bluuebunny/crossref_metadata_2025_split huggingface dataset:
TP6.1.6 The management of pancreatic fluid collections with AXIOS stenting in Belfast HSCT
Authors: Doyle Joseph , Latip Nadiah , McCain Stephen , Magee Claire , Jones Claire 
Published: October 2021

Abstract

Aims
To assess the viability of using lumen-apposing self-expandable AXIOS stents, inserted under endoscopic ultrasound guidance, in the management of pancreatic fluid collections (PFCs) within the Belfast Health and Social Care Trust.

Methods
Data for all AXIOS stents inserted endoscopically between May 2016 and July 2019 were included. Electronic care records (ECR) and Radiology reports were reviewed for each patient. PFCs were categorised into walled-of pancreatic necrosis (WOPN) and pseudocysts, and the number of repeat procedures, OGDs with lavage, or the need for definitive surgery were recorded. The timeframe to surgery and whether PFCs recollected was also noted.

Results
45 AXIOS stents were inserted for PFCs in the audit period. n = 17 (37.8%) were for WOPN, n = 28 (62.2%) for pseudocysts. Mean duration of stenting was 38 ± 19.7 days. n = 11 (35.6%) patients were readmitted for sepsis with stent in situ, and n = 16 (35.6%) required OGD and lavage for stent blockage (n = 11 WOPN; n = 5 pseudocyst). n = 2 (4.4%) stents accidentally dislodged during lavage necessitating surgical removal. n = 4 (8.9%) patients required a second AXIOS stent following removal, n = 2 (4.4%) required CT guided drainage and n = 8 (17.8%) ultimately required surgical intervention.

Conclusions
Despite some drawbacks, including the need for intermittent OGD and lavage to maintain patency, AXIOS stenting appears to be effective first-line management for PFCs. Our audit showed they were successful in 71% of cases, requiring no further intervention. In PFCs that do require surgical management, AXIOS stenting may represent an effective bridge to surgery allowing for patient optimization before definitive care.
TP6.2.1 Does the use of Negative Pressure Wound Dressings decrease superficial Surgical Site Infections in the Emergency Laparotomy?
Authors: Smith Eleanor , Merriman Hannah , Haidar Safia , Knudsen Grace , Kinkaid Victoria , Burton Sarah 
Published: October 2021

Abstract

Aims
Surgical site infection (SSI) can be a significant cause of morbidity in the emergency laparotomy patient. Previous research into the role of negative pressure wound dressings to improve the rate of SSI culminated with NICE guidelines in 2019 recommending the use of negative pressure wound dressings in people who would be considered high risk for developing an SSI. Based on this guideline, we changed our policy to recommend the use of PICO dressings for all emergency laparotomies in order to decrease our rate of SSI. Our aim of this study was to assess the success of this policy change.

Methods
In this closed-loop audit we analysed data from all laparotomy patients at Frimley Park Hospital over 12 months. We retrospectively analysed the data of the pre-intervention group between January – June 2019, and prospectively audited all laparotomy patients between July – December 2019.

Results
We found that there was no significant decrease in the rate of superficial SSI, from a pre intervention rate of 22.2% to a post intervention 24.1%. Similarly, we found no significant decrease in the rate of wound dehiscence, which increased from 13.8% to 17.7%. In further assessment we saw no significant difference in the rates of contamination, ASA grades, or closure techniques to account for these increased rates.

Conclusion
While other studies have demonstrated a decrease in SSIs following the use of PICO dressings, we did not show such a result, leading us to question the cost-effectiveness of negative pressure wound dressings in the emergency laparotomy patient.
TP6.2.3 Abnormal liver function tests: A helpful diagnostic test and a predictor of severity in acute appendicitis
Authors: Telfah Muwaffaq , Mason Mathew , Hollyman Marianne , Noble Hamish , Mahon David , Welbourn Richard 
Published: October 2021

Abstract

Aim:
Acute appendicitis (AA) is the commonest surgical emergency worldwide. The diagnosis usually is clinical but imaging and bloods tests are helpful. The study aims to establish the role of abnormalities in liver function tests (LFTs) in the diagnosis and in predicting the severity of AA.

Methods
Retrospective, observational study performed in district general hospital between June 2018 and June 2019. Patients with abdominal pain and appendicectomy (excluding children &lt;16 years with isolated ALP rise) were categorized into two groups based on presence (Group-A) or absence (Group-B) of abnormal LFTs. Demographics data, diagnosis and severity of appendicitis, hospital stay and postoperative complications were analysed.

