bluuebunny/crossref_metadata_2025_split huggingface dataset:
WP4.11 - Oral Gastrograffin Usage in Adhesive Small Bowel Obstruction: a re-audit
Authors: Hussain Mubashar 
Published: September 2024

Abstract

Aim
to establish the successful usage of oral gastrograffin in patients presenting with adhesive small bowel obstruction (SBO).

Methods
This is a retrospective follow-up study, using a combined data collected from two NHS Trusts, from July 2022 to January 2024. Patients presented with adhesive SBO were included in this study, who were given 100 ml of oral gastrograffin after diagnosis for SBO. Patients were arranged to have plain abdominal x-ray approximately 8-hours post-gastrograffin drinks/or infusion via nasogastric (NG) tube to ascertain if oral contrast had passed the transition point, identified on initial abdominal CT scan. Patients were then reviewed for their symptomatic relief including bowels movement.

Results
132 patients were identified but 108 patients were included, who had surgery. 24 patients were excluded because they did not have post-gastrograffin x-ray. Average age of patients was 63+/-14 years.
It was observed that 82 patients (75.9%) opened their bowels after administration of first dose of gastrograffin, while 26 patients (24%) did not. 16 out of these 26 patients required surgery; and the remaining 10 (38.4%) had 2nd dose of gastrograffin, of which 4 patients (40%) moved bowels but 6 (60%) still did not and required surgery.
Post-contrast x-rays, showed that contrast passed through into large bowel in 76 patients (70.3%) after 1st dose of gastrograffin and in further 40% after 2nd dose.

Conclusion
clinically significant number of patients responded to such conservative measures. Therefore, routine oral gastrograffin usage is suggested as an effective adjunct to non-operative measures in adhesive SBO management.
WP5.5 - Investigating the Optimal Timing for Definitive Treatment in Sigmoid Volvulus: A Retrospective Cohort Study
Authors: Walshaw Josephine , Solkar Maseera , Hugh Katherine , Munasinghe Chathura , Burke Joshua , Peckham-Cooper Adam 
Published: September 2024

Abstract

Aims
The evidence base is replete of guidance on the optimal timing for definitive surgical management of acute sigmoid volvulus (ASV), with limited understanding or long-term outcomes for those managed conservatively. This study aimed to assess the management and outcomes of this understudied patient population.

Methods
A retrospective cohort study was conducted in a UK tertiary centre between January 2018 and December 2022.

Results
69 patients presented with ASV (54M:15F, age 73.7 SD +/- 15.0 years). The median number of acute admissions per patient was 2 (IQR 1-4.5), with 29 patients (42.0%) presenting only once. 44 patients (63.8%) were managed conservatively. Of those patients, 22 (50.0%) were readmitted within the study period. 25 patients (26.2%) underwent operative management, with 18 (72.0%) of these patients undergoing emergency surgery (6 during their index admission, 33.3%). Elective surgical management was performed in 7 patients after an average of 3 previous admissions. All-cause mortality amongst the cohort was 47.8% (n=33), with a median life span of 1.1 years from index admission (IQR 0.3-2.6); 24.0% in the operative group (5 acute, 1 elective) versus 61.4% in the conservatively managed group. Conservatively managed patients were at greater odds of mortality compared to acutely operated patients (OR 4.129, 95% CI 1.25-13.67, p=0.02) and electively operated patients (OR 9.529, 95% CI 1.05-86.20, p=0.045). Acute operations had no significant greater odds of mortality compared to elective operations (p=0.49).

Conclusions
Conservative management of ASV was associated with greater odds of all-cause mortality compared to patients who received an operation. Operations performed in the acute setting had no greater mortality odds than in the elective setting.
WP5.10 - Improving documentation of Surgical Site Infection Reduction Bundle (SSIRB) use in emergency laparotomies
Authors: Bramer Solange , Pamias-Lopez Blanca , Down Billy , Bond-Smith Giles 
Published: September 2024

Abstract

Aims
Surgical site infections (SSI) are associated with significant morbidity and mortality, substantial costs for hospitals due to increased length of stays, intensive care admissions and hospital re-admissions. NICE and the WHO support evidence based SSI reduction bundles (SSIRB). An evidence based SSIRB consisting of eight steps was implemented in the Surgical Emergency Unit (SEU) of a large teaching hospital to reduce SSI rates after emergency laparotomies. An audit was undertaken to assess documentation of SSIRB use.

