bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.WE.805From bench to bedside; A rationale for Immunotherapy in the adjuvant setting for Oesophageal cancer
Authors: Donlon Noel , Davern Maria , Sheppard Andrew , Reynolds John , Lysaght Joanne 
Published: October 2021

Abstract

Background
Immunotherapy is being intensively investigated for its utilisation in the curative setting as a single agent and in the multimodal setting, however, the most appropriate time to incorporate ICIs remains unknown. Our study profiles systemic anti-tumour immunity perioperatively to provide a rationale for adjuvant immunotherapy.

Methods
Systemic immunity was immunophenotyped pre and post-oesophagectomy on days 0, 1, 3, 7 and week 6 by flow cytometry (n = 14). The frequency of circulating lymphocytes, T cells, cytotoxic and helper T lymphocytes was profiled longitudinally including the proportion of T cell subsets in circulation. This study also profiled immune checkpoint expression on circulating T cells including: PD-1, CTLA-4, TIGIT, TIM-3, LAG-3, PD-L1 and PD-L2. Markers of immunogenicity (calreticulin, HMGB1 and MIC-A/B) were also assessed.

Results
The frequency of circulating CD27 + T cells increases sequentially in the immediate post-operative period peaking on day 7 in OAC patients. (p &lt; 0.01) There is a sequential decrease in the percentage of effector memory and central memory T cells in circulation and an increase in the percentage of naïve T cells in peripheral circulation of OAC patients in the immediate post-operative period. The expression of CTLA-4 on the surface of circulating CD4 + T cells decreases 6 weeks post-operatively in OAC patients.

Conclusions
We observed increased T cell activation and immune checkpoints immediately post-surgery with returns to baseline by week 6. These results suggest that immune checkpoint inhibitors such as anti-PD-1 may be beneficial immediately post-surgery to maintain T cell activation and prevent exhaustion of this increased population of activated T cells observed immediately post-surgery.
EP.WE.842Maintaining Recruitment to Surgical Trials during the Pandemic
Authors: Shahid Mishal , Barton Jessica , Richardt Mike , Shovelton Charmaine , Hollyman Marianne 
Published: October 2021

Abstract

Aims
Recruitment to Randomised Controlled Trials (RCTs) has traditionally been the domain of Research Nurses. Due to the unprecedented pressures of the COVID pandemic, the majority of Research Nurses have been redeployed to other clinical roles, or those still working within research have had to focus on COVID-related projects. This has left existing surgical trials struggling to recruit. We report on our experience of engaging Specialist Nurses without a research background as well as Consultants and Trainees to support surgical research in these challenging circumstances.

Method
The Sunflower RCT was first opened to recruitment in August 2019 at our trust. The recruitment was led by single Research Nurse, but the delegation log included a range of Consultants, Trainees, and Specialist Nurses. Due to the COVID pandemic, recruitment was paused from March 2020 and restarted in July 2020. Data were collected on recruitment until January 2021.

Results
In the seven months before the recruitment pause, 80 patients were recruited (average 11 per month), with the highest proportion of recruits by the sole Research Nurse. Following the recruitment pause, a further 45 patients were recruited (average 7.5 per month). These patients were recruited by Consultants (20, 44%), Specialist Nurses (12, 27%), Trainees (7, 16%), Research Nurse (3, 7%) and postal consents (3, 7%).

Conclusions
We have demonstrated that surgical research activity can be maintained even with minimal Research Nurse recruitment by engaging all members of the surgical team, especially utilising Specialist Nurses, who may not commonly be approached for such a role.
EP.WE.852Role of Prophylactic steroids in the prevention of post-thyroidectomy hypocalcaemia and voice dysfunction
Authors: Ahmed Raheel , Dhahri Adeel Abbas , Bhatti Dujanah S , Ahmad Sheikh Haseeb , Kirmani Naveed 
Published: October 2021

Abstract

Aim
Total thyroidectomy, being a common surgical option, for multinodular goitre and selective cases of Graves’ disease, is associated with risks related to temporary hypocalcaemia and vocal quality dysfunction. Dexamethasone, as a steroid, has well-established anti-inflammatory and immune-modulating effects. As researchers continue to understand its pathophysiology on hypocalcaemia and voice quality, we aim to assess the effect of preoperative dexamethasone used to improve hypocalcaemia and vocal cord function/post-thyroidectomy voice disorder.

