bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.TU.933Late enterocutaneous fistula formation after evisceration repair using intraperitoneal mesh
Authors: Rodicio Jose , Sanz Sandra , Vico Tamara , Amoza Sonia , Moreno Maria , Sanz Lourdes 
Published: October 2021

Abstract

Introduction
Intraperitoneal meshes pose a potential risk of complications, either due to the material itself or the method of fixation. Enteric fistulas are a rare but serious complication following the repair of an abdominal wall reconstruction using an intraperitoneal prosthesis.

Case report
We present a 59-year-old male patient, who underwent surgery 5 years previously for urothelial carcinoma with radical cystoprostatectomy and a Bricker-type urinary diversion, without subsequent radiotherapy. He presented an evisceration in the postoperative period treated with an inlay placement of an intraperitoneal mesh, without fascial closure. During these five years the wound did not present any complications, and spontaneous intestinal drainage began through the laparotomy. The physical exploration showed a 2cm hole in the abdominal infraumbilical midline, a wall defect of 20x20cm contained by mesh, no parastomal hernia, BMI 31.2 kg/m2. Thoraco-abdominal CT studies were completed that ruled out other pathologies, nasal culture and optimization were performed with parenteral nutrition and glycosylated hemoglobin control to achieve values below 6. The reconstruction of the abdominal wall was done with posterior component separation with transversus abdominis release, double mesh placement a BioA and PVDF mesh, with a final bridge measuring 8x5cm. The postoperative period was prolonged by an ileus, with an admission period of two weeks.

Discussion
Intraperitoneal meshes, some of which are no longer commercially available, represent a potential risk of complication. As long as we can optimize the patient for surgery, we will improve the results. Retromuscular repair with large mesh and PVDF material gives us good results.
EP.TU.991Developing as Future Leaders: A Systematic Review of Quality Improvement Training in Junior Doctors
Authors: Aseem Rabiya , Simillis Costas , Smith Jason , Arora Sonal , Pawa Nikhil 
Published: October 2021

Abstract

Aims
Quality improvement (QI) training in Junior Doctors (JDs) is essential for providing High Quality Care for patients and facilitating organisational success. The aim of this study was to systematically review the evidence on QI training in JDs and determine the impact and effectiveness of training methods.

Methods
A systematic review was conducted as per PRISMA guidelines. Searches were carried out using MEDLINE, EMBASE and HMIC for English-Language articles between January 2005 to December 2019. Selected articles underwent critical appraisal using the CASP criteria by two independent reviewers. A qualitative and thematic analysis was conducted.

Results
43 studies were identified in a range of medical and surgical specialities. Common QI methodology included theoretical and project-based curricula with content focussing on PDSA cycles, root causes analyses and project development. Majority of studies reported improved knowledge, leadership skills and satisfaction. Mentorship and coaching were highly valued, but few studies adhered to this practice. Few studies demonstrated increased QI engagement. Key themes identified (i) Effectiveness of QI training (ii) Barriers to engagement (iii) Organizational culture of fostering QI.

Conclusion
There is growing mandate for training JDs in QI practices to enhance patient care. QI curricula targeting JDs have demonstrated improved knowledge and leadership skills. Nonetheless, significant barriers in QI engagement endure. Additional research is required to combat disengagement and assess sustainability of QI interventions in JDs. We further aim to introduce a pilot QI training programme for surgical JDs to enhance leadership skills.
EP.TU.1069Improved Perioperative and Survival Outcomes for Minimally Invasive Rectal Surgery
Authors: Nnaji Martin , Khan Kashuf , Hughes Sam , Inani Mohit , Yassin Nuha A 
Published: October 2021

Abstract

Aim
Although laparoscopic colon cancer surgery has been widely embraced as current evidence demonstrates comparable oncological results with open surgery, similar evidence is lacking for laparoscopic rectal cancer surgery. We present the outcomes of patients undergoing laparoscopic and open total mesorectal excision (TME) for rectal cancer in our unit.

Methods
We retrospectively analysed data collected for patients who underwent laparoscopic and open TME from January 2014 to December 2018. Sociodemographic, perioperative, circumferential resection margin (CRM) positivity, locoregional recurrence and survival data were analysed.

