bluuebunny/crossref_metadata_2025_split huggingface dataset:
VS 08 - HPB Laparoscopic cholecystectomy for left-sided gallbladder – How not to do it?
Authors: Gada Parth , Viswanath Y K S 
Published: November 2024

Abstract

Background
Left-sided gallbladder (LSG) is a rare congenital anomaly in the gallbladder, which is defined as a gallbladder located on the left side of the falciform ligament and round ligament without situs inversus. (1) The reported prevalence of sinistroposition ranges from 0.2% to 1.1%. (2) There are three recognized variants of LSG: LSG associated with situs viscerum inversus, true LSG, and gallbladder located to the left of abnormally located right-sided round ligament/ ligamentum teres.

Method
We present a case of a gentleman who was diagnosed as having gall bladder sinistroposition intraoperatively, after all the laparoscopic ports had been placed as per a routine laparoscopic cholecystectomy. Although the gentleman had undergone preoperative MRCP, it was not reported by the radiologists as such. The surgery was carried out using the usual ports used for standard four-port laparoscopic cholecystectomy and demonstrates the difficulty faced by the surgeon with these ports.

Results
Critical view of safety was demonstrated. Gall bladder was removed in piece meal. Surgery lasted for more than 90 minutes. There were no post-operative complications. Suggested modifications include Right working port from the Palmers point(3) or using a robotic approach with the same standard configuration(4). Our reflection revealed – interchanging of 5 mm and 12 mm working ports could have been helpful for better access.

Conclusion
The presence of a left sided gall bladder is often associated with various biliary, portal venous and other anomalies that might lead to intra-operative injuries. (5) The diagnosis is usually incidental and is done intraoperatively. Hence surgeons must be aware of these possibilities.
EDI&S SO02 The Aspire Initiative: A Community-Based Intervention to Champion Equality, Diversity and Inclusion in the Future Surgical Workforce
Authors: Kanani Trisha , Millard Alice , Robertson Francis , Issa Eyad , Bhardwaj Neil , Malde Deep , Dennison Ashley , Garcea Giuseppe , Isherwood John 
Published: November 2024

Abstract

Background
In March 2021, the Royal College of Surgeons of England published The Kennedy Report, an independent and powerful review addressing the critical issues surrounding equality, diversity and inclusion within the surgical profession. Chapter 5 of the review states that aspirations to become a surgeon can begin whilst at secondary school, yet students from diverse ethnic and social backgrounds felt discouraged by teachers who doubted their potential. We describe the development and implementation of a strategic careers outreach initiative across the state-funded secondary schools in our diverse community, aiming to engage and support aspiring surgeons early in their journey.

Method
In June 2023, The Aspire Initiative was launched as an independent entity supported by surgeons from the local Hepato-Pancreato-Biliary Unit and sponsorship from the Royal College of Surgeons of England. Targeting students aged 13 to 17, the initiative offers community open events, inspiring video content, surgical work experience for those over 16, and outreach careers assemblies. Between November 2023 and March 2024, 13 assemblies were delivered at various state-funded secondary schools across Leicester. These sessions were led by surgeons reflecting ethnic, gender, and socio-economic diversity. Students were invited to complete surveys before and after the assembly to assess their impact.

Results
The pre-session survey, completed by 874 students from Years 8-11, revealed that 149 aspired to be doctors or surgeons, while 243 were considering this (n=392). Of the 392 students, 57% reported that their parents had not attended university. Only 19% had a good understanding of the medical school application process, and 21% knew about the support available. Furthermore, 31% felt knowledgeable about the daily responsibilities and training pathways of medical professionals. The post-session survey, with 420 responses, showed significant improvements: 91% gained a better understanding of a surgical career and 52% felt more inspired and motivated to pursue their aspirations.