Methods
We conducted a single-centre, non-randomised, double-blinded placebo-controlled, parallel-group study with short follow-up in a public sector hospital from January 2014 to December 2019. Patients were equally distributed in two groups to compare the effect of dexamethasone with placebo on hypocalcaemia and vocal cord function/post-thyroidectomy voice disorder

Results
Out of 192 patients, 36 (18.75) male patients while 156 (81.25) were female. Age range was 18 to 60. Eighteen patients had both low calcium level at 24 hours after the operation and hypocalcemic symptoms, of which 4 remain to have hypocalcaemia on third postoperative day. Forty patients defined as having voice dysfunction at 24 hours after being scored using Voice scale. Of these 40 patients with voice dysfunction, 8 had low calcium level in blood at 24 hours while only 2 of these remained with low calcium level on third postoperative day. 6/8 patients had symptomatic hypocalcaemia on first postoperative day.

Conclusions
Single-dose dexamethasone, during the preoperative period, is as safe and as effective in improving transient postoperative hypocalcaemia and Temporary vocal quality dysfunction/post-thyroidectomy voice disorder.
EP.WE.962Pre-emptive arterial stenting with covered vascular stents to prevent mycotic haemorrhage in infected fields following failed kidney and pancreas transplants prior to graft explant
Authors: Spiers Harry , Burke Kelly , Anantha-Krishnan Ganapathy , Van Dellen David , Moinuddin Zia , Augustine Titus 
Published: October 2021

Abstract

Aims
Allograft nephrectomy and pancreatectomy present a significant surgical challenge in contaminated surgical fields, with risks of post-operative pseudoaneurysms and mycotic bleeds. We report on our experience of prophylactic endovascular stenting shortly before or after allograft nephrectoym and pancreatectomy to reduce the risk of subsequent pseudoaneurysm formation from the donor arterial conduit.

Methods
A retrospective analysis of all patients undergoing arterial stenting by interventional radiology prior to graft explant in our unit was performed.

Results
Twelve patients were identified, 6 of whom had undergone kidney transplant and 6 simultaneous pancreas kidney transplant (SPK) with an average age of 46. Iliac stenting was prophylactic in 7 patients, for pseudoaneurysm (28%), graft pancreatitis (28%), acute rejection (28%), enteric anastomotic leak (16%) and transplant pyelonephritis (14%). Therapeutic stenting was performed in 5 patients, all of whom had ruptured pseudoaneurysms. Post-operative 30-day mortality occurred in 1 patient resulting from an acute on chronic limb ischaemia and subsequent sepsis and death. Of the remaining patients, none experienced complications from stenting. 9 of the 12 stented patients remain alive, with the 3 mortalities resulting from other pathology not relating to stenting.

Conclusion
Prophylactic iliac stenting around the time of graft excision in inflamed or infected fields provides a safe and effective technique to completely exclude the donor arterial stump, with no subsequent vascular complications reported within our series. Preventing mycotic aneurysm formation in this way may mitigate the risk of potentially catastrophic post-operative mycotic arterial bleeds.
EP.TH.3Male Breast Cancer: A Series of Three Extremely Rare Cases
Authors: Latif Ahmed , Suliman Amna , Nagarajakumar Anupama , Khan Mihir , Metafa Anna , Uhercik Michal 
Published: October 2021

Abstract

Aims
Male breast cancer (MBC) is rare and accounts for 1% of all breast cancers. We present a case series of three very rare histological subtype MBC within one year in a UK hospital.

Methods
We retrospectively identified all MBCs from the local breast cancer database. Their presentations, radiology and histopathology were analysed.

