bluuebunny/crossref_metadata_2025_split huggingface dataset:
WP5.6 - Beyond the Left Side: Emergency Colonic Stenting for Acute Malignant Large Bowel Obstruction
Authors: Gardner Shona , Farrow Emily , Pullyblank Anne 
Published: September 2024

Abstract

Introduction
Acute malignant large bowel obstruction (LBO) is traditionally treated by surgical diversion or resection in patients who are fit enough. European guidelines suggest colonic stenting as a bridge to surgery in curative disease.
The aim was to examine the safety and efficacy of a change in practice from emergency laparotomy towards colonic stenting for acute malignant LBO.

Methods
Patients with LBO from 01/01/2019 to 31/12/2022 were included and data was obtained from the NELA database and electronic patient records.

Results
42 patients underwent emergency laparotomy (EL) for LBO. 33% (14/42) patients had right-sided tumours (n=14) and/or perforated disease (n=6) where stenting was contraindicated. 28/42 patients (22% of total) went straight to EL for clinical/ organisation factors.
73 patients were stented; 44% (32/73) were at/ proximal to splenic flexure. Perforation rate was 10% (7/73) with 4/7 requiring EL. Failure rate was 14% (10/73) with 6/10 patients requiring EL. 41% (30/73) were stented with curative intent; 70% (21/30) then underwent elective resection.
The rate of stoma formation and minimally invasive surgery in patients stented with curative intent was 40% (12/30) and 60% (18/30) respectively (including 9 EL following stent complications). Compared with 88% (37/42) and 19% (8/42) in patients undergoing primary EL.

Conclusion
Almost 2/3 of patients presenting with acute malignant LBO were suitable for stenting. Stenting reduced the need for a stoma and enabled elective minimally invasive surgery with low complication rates. This rate of colonic stenting was achievable without a 24/7 colonic stenting rota or sub-specialty cover.
WP5.8 - Robotic versus laparoscopic general surgery in the emergency setting: a systematic review
Authors: Anyomih Theophilus T K , Mehta Alok , Sackey Dorcas , Woo Caroline A , Gyabaah Emmanuel Y , Askari Alan 
Published: September 2024

Abstract

Introduction
Robot-assisted general surgery, a cutting-edge technology in minimally-invasive procedures, is increasingly utilised in elective general surgery, demonstrating advantages over laparoscopy in select cases. While laparoscopy remains a standard approach for common acute abdominal conditions, the role of robotic surgery in emergency general surgery is unclear. This systematic review aims to compare outcomes in acute general surgery settings for robotic versus laparoscopic surgeries.

Method
A PRISMA compliant systematic search across MEDLINE, EMBASE, Science Citation Index Expanded, and Cochrane library was performed. The literature review focused on articles comparing perioperative outcomes of emergency general surgery managed laparoscopically versus robot-assisted. A descriptive analysis was performed and outcome measures recorded.

Results
Six articles, reporting on 1063 patients, compared outcomes of robotic and laparoscopic procedures. Two covered cholecystectomies, while the others addressed ileocaecal resection, subtotal colectomy, hiatal hernia and perforated gastrojejunal ulcer repair. The level of evidence was low. Laparoscopic bowel resection in inflammatory bowel disease (IBD) patients had higher complications; no significant differences were found in complications for other operations. Operative time showed no differences for cholecystectomies, but robotic approaches were longer for other procedures. Robotic cases had shorter hospital length of stay, though the associated costs were significantly higher.

Conclusion
Perioperative outcomes for emergency robotic surgery in selected general surgery conditions are comparable to laparoscopic surgery. However, recommending robotic surgery in the acute setting requires a well-powered large population study for stronger evidence.
WP5.16 - Profile of Colorectal cancers presenting as emergencies at GEH during last 3 years - (Jan 2019 -Jan 2022) Incidence, presentations ,treatment options Biology, and prognosis -Single institutional experience
Authors: Haji Altaf , Vijayaraghavalu Shashikanth , Elhassan Ali Ali , Ahmad Aftab , Narayanan Aravindan , Piramanayagam Bala , Marimuthu Kalimuthu , Aslam Imran 
Published: September 2024

Abstract

Aim
This retrospective, single-institutional study aimed to comprehensively investigate the demographic features, clinical presentations, and outcomes of emergency procedures in individuals with colorectal cancers presenting as acute emergencies at GEH over the last three years.