Conclusion
The Kennedy Report recommended that careers outreach to diverse communities should be planned for as a strategic priority. This study highlights the impact of such initiatives in state-funded secondary schools, showing how they provide students from diverse social backgrounds with crucial insights into surgical careers. These programs help students make informed decisions and inspire them to pursue their aspirations by connecting with relatable role models. We propose that engaging with students at the secondary school level offers an ideal opportunity for surgeons to foster and sustain professional relationships with a diverse future workforce, laying foundations for continued support and mentorship.
EDI&S SO04 Accuracy of Outsourced Radiology Reports in Emergency Surgical Care; Do they provide a high-quality cost-effective service?
Authors: Barghash Mohammed , Obayi Emmanuel , Aung Ye Htet , Furber Zoe , Haq Shua , Mansour Moustafa 
Published: November 2024

Abstract

Background
Computed Tomography (CT) scans play a crucial role in emergency surgical care enabling proper management and prompt decision making. In our study we aimed to compare abdominal CT scan reports created by inhouse radiologists to those created by outsourced radiology reporting service for patients admitted with acute surgical pathologies. The study also looked at the impact of the reporting style (free text or structured format) on the quality of scan reports.

Method
The study was conducted in a busy general surgery unit located in the North West of England. Patients who were admitted acutely under the surgical specialty and had abdominal CT scans over a period of three months from August 2023 to October 2023 were included. Patients who were admitted following trauma or had non abdominal CT scans have been excluded. Statistical analysis was conducted to compare inhouse radiology reports to outsourced ones. Scan reports were thoroughly scrutinised to identify whether they included all relevant information needed and whether they were written in structured or free text format.

Results
A total of 192 patients were identified with a median age of 59 years. Outsourced radiology reports were found to be significantly underreporting comments on the biliary system (OR=0.369, P=0.046), spleen (OR=0.414, P=0.044), kidneys (OR=0.354, P=0.027), lymph nodes (OR=0.412, P=0.011), mesentery and peritoneum (OR=0.364, P=0.004), vasculature (OR=0.381, P=0.002), bones and soft tissues (OR=0.273, P=0.003), as well as lung bases (OR=0.300, P=0.009). Structured format was found to outperform free text style on comments on spleen (OR=8.064, P=0.044), adrenals (OR=8.468, P=0.039), mesentery and peritoneum (OR=4.618, P=0.000), as well as bone and soft tissues (OR=9.295, P=0.031).

Conclusion
CT scans reported by outsourced radiology service were found to be significantly underreporting certain key elements. Additionally, free style reporting format was found to miss some crucial aspects of abdominal scan reports. That adds further challenges to clinicians assessing and managing acute surgical patients. Further studies auditing different outsourced companies are recommended to ensure patients are provided with high-quality cost-effective emergency service.
EDI&S SO07 Future of Low-Cost Laparoscopic Cholecystectomy Simulation (LaChSi) Model: Integration of Segmentation-Based Artificial Intelligence Models for Realism Enhancement in Simulation-Based Laparoscopic Cholecystectomy Training in Lower-Middle-Income Countries
Authors: Karki Bishow Bekhyat , Sharma Swodesh , Katuwal Sulav , Satyal Sanjivan , Loubani Prof Mahamud 
Published: November 2024

Abstract

Background
To introduce an approach of employing segmentation-based Artificial Intelligence (AI) models to meticulously isolate the silicon-based Laparoscopic Cholecystectomy Simulation Model (LaChSi) model within the laparoscopic trainer box, thereby enhancing realism. To assess the effectiveness of the AI Model to track camera angles to seamlessly replace the background with a virtual environment reminiscent of authentic intra-operative intra-abdominal visuals.

Method
The proposed methodology integrates a sophisticated segmentation model that identifies and accurately delineates the LaChSi Model within the laparoscopic Trainer box. Simultaneously, the model exhibits the capability to segregate the background, while closely monitoring camera angles for real-time adjustment. Importantly, the model is trained to perform precise segmentation of surgical tools, ensuring a comprehensive and realistic representation of the laparoscopic environment.

Results
Implementation of the proposed method is thought to demonstrate a notable improvement in trainees’ adaptation to surgical scenarios. The visual transition experienced by trainees moving from simulation-based surgeries to actual surgical environments will significantly reduce disparities increasing the effectiveness of the Laparoscopic simulation training. This will further avoid the need to use sensors and wires on the LaChSi model to simulate the surgical settings.

