readmission rates. CINPT and standard surgical dressing group were compared with respect to peri-operative characteristics and post-operative outcomes. A propensity- score matching (PSM) was performed to mitigate for selection bias.

Results
A total of 1484 patients were identified. Following PSM, a matched cohort of 474 patients were identified with 237 patients in each arm. SSI rate in CINPT cohort was found to be significantly lower compared to the SSD cohort (16.9% vs. 33.8%, p &lt; 0.001). The rate of superficial and deep infections was higher in the standard dressing arm compared to the CINPWT, p &lt; 0.001. There were no overall differences in 30-day morbidity and grade of post-operative complications.

Conclusions
Prophylactic CINPT in the emergency laparotomy is associated with reduced SSI rates.
363 Patient-Reported Outcomes Measures From 153 Men Treated with Water Vapour Thermal Therapy (Rezūmtm) For Symptomatic Benign Prostate Hyperplasia
Authors: Rai A , Connor M J , Khoo C C , Eldred-Evans D , Bass E J , Hosking-Jervis F , Tanaka M B , Agarwal S , Winkler M , Abboudi H , El-Husseiny T , Ahmed H U 
Published: October 2021

Abstract

Background
Transurethral water vapour treatment (RezumTM) is a novel minimally invasive technique (MIST) for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). The aim of this study was to report patient-reported outcome measures (PROMS) and adverse events from patients treated with RezumTM.

Method
Consecutive patients were retrospectively identified at a single tertiary centre. Exclusion criteria included a history of acute urinary retention, previous BPH surgery, prostate cancer or prostatitis. PROMS including International Prostate Symptom Score (IPSS), IPSS-quality of life (IPSS-QoL) and the International Index of Erectile Function (IIEF-5) were compared between baseline and at a single discrete follow-up period (Initial [4-6 months]; Early [7-12 months]; Medium [13-18 months]; or Late [&gt; 18 months]) using student’s t-test (SPSS v26.0; p &lt; 0.05).

Results
153 patients were included. IPSS, IPSS-QoL and IIEF-5 at baseline were 23.4 (SD 6.8), 4.8 (SD 3.7) and 14.9 points (SD 7.1), respectively. Paired PROMS were available at: Initial 20.2% (31/153), Early 43.7% (67/153), Medium 24.8% (38/153) and Late 11.1% (17/153) follow-up. Compared to baseline, all mean IPSS and IPSS-QoL reductions were significant (p &lt; 0.05). At medium follow-up, paired IPSS and IPSS-QoL reductions were significant at -14.2 points and -3.2 points (p &lt; 0.0001), respectively. There was no reported de novo erectile dysfunction. One patient required re-operation due to persistent symptoms, and one patient experienced postoperative urosepsis (Clavien-Dindo II).

Conclusions
Our findings demonstrate real-world data that water vapour therapy for BPH confers durable patient-reported improvements in most men, with preservation of patient-reported erectile function.
73 The Use of Topical Anaesthetic in The Banding of Internal Haemorrhoids: A Feasibility Study for A Randomized Control Trial
Authors: Sharma V , Sharma D , Stearns A , Hernon J 
Published: October 2021

Abstract

Aim
Rubber band ligation (RBL) is a procedure commonly performed in colorectal clinics for internal haemorrhoids. 90% of patients experience pain following RBL. We aimed to complete a feasibility randomized control trial assessing the role of topical anaesthetic before RBL of internal haemorrhoids.

Method
We performed a prospective, single-centre, single blinded, randomized(1:1) controlled feasibility trial. Patients presenting with symptomatic haemorrhoids suitable for banding were randomized to undergo the procedure with local anaesthetic or without(control). Pain scores and vasovagal symptoms were assessed at 0 minutes, 30minutes, 4 hours, and 72 hours after the procedure. Primary outcome measures were recruitment rate, participant retention rate, patient and surgeon acceptability. Secondary outcome measures were pain scores up to 72 hours, vasovagal episodes, new use of analgesia, and adverse outcomes.

Results
35 patients (18 topical anaesthetic, group A; 17 no anaesthetic gel, group B) were recruited. Mean recruitment rate was 11.7 participants per month. 33(94%) participants remained in the study until completion, with 2 patients lost to telephone follow-up. The treatment was acceptable for 35(97%) eligible patients. 1 patient declined enrolment. The treatment was acceptable to all surgeons (100%). There was a significant difference in median pain scores of -2(95% CI -4.0 to -1.0, p = 0.0006) at the 30-minute time point only. There was no significant difference in vasovagal symptoms(p = 0.10) or new analgesia use(p = 0.85).