Methods
In this study at GEH, we analysed colorectal cancer cases presenting as emergencies from January 2019 to January 2022 were examined. Out of 310 total colorectal malignancy surgeries during this period ,57 cases (18.38%) were identified as acute emergencies. Demographic details, clinical history, outcomes of emergency procedures, adjuvant therapies, and prognostic variables were retrieved from hospital records and electronic medical records. Cases operated on elective basis & cases without confirmed colorectal cancers were excluded.

Results
The study revealed demographic insights, with an average age of 72 years and a balanced gender distribution. The majority presented with obstructive symptoms (87.7%), emphasizing the acute nature of cases. Emergency procedures exhibited diversity, with right hemicolectomy and Hartman's procedure being predominant. Gender-specific patterns in emergency procedures, along with details on tumor location, morphology, and complications, were analysed. Right-sided tumours, particularly caecal tumours, were prevalent. Adenocarcinoma was the predominant tumor morphology. Treatment approaches included curative intent in 56.14% and palliative intent in 35.09%. Adjuvant chemotherapy was administered in 50.88%, and adjuvant radiotherapy in 7.02%. Recurrence was noted in 12.28%, while mortality rates varied among different emergency procedures.

Conclusion
This study provides a comprehensive understanding of colorectal cancers presenting as emergencies, offering valuable insights into demographic characteristics, emergency procedures, tumor characteristics, treatment approaches, and outcomes. Prospective studies are recommended to further validate and extend these findings, contributing to a nuanced comprehension of emergency colorectal cancer scenarios.
WP6.13 - REINVENT- Robotic SurgEry: INnoVation for EfficieNt Training- A qualitative study assessing training in RAS (Robotic Assisted Surgery) and future implementation
Authors: El-Sayed Charlotte , Munsch Chris , Campbell Marion , Bach Simon P , Rooshenas Leila 
Published: September 2024

Abstract

Introduction
Despite the rise in use of RAS in UK surgical practice, concerns have been reported regarding the lack of standardisation in training.
Little is known on the current exposure to RAS training in the UK and thoughts on how training should be delivered in the future.

Methods
Semi-structured interviews were completed in person/online with four stakeholder groups:(1) pan speciality surgical trainees; (2) robotic trainers; (3) leads in curriculum development; (4) RAS industry leads. Respondents were pan-speciality and from across the UK. Topic guides focussed on personal perspectives on RAS training, current barriers to accessing training and views on how RAS training can be optimally delivered in the future. Data collection ceased upon saturation in themes and were analysed thematically.

Results
Twenty-seven informants were interviewed, including 8 trainees, 7 curriculum developers, 6 robotic surgeons and 6 industry leads. Respondents reported multiple challenges in training including barriers to accessing the robot such as the geographical location of the systems; the consultant RAS learning needs; equality and diversity issues and challenges with delivering platform agnostic training. However, respondents reported an anticipated growth in RAS and a need for the surgical training bodies to invest in structured RAS training which should be implemented earlier in surgical training.

Discussion
RAS training in the UK requires overcoming several barriers to deliver equitable, standardised training. A further study is required to reach a consensus amongst stakeholders on how RAS should be delivered within the current infrastructure of both the UK health care system and surgical training climate.
WP7.4 - A closed loop audit assessing adherence to NELA frailty guidelines in over 75’s undergoing Emergency Laparotomy
Authors: Harper Alexander , Banks Philippa , Edginton Oscar , Yiasemidou Marina , Clarke Rory , Lockwood Sonia 
Published: September 2024

Abstract

Background and Aims
The National Emergency Laparotomy Audit (NELA) 2023 recommend patients over 65 should have clinical frailty score (CFS) recorded, and, if frail or aged 80 or over, should have Care of the Elderly (COE) input. Due to the multi-morbid nature of frailty this population carry additional surgical and post-operative risk. This audit reviewed use of these recommendations at a large District General Hospital (DGH).