Methods
The first audit cycle evaluated SEU laparotomies in January 2022 (n=31). The operation notes in patients’ electronic records were reviewed to extract SSIRB use. The intervention involved altering the electronic operation note to include a section on SSIRB use, which occurred in October 2022. The surgical team were educated about the importance of documenting SSIRB use and the updated operation note. A re-audit was completed for April 2023 (n=21).

Results
The first cycle showed that SSIRB documentation was poor (ranging from 0% to 55% for each step). After the operation note was updated, documentation of SSIRB use improved significantly for five of the eight steps. 48% of operation notes used the SSIRB section and documentation was higher for these laparotomies.

Conclusions
Documentation of SSIRB use improved after the intervention. Trusts are obliged to report accurate post-operative SSI rates. Improved documentation allows evaluation of SSIRB use compliance, enabling SSIRB steps with low compliance to be targeted. A high compliance rate to a SSIRB will reduce SSI rates, ultimately benefiting both patients and trusts.
WP5.14 - Cost of conservative management of acute appendicitis: a cohort study
Authors: Gok M A , Bughio M , Akmal Y , Yim S , Sadat M M , Khan U A , Mathieson N O M 
Published: September 2024

Abstract

Aims
Potential benefits of non surgical treatment of appendicitis: low risk treatment, suitable for older patients, avoids negative appendicectomy & lower healthcare costs. It is associated with recurrent appendicitis, prolonged hospitization, antibiotic related complications, prolonged follow up. Aim of study is to assess costs of conservative management.

Methods
Cohort study was carried out from Mar'2020 to Dec'2023 at single centre. Descriptive demography & outcomes were evaluated for non surgical management. Appendicectomy (acute & interval) were used as controls. Costing was calculated using the standardised NHS cost ledger for resources, procurement and services.

Results
Conservative (n = 235) Appendicectomy (n = 518) Interval (n = 45) Kruskal Wallis (p value) Age(yrs) 39.0 35.9 47.9 &lt;0.0001 Sex(M : F) 121 : 114 251 : 267 19 : 26 NS BMI(kg/m2) 26.0 25.5 26.5 NS GP(n) 69 143 NS A&E(n) 166 375 NS WCC(x109/L) 12.0 13.2 6.5 &lt;0.0001 CRP(mg/L) 76.3 66.3 3.4 &lt;0.0001 Open(n) 11 0 NS Lap(n) 507 45 NS ASA(med) 1 2 NS Appendgrade(n) Uncomplicated 161 186 42 &lt;0.0001 Complicated 74 332 3 &lt;0.0001 Diagnostic (n) Clinical 9 34 USS scan 65 138 CT scan 161 346 Op time(mins) 74.9 74.4 NS LOS(days)(med) 2 2 0 &lt;0.0001 IP AB(days) 2 2 0 &lt;0.0001 Post-op AB(days) 7 0 0 &lt;0.0001 App HPA(mm) Length 66.6 55.7 &lt;0.001 Diameter 11.2 9.9 NS Normal(HPA)(n) 41 Appendicitis (HPA)(n) 477 Cost(£) 1529 4269 1046 &lt;0.0001

Conclusions
Appendicitis grading clinically & radiologically has facilitated safe conservative management. Costs is lower for index admission, but is associated with additional costs & workload.
WP6.4 - General Surgery Bootcamp: Improving Induction for Higher General Surgery Training
Authors: Clarke Rory , Kuligowska Anna , Cooper Adam Peckham , Biyani Shekar 
Published: September 2024

Abstract

Aim
To create an introductory course or “bootcamp” to assist new ST3s transition from working at core trainee to General Surgical Registrar level.

Method
Using previous expertise of “bootcamps” delivered in the region in similar specialities, a 3-day programme was designed to offer training in areas aligned to the curriculum and considered useful to newly starting higher surgical trainees. The course involved a mix of simulation-based workshops, lectures and skill-based labs. The programme was delivered by a senior faculty directing activity with support from industry partners and medical education/simulation expertise. A range of skills were targeted using animal, virtual and augmented reality models, low and high-fidelity simulation, and non-operative technical skills (NOTSS) in simulated ward and theatre environments.