Conclusion
As the visual representation in simulations often deviates substantially from the intricate nuances of actual surgical procedures. This study introduces an innovative AI-based model that will contribute to the augmentation of surgical realism within simulation-based training. By effectively integrating segmentation techniques, our approach will minimise visual discontinuities, providing trainees with a more authentic and immersive experience, and ultimately fostering a smoother transition to acute surgical settings.
BS SO14 - Is there a correlation between preoperative HbA1c changes and long-term weight loss plus glycemic control in patients with type 2 diabetes undergoing metabolic surgery?
Authors: Tempany Jennifer , Collier Professor Andrew , Ali Professor Abdulmajid 
Published: November 2024

Abstract

Background
Optimization of patients with type 2 diabetes mellitus (T2DM) prior to metabolic surgery aims to achieve tight glycemic control by the time of surgery. Little is known about the influence of altering preoperative HbA1c on postoperative weight loss and glycemic control. The aim of this study was to determine whether a change in HbA1c during the preoperative period correlated with long term weight maintenance and HbA1c in patients undergoing metabolic surgery. The proportion of glucose-lowering medication used following surgery was also examined.

Method
Retrospective analysis was conducted of patients with T2DM who underwent metabolic surgery between 2013 – 2017. Preoperative HbA1c change was measured as change in glycemic control during the 1-year pre-surgery. Primary outcomes were % excess weight loss (EWL) and HbA1c at 5 years post-surgery. Secondary outcomes were % EWL and HbA1c at 1-year post-surgery and the use of glucose-lowering medications post-surgery. The Pearson correlation coefficient (r) was used to determine the relationship between the pre-surgery HbA1c change and postoperative % EWL and HbA1c. Chi-squared test was used to calculate the statistical impact of change in medication use post-surgery

Results
Sixty-nine patients with complete data were included in the study. The mean change in HbA1c in the 1-year pre-surgery, the 1-year post-surgery and 5-years post-surgery was -0.9% (± 1.5), -0.7% (± 1.2) and 0% (± 1.8), respectively. The change in HbA1c in the 1-year pre-surgery did not correlate with % EWL at 1-year and 5-years post-surgery or with HbA1c at 1-year and 5-years post-surgery. There was a significant decrease in the proportion of patients requiring glucose-lowering medications at 1-year and 5 years post-surgery (p&lt;0.05).

Conclusion
This study demonstrated a significant reduction in the proportion of glucose-lowering medication required long-term following metabolic surgery. Altering pre-operative glycemic control was not associated with long term weight maintenance or glycemic control.
BS SO15 - Outcomes of Braun procedure for reflux after OAGB- Audit from a single center
Authors: Haider Ijlal , Kaur Mandeep 
Published: November 2024

Abstract

Background
Braun procedure is a procedure used for management of reflux in gastric bypass patients. It is a simple procedure offering a jejuno-jejunal anastomosis to bypass bile away from stomach to prevent symptoms of reflux. It has been used in cancer patients needing bypass surgery. This has also been used in One anastomosis gastric bypass patients presenting with reflux.

Method
We would like to present the steps of Braun procedure. At the same time, we would like to take this opportunity to present the results of our audit of patients presenting with bile reflux needing surgical management of symptoms.
We analysed our operation sheets from December 2016- Jan 2024 and retrospectively looked into the patients who needed surgical management of bile reflux.

Results
Total number of OAGB procedures done –1024, out of these 30 patients presented with bile reflux needing surgical management. 26 of these 30 patients underwent Braun procedure and 4 underwent RYGB. 6 patients out of the 26 patients who underwent Braun procedure needed conversion to RYGB because of non-resolution of symptoms.
Since we looked at operation sheets, we have not analysed the total number of patients who have reflux post OAGB.

Conclusion
Conversion to RYGB is the gold standard procedure for managing bile reflux after OAGB. Braun’s procedure is a simpler procedure which can be done as day case and suffices in 86 % of patients. Patients should be offered both the procedures.
BS SO19 - Left Paraduodenal Hernia - Laparoscopic reduction and repair
Authors: Ravichandran Madhumitha , Kannan Shanmuga , Niaz Osamah , Munasinghe Aruna 
Published: November 2024

Abstract

Background
We present a case of a 39 year old female patient, with a BMI of 37.5 and a background of hypertension scheduled for a bariatric gastric sleeve surgery. During the surgery, incidentally, a left paraduodenal hernia was identified. The incidence of a left paraduodenal hernia is 0.03% of all hernias, which makes it a rare case to present.