Results
Three MBCs were identified from 2019 to 2020. A healthy 28-year-old presented with a right breast lump. Ultrasound (USS) revealed a partially cystic 15mm U3 lesion. Mammography (MMG) was suggestive of gynaecomastia (M2). Biopsy was inconclusive. Diagnostic excision revealed Papillary Ductal Carcinoma in Situ (DCIS) with involved margin. Mastectomy and Sentinel Node Biopsy (SNB) confirmed low-grade Papillary DCIS.
A 48-year-old with background of hyperlipidaemia presented with a 2-year history of left axillary lump. PET CT demonstrated an FDG-avid lesion. USS showed a superficial U3 28mm lesion. MMG showed a 34mm density (M4). Biopsy identified Mucinous Carcinoma. Wide Local Excision and SNB confirmed grade 2 Mucinous Carcinoma.
A 75-year-old with history of cardiac disease, COPD and Type 2 Diabetes, presented with a right retro-areolar lump. MMG identified a 47mm mass (M4). USS showed a 41mm cystic lesion with wall thickening (U4). Cytology was inconclusive. Biopsy identified intra-cystic papillary carcinoma. Mastectomy and SNB confirmed intra-cystic papillary carcinoma. All three histological subtypes are extremely rare and account for less than 4% of all MBCs.

Conclusions
MBC is rare but increasing in incidence. More research and awareness are needed to minimise delays in diagnosis and treatment even in young men.
EP.TH.108A Descriptive Case Series of Incisional Hernia Repair Using Dual Mesh Technique
Authors: Theodorou Chloe , Moinuddin Zia , Dellen David Van 
Published: October 2021

Abstract

Aims
Incisional hernias are a common complication after surgery that cause significant patient morbidity. Symptomatic patients are offered repair but many surgical techniques exist, with abdominal wall reconstruction becoming preferable for large complex defects. This paper describes our experience of abdominal wall reconstruction using a dual mesh technique.

Method
22 patients underwent incisional hernia repair between March 2019 and September 2020. All patients received dual mesh, placed in retrorectus or transversalis fascial/retromuscular space. Absorbable BIO-A GORE mesh was used with a polypropylene mesh above. All patients were followed up to assess for complications and recurrence.

Results
No patients experienced fistula formation, long-term pain or obstructive symptoms.
We report one true hernia recurrence (4.5%) and one case of infected mesh (4.5%), these both await further treatment. One patient had a proven wound infection which resolved with conservative treatment. 4 patients (18.2%) experienced seromas, 3 of these resolved spontaneously, one requiring image-guided drainage.

Conclusion
Incisional hernia repair using combination polypropylene and bio-absorbable mesh provides a safe and effective repair with low recurrence and incidence of surgical site occurrences in the short term. Longer follow up and further studies are needed to evaluate this mesh technique to support ongoing use of absorbable meshes in complex hernia repair.
EP.TH.109Full cycle audit reviewing the post-operative blood transfusion rate in open hernia repairs in order to reduce the number of pre-operative Group and Save Tests required: an aid to rational resource utilisation of finite resources during the COVID-19 pandemic
Authors: Wong Nicholas , Anantaprakorn Navamint , Conn Gemma , Pearson Thomas 
Published: October 2021

Abstract

Aims
Open hernia repairs are common elective and emergency surgical procedures; the majority are performed without complication. A primary audit indicated pre-operative group and save could be disregarded without compromising safety. A selective group and save policy was introduced, and safety of this approach examined with a 2nd cycle audit.

Methods
Retrospective review of electronic patient records between October 2019 to September 2020. Cross referencing of operative and blood transfusion records performed compared to the primary audit cycle of April 2018 to March 2019.

Results
A total of 225 open hernia repairs including inguinal, femoral and all other abdominal wall hernias were performed during the 2nd cycle compared to 410 in the 1st cycle. Patients were ASA 1-5 including emergencies.
The post-operative blood transfusion rate was reduced from 1.46% to 0% following implementation of the selective policy. The number of pre-operative group and saves obtained reduced to 117; saving £6,840.19.

Conclusions
This single centre full cycle audit indicates pre-operative group and save tests are unnecessary in open hernia repair. A selective group and save policy introduced for certain patient characteristics such as emergency repair, ASA ≥3 or abdominal wall reconstruction reduced the post-operative blood transfusion rate to 0%.
Discontinuing mandatory pre-operative group and save is a safe approach synchronously reducing clinical and financial burden. COVID-19 has stretched already limited resources, resulting in reduced surgical services and diminished case numbers during the 2nd cycle. Therefore, rational resource utilisation with a selective group and save policy maintains patient safety during the pandemic.
EP.TH.111Assessing the efficacy of the modified S-PECS anaesthetic block in patients undergoing breast augmentation surgery – a randomised double-blind control trial
Authors: Saghir Noman , Saghir Reyan , Sidhu Manu , Okhiria Terrell , Okhiria Renee , Sforza Marcos 
Published: October 2021

Abstract

Aim
Postoperative acute chronic pain following breast surgery is a common complication which needs resolving to allow for improved patient outcomes. Previously thoracic epidurals and paravertebral blocks (PVB) have been the gold standard administered intra-operatively. However, more recently the introduction of the Pectoral nerve block (PECS and PECS-2 blocks) has looked promising to control the pain more effectively, but further robust analysis is required to prove its efficacy. The authors aim to study the efficacy of a new block S-PECS that comprises a serratus anterior and a PECS-2 block associated.