Conclusions
In conclusion, we have shown that a phase III clinical trial is feasible. We have demonstrated excellent patient recruitment and retention as well as patient and surgeon acceptability.
28 Colorectal Cancer Resections During COVID-19: To Do or Not to Do?
Authors: Barter R , Kalaiselvan R 
Published: October 2021

Abstract

Introduction
Ascertaining the practice of colorectal cancer (CRC) resections during the COVID-19 pandemic in England and Wales.

Method
A list of all colorectal multi-disciplinary teams (MDTs) was obtained from the National Bowel Cancer Audit (NBOCA) database. A survey was designed using Google Forms and emailed to at least one consultant colorectal surgeon of each MDT. One response per MDT was used in the analysis. All responses were anonymous. Study duration was from 15th April 2020 to 30th June 2020.

Results
Sixty-eight of the 150 MDTs enlisted on the NBOCA database in England and Wales responded. 86.6% were performing CRC resections and 86% were screening patients pre-operatively for COVID-19. 84.9% were using full Personal Protective Equipment (PPE - FFP3 and eye protection) in all cases whereas 12.3% were using PPE only in suspected cases. 44.4% had resorted to open resections due to risk of laparoscopy being an aerosol generating procedure. 13.7% attributed post-operative complications to COVID-19 and 4 centres reported death due to COVID-19 related complications. 40% of MDTs used short course radiotherapy in rectal cancer patients where resections were postponed either by patient or by the team. 55% responded to feeling uncomfortable/very uncomfortable to cancel cancer resections while 31.7% were equivocal and others comfortable not to operate during the pandemic.

Conclusions
This survey demonstrates a snapshot of practice during the peak of the COVID-19 pandemic. The majority of the centres continued to perform CRC resections safely where possible. There has been obvious disruption to services and change to normal practice.
51 The Impact of Disability on Performance in the Intercollegiate Membership of the Royal College of Surgeons examination (MRCS)
Authors: Ellis R , Scrimgeour D , Cleland J , Lee A , Brennan P 
Published: October 2021

Abstract

Aim
The number of clinicians with disabilities is increasing, however there is no data on the performance of doctors with registered disabilities in the postgraduate environment. If we are to ensure diversity and equality within the workforce, we must first identify whether attainment differences exist in markers of performance. To address this, we assessed the impact of disabilities on performance in the MRCS.

Method
All UK medical graduates who had attempted MRCS Part A (n = 9,597) and Part B (n = 4,562) between 2007-2017 with linked disability data in the UK Medical Education Database (https://www.ukmed.ac.uk) were included. Univariate analysis identified associations with MRCS performance and logistic regression models identified independent predictors of success.

Results
Candidates with registered disabilities (n = 635) had lower MRCS Part A pass rates (46.3% vs 59.8% (p &lt; 0.001)) but similar Part B pass rates (68.2% vs 70.9% (p = 0.339)). They were nearly twice as likely to fail Part A (odds ratio 0.55 [95% Confidence Interval 0.46-0.64]). When prior academic attainment (A-Levels and medical school performance) was accounted for, there was no statistically significant difference in the likelihood of MRCS success (p&gt;0.05). Pass rates were similar for candidates with specific learning difficulties and those with other registered disabilities (p&gt;0.05).

Conclusions
This is the first study to assess the impact of disability status and type on performance at a postgraduate medical examination. It appears that candidates with registered disabilities performed less well in formal, written examinations generally. Although our data indicate that current MRCS testing accommodations are fair, enabling performance unrestricted by disability.
626 Barriers Faced by Female Surgical Trainees – A Qualitative Study
Authors: Morgan J , Manning K , Wyld L 
Published: October 2021

Abstract

Aim
Today women make up 56% of medical students, yet just 12% of surgical consultants, a number that has remained static since 2013. This qualitative study aimed to explore the barriers to female success in modern surgery.

Method
Semi-structured qualitative interviews were undertaken primarily with female surgical trainees to determine the barriers they face. Male trainees and Training Programme Directors were also interviewed for triangulation.

Results
Nineteen interviews were performed (15 female trainees, 3 male trainees and 1 TPD) between October 2019 and March 2020. Family pressures and becoming a mother were significant barriers for women training in surgery, a barrier that did not apply to male trainees who were fathers, often resulting in women choosing to train less than full time (LTFT). Unfortunately, LTFT training presents further obstacles for female trainees. The set-up of the National training programme in surgery provides many non-gender specific barriers, chiefly moving hospital every 6 months resulting in disrupted training and long commutes. Sexism and discrimination are still common, both from colleagues and patients. Many participants perceived inherent differences between genders in communication and methods for coping with stress.

Conclusions
Greater gender equality in surgery may be achieved by changes in the structure and organisation of training to reduce the tension between the professional role and the predominantly female-led role of raising children. Better equality and diversity training and awareness at all levels in surgery may help to mitigate some of the conscious and unconscious bias that still exists.