Results
Two hundred and seventy nine patients were included: Group-A (n = 146, mean age 37.5 years, M: F 1.3/1.0) and Group-B (n = 133, mean age 29.7 years, M:F 1.0/1.8). Appendicitis occurred in 85.6% of Group-A (125/146) and in 62.4% (83/133) of Group-B with positive predictive value 85.6%. The appendix was normal in 14.4% of Group-A (21/146) and in 37.6% of Group-B (50/133) with specificity of 70%. Laparotomy was required in 6.1% in Group-A (9/146) compared to 1.5% in Group-B (2/133). Average hospital stay was 4.7 days (range: 1-21) in Group-A versus 2.7 days (range 1-14) in Group-B. Readmission rate due to a postoperative complication was 16.4% in Group-A (24/146) compared to 6% in Group-B (8/ 133).

Conclusion:
Deranged LFTs is an additional diagnostic tool in AA and a good predictor of its severity. This may help to decrease the negative appendicectomy rate and guide surgeon in the decision-making process.
TP6.2.8 Impact of patients’ characteristics on operative difficulty and clinical outcomes of laparoscopic cholecystectomy
Authors: Orabi Amira , Di Mauro Davide , Njere Ikechukwu , Ratano Marco , Thavakumar Sankavi , Manzelli Antonio 
Published: October 2021

Abstract

Background
Laparoscopic cholecystectomy (LC) is a common surgical procedure. Intraoperative findings are highly unpredictable and the operative difficulty varies from straightforward to very challenging procedures. Several studies described predictors of technical difficulty and graded intraoperative findings of LC, however none specifically reported on the effect of such factors on clinical outcomes. This study aims to evaluate the impact of patients’ preoperative characteristics on operative difficulty of LC and clinical outcomes.

Methods
Data of patients who underwent LC from 2015 to 2017 retrospectively analysed. Subjects were divided into four groups, according to Nassar’s classification of intraoperative difficulty. Differences in frequencies were evaluated with the Fisher’s exact test; logistic regression analysis was used to identify independent variables that were predictors of postoperative morbidity and length of stay.

Results
A total of 1069 patient were included. Male to female ratio of 1:2.5. Older age, male gender and comorbidities were associated with higher Nassar score (p &lt; 0.0001); Nassar 3 and 4 were predictors of postoperative morbidity(P£0.01). The day case rate was 88.8% (Nassar 1), 86.1% (Nassar 2), 69.6% (Nassar 3), 62.3% (Nassar 4), respectively. Age of 60 and above(P£0.018), ASA 2 or 3(P£0.04) and Nassar 3, 4 (P£0.012), were predictors of increased conversion from day case to in-patient stay.

Conclusion
LC can be performed on a day case basis even when surgery is technically challenging. However, the need of in-patient stay can be predicted in comorbid old adult men with anticipated higher Nassar’s score.
TP6.2.23 Does using intraoperative Tisseel reduce the leak rate in Cardio-Oesophagectomy: A single centre retrospective audit of anastomotic and chyle leaks
Authors: Blake Iain , Chapman Stuart , Turner Paul 
Published: October 2021

Abstract

Aims
Anastomotic leak and chylothorax are serious complications of cardio-oesophagectomy. The application of a tissue sealant to the anastomosis and ligated thoracic duct could be beneficial in protecting against leaks. We aimed to determine if using Tisseel, a fibrin-based tissue sealant, had any impact on anastomotic or chyle leak rates following cardio-oesophagectomy.

Methods
All elective cardio-oesophagectomys performed in a tertiary upper GI centre between 01/01/2013 and 01/01/2018 were identified. Patient records were retrospectively analysed to assess basic demographics; whether Tisseel was used; whether anastomotic or chyle leak occurred and if so whether this was managed conservatively or surgically.

Results
245 records were available, Tisseel was used in 151 cases (61.6%). Patient demographics were similar between the Tisseel and no Tisseel groups (82.7% vs 77.7% male, mean age 66 vs 65 years). There was no significant difference in anastomotic leak (4.0% vs 7.4%, p = 0.24) or chyle leak (6.6% vs 4.3%, p = 0.44) rates. For patients who had an anastomotic leak there was a significantly lower rate of re-thoracotomy when Tisseel was used (16.7% vs 85.7%, p = 0.021). There was no significant difference in re-thoracotomy rates for chyle leak (40% vs 100%, p = 0.085).