Method
The hernia with all it contents was reduced. The defect was visualised and repaired. Haemostasis achieved.

Results
The postoperative period was uneventful. The patient was followed up regularly in the bariatric clinic with no further complaints.

Conclusion
In conclusion, this case highlights the incidental discovery and successful management of a rare left paraduodenal hernia in a 39-year-old female patient undergoing bariatric gastric sleeve surgery. Despite the rarity of this type of hernia, with an incidence of 0.03% of all hernias, prompt intervention led to a favorable outcome. The postoperative course was uneventful, and the patient reported no further complaints during regular follow-ups in the bariatric clinic. This case underscores the importance of vigilance for unexpected findings during surgery and demonstrates the successful resolution of such rare occurrences through careful surgical management.
EGS SO02 - The undifferentiated general surgical take over 10 years: Admissions
Authors: Dean Lydia , Hale Emily , Bowling Kirk 
Published: November 2024

Abstract

Background
Hospital admissions in England and Wales have been increasing over time. This increase has occurred across many specialties, including across the surgical specialties. The aim of this study is to review the undifferentiated emergency general surgical take, with regards to admissions in July 2013 and July 2023, at a District General Hospital to understand the specific pressures on the department and to identify areas in which we could adapt to facilitate these demands.

Method
Retrospective data regarding admission and re-admission on all patients treated by the emergency general surgical team in July 2013 and July 2023 was collected from electronic notes. If insufficient information was available, patients were excluded from analysis.

Results
Patient numbers increased by 50% from 2013 to 2023, from 395 to 594. Average length of stay in 2013 was 3.26 days (+/-0.2, p = 0.03), reducing to 2.58 days (+/-0.2, p = 0.03) in 2023. Number of patients admitted overnight has decreased from 74% (n=291/395) in 2013, to 54% (n=324/594) in 2023. Proportion of referrals from ED increased from 48% in 2013, to 69% in 2023. Planned reviews and patients ambulated for surgery the following day has increased from 4% of all patients seen in 2013, to 16% in 2023.

Conclusion
Volume of patients has increased significantly over this 10-year period. Simultaneously, duration and number of overnight admissions have decreased, alongside increasing use of ambulatory services. This reflects the aims of the Government, and the Royal College of Surgeons, with increasing investment in day-case and ambulatory services. However, without an increase in hospital bed numbers, the rising volume of patients may become difficult to manage.
EGS SO05 - Improving the Flow of Patients Attending Surgical Assessment Unit: Introduction of Ambulatory USS Slots - Closed Loop Audit
Authors: Yershov Danylo , Stylianou Theodoros , Hirri Faith , Findlay Laura 
Published: November 2024

Abstract

Background
Modern emergency surgical service recognises that a significant proportion of patients presenting with acute abdomen can be diagnosed and treated in the ambulatory fashion. However, this approach requires multidisciplinary cooperation between the general surgery team and radiology department. We aimed to assess and improve the flow of patients presenting to Surgical Assessment Unit (SAU) with complaints of right iliac fossa (RIF) and right upper quadrant (RUQ) pain.

Method
We performed a retrospective analysis of all ambulatory patients returning to SAU of a District General Hospital with RUQ and RIF pain in January 2023. We measured the waiting time between the arrival to SAU and the time of USS. We presented the results in a local meeting and negotiated the introduction of two daily USS slots for SAU patients. We re-assessed the impact of the USS slots on waiting times in July 2023.

Results
In January 2023, 13 patients returned to SAU for USS. The minimum waiting time for this cohort was 59 minutes and the maximum waiting time was 3 hours and 39 minutes. The median was 2 hours and 15 minutes. In July 2023, 18 patients returned to SAU for USS. The minimum waiting time for this cohort was 4 minutes and the maximum waiting time was 2 hours and 20 minutes. The median was 1 hour and 5 minutes. There was an average reduction of 1 hour and 10 minutes in waiting time for USS.

