bluuebunny/crossref_metadata_2025_split huggingface dataset:
FP6.1 - Core Surgical Training in Northern Ireland: Regional Compliance with Quality Indicators
Authors: Lockhart Jessica , Phillips Sally-Anne 
Published: September 2024

Abstract

Aims
Standards for training programmes are set by the GMC, with the Joint Committee for Surgical Training developing a curriculum and quality indicators (QIs) specific to Core Surgical Training. To ensure local training fits within these guidelines, placement quality is evaluated by NIMDTA, using specialty specific surveys sent to all Core Trainees in the region.

Methods
A survey, related to their current post, was sent to all Core Trainees in Northern Ireland. The responses were collated and cross-referenced against the 14 generic QIs for Core Surgery in order to assess compliance with published standards.

Results
Response rate from trainees was 70%. Compliance with the quality indicators was generally poor; 24% of trainees reported receiving the recommended 2 hours per week of formal teaching, 59% were able to complete a quality improvement project, 83% of trainees completed a learning agreement within the recommended 6 weeks from post commencement, 21% reported adequate exposure to simulation training and only 11% reported attending the expected one or more MDT meetings per week.

Conclusions
The level of adherence to the QIs for core surgery in Northern Ireland could be significantly improved. Despite some themes achieving a majority response in line with the QIs, overall alignment is poor. Subsequently we have developed key recommendations for focused improvement in the local Core Training programme in NI in an effort to better align our training with the JCST QI framework. A further survey will be conducted to assess the effect of these recommendations on compliance with JCST QIs.
FP6.6 - Diagnosing the improvements required for enhancing the medical student ward round bedside teaching experience utilising a cohort of surgical teaching fellows
Authors: Tokeisham Karim , Alnabhan Ahmad , Khera Goldie 
Published: September 2024

Abstract

Aim
After previously having mixed student feedback as a learning experience, our UK medical school have embedded a cohort of dedicated surgical teaching fellows into acute surgical ward rounds. Since this has happened, we aimed to further improve traditional Surgical Ward Round Bedside Teaching methods.

Method
Post event, retrospective, optional questionnaire formed of 5 Questions evaluated by a Likert scale and 2 open ended Questions. Presented to year 3, UK undergraduate medical students.

Results
20 complete responses received. The majority of students strongly agreed that Surgical Ward Round Bedside Teaching sessions with dedicated fellows present were effective in enhancing clinical knowledge and skills.
90% strongly agreed that teaching fellows were engaging and approachable during Surgical Ward Round Bedside Teaching. Also 90% strongly agreed that they felt comfortable asking questions and seeking clarification during Surgical Ward Round Bedside Teaching sessions.
However, only 60% strongly agreed that Surgical Ward Round Bedside Teaching sessions were well-organized and focused on relevant surgical/clinical cases.
When asked ‘How could the bedside/Ward Round teaching sessions be improved?’ – Responses revolved around suggesting teaching in smaller groups, reminding wards/departments to expect students/clinical fellows, providing online resources or hand-outs before teaching, identifying teaching session objectives, and spend more time on history taking and examination sessions

Conclusions
The introduction of surgical teaching fellows has had a positive impact on the student Surgical Ward Round Bedside Teaching experience. There is still room for future refinement however and further enhancement strategies are in progress.
FP7.4 - Interval appendicectomy: A single centre cohort Study
Authors: Gok M A , Bughio M , Yim S , Aris R , Akhmal Y , Khan U A , Riaz Komal 
Published: September 2024

Abstract

Aims
Interval appendicectomy occurs at a rate of &lt; 15 %. It is recommended in non operative appendicitis (complicated appendicitis, appendix mass) to reduce recurrence. Acute appendicectomy rate was reduced in Covid 19 pandemic era, as aerosol generating procedures were deemed high risk. Interval appendicectomy can be offered after 6 weeks dependent on pre-requisite interval colorectal screening (colonoscopy or CT scan) prior to surgery. Aim of study is to assess the interval appendectomy at a single centre.

Methods
Cohort study carried out from Mar'2020 to Dec'2023. Descriptive demography & post-operative outcomes were evaluated for interval appendicectomy, and acute appendicectomy were used as controls.