Methods
In this study we performed a prospective, single-centre randomised controlled double-blind group trial in 30 female patients undergoing breast augmentation surgery with silicone breast implants and the S-PECS block. Divided into groups of 15, the S-PECS group received local anaesthetics with the no-PECS control group receiving a saline injection. All participants were followed up at recovery (REC), 4, 6 and 12 (4H, 6H and 12H) hourly postoperatively.

Results
Our results showed that the pain score in the S-PECS group was significantly less than the no-PECS group across all time points REC, 4H, 6H and 12H. Furthermore, the patients that received the S-PECS block were 74% less likely to request pain medications compared to the no-PECS group (p &lt; 0.05).

Conclusion
Overall, the modified S-PECS block is an effective, efficient and safe method of controlling pain in patients undergoing breast augmentation surgery with additional applications yet to be explored.
EP.TH.174The FLIP Study – Fluid Resuscitation in Pancreatitis
Authors: McGovern Julia , Moir John , Tingle Sam , Hawthornwaite Emma , Robinson Stuart ,   Northern Surgical Trainees Research Association NOSTRA
Published: October 2021

Abstract
Acute pancreatitis is a common condition encountered in emergency general surgical presentations. The severity of this condition can range from mild to severe and potentially life threatening in up to 20% of cases. Intravenous fluids are the cornerstone of management however there is very little guidance and poor quality evidence regarding optimal intravenous fluid administration. Aim to establish current clinical practice regarding the rate of intravenous fluid administration in acute pancreatitis and the effect this has on patient morbidity and mortality.
A prospective multi-centre audit of patients presenting with acute pancreatitis in the North East of England (Sixty days recruitment with 30-day follow-up, November 2020 – February 2021). Patients aged 18 years or above with acute pancreatitis will be included. Data will be collected on intravenous fluid administration within 72 hours of admission. The primary outcome measure will be admission to HDU/ITU with secondary end-points including 30-day mortality, length of stay, radiological evidence of necrosis, and evidence of organ failure.
Data collection has commenced across nine sites with over 150 patients recruited to date. The results of this study will be prepared in accordance with guidelines set by the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement for observational studies. Data will be analysed using SPSS. Statistical significance will be defined as a p value of ≤ 0.05.
Data collection will be completed in February 2021. Pending the results of phase one, an RCT will be designed to determine the optimal rate of intravenous fluids for improved patient outcomes.
EP.TH.249Evaluating the incidence and predictors of readmission in patients awaiting cholecystectomy for previously diagnosed acute gallstone disease
Authors: Noureldin Khaled , Razzaq Humayun , Najdawi Amal , Dick Georgina , Whelan Katy-Louise , Ayantunde Abraham 
Published: October 2021

Abstract

Background
Recurrent hospital admission remains a major issue with patients awaiting surgery for symptomatic gallstones. We evaluated the incidence and predictors of readmission in patients previously admitted with acute gallstone disease.

Patients and Method
We analysed laparoscopic cholecystectomies performed between January 2018 and December 2019. Data relating to the acute index admissions, readmissions, waiting time to surgery, operative details including emergency, elective procedures and conversion rates were analysed.