Results
26 trainees (23 new General Surgery ST3s, 3 returning to training) completed the bootcamp. Feedback questionnaires using a likert scale demonstrated clear improvements in trainees’ own skill perception in endoscopy, laparoscopy, open surgery and NOTSS. 100% of responding trainees’ were confident or strongly confident post course, compared to 69% before. We also showed an increase in confidence in laparoscopic suturing (77%), duodenal ulcer repair (69%) and operating in a stressful environment.

Conclusions
A transitional “bootcamp” can provide both tangible and intangible benefits. This project showed clear improvement in trainee confidence both in key practical and non-practical skills such as communication. It also enabled registrars to familiarise themselves with new colleagues, facilitating an early welcome from the region and embedded support network.
WP7.12 - The Impact of a ‘Golden Abscess Pathway’ in a Tertiary Teaching Hospital to Optimize Acute Abscess Management
Authors: Solkar Maseera , Walshaw Josephine , Ofoezie Frank , Pha Sai Yan , Jones Sian , Peckham-Cooper Adam 
Published: September 2024

Abstract

Introduction
The 'Golden Patient' initiative targets operating room efficiency by pre-selecting initial patients, especially beneficial for non-urgent emergencies like abscesses. Anorectal abscesses often face treatment delays due to the prioritization of critical cases. WSES guidelines advocate prompt incision and drainage (I&D) within 24 hours, recommending outpatient management for suitable patients. This study aims to establish an ambulatory 'Golden Abscess Pathway' in a tertiary teaching hospital and assess its impact on acute abscess management efficiency.

Patients and Methods
This retrospective study at the Leeds Institute of Emergency General Surgery included individuals undergoing I&D for acute abscesses. The pre-pathway cohort spanned 03/01/2023 to 28/04/2023, with the 'Golden Abscess Pathway' implemented on 19/06/2023. The post-pathway cohort covered 19/06/2023 to 16/10/2023. The analysis focused on patient demographics and intervention timelines.

Results
The study included 199 patients, with 93 pre-pathway (55M: 38F, mean age 34.3 ± 14.5 years) and 106 post-pathway (70M: 36F, mean age 35.4 ± 13.3 years). The 'Golden Abscess Pathway' reduced the average duration from consultation to operation (1.73 days vs. 2.75 days), advanced median operation start time (09:20 vs. 09:47), and decreased overnight stays (34.9% vs. 44.1%).

Conclusion
Implementation of the 'Golden Abscess Pathway' demonstrated positive outcomes, reducing delays in patient management. These results highlight the pathway's potential to enhance efficiency and overall patient care in acute abscess management.
WP8.9 - Laparoscopic Cholecystectomy Performed by a Surgical Care Practitioner: Review of Outcomes
Authors: Mirza Muhammad , Odogwu Steve , Morris Sarah , Addison Sarah , Abbott Sian 
Published: September 2024

Abstract

Introduction
Surgical Care Practitioners (SCPs) are non-medical workers involved in various aspects of management of surgical patients. The role includes assisting and performing surgical procedures. Over 60,000 laparoscopic cholecystectomies (LC) are performed annually in the UK. With ever increasing pressure on waiting lists, it is important to look at fully utilising the skills of our entire workforce. We report what we believe is the first published series of LC performed by an SCP.

Materials and Methods
A retrospective review of a prospectively collected database was performed. Primary outcome was any complication requiring intervention. Secondary outcomes were minor complications, operative time, length of stay, conversion and readmission.

Results
170 patients were operated on. Indications were biliary colic in 127 (74.7%), cholecystitis 30 (17.6%) and pancreatitis in 13(7.6%). Mean operating time was 65 minutes (Range 35-152). 53 operations were assisted by a consultant, 110 by a senior SAS grade and 7 by a CT2. 139 (81.7%) patients were discharged on the day of surgery. 24 (14.1%) stayed one night in hospital. There were no major complications. Four patients required readmission. Two with pain and 2 with port site infections. There were no conversions or transfusions required.

Conclusion
There is a paucity of published data on surgical outcomes of procedures performed by SCPs. With a structured, supervised approach SCPs could be trained to take on more complex procedures and further strengthen the surgical workforce. This study demonstrates that elective LC can be safely performed by an appropriately trained and supervised SCP.
ThP1.8 - Margin re-excision after Wise pattern or Vertical scar therapeutic mammoplasty for early breast cancer - a single institution 4-year review
Authors: Badawi Marwa , Khatun Azra , Agrawal Avi , John Edward St , Alder Louise , Cook Lorna 
Published: September 2024

Abstract

Introduction
Therapeutic mammoplasty is a technique which facilitates large volume cancer excisions whilst maintaining breast cosmesis in patients with breast cancer. The aim of this audit was to evaluate the rates of positive margins and cancer recurrence in this cohort and determine any risk factors for requiring margin re-excision.