Conclusion
Our data does not show any significant difference in leak rates when Tisseel is used. However, it does show that Tisseel use is associated with lower rate of re-thoracotomy in patients with anastomotic leak. This could possibly be due to smaller contained leaks. Further work is needed to determine the true benefit of Tisseel use in cardio-oesophagectomy.
TP6.2.26 Innovations Towards Achieving Environmentally Sustainable Operating Theatres: A Systematic Review
Authors: Perry Helen , Reeves Nicola , Brennan Fiona , Morris Daniel , Torkington Jared , Horwood James 
Published: October 2021

Abstract

Introduction
The NHS accounts for 5.4% of the UK’s total carbon foot print, with the perioperative environment being the most resource hungry aspect of the hospital. The aim of this systematic review was to assimilate the published studies concerning the sustainability of the perioperative environment, focusing on the impact of implemented interventions.

Methods
A systematic review was performed using Pubmed, OVIC, Embase, Cochrane database of systematic reviews and Medline. Original manuscripts describing interventions aimed at improving operating theatre environmental sustainability were included.

Results
648 abstracts were screened with 33 manuscripts included. Studies were divided into broad themes; recycling and waste management, waste reduction, reuse, reprocessing or life cycle analysis, energy and resource reduction and anaesthetic gases. This review summarises the interventions identified and their resulting effects on theatre sustainability.

Discussion
This systematic review has identified simple, yet highly effective interventions across a variety of themes that can lead to improved environmental sustainability of surgical operating theatres. Combining these interventions will likely result in a synergistic improvement to the environmental impact of surgery.
TP7.2.3 The effect of immediate versus early instillation of mitomycin C after transurethral resection of bladder cancer: Is timing everything?
Authors: Fernandes Ricardo , Mukherjee Ankur , Patel Ameet 
Published: October 2021

Abstract

Introduction and Aims
Almost three quarters of patients diagnosed with bladder cancer have non-muscle invasive disease. The European Association of Urology (EAU) guidelines recommend the use of intravesical instillation of Mitomycin C (MMC) to reduce the rate of recurrence.

Methods
A retrospective cohort analysis was carried out of all patients who underwent a TURBT between January 2016 and January 2019 in our Trust. A comparison of recurrence outcomes was investigated between patients who had immediate instillation of MMC (within 1 hours post-TURBT) versus early instillation (within 24 hours post-TURBT). Recurrence was assessed at 3 months cystoscopy and at 1 year follow-up.

Results
201 patients were included. 100 underwent immediate MMC instillation (75% male, 25% female); 101 early instillation (72% male, 28% female). There was 11% recurrence (immediate) versus 13% (early) in instillation groups at 3 months. At first year, recurrence was seen in 12% (immediate) versus 14% (early) groups. Of these recurrences, there was an upstaging of tumour in 27% (immediate) versus 31% (early) at the 3 monthly follow-up and 25% (immediate) versus 28% (early) at the 1st year. The mean period of post-operative stay following initial TURBT was 0.8 days in the immediate versus 1.1 days in the early instillation groups.

Conclusion
Although no statistical differences were seen in this study, the results appear to favour immediate instillation of MMC after TURBT with respect to reduction in recurrence and upstaging rates. Post-operative length of stay in hospital was also shorter in patients who had an immediate MMC instillation.
TP7.2.9 Natural orifice surgery in early rectal cancer; is it the way forward?
Authors: Sharma V , Shang E , Abu Talib M , Hamer N , Garg D , Jha M 
Published: October 2021

Abstract

Aims
Transanal-endoscopic microsurgery (TEMS) for early rectal cancer is an attractive alternative to radical surgery. With proper patient selection, it is possible to achieve acceptable oncological outcomes with fewer complications. We aim to study the outcomes following TEMS for suspicious or proven rectal cancers performed in our unit.

Method
We performed a retrospective analysis of prospectively collected data between May-17 and Oct-20. The patients’ details, tumour specific data, short term outcomes, and recurrences were recorded.

Results
A total of 45 patients with early rectal cancer (M = 29, F = 15) were included in this study. With1 exclusion due to intraoperative rectal perforation, 44 were available for further analysis. Eleven had a diagnosis of cancer at the time of surgery, an additional 11 patients were confirmed on final histology, and 22 were benign. Final histology showed: T1=14, T2=4, T3=3 &Tx=1. The majority (68%) had clear resection margins (R1=3, R2=1, Rx = 3). Twelve patients went on to have further treatment. Seven had resectional surgery (AR = 5, APR=2) for unfavorable histology (2), residual disease (3), or recurrence (2). The other 5(23%) received chemotherapy+/-radiotherapy (unfit/patients’ choice) for unfavorable. Histology (3) or residual disease (2).