Results
Interval appendicectomy (n = 45) Appendicectomy (n = 515) Mann Whitney U (p test) Age(yrs) 47.9 35.8 &lt; 0.0001 Sex(M:F) 19 : 26 251 : 264 NS ASA(median) 2 1 NS BMI 26.5 25.5 NS WCC(x109/L) 6.5 13.2 &lt; 0.0001 CRP(mg/L) 3.4 66.3 &lt; 0.0001 Laparoscopic 45 507 Op time(mins) 74.4 74.9 NS Appendix length(mm) 55.7 66.6 &lt; 0.0001 Appendix diameter(mm) 9.9 11.2 NS LOS(days) 0 2 &lt; 0.0001 AB use(days) In-patient 0 ± 0.5 2 ± 1 &lt; 0.0001 Post-op 0 ± 0 0 ± 2.5 Cost(£) 1046 4269 &lt; 0.0005

Conclusion
Interval appendicectomy is a safe and cost effective option in the management of appendix mass. Interval appendectomy allows resolution of acute appendicitis resulting in fewer intraoperative & postoperative complications. It reduces the chance of bowel resection & can be done as a day case procedure. However interval appendicectomy my require work-up prior to surgery.
FP8.3 - Reducing Waste with Remanufactured Harmonic Devices
Authors: Gordon Caitlin , Gardner Shona , Beniwal Abhijeet , Pullyblank Anne 
Published: September 2024

Abstract
The NHS produces an estimated 590,000 tonnes of waste per annum and disposable harmonic scalpels are costly both financially and environmentally. The average cost of a new harmonic device nationally is £460. Remanufactured harmonic devices are not only recommended by the Intercollegiate Green Theatre Checklist and NHS England but also the Department of Health Med Tech Strategy.
North Bristol NHS Trust has engaged with the initiative from Vanguard to reduce clinical waste as well as utilise remanufactured harmonic devices. Initially the project began in January 2023 with collecting used devices only, but this was followed by the rollout and use of remanufactured devices within colorectal surgery in May 2023. The initiative has resulted in a reduction of clinical waste produced as well as a significant cost saving. 56 devices used so far in colorectal surgery have saved £12,880 and the estimated CO2 saving is 97 kilograms. There have been no incidents regarding the use of remanufactured devices or concerns raised. The project’s success has resulted in recent expansion into gynaecological surgery where the first remanufactured devices are in use.
Based on previous harmonic device usage within NBT of 618 per annum, projected savings of using remanufactured devices are likely to reach £71,070 and half a tonne of CO2 in the next year. This represents a significant financial and environmental initiative to continue the drive to reduce disposable waste within surgical theatres.
FP8.8 - LumenEye XI rigid digital rectoscope in the assessment of anorectal symptoms: a sustainable substitute for outpatient flexible sigmoidoscopy?
Authors: Attard Nathalie , Fava Leanne , Pace Gillian , Diacono Emily , Camilleri-Brennan John 
Published: September 2024

Abstract

Aims
To evaluate the acceptability, safety and diagnostic yield of the LumenEye XI in the assessment of anorectal symptoms.

Methods
Consecutive patients with anorectal symptoms, referred to the colorectal unit by their general practitioner, had a full clinical assessment followed by endoscopic examination using the LumenEye XI by a consultant colorectal surgeon.

Results
59 consecutive patients,16 being male, were examined. The median age was 59 years (range 27-90). The main reported presenting complaints were rectal bleeding (n = 18, 21.4%), proctalgia (n = 10, 15.5 %), faecal incontinence (n=12, 14.3%), obstructive defaecation (n=7, 8.3%), anorectal swelling (n = 7, 8.3%), and mucous discharge (n = 2, 2.4%). The main findings were haemorrhoids (n= 18, 22.5%), rectal prolapse and rectocoele (n=14, 17.5%), and inflammatory conditions (proctitis, anal fistula, pouchitis) (n=4, 5%). One patient was diagnosed with rectal cancer. 19 patients (23.75%) had normal findings. 13 patients (22%) were referred for further investigations. Out of the 18 patients with rectal bleeding, 16 had a definitive diagnosis made with LumenEye. The diagnoses in patients with rectal bleeding were haemorrhoids (n=15, 53.6%), inflammation (n=4, 14.3%), prolapse (n=2, 7.1%), and ulceration (n=1, 3.6%). No cause could be identified in 2 of these patients.
The rectosigmoid junction was visualised in all patients who had an intact rectum (57 out of 59 patients). All patients tolerated the procedure well, with no complications.