Results
260 (144 laparoscopic and 116 open) were included. Median age in the laparoscopic group was 69 years and in the open group 68 years.
Neoadjuvant therapy was given in 21 patients (14.6%) in laparoscopic and 13 (11.2%) in the open group (p = 0.42). CRM was positive in 16 cases (11.1%) laparoscopic and 32 (27.6%) open (p = 0.0007;95%CI:6.9-26.2).
No statistically significant difference in anastomotic leak rate was observed both groups (4.9% laparoscopic vs 4.3% open;p=0.82). Surgical site infection was significantly more in open cases (13% vs 5.6% laparoscopic,p=0.04). Similar locoregional recurrence rates were observed in both groups (18% laparoscopic vs 19% open,p=0.84).
Median follow up was 34 months or more allowed for Disease-free (DFS) and overall survival (OS) to be analysed for 144 of 260 patients. DFS and OS were better in laparoscopic (73% and 94%) compared to open (68% and 85% respectively) (p = 0.40 and p = 0.015 respectively).

Conclusion
From an oncological perspective, laparoscopic surgery for rectal cancer is safe with additional perioperative and survival benefits compared to open surgery.
EP.FRI.9Meta-analysis of mortality risk in octogenarians undergoing emergency General Surgery operations
Authors: Hajibandeh Shahab , Hajibandeh Shahin , Antoniou George A , Antoniou Stavros A 
Published: October 2021

Abstract

Aims
To quantify the risk of perioperative mortality in octogenarians undergoing emergency general surgical operations and to compare such risk between octogenarians and non-octogenarians.

Methods
A systematic review was performed in accordance with the PRISMA statement standards to identify studies reporting the mortality risk in patients aged over 80 years undergoing emergency general surgery operations. The certainty of evidence was assessed using the GRADE system. Random-effects models were applied to calculate pooled outcome data.

Results
Analysis of 66701 octogenarians from 22 studies showed that the risk of 30-day mortality was 26% (95% CI 18-34%) for all operations;29% (95% CI 25-33%) for emergency laparotomy,9% (95% CI 1-23%) for non-laparotomy emergency operations;21% (95% CI 13-30%) for colon resection;17% (95% CI 11-25%) for small bowel resection;9% (95% CI 7-11%) for adhesiolysis;6% (95% CI 5.9-6.8%) for perforated ulcer repair;3% (95% CI 2.6-4%) for appendicectomy;3% (95% CI 2.8-3.3%) for cholecystectomy;5% (95% CI 0.2-14%) for hernia repair. When stratified based on ASA status, the risk was 11% (95% CI 4-20%) for ASA 2, 22% (95% CI 10-36%) for ASA 3, 39% (95% CI 29-48%) for ASA 4, and 94% (95% CI 77-100%) for ASA 5. The risk was higher in octogenarians compared with non-octogenarians (OR:4.07,95% CI 2.40-6.89), patients aged 70-79 (OR:1.21,95% CI 1.13-1.31), and patients aged 50-79 (OR:2.03,95% CI 1.68-2.45).

Conclusions
The risk of perioperative death in octogenarians undergoing emergency general surgical operations is higher than the risk in younger patients. Laparotomy, bowel resection, and ASA status above 3 carry the highest risk.
EP.FRI.16 Use of Pulsed Lavage Reduces the Rate of Surgical Site Infection After Laparotomy
Authors: Bath Michael , Powell Jordan , Ismail Ismail , Machesney Michael 
Published: October 2021

Abstract

Aims
Surgical site infections (SSIs) are a preventable and common post-operative complication within general surgery. Intra-operative irrigation of surgical incisions is an inexpensive method to reduce post-operative SSI rates, however its use is currently limited to orthopaedic surgery. We aimed to assess the effects of pulsed lavage (PL) irrigation on SSI rates following elective and emergency laparotomies.

Methods
Elective and emergency patients who underwent a laparotomy between 2018 and 2019 were included. Relevant demographic and peri-operative risk factors collected retrospectively, following STROBE criteria. The primary outcome was rate of superficial SSIs within 30 days of the operation. Independent risk factors were assessed via multivariate logistic regression analysis.

