bluuebunny/crossref_metadata_2025_split huggingface dataset:
ThP4.5 - The challenges of the emergency laparoscopic cholecystectomy in the obese patient
Authors: Davies Sian , Bodla Salman , Roy Sornali , Pallister Santiago , Olaifa Fumi , Athwal Tejinderjit , Laing Richard 
Published: September 2024

Abstract

It’s well documented that obesity is a positive predictor of surgical morbidity and with increasing obesity rates it is becoming a challenge for patients presenting with obesity related surgical conditions such as acute cholecystitis. This study aims to assess the impact of the class of obesity on the outcomes following laparoscopic cholecystectomy for acute cholecystitis.

Methods
A retrospective observational study was performed on patients undergoing emergency laparoscopic cholecystectomy at UHNM from January 2022 to January 2023. These patients were then stratified by their class of obesity as defined by the WHO; Healthy weight (BMI &lt;25), Overweight (BMI 25 – 30), ClassI Obesity (BMI 30-35), ClassII Obesity (BMI 35-40), and ClassIII Obesity (BMI &gt;40). Primary outcomes included LOS, mortality, 30 day readmission rates and postoperative complications. Secondary outcomes included total operative time.

Results
A total of 643 patients were identified. The classes of obesity were on average a younger cohort (median age, Healthy Weight = 60 [32–82], Overweight = 62 (28-86), Class I = 56 (27-80) ClassII = 50 (22-83) and ClassIII = 47 (28-90); p &lt; 0.001). Length of hospital stay, mortality and operative duration, were similar between groups. However readmission rates were higher for the obese groups (Healthy Weight 8% vs Overweight 8% vs ClassI = 7% vs ClassII = 14% vs ClassIII 16%; p &lt; 0.001) and postoperative complications (p = 0.067).

Conclusions
Emergency laparoscopic cholecystectomy can be performed safely on patients with higher classes of obesity but an appreciation of the class of obesity needs to be taken into consideration and higher class of obesity is associated with increasing risk of post operative complications.
ThP4.12 - Impacted Bile Duct Stones Encountered during 1447 Laparoscopic Explorations; Incidence and Management
Authors: Hayyawi Israa , Attia Abdel Aziz , Omran Asmaa , Al-Shaye Ahmad R A , Nassar Ahmad H M 
Published: September 2024

Abstract

Aim
To study the incidence and management of impacted bile duct stones encountered during laparoscopic bile duct exploration (LCBDE).

Methods
A review of patients undergoing LCBDE for impacted stones. Preoperative imaging, operative difficulty grading, impaction location, dis-impaction methods, operative complications and postoperative outcomes were analysed.

Results
136 of 1447 (9.4%) LCBDEs had impacted stones; median age 53 years, 63.2% females. 88.2% were emergencies; 94 Jaundiced (69.1%). USS showed CBD dilatation in 30.1%. 16.9% had previous ERCP and 43% previous biliary admissions. CBD exploration was transcystic in 52 (38.2%) and via choledochotomy in 84 (61.8%). LCBDE difficulty grading was IV in 61 (44.9%) and V in 75 (55.1%). The number of stones ranged from 1-70 (mean 6, median 2) and stone size 4-30mm (median 12). All needed choledochoscopy. Impaction was at lower CBD in 83 (61%), Mid-CBD 29 (21.3%), Intra-hepatic 15 (11%), intra and extra hepatic in 6 (4.4%) and intramural in 3. Dis-impaction needed biopsy forceps/grasper fragmentation (45.6%) basket/Fogarty manipulation in 35.3%, laser in 8.8%, pushing stones using the choledocoscope in 6 cases (4.4%) and conversion or leaving stone for ERCP in 7 (5.8% 6 prior to1997). The median operative time was 150 minutes (60-630 minutes).
Complications occurred in 33 (24.2%) including15 biliary-related and 9 biliary drain-related. Readmissions occurred in 18 patients (11 biliary-related) and one death was caused by pneumonia. Hospital stay median was 10 days (3 to 54). On 80% follow up the presentation to resolution period median was 2 weeks (1- 30).

Conclusions
Apart from CBD stones shown on USS and failed ERCP this study identified no obvious risk factors.
ThP5.3 - A Clinical Audit on Assessing Severe Acute Pancreatitis: Improving the use of the Glasgow-Imrie Criteria and outcomes
Authors: Nazar Naadir , Read Phoebe , Bolton Hannah , Bailey Charles 
Published: September 2024

Abstract

Introduction
Severe acute pancreatitis (SAP) is defined by pancreatic and extra-pancreatic necrosis, ITU admission, multisystem organ failure and death. Severity should be predicted on admission using the Glasgow-Imrie Criteria (GIC) to stratify patients and scores ≥ 3 are indicative of SAP and requires review by a senior and/or HDU/ITU to determine possible transfer to HDU/ITU.

Methods
We performed a 2-cycle audit on the use of the GIC to score 140 patients with acute pancreatitis (AP) from November 2022 – October 2023. Initial interventions included a presentation, posters and an email. The second intervention was the insertion of a scoring tick box into the electronic clerking notes.

Results
At baseline 44% (22/50) of patients with AP were scored using the GIC. Post first intervention this was 66% (21/32), post second intervention it was 84% (49/58).
Post interventions the proportion of patients scoring ≥3 escalated to a senior and/or HDU/ITU increased from 17% to 100% and mean length of stay reduced from 14.5 to 11 days, also the completeness of documentation rose from 78% to 96%.
There were 18 Glasgow-Imrie scores ≥ 3 and 8 of these patients developed clinical SAP.

Conclusion
Our audit showed that simple interventions and incorporation of the scoring system into the electronic notes increased the percentage of patients being scored on admission and resulted in all patients with a score ≥ 3 being reviewed by a senior and/or HDU/ITU. Incorporating the scoring into the electronic clerking document was relatively straightforward and could be adopted by other Trusts.
ThP6.6 - Enhancing Management Strategies: Exploring the Expansion of Low-Risk Criteria in Glasgow-Blatchford Scoring for Acute Upper Gastrointestinal Bleeding – A Retrospective Cohort