Conclusions
LumenEye XI is safe and well accepted by patients with good diagnostic accuracy. It therefore offers a potential solution to helping to relieve the endoscopy burden and enable cost savings by reducing the number of outpatient flexible sigmoidoscopies.
FP8.11 - Surgical Site Infection Post-operation (gowning vs not gowning): A District General Hospital Experience
Authors: Ong Chon Sum , Lala Anil 
Published: September 2024

Abstract

Aims
Increasing evidence shows that surgical site infection (SSI) does not differ significantly between main operation theatre and field sterility for many surgical procedures. This audit aimed to assess the rate of surgical site infection (comparing the operating surgeon using a disposable gown vs not using one) for emergency/elective skin procedures like uncomplicated incision and drainage of abscess, excision of lipoma, sebaceous cyst, and pilonidal sinus.

Methods
The electronic database was used to collect data (September-October 2023) on the type of surgery performed, number of theatre staff scrubbed in. Poster displays and informal education were used to raise awareness of theatre wastage (November 2023). All were advised to wear an apron, mask, sterile gloves, and field sterility only for uncomplicated cases. Data was recollected (December 2023-January 2024).

Results
54 cases were performed in September and October 2023. All theatre staff scrubbed in and 160 gowns were used. 5/54 (9.3%) returned with wound infection and managed with antibiotics. The median of the number of days in which the patients returned post-operatively is 7 days. 24 cases were performed from December 2023-January 2024. Theatre staff in 5/24 cases did not scrub in and none of these patients returned with wound infection. Out of the other 17/24 cases, 5/17 (29.4%) returned with wound infection.

Conclusions
With the limitation of small sample size and multi-factorial aetiology of wound infection, surgeons who did not gown up had no increased risk of wound infection. The higher monetary and environmental costs of complete gowning without improvement of patients’ care are unjustifiable.
EP58 - Gangrenous appendicitis in an incarcerated femoral hernia: A rare case of De Garengeot Hernia
Authors: Hamadziripi Millicent , Saeed Munir 
Published: September 2024

Abstract

Aims
To present a rare case of gangrenous appendicitis within an incarcerated femoral hernia, discussing its clinical background and highlighting the challenges in its diagnosis and surgical management.

Methods
We detail a 74-year-old female with a painful, non-reducible groin mass. A CT abdomen pelvis revealed a right femoral hernia with acute reactive inflammatory changes, with no comment made on the appendix (Figure 1 and 2). Emergency open femoral hernioplasty and laparoscopic appendectomy were performed.

Results
Intraoperatively, a femoral hernia with a gangrenous appendicitis were identified. The appendix was reduced into the abdominal cavity to allow for better evaluation of its base. A laparoscopic appendectomy was performed after identifying the healthy base (Figure 3), followed by a femoral hernioplasty.
This case sheds light on the rarity not only of the De Garengeot hernia which is defined by the presence of the vermiform appendix within the femoral hernia sac, but also even rarer the finding of a gangrenous appendix within the sac, with a reported incidence from 0.08-0.13% in cases of acute appendicitis. The case emphasizes the importance of considering an acute appendicitis and its complications within a femoral hernia as a differential diagnosis of painful groin masses with raised inflammatory markers.

Conclusion
Given the scarcity of literature on the surgical management of acute appendicitis in De Garengeot hernias, this case contributes valuable insights. The absence of established guidelines underscores the need for further exploration of optimal surgical strategies in such cases. Our report aims to enhance awareness of this rare presentation and facilitate future discussions on its management.
EP110 - Chyloperitoneum in Follicular lymphoma – presenting as an inguinal hernia
Authors: Farooqui Marryam Riaz , Shafique Muhammad Salman , Bhatti Hamza Waqar , Hanif Muhammad 
Published: September 2024

Abstract

Introduction
Follicular lymphoma is one of the subtypes of slow growing Non-Hodgkin Lymphoma. Rarely, follicular lymphoma can present with chyloperitoneum or chylous ascites which is characterized by a milky-white coloured fluid with raised triglyceride levels.