Results
176 patients were identified, with an average age of 60.7 ±19.1 years. 82.4% (145/176) were emergencies and the mean ASA grade was 2.8. Fifty two patients (29.5%) had PL used during their operation. Thirty seven patients (29.8%, 37/124) in the control group developed a SSI, compared to seven patients (13.5%, 7/52) in the PL group (p = 0.022). At multi-variate analysis, the use PL conferring an Odds Ratio 0.36 (CI 0.12-0.94, p = 0.047) for developing a SSI.

Conclusions
PL appears to significantly reduced the rate of SSI following laparotomy. There remains scope to reduce the incidence of this common and expensive post-operative complication, and PL could provide a potential cost-effective means to deliver improved outcomes. Future prospective randomised trials are essential to fully assess its benefits and wider use within general surgery.
EP.FRI.34 Audit of management of shoulder dislocations against BOA Traumatic anterior shoulder instability Guidelines
Authors: Varasteh Amir , Hakim Zuned 
Published: October 2021

Abstract

Background
Traumatic anterior shoulder dislocation is associated with a high risk of shoulder instability, reduced functional outcome, and recurrence. We conducted an audit to assess the direct management, review in fracture clinic, and definitive imaging of patients with anterior shoulder instability in Southport and Formby Hospital.

Aim
To identify compliance with the 2015 BOA Traumatic anterior shoulder instability guidelines.

Method
Identified all patients from 01/01/2019 to 31/12/2019 who had shoulder dislocation coded for their diagnosis. We used imaging, scanned notes, and clinic letters where available to identify the clinical information. We excluded patients with a false diagnosis code, and those with non-local post codes from the analysis.

Results
We identified 67 patients who had an anterior dislocation. 88% of patients had x-rays in both AP and Lateral. We identified that 8.9% of patients had pre-reduction x-rays in AP only, 11.9% had no pre-reduction x-rays, and 1.5 % had no post reduction imaging. 79% of patients were seen in clinic within 6 weeks but only 40.3% were seen by a shoulder specialist and only 43.3% had appropriate imaging. 16.4% of patients were not given fracture clinic follow up.

Conclusion
Although most patients were managed acutely according to the guidelines, the follow up and subsequent investigations of these patients can be improved. One method we suggest is renaming fracture clinic days from consultant names to sub-specialty clinic names. In addition, a dedicated session to review the guideline with senior orthopedic surgeons cold improve the compliance as well.
EP.FRI.36 Clinical outcomes for surgical management of unstable spinal fractures in polytrauma patients: A systematic review
Authors: Qayum Mohammed , Malik Atif , Nawaz Ghulam , Razzaq Ahsen , Sudarshan Veena 
Published: October 2021

Abstract

Aims
This systematic review seeks to identify and discuss clinical outcomes in polytrauma patients who undergo surgical fixation of unstable spinal fractures. Specifically, this review aims to address the question of whether one surgical treatment modality outperforms other surgical approaches.

Methods
PubMed and the Cochrane Library database were systematically searched for case reports and clinical studies using key words and MeSH terms. Titles and abstracts were skimmed, and relevant articles were identified for further analysis. A total of 96 results were returned, 16 of which were included for full-text review.

Results
Six articles met the inclusion criteria. Four case reports, one case series, and one retrospective study published variable datasets, and each article failed to include highly relevant information. Thus, while conclusive statements about clinical outcomes in this population cannot be made, specific recommendations for future publications can.

Conclusion
Limited studies, a small overall cohort, and inconsistent reporting of data preclude a comprehensive systematic review of clinical outcomes. However, this review serves to highlight the need for consistent and standardized reporting guidelines for this cohort. In addition, two cases were successfully treated with minimally invasive techniques, suggesting that viable surgical options exist for patients who cannot undergo open spine surgery. Finally, these data support early surgical intervention when medically possible.
EP.FRI.60 A complete audit cycle into the paediatric negative appendicectomy rate for children presenting to A&E with suspected appendicitis at a District General Hospital
Authors: Maroof Hanna , Khalifa Khalid , Bakr Ahmed , Shah Isran , Abuelgasim Mona , Sultan Tabinda 
Published: October 2021

Abstract

Aim
Determine compliance rate with a local policy implemented in 2017, and whether interventions from audit cycle 1 were successful. The policy stated that all children aged 6-18 with acute abdominal pain must initially be reviewed by the ED registrar/consultant and have a documented Alvarado score.