Methods
All patients undergoing therapeutic mammoplasty using a Wise-pattern or vertical scar technique for the treatment of breast cancer over a 4-year period (November 2019- October 2023) were included. Data was collected on patient demographics, tumour characteristics, re-excision rates and cancer recurrence.

Results
Of a total of 61 patients who underwent therapeutic mammoplasty, 10 (16.4%) required margin re-excision. DCIS alone was present at the margin in the majority (70%). Re-excision specimens contained further cancer in 4/10, of which 2 had clear new margins, one required further re-excision and one underwent completion mastectomy. Half of those who required re-excision had a cancer that was either mammographically occult or was non-concordant with the pre-operative imaging on final histology in terms of extent and/or focality. There was one case only of in-breast recurrence, in a patient who had not previously required margin re-excision.

Conclusions
Therapeutic mammoplasty is an oncologically safe technique and in the vast majority of patients the breast can continue to be preserved even when margins are close or involved. Patients undergoing therapeutic mammoplasty who have mammographically occult tumours may be at higher risk of margin re-excision even with the addition of MRI imaging.
ThP1.9 - Seroma in Pre-pectoral Acellular Dermal Matrix-based procedures
Authors: Gavisiddappa Chandana , Parmeshwar Rishikesh 
Published: September 2024

Abstract

Aims
Pre-pectoral reconstruction has gained popularity in recent years and is now considered to be the preferred technique in immediate breast reconstruction. This is done with silicone implants and various synthetic, biological acellular dermal matrix (ADM). Seroma is a well-recognized issue after these IBRs with a wide range of reported incidence (iBAG study). This study reviews incidence and management after Pre-pectoral IBRs with the use of one such porcine ADM (Braxon®).

Methods
A retrospective audit from a single institution, single surgeon prospectively kept data. The data concerning seroma and its effective management was audited in this study.

Results
Over an eight-year period, a total of 74 patients with 86 procedures (12 bilateral) were analysed. The mean age was 52.6 and BMI 23.5. Reconstruction was carried out in 89.1% for malignancy, 9.4% had prophylactic surgery and 5.4% had revisions (Subpectoral to Pre-pectoral) for animation. All patients had drains in situ for a mean duration of 7 days. Seroma was seen in 15%(11 patients) of patients but only 18%(2patients) needed intervention in terms of aspiration and/or re-exploration. The authors’ indications for seroma aspiration were based on an algorithm (clinical signs of progression of seroma, skin changes along with signs of poor integration rather than US findings alone)

Conclusions
From the audit, we could conclude that the formation of seroma is common after ADM and pre-pectoral implant-based IBR but careful monitoring and selective use of aspiration can be practiced thereby minimizing the risk of infection and implant loss as a result of intervention.
ThP2.8 - Reducing postoperative length of stay after thyroidectomy through a standardised multidisciplinary postoperative care protocol does not compromise patient safety
Authors: Naseer Afifa , Elkorety Mohamed , Belbase Sushen , Jamil Sanober , Bhatti Tahir 
Published: September 2024

Abstract

Aims
Our unit had a significantly longer length of stay after thyroid surgery. We introduced change of practice through a standardised multidisciplinary postoperative care protocol. We analyse the effect of the protocol on postoperative length of stay and any impacts on patient safety.

Methods
A multidisciplinary protocol was implemented and embedded into clinical practice. Data was collected prospectively on consecutive patients undergoing thyroid surgery. Outcomes with reference to adverse events, length of stay and readmissions were audited. Comparisons were made with unit's pre-protocol data and national figures published in BAETS (British Association of Endocrine and thyroid Surgeons) audit report.

Results
A total of 78 patients underwent 37 total thyroidectomies and 41 lobectomies. Three (8.3%) of the total thyroidectomies had transient hypocalcaemia but none were permanent. None had voice changes or recurrent laryngeal nerve palsy. Three patients were reviewed few days after discharge with mild hypocalcaemia symptoms treated with calcium supplements. One was re-admitted 5 days post discharge with wound infection. Twenty-seven (75%) were discharged on 1st postoperative day as opposed to 0% pre-protocol (BAETS audit report 66%).
Thirty-seven (90%) of lobectomies were discharged on 1st postoperative day (Units pre-protocol 42%, BAETS audit 81%). There was no postoperative bleed or hypocalcaemia. One patient with a large recurrent retrosternal goitre had transient recurrent laryngeal nerve palsy that recovered subsequently.
There were no readmissions or adverse events directly related to early discharge.