Methods
We performed a closed loop audit on all patients aged 75 and older who had an emergency laparotomy between September 2020 to December 2023. We collected data from their admissions, including CFS and if COE reviews had occurred. The data was analysed. Interventions included presentation at clinical governance, discussion with the COE consultant and a poster was developed for the surgical assessment unit. The data was again retrospectively collected to complete the audit cycle.

Results
A total of 94 patients were included. The initial audit found 0 patients had CFS recorded and 16% had COE review. The reaudit found significant improvement, with 92% of patients having CFS recorded and 46% having had COE review.

Conclusion
The second cycle audit has shown significant improvement at the DGH in recording CFS and organising COE reviews for patients over 75 having an emergency laparotomy. However, there remains scope for improvement. Suggested improvements include: a referral pathway to prompt COE reviews and the creation of the “general surgery geriatrician” similar to the ortho-geriatrician role. Organising COE reviews could improve patient outcomes and provide more holistic care.
WP8.3 - "Effectiveness of Malnutrition Screen and Interventions for Surgical Inpatients - A MUST Score Based Audit"
Authors: Ylli Kristali , Sheehan Ciaran , Nugent Tim 
Published: September 2024

Abstract
Malnutrition significantly impacts surgical inpatients, affecting outcomes like infection rates, hospital stays, and wound healing. This audit evaluates the effectiveness of the Malnutrition Universal Screening Tool (MUST) in identifying at-risk surgical inpatients and examines the subsequent interventions and nutrition assessments.
Our prospective audit encompassed surgical inpatients admitted for elective procedures or via the emergency department. Data were collected through patient records and medical charts, focusing on MUST score completion, accuracy, and updates. The audit assessed staff training, consistency in scoring, and the quality of nutrition interventions documented by dietitians.
Key findings revealed a high completion rate (83.3%) of MUST scores but identified significant inaccuracies due to insufficient consideration of BMI, weight loss, and acute disease effect. Only a minor percentage (15.6%) of patients had their MUST scores updated. Staff training inadequacies and inconsistent scoring practices were noted. Despite these limitations, clinical teams effectively identified at-risk patients using their judgment and promptly initiated interventions.
A malnutrition awareness week was organised with the dieticians, and teaching sessions were conducted for the healthcare staff to enhance understanding and application of the MUST tool. This initiative aimed to raise awareness and improve the quality of malnutrition screening and management.
The audit highlights the need for improved accuracy in MUST scoring, enhanced staff training, and ongoing professional development. Recommendations include comprehensive staff training, standardized documentation processes, interdisciplinary collaboration, and patient and family education.
This audit underscores the importance of accurate malnutrition screening and effective interventions to improve patient care quality for surgical inpatients. It calls for action plans to address the identified gaps, thereby enhancing malnutrition management within healthcare settings.
ThP1.1 - Unilateral Nipple Discharge: Contemporary Approaches to Investigation and Management across a Multi-site Trust
Authors: Calcuttawala Mr Murtaza , Lawrence Miss Eloise , Ali Amina , Dobrogowska Rozalia , James Shiney , Wahab Tajudeen 
Published: September 2024

Abstract

Nipple discharge, in the absence of a palpable breast lump, constitutes 3-9% of referrals to breast services[i],[ii]. While the ABS released updated guidelines on nipple discharge in 2019, a standardised management protocol is yet to be established. This study aims to scrutinize the efficacy of imaging (mammogram, USS, MRI) and nipple discharge cytology in predicting malignancy outcomes in patients with unilateral nipple discharge.

Aims
Determine the incidence of malignancy in women presenting with unilateral nipple discharge.
Assess sensitivity, specificity, and positive predictive value of imaging modalities (mammogram, USS, MRI) and cytology.

Methodology
110 patients presenting with unilateral nipple discharge between 11/2022-12/2023 were retrospectively analysed. Data encompassing patient demographics, diagnostic procedures, and outcomes were systematically collected.