Method
A closed loop audit on adherence to the 2017 policy and negative appendicectomy rate in children aged 6 to 18, with suspected appendicitis. The data were collected and analysed. Areas for improvement were discussed at the M&M meeting, alongside methods to achieve these improvements.

Results
The study included 67 patients aged 6-18 who underwent an appendicectomy in 2019. The study found that the Alvarado score had only 14.29% specificity. There was poor adherence to the 2017 protocol as only 36% had a documented Alvarado score and 55% had a senior ED review. Audit cycle 1 recommended improvement of ultrasound quality and increased use of CT scanning to reduce the negative appendicectomy rate. We found that only 2 patients had a CT. The negative appendicectomy rate in patients with and without an ultrasound remained at 8%, indicating no quality improvement. Nevertheless, our primary outcome showed that negative appendicectomy rates reduced from 28% to 11%.

Conclusion
These results demonstrate negligible impact of ultrasound and Alvarado scores. Good history-taking and clinical examination skills are key in reducing the negative appendicectomy rate. A specific ambulatory care pathway for children with suspected appendicitis has been implemented to lower inpatient stays and cost impact of unnecessary laparoscopies.
EP.FRI.96 Negative appendectomy rate in young females, between theory and practice. Full audit cycle
Authors: Hatem Fady , Mostafa Samir , Ross Rebecca , Chamali Basel , Ivanov Andrea , Sonsale Aniket , Kaldas Foad 
Published: October 2021

Abstract

Aims
Females of child bearing age are at higher risk of negative appendectomy rate, the accepted overall NAR is up to (20-25%). Presented is our study to examine the real NAR in the female’s cohort aged (15-45 years) in the form of quality improvement project to improve patient’s outcome.

Methodology
Retrospective study in the form of Full audit cycle over 18 months, the first cycle was conducted over 12 months period, followed by the action plan and reassessment over 6 months. Preoperative clinical, laboratory, radiographic and histopathological data were collected.

Results
Over the whole audit period 632 cases were analysed, 238 cases were females in the child bearing age included in our cohort. Over the first phase 419 appendectomy cases were performed, among those 156(37%) were females in child bearing age. Overall NAR was 29% and in our females cohort was 43.5%. Over the second cycle, 213 cases performed, out of which 82(38%) cases included in our cohort. Overall NAR reduced to 25% and in our cohort was 37%

Conclusions
Despite the advances in diagnostic modalities, Females are at significantly higher risk of NAR 37%. Our overall NAR reduced from 29% to 25% compared to the young females cohort, the rate dropped from 43% to 37%. specific consideration and regular auditing of results regards this cohort are highly recommended. Validation of appendicitis scores for risk stratification, Serial examinations and radiological adjuncts are possible solutions to reduce the NAR among this group.
EP.FRI.103 Acute Appendicitis in an Amyand Hernia – a case report and literature review
Authors: Ahmad Manal , Fazili Noureen , Chang Tou-Pin , Abdalla Hashim , Watfah Josef , Leo Cosimo Alex 
Published: October 2021

Abstract

Introduction
An Amyand Hernia (AH) is the presence of an Appendix within an Inguinal Hernia. We present here our clinical management of acute appendicitis in an AH and subsequent literature review. A 73 year old male patient presented with a two day history of right sided irreducible inguinoscrotal hernia with tender swelling on standing and walking. This was not associated with symptoms of bowel obstruction or fevers. Blood investigations revealed a raised C-Reactive Protein of 129m/l and White Cell Count of 15x 10^9/L. A Computed Tomography scan of the Abdomen and Pelvis revealed a right sided inguinoscrotal hernia arising lateral to the inferior epigastric vessels, containing an inflamed appendix and omental fat. The patient underwent an emergency open hernia repair with mesh and, considering that the appendix base was intra-abdominal, also underwent a laparoscopic appendicectomy.

Method
We conducted a literature review on Pubmed and Medline using the MeSH terms ‘Amyand Hernia’ AND ‘Appendicitis’ from 1970-2020.