Conclusion
A well embedded dedicated postoperative care protocol can significantly reduce postoperative hospital stay after thyroid surgery without compromising patient safety.
ThP2.17 - Efficacy of Mesenchymal Stem Cells in the Treatment of Osteonecrosis of Femoral Head
Authors: Lim Jun Sing , Cui Xiangmei , Konan Sujith 
Published: September 2024

Abstract

Introduction
Osteonecrosis of the femoral head (ONFH) has substantial morbidity and impacts patient populations worldwide. Mesenchymal stem cells (MSCs) are implicated for their potential in ONFH treatment. The objective of this study is to examine the effectiveness of MSC when compared to existing surgical options in the treatment of ONFH.

Method
A literature search is conducted through Pubmed, MedlineOvid, and Cochrane. The studies were selected using PRISMA and ROBVIS. Four randomised controlled trials and two preliminary studies with a total of 599 participants were included in the study.

Results
Progression to advanced stages of ONFH was reduced in bone marrow mesenchymal stem cells (BMMSC) applied in conjunction with core decompression (CD) when compared to CD alone (3.77% vs. 22.7%, p&lt;0.05) and reduced femoral head collapse (28% vs. 72%). Improvement in Hip Harris Score (HHS) when compared to CD alone (31.85 vs. 19.72 control, p = 0.03) was also observed. The joint preservation rate of applying BMMSC in tantalum rod insertion with vascularized iliac grafting in end-stage ONFH patients was greater than that of vascularized iliac grafting alone (83.33% vs. 57% in stage IV patients) and associated with a better outcome (HHS 6.29±6.11 to 77.23±14.75). Improvement in WOMAC, VAS and Lequesne index was also observed when comparing CD with bone grafts and CD, bone grafts and BMMSC.

Conclusion
The use of MSC applications along with current surgeries has been shown to improve post-operative outcomes and progression to advanced ONFH stages in the treatment of ONFH compared to surgeries done alone.
ThP4.7 - The outcome of a single stage Laparoendoscopic rendezvous ERCP and laparoscopic cholecystectomy for cholecystocholedocholithiasis in a DGH
Authors: Thompson Luke , Fultang Joshua , Gao Neng , Cullen Fraser , Apollos Jeyakumar 
Published: September 2024

Abstract
Cholecystocholedocholithiasis is managed surgically by laparoscopic cholecystectomy (LC) and simultaneous common bile duct (CBD) exploration or by preoperative Endoscopic Retrograde Cholangiopancreatography (ERCP) followed by LC. Rendezvous ERCP (RERCP) is an innovative laparoendoscopic technique combining LCs and ERCPs. As a single staged procedure, a LC is performed and selective canulisation of the CBD is aided by laparoscopic transcystic placement of a guide-wire into the duodenum. We present a case series of RERCPs within a DGH.
This case series collected retrospective data (2014-2023) involving 33 patients, of which 21 underwent RERCP. Preoperative variables included age, indication, gender, ASA grade, Charlson comorbidity index (CCI), frailty score and indication. Postoperative variables analysed were operating time, complications, 30-day re-admission rates and length of stay in hospital (LOSH).
Of the 21 patients who underwent a RERCP, 76% (n=16) were female. The average age was 60±17years and 59% (n=13) of all procedures were elective. The ASA range was I to III, average CCI and frailty score were 2.4±1.9 and 0.1±0.4 respectively. 52% (n=11) of patients had a previous failed ERCP. The average operating time was 152±39mins. The average LOSH was 3.5±2.8days and 2.5±2.1days following the RERCP. Biliary (including pancreatitis) and non-biliary complications were 9.5% (n=2) and 9.5% (n=2) respectively. The 30-day readmission rate was 9.5% (n=2). There was no significant difference in the operating time (p=0.16), LOSH (p=0.19) complication (p=0.13) and readmission rates (p=0.50) between emergencies and elective procedures.
RERCP remains a valuable option when managing cholecystocholedocholithiasis in emergency and elective settings.