Case Report
We present a case of a 60-year-old diabetic male, complaining of a right sided inguinal swelling for 1 year. Examination revealed a reducible right inguinal swelling with a positive cough impulse. The laboratory workup was unremarkable. Ultrasound scan of anterior abdominal wall showed a defect of 2.1 cm in right inguinal region with protrusion of abdominal contents and a positive cough impulse. A diagnosis of right sided reducible direct inguinal hernia was made. Patient was scheduled for Lichtenstein repair. Per-operatively, the hernial sac contained healthy omentum with milky-white ascitic fluid. Omentum was reduced and suture repair was performed. A drain was placed intra-peritoneally. The postoperative course of the patient was uneventful. Ascitic fluid analysis showed high triglyceride levels and no evidence of malignant cells, suggesting chylous ascites. Contrast enhanced CT scan of abdomen and pelvis revealed a large homogenous minimally enhancing soft tissue density retroperitoneal mass in peri aortic and paravertebral location with abdominal lymphadenopathy suggesting retroperitoneal lymphoma. Excisional biopsy of an enlarged inguinal lymph node confirmed follicular lymphoma with positive BCL2 and CD10 markers.

Conclusion
Follicular lymphoma presents in a variety of ways including chylous ascites in an inguinal hernia and a high index of suspicion is required to diagnose it.
EP146 - Feasibility Study: SmartWatch and Rockport Walk Test safely measures estimated VO2 Max
Authors: Razi Kasra , Szepietowski Olivia , Moorthy Krishna 
Published: September 2024

Abstract

Aims
To assess feasibility and safety of estimating VO2 max using a SmartWatch and the Rockport Walk Test, and to assess robustness of the protocol for a pilot study on oesophageal adenocarcinoma patients.

Methods
This prospective feasibility study included ASA grade 1 adults with a SmartWatch. Participants walked 1 mile on the flat, and end heart rate and time taken were recorded both via SmartWatch and manually. Pre- and post-exercise questionnaires provided. Estimated VO2 calculated using the Rockport formula.

Results
Ten participants (five female), mean age 32.8 (25-37). Mean heart rate via SmartWatch 107.25bpm (80-133) and manually 104.6bpm (84-120). Mean time to complete 1 mile 15:17 minutes (13:08 – 16:48). Average estimated VO2 max 43.6 (41.57- 50.03).
Pre-activity 100% of participants found instructions clear and easy-to-follow, and were confident to undertake the activity and complete it safely. Although pre-activity 20% of participants were not confident in finding a suitable flat location and 10% not confident with the technology, in the post-activity survey 100% of participants found it easy to find a suitable location and easy to measure, record and upload their results. One user highlighted difficulty with manually measuring heart rate, and another noted challenges with road crossings disrupting their walk.

Conclusions
It is feasible to measure estimated VO2 max remotely using wearable technology and a validated test such as Rockport Walk Test in healthy adults. This study highlighted several areas of protocol improvement to deploy the study in oesophageal cancer patients to minimise potential risks and optimise safety and usability.
EP202 - Mesh-Mediated Fascial Traction (MMFT) and Negative Pressure Abdominal Dressing (ABTHERA): Useful in Difficult Open Abdomens?
Authors: Shakya Sasa , Tamrakar Abhishek , Pangeni Anang , Shrestha Ashish Kiran , Basu Sanjoy 
Published: September 2024

Abstract

Background
Challenging abdominal surgical emergencies may require an 'Open Abdomen (OA)' as a life-saving procedure. OA has serious complications: wound infection, fluid and protein loss, catabolic state, loss of abdominal domain, and entero-atmospheric fistula. To assess the efficacy of mesh-mediated fascial traction (MMFT) & Abthera Dressing in achieving definitive abdominal closures.

Patients and Method
Retrospective analysis of prospectively collected data of 6 patients managed between August and November 23 in a large DGH. Following laparotomy and management of primary pathology, Abthera Dressing combined with bilateral continuous 2-0 PDS suture fixation at 0.5cm gap of macroporous Prolene (Merinium, Meril Life) meshes to each rectus sheath followed by sequential midline mesh traction closure over a time period that allowed subsequent definitive abdominal wound closure. Data collection included patient demographics (age, sex, BMI, ASA), intervention details for OA, wound characteristics, follow-up, and outcome.