Results
31.6% underwent surgical intervention, revealing a malignancy rate of 5.6%. Positive predictive values for detecting malignancy were 75% for mammogram, 50% for ultrasound, and 66% for nipple discharge cytology. No patients underwent MRI or ductoscopy as part of investigations.

Conclusion
This study highlights variable diagnostic accuracy of imaging and cytology and the necessity for large-scale collaborative data to draw substantive conclusions. The National Unilateral Discharge Study is anticipated to provide comprehensive insights and contribute to the establishment of a national investigative framework for patients presenting with unilateral nipple discharge.
[i] Vargas HI, Romero L, Chlebowski RT. Management of bloody nipple discharge. Curr Treat Options Oncol 2002; 3: 157–161.
[ii] Seltzer MH. Breast complaints, biopsies, and cancer correlated with age in 10,000 consecutive new surgical referrals. Breast J 2004; 10: 111–117.
ThP1.6 - Chaperone in Breast Examination: A Comprehensive Systematic Review of Patient and Clinician Perspectives, and Documentation
Authors: Ou Kai Qi , Wong Zhen Ning , Wong Zhen Yu 
Published: September 2024

Abstract

Aims
The use of chaperones during breast examination is a logical step, particularly in an increasingly litigious society. This review aims to summarise the current information regarding patients’ and clinicians’ perspective in chaperone use in both specialities.

Methods
A PRISMA compliant search was conducted in electronic databases from inception until April 2023 for qualitative literature regarding patients and clinician perspective in chaperone use in breast and plastic surgery. An inductive thematic analysis in three domains (physician-associated, patient-associated factors and chaperone documentation) was done.

Results
10 studies were included after screening 939 articles. Regarding breast surgery, the presence of male and older surgeons, nurse availability, rural setting, and patients’ psychiatric comorbidities were found to increase the propensity of having a chaperone present during consultations. With medico-legal concerns being a prominent factor for male breast surgeons, female breast surgeons highlighted the need for technical support as their main motivation for having a chaperone while logistical issue was a common hindrance. Gender of physicians remained to be an important factor for patients, but conflicting evidence was found regarding patient preferences for chaperone and purpose for having a chaperone present during consultations. Poor documentation was generally observed despite implementing quality improvement projects.

Conclusion
This study emphasizes the vital role of chaperones in clinical practice, urging a precise definition and targeted resolution for implementation challenges. Patient preferences highlight the need for a personalized approach, and increased awareness among healthcare professionals is essential.
ThP2.2 - Breast cancer in the very young
Authors: Sonola Omobolade , Goh Steven 
Published: September 2024

Abstract

Aims
A small proportion of breast cancer (BC) affects women under 35 years old: very young breast cancer (VYBC). We conducted a retrospective cohort study of VYBC treated by our breast unit with the aim of adding to the existing, limited literature.

Methods
All patients treated between January 2012 and July 2023 were included. Case notes, MDT outcomes, operative findings and histology reports were cross-referenced. The primary outcome assessed was overall survival. Other factors investigated were parity, genetics, treatment plans and some, specific, psychosocial concerns.

Results
There were 95 women with VYBC in this 11-year study period. The median age at diagnosis was 32 years, and median length of follow-up was 5 years. 81% of the cohort had early BC, and 28% of carcinomas were triple negative. Overall survival was 87%. 16% of women either presented with or developed distant metastases, with a survival rate of less than 27% in this group. BC recurrence affected 21% of women. Surgery was performed in 94% of patients, with 64% having at least a unilateral mastectomy. Ahead of treatment, fertility concerns were expressed by at least 45% of women. 85% of the cohort were genetically tested, revealing a genetic mutation in 20% of these patients.