Results
532 procedures were performed over a two-year period. Patients with non-acute gallstones (111), primary open (4) and abandoned procedures (2) were excluded. Median age 415 included patients was 50(13-89) years and a male to female ratio of 1:3. Index admission presentations were acute cholecystitis (41.7%), biliary colic (23.1%), pancreatitis (15.9), obstructive jaundice (9.2%) and combinations (10.1%). 56.4% of the of the patients were readmitted between 1-6 times before surgery. Readmission diagnoses were cholecystitis (12.5%), biliary colic (26.7), pancreatitis (8.2%), obstructive jaundice (8.0%), acute cholecystitis with gallbladder perforation and abscess (0.5%), post-ERCP pancreatitis (0.5%) and pancreatic pseudocyst (0.2%). 14.9% of the patients underwent emergency procedures. Overall conversion rate was 1.4%. Median waiting time to surgery was 12(0-123) weeks. Waiting time to surgery was significantly lower in gallstone pancreatitis compared with other presentations (p-value 0.008). Acute pancreatitis (p-value 0.0001) and complicated index presentations (p-value 0.0001) were predictors of recurrent symptoms and readmission. Age, gender, comorbidities, high BMI, ASA have no significant impact on readmission episodes.

Conclusion
Readmission is a common occurrence following acute gallstone attacks with acute pancreatitis and complicated index presentations as significant predictors.
EP.TH.273Intestinal Malrotation in Adults: A case series and Literature Review
Authors: Rajebhosale Ramprasad , Chidambaranath Rajesh , Cleto Cindy , Parmar Dylan , Husain Najam , Thomas Pradeep 
Published: October 2021

Abstract

Aim
Midgut malrotation is a rare but a very well-known congenital anomaly. It is a result of non-rotation, incomplete rotation or reversed rotation and fixation of midgut. Delayed diagnosis due to non-specific symptoms in elective cases and conversion to laparotomy due lack of intra-operative anatomical understanding in emergency cases imposes increase in patient dis-satisfaction, delayed recovery and healthcare cost burden. Here we report an interesting case series which impose a significant diagnostic challenge due to atypical clinical and radiological signs. Management of such cases by minimal invasive surgery is possible if general surgeons are aware of unusual anatomy and general practitioners are aware of such known but rare cases.

Cases
Two patients who presented on background of on and off recurrent non-specific attacks of abdominal pain, one of them as an emergency as midgut volvulus, were diagnosed radiologically and treated laparoscopically. The other one presented as an acute appendicitis and was converted to laparotomy, in spite of good laparoscopic expertise due to lack intra-operative anatomical understanding.

Conclusion
In the era of laparoscopic surgery, a general surgeon should encounter such an unusual case once in a lifetime. It is of paramount importance to be well verse with such unusual cases. General Practitioners should be aware of such atypical presentations of rare conditions causing recurrent abdominal pain. They should consider appropriate further imaging investigations and referrals for best possible patient care.
EP.TH.282Adherence to ERAS® Society recommendations following elective colonic surgery (2012) in regard to urinary drainage, postoperative nutritional care and intra-abdominal drainage
Authors: Limnatitou Dimitra , Franklyn Joshua , Douie Walter 
Published: October 2021

Abstract

Aims
Evaluating adherence to ERAS® recommendations for post-operative urinary drainage, nutritional care and intra-abdominal drain placement in elective colorectal surgery.

Methods
Approval was obtained by the audit department of a university teaching hospital. Data was collected prospectively over a seven-week period for nineteen (n = 19) patients. Results were compared against the standard set by the ERAS® Society (2012).

Results
Right colonic surgery (n = 5): catheter removed on post-operative day (POD) 1 n = 1 (20%), normal diet started on POD 0 or 1 n = 3 (60%), IV fluids discontinued on POD 1 n = 3 (60%) and n = 4 (80%) did not have a drain placed. High anterior resection or left/subtotal colectomy (n = 9): catheter removed on POD 1 n = 3 (33%), normal diet started on POD 0 or 1 n = 4 (44%), IV fluids discontinued on POD 1 n = 3 (33%) and n = 2 (22%) did not have a drain placed. Low rectal surgery (n = 4*, *one patient, n = 1, excluded from all domains except intra-abdominal drainage due to immediate post-op complication): catheter removed on POD 3 n = 4 (100%), normal diet started on POD 0 or 1 n = 2 (50%), IV fluids discontinued on POD 1 n = 1 (25%) and all patients had a drain placed n = 5 (100%).

Conclusions
Adherence for urinary drainage in low rectal surgery and intra-abdominal drainage for right colonic surgery was satisfactory. Multiple areas of improvement were identified, in order to optimise compliance, and recommendations were generated. The exception may be drains for lower rectal surgery where recent data has recommended selective drain placement.