Results
Six included M: F 4:2, age 61* (40-76 ) years, BMI 30* ( 24-35), ASA 3. Three were strangulated incisional hernia, 2 burst abdomens from faecal peritonitis, and 1 necrotizing fasciitis. Initial wound length 25*(20-32) cm, width 12.5* (4-17) cm after management of primary pathology reduced to width 4.5* (0-9) cm through MMFT and Abthera Dressing followed by definitive abdominal closure. Relook surgery required were 4* (1-9) with one full and 4 bridged mesh closures. Length of stay 39* (14-74) days. One death from respiratory failure.

Conclusion
The study highlights the benefit of MMFT & Abthera Dressing in achieving definitive abdominal closure for challenging OA where primary abdominal closure was not possible.
* Median
EP230 - A Closed Loop Audit for Peri-Operative Outcomes Comparing Laparoscopic and Robotic-Assisted Nephroureterectomy for Upper Tract Transitional Cell Carcinoma
Authors: Spence Rachel , Taggart Ruairidh , Qureshi Khaver , Umez-eronini Nkem , Oades Grenville , Hendry Jane 
Published: September 2024

Abstract

Introduction
Transitional cell carcinoma (TCC) of the upper urinary tract (localised high-risk disease) is treated with a radical nephroureterectomy (RNU). Evidence shows laparoscopic and robotic-assisted RNU have similar oncological outcomes to open RNU, but improved peri-operative outcomes, namely length of stay (LOS) and time to mitomycin C (MMC) – given to reduce bladder recurrence.

Standard
The European Association of Urology (EAU) Guidelines suggest MMC instillation should occur 2-10 days after RNU.

Aim
To determine if this standard was being met in a single tertiary centre following laparoscopic RNU, and if the expansion of the robotics service has improved this and other peri-operative outcomes.

Methods
Retrospective data was collected from patient notes and collated in an excel spreadsheet for descriptive statistical analysis.

Results
The first loop analysed laparoscopic procedures (n = 36). The average LOS was 5 days (SD = 3.7±) and the average time to MMC was 14 days (SD = 6.7±). Bladder recurrence occurred in 41% (n = 14) of this cohort, over an average follow up time of 30.6 months.
The second loop analysed robotic-assisted procedures (n = 33). The average LOS was 4 days (SD = 2.23±) and the average time to MMC was 2 days (SD = 0.57±). Bladder recurrence occurred in 30% (n = 8) of this cohort, over an average follow up time of 13 months.

Conclusion
Both procedures are safe and effective with satisfactory oncological outcomes. By expanding the robotics service, the average LOS and time to MMC decreased. Disease recurrence was higher in the laparoscopic cohort, but the follow-up period was longer.
EP281 - Outcomes of the Abdominal Wall Reconstruction in a District General Hospital
Authors: Mohamedahmed Ali Yasen , Ramasamy Sadhasivam , Agrawal Dakshita , Muras Zbigniew , Marzook Himaz 
Published: September 2024

Abstract

Background
The aim of this study was to explore the outcomes of abdominal wall reconstruction surgery by assessing postoperative complications and recurrence.

Methods
This is a retrospective case series. All patients who underwent abdominal wall reconstruction between 2018 and 2023 were included and followed up for complications and recurrence till January 2024. Patient demographics, operative parameters and postoperative complications were extracted in an Excel sheet, and data analysis was performed with SPSS 27 software.

Results
Forty-two patients were included in this study with a median age of 61.5 (34-83) and 1.2: 1 female: male gender distribution. Moreover, 41% of the included patients had a BMI &gt; 35, and 47.6% were smokers. The type of hernia was incisional in 50% and recurrent hernia in 31%, and the defect size was &gt; 10 centimetres in 48% of the included cohort. The type of operation was as follows: Rives-Stoppa (50%), TAR (24%), and combined procedure (26%). additionally, only 18% had their operation laparoscopically, and the position of mesh was retro-rectus in 88% of the cases. Post-operative complications were SSI (11.9%), seroma (28.6%), haematoma (7.1%), re-operation (9.5%), entero-cutaneous fistula (2.4%), and Hernia recurrence (4.7%) at a median follow-up of 42.5 months. Length of hospital stay was &lt; 5 days in 48% of patients.

Conclusion
The Component separation technique is an excellent approach to repairing complex incisional hernia with excellent results (&lt;5% recurrence rate). Abdominal reconstruction is feasible in district general hospital settings.