Conclusions
This study demonstrates the outcomes of VYBC within our breast unit, which are comparable to published reports. It also highlights unique, psychosocial challenges faced by these women. Long term follow-up of this group is recommended.
ThP2.16 - A prospective study with meta-analysis of echocardiographic changes of left ventricular function in aortic valve replacement patients
Authors: Bhaskaran India Premjithlal , Bhaskaran Premjithlal , Aslam Mohammed 
Published: September 2024

Abstract

Aortic valve replacement (AVR) improves cardiac function and it reverses adverse remodeling. Measurements of left ventricular ejection fraction (LVEF) are used to identify the patients for pharmacological therapy or AVR.
Systematic review identified the Echocardiographic indices followed by AVR. Second part of this study compares the Echocardiographic indices of the patients, who had followed AVR.

Results
Overall, 145 citations were identified from the initial search, of which 43 studies were retrieved. Later, 8 studies included in the review and 5 were subjected to meta-analysis. There was a change in peak A-wave (MD = 7.30; 95% CI = 5.51 to 9.09), peak E-wave (MD = 3.70; 95% CI = 1.86 to 5.54) before and after AVR. There was no change in LVEF (MD = 0.74; 95% CI = -0.76 to 2.25), E/A ratio (MD = -0.26; 95% CI = -0.75 to 0.23), diastolic dimension (MD = 1.10; 95% CI = -2.08 to 4.28) and systolic dimension (MD = 0.20; 95% CI = -3.41 to 3.81) among AVR cases. Prospective study includes 30 AVR cases. Of these, 23 (76.7%) males and 7 (23.3%) females with mean age was 63.36 + 8.34. There was a change (p &gt;0.05) in peak E-wave, peak gradient and peak diastolic gradient from preoperative to six months after AVR.
According to literature, peak E-wave, peak gradient, and peak diastolic gradient changed after AVR. E/A ratio, peak A-wave, E/E ratio, LVEF, diastolic dimension, and systolic dimension were stable (p &gt;0.05) from preoperative to six months after AVR.
ThP3.3 - Prophylactic Endoluminal Vacuum Therapy – towards an era of reducing leak related morbidity after elective oesophago-gastric resection
Authors: Saqib Imad-ud-din , Al-Ani Zena , Ribbits Alexander , Gourgiotis Stavros , Bennett John , Hardwick Richard , Safranek Peter , Sujendran Vijay , Hindmarsh Andrew , Noorani Ayesha 
Published: September 2024

Abstract

Aims
Uncontrolled sepsis following leak from oesophago-gastric surgery is a devastating condition with increased morbidity & mortality affecting longer-term cancer-free survival in patients with cancer resections. We hypothesised that endoluminal vacuum therapy (EVT), previously used to treat leaks, could be used in prophylactic settings to provide source-control, prevent mediastinitis and minimise sepsis related morbidity from leaks.

Methods
An ad-hocEVT device was created using VACgranufoam (KCI)and a nasogastric-tube(16/18Fr), and placed intraluminally across the repair/anastomosis in select high-risk cases. Continuous negative pressure(75–125mmHg) was applied. Assessment of the repair-site/anastomosis was performed by radiology, endoscopy, clinical assessment or a combination following cessation of EVT.

Results
27 patients had prophylactic EVT; M:F ratio was 3:1 and the median age was 68 years (range: 41-82years). 26surgeries were for cancer, while 1 was benign. The rationale for prophylactic EVT included patient related (10), technical factors (16) or both (1). The median duration of prophylactic EVT was 7 days (range: 4-14days). The median length-of-stay was 19.7 days (range: 6-96 days), the two longest admissions were unrelated to the anastomosis(prolonged chyle-leak, and long-term-sequelae of life-threatening bleed). One-patient developed a full-thickness microleak at endoscopic-evaluation, yet remained well with no systemic signs of sepsis, successfully managed with luminalEVT for a further 6days in a ward-based environment. Though prophylacticEVT did not prevent the leak, it significantly minimised the systemic hit that traditionally results from leak and associated mediastinal sepsis.

Conclusions
ProphylacticEVT is a useful adjunct for management of patients with a high risk for leak, though not a substitute for good surgical technique. There are no short-term complications, yet the additional morbidity, mortality and length-of-stay associated with a fully-fledged leak is avoided. Randomised-controlled-trials are required to further standardise selection criteria, assess potential patient benefit and longer-term impact on survivorship.