Results
We longlisted 179 articles. Of these, 117 were excluded, as they were either paediatric cases, not relevant or mentioned in discussions. Finally, 62 relevant articles were included in the review.

Conclusion
Acute Appendicitis in Amyand Hernias has an incidence of 0.07-0.13%. Most cases remain as incidental findings however, increased use of imaging techniques has allowed accurate diagnoses and attempts at classifications. There is also weak association with Situs Inversus and atypical appendiceal tumours including adenocarcinoma, carcinoid and neuroendocrine tumour. Their management varies according to the extent of inflammation, radiological and intraoperative findings.
EP.FRI.116 Bleeping Etiquettes
Authors: Sandhya Anu , Oyewole Bankole , Ng Vivian , Cheng Amanda , Ghani Anum , Mangat Shannon 
Published: October 2021

Abstract

Introduction
Bleeps are a vestige of decades old technology common place in NHS Trusts. No formal guidelines exist to regulate the use of the bleep leading to user frustration on both ends of the system. Many junior doctors reported a high number of inappropriate and disruptive bleeps. This quality improvement project aimed to formulate a guide for the use of the bleep system.

Methods
Formal interviews were conducted among clinical and non-clinical staff as to the expectations in the use of the bleeping system. A list of bleeping etiquettes was created following formal interview and formed the basis of a Trust survey to formulate a Bleeping protocol.

Results
The following bleeping etiquettes were agreed upon;

Conclusion
A formalized protocol for bleeping can lead to a more effective and stress-free bleeping system.
EP.FRI.132 Current practice in the investigation and management of post-operative ileus
Authors: English Camilla , Jakes Adam , Wheatstone Sarah 
Published: October 2021

Abstract

Post-operative ileus is non-obstructive impairment of gastrointestinal motility after surgery. Treatment involves nil-by-mouth, correction of electrolytes and stopping aggravating medications. There is no national/trust guideline for investigation and management of post-operative ileus.

Aim
To assess current practice in investigation and management of post-operative ileus.

Method
All patients with a diagnosis of post-operative ileus on surgical wards at a London hospital between November - December 2020 were identified using clinical coding. Their clinical notes were reviewed and common themes explored.

Results
16 patients were diagnosed with post-operative ileus. 12 (75%) patients were male, with a median age of 60 (IQR: 28). 10 (63%) were open procedures, majority being colorectal (10; 63%), cardiothoracic (3; 19%), urological (2; 13%), vascular (1; 6%) operations. Average time between operation and diagnosis was 5.2 (range: 2-14) days. Only 2 (12.5%) patients had documented auscultation of bowel sounds at initial assessment. 8 (50%) patients had imaging to confirm diagnosis (AXR; 5, CT scan; 4). Majority (15; 94%) of patients had serum magnesium and potassium checked at diagnosis. Patients with serum potassium &lt;4.0mmol/L (5) and magnesium &lt;0.7mmol/L (2) had intravenous supplementation. 14 (88%) were administered Hartmann’s solution. 10 (63%) patients were made nil-by-mouth and 15 (94%) had a Ryles tube inserted. 2 (12.5%) patients were prescribed a prokinetic, and only 2 had either opioids or laxatives stopped. No patients were offered gum.

Conclusion
There is apparent clinical variation in investigation and management of post-operative ileus. We plan to develop an evidence-based trust guideline to reduce unwarranted clinical variation.
EP.FRI.148 Profile and management of Hand injuries in a tertiary institute
Authors: Mago Vishal 
Published: October 2021

Abstract

Aims
To outline the demographic profile and outcome of hand injuries in a tertiary institution

Methods
This study was done over a period of 4 years in a tertiary institution in patients presenting with open hand injuries and management protocols will be discussed based on presentation in emergency and opd of burn and plastic surgery.

Results
Majority of patients were labourers or skilled artisans who sustained injury during operation of machines and right hand was predominantly affected. Maximum injuries occurred in night time. Traumatic amputations were commonly seen along with involvement of thumb in some patients. Various reconstructive options will be discussed based on the involvement of hand injury.

Conclusion
Proper knowledge of mechanism of injury can guide in the management of patients. Exposure to machines and hazard prevention should be taught in factory establishments or threshers for reducing this menace.