Conclusion
The introduction of two USS slots per day for patients returning to SAU with RUQ and RIF pain resulted in a 48% reduction in waiting times. This improved the flow of patients, sped up the diagnosis and timely access to treatment, as well as significantly improved patients experience and satisfaction. We would recommend close co-operation between general surgery and radiology to allow timely access to imaging for patients presenting with acute abdomen to SAU.
EGS SO09 - Documentation Of Mortality While Consenting For Major Emergency Operation In General Surgery : Are We Informing Patients Or Just Impressing NELA? A Three-Cycle Clinical Audit
Authors: Isswiasi Sanad , Esawi Ahmed , Anwaar Muhammadhasan , Lord Ian 
Published: November 2024

Abstract

Background
Approximately 30,000 to 50,000 emergency laparotomies are performed annually in the United Kingdom (UK), with an in-hospital mortality rate of 9.2%. The UK National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report from 2011 recommends that the risk of mortality should be explicitly discussed with patients and clearly documented on consent forms and in medical records. The purpose of our audit was to assess the frequency of documenting the risk of mortality in consent forms and to evaluate the reporting of corresponding discussions in the medical records of patients undergoing major emergency general surgical operations.

Method
Patients were identified from our National Emergency Laparotomy Audit (NELA) database, and data was collected retrospectively from our online medical records. We included procedures from NELA performed on patients aged 16 and older who had the capacity to give consent. The first audit cycle took place from April to June 2021, the second from March to May 2022, and the third from March to May 2023. The results of the first cycle revealed gaps in documentation, leading to the implementation of periodic reminders for surgeons during meetings and the use of posters to reinforce best practices.

Results
The 1st cycle included 40 cases, with 93% documented mortality in NELA, 40% in consent forms, and 35% documented discussion about mortality in medical notes. The 2nd cycle reviewed 38 cases, showing 92% documented mortality in NELA, 71% in the consent forms, and 42% of documented discussion about mortality in the medical notes. The 3rd cycle assessed 32 cases, with 90% documented mortality in NELA, 92% in consent forms, and 51% in the medical notes. The improvement in documentation of the risk of death in the consent forms was statistically significant across all three cycles (p &lt; 0.0001).

Conclusion
The three audit cycles demonstrated that implementing periodic reminders and posters for surgeons significantly improved the documentation of mortality risk. Documentation rates in consent forms increased from 40% in the first cycle to 92% by the third cycle, and in medical notes from 35% to 51%. These interventions effectively enhanced compliance with best practices. However, continuous effort is essential to maintain this improved practice. Regular monitoring, ongoing education, and reinforcement strategies should be employed to ensure that the documentation standards remain high and continue to improve patient care and safety.
EGS SO14 - Tip First vs. Base First approaches in appendicectomies
Authors: Agrawal Kapil , Kaur Jaspreet Singh , Liu Ben 
Published: November 2024

Abstract

Background
Appendicectomies are common. Techniques can be classified into tip-first (stripping the appendix off the mesoappendix) or base-first (ligating the base of mesoappendix), where the latter includes the entire mesoappendix in specimens. This study examines these two techniques and compare their pathological and clinical outcomes, noting that tip-first technique leaves mesoappendices behind.

Method
This retrospective study classifies the two techniques of appendicectomies according to histological analyses where the tip-first approach produced no mosoappendix in the specimen. We investigated:Baseline characteristics: Age, gender, ASA-grades, emergenciesOperative differences: Surgeon grades, operating duration, laparoscopic ratesThe pathological outcomes: specimen length, presence of malignanciesClinical outcomes: Post-op stay, further treatments

Results
Over 12-months, 134 consecutive appendicectomies were identified (94 base-first and 40 tip-first), without significant baseline differences, although the base-first group were notably older (p=0.051). Laparoscopic rates and operating times were comparable. There were significantly higher number of consultant-led operations in the base-first group: 41.5% vs 22.5% (P=0.036). The appendix specimen is insignificantly longer in the base-first group (P=0.477). Five incidental malignancies were found, of which 2(5%) were in the tip-first group. Without the mesoappendix, completeness of excision was indeterminate and subsequent right hemicolectomies were performed. Lengths of stays were not significantly different.

Conclusion
We found preference of tip-first appendicectomies among junior surgeons while consultants favour base-first approaches, which may be attributable to experiences and trainings. Two tip-first appendicectomies resulted in incomplete staging of incidental malignancies which necessitated further surgical resections. We conclude base-first appendicectomies should be taught to all trainee surgeons.