Conclusion
With judicious patient selection, it is possible to offer a less invasive option with acceptable oncological and patient related outcomes for suspicious and proven malignant rectal lesions. The majority of patients (84%) were able to avoid radical surgery or stoma, thereby reducing the associated morbidity. Whilst this is a single institution study, we believe with available expertise this could be widely replicated.
TP8.1.1 Does ultrasound quantification of suspicious axillary nodes correlate with pathological results?
Authors: Abdullah Muhammad 
Published: October 2021

Abstract

Aims
Fast-track axillary node clearance (ANC) leads to overtreatment of axilla. Improved quantification by axillary US (AUS) is suggested to avoid unnecessary ANC and proceed with ANC or SLNB based on the number of abnormal axillary nodes. This retrospective study was aimed to evaluate whether ANC can be omitted based on AUS quantification in patients with low axillary burden.

Methods
Retrospective data of breast cancer patients who underwent ANC following a positive pre-operative axillary nodal biopsy between 1 January 2017 and 31 December 2018 were included in this study. The patients who received neoadjuvant chemotherapy, those having ANC following positive SLNB and those with axillary recurrence were excluded. The histopathology results of ANC were correlated with axillary ultrasound findings.

Results
45 patients underwent fast-track ANC following positive axillary core biopsy. On pre-operative AUS, 18 of these patients were reported to have a single abnormal node, while 8 had two abnormal nodes and 19 patients had multiple abnormal nodes. The comparison of the number of metastatic nodes following ANC, and the reported abnormal nodes on pre-operative AUS, showed that 57.3% of patients with 1 – 2 abnormal nodes on AUS had 3 or more metastatic nodes and 26.3% of patients with multiple abnormal nodes on AUS had 1 – 2 metastatic nodes following ANC.

Conclusions
The quantification of the axillary burden with pre-operative AUS does not correlate with the number of metastatic axillary nodes. The reported relevant axillary burden on AUS is not sufficiently specific to form the basis of omission of ANC.
TP8.1.11 Discussing results and breaking bad news in breast video consultations: a pilot questionnaire
Authors: Touqan Nader , Nasir Nabila , Williams Kate , Bramley Maria , Shamim Absar M 
Published: October 2021

Abstract

Aim
Virtual consultations (VC) in Breast Surgery have become well-established during the COVID pandemic. They are successfully utilised in routine follow ups and low-risk new referrals. We aimed to assess the utility of VC in more complex clinical discussions.

Methods
We collected feedback anonymously via electronic link from 20 consecutive patients who specifically had more challenging video-VC including: 12 diagnostic MDT results (10 patients received bad news of new cancer diagnosis, 2 had benign results); 6 post-operative wound checks with therapeutic MDT outcomes; 2 new consultations for chest wall reconstruction.

Results
The time saved by patients was between 1 and 3 hours (median=2). All patients felt that booking and joining a VC was either very easy (12) or easy (8). 18 patients were satisfied with the quality of sound and picture and all 18 felt they were able to communicate everything to the clinician during their VCs. Compared to a face-to-face consultation, 14 patients felt that VC was better (70%), 4 felt it was similar (20%) and 2 thought it was worse (10%).
Most received comments were themed around VC had allowed patients to get their results, discuss their management plans and ask questions while they were safely at home with other family members, at times when COVID restrictions applied to outpatient clinical settings.

Conclusion
VC may be utilised selectively to provide complex consultations including discussing results, breaking bad news and wound inspections. Qualitative studies in this field can be beneficial.
TP8.2.9 Development & Evaluation of LapPass™: The Laparoscopic Passport
Authors: Fong Michelle , Treglohan Jenny , Selvasekar Chelliah , Sedman Peter , Leeder Paul , Francis Nader 
Published: October 2021

Abstract

Aims
Laparoscopic surgery is technically challenging and assessment of competency is necessary to ensure patient safety and guide training. Existing tools of assessment are mostly subjective, with a growing need for objective credentialing. LapPass™ was developed by a UK-based laparoscopic society as an accessible simulation assessment tool. The aim of this study was to report on its development and preliminary findings of usability and validity.

Methods
LapPass™ consists of 4 tasks that test: bimanual dexterity, simulated appendicectomy, dissection and intracorporeal suturing. Participants were prospectively recruited from testing events. Online surveys were sent to assessors and participants to assess the usability, face and content validity of the tool. Options to respond were on a five-point Likert scale with ratings from strongly disagree (1) to strongly agree (5).

Results
LapPass was launched and offered to trainees as free-of-charge assessment tool. 31 participants and 12 assessors took part. The 1st time pass rate for bimanual dexterity was 19/29 (65.5%), appendicectomy 13/23 (56.5%), dissection 20/27 (74.1%) and intracorporeal suturing 6/19 (31.5%). The mean scores for participants’ usability and validity were 3.8 and 4.12 for bimanual dexterity; 3.96 and 4.37 for appendicectomy; 4.5 and 4.16 for dissection and 3.84 and 4.52 for intracorporeal suturing. Assessors' mean score of usability was 4.5 across all tasks. Assessors scored validity of bimanual dexterity 4.35, appendicectomy 4.42, dissection 3.71 and intracorporeal suturing 4.65.

Conclusion
LapPass™ is a an accessible objective assessment tool for laparoscopic basic surgical skills with preliminary data to confirm its usability and face and content validity.
TP8.2.16 A survey to assess the confidence and knowledge of Foundation Year one doctors to perform a Digital Rectal Examination
Authors: Sahni Dhruv , Carson Daniel , Khan Khurram 
Published: October 2021

Abstract

Aims
Digital Rectal Examination (DRE) is an essential component of comprehensive assessment of a surgical patients, both in acute and elective settings. Due to the intimate nature of the examination, this important examination is often not well taught. This study aims to assess the confidence and knowledge of the Foundation Year 1 (FY1) doctors in performing DRE.

Methods
FY1 doctors were invited for online voluntary anonymous survey via Google forms. The survey consisted of 16 questions on the indications, findings and interpretation of DRE. The purpose and aims of the study were explained in an invitation email and participants provided a declaration of consent, giving permission for their anonymous results to be used in the study.

Results
There were 24 responses, 79% had performed DRE (including on mannequins and simulations) less than 10 times. Two thirds of DRE were performed during the FY1 rotation and two thirds in the elective wards. Majority of respondents (83%) were moderately confident in performing and appreciating DRE findings. 63% respondents though that a chaperone is not mandatory if the gender of the doctor and patient was same. 58% respondents thought that hematuria is not an indication to preform DRE. Interpretation of DRE findings - approximately 80% respondents correctly interpreted the findings, however only 45% could formulate the correct initial management plan.

Conclusions
This study illustrates that FY1 doctors receive inadequate exposure to performing and interpreting DRE. Their teaching should be enhanced by providing them with more opportunities through simulation and dedicated teaching sessions.
TP8.2.17 Supplementing Undergraduate ENT Teaching: A Neglected Surgical Speciality?
Authors: Luff Edward , Gurung Pratha , Waters Chris 
Published: October 2021

Abstract

Aims
A 2020 survey of undergraduate ENT education found there was wide variability between Medical Schools despite a standardised curriculum, published by ENT UK. To improve this, a group of CTFs designed and led teaching sessions covering each aspect of ENT based on the ENT UK curriculum. The aim was to improve confidence in and knowledge of ENT conditions expected at junior doctor level.

Methods
Final year students participated in three 1-2 hour teaching sessions focused on ‘Otology’, ‘Rhinology’ and ‘Head & Neck’. Each session started with an MCQ assessing prior knowledge, with a post-teaching MCQ to assess for improvement. There was an additional questionnaire to measure confidence in several domains pre- and post-teaching, and of the undergraduate teaching they had received within their medical schools.

Results
Overall, students’ pre-ENT teaching and post-ENT teaching MCQ scores improved from 67% to 87%. The percentage of students who felt ‘fairly confident’ and/or ‘completely confident’ in the following domains were compared pre- and post-teaching respectively: recognising ENT conditions (26% vs 42%); managing & treating ENT conditions (5% vs 42%); and recognising surgical airways (3% to 40%). 47% of students found tutorials based on ENT ‘very useful’ for their learning, compared to 16% for outpatient clinics & lectures. 94% of students had received ENT teaching for a period of &lt; 2 weeks, with 37% of those receiving &lt;1 week.

Conclusions
This project demonstrates how a small series of curriculum specific ENT teaching can help final year students to supplement their knowledge and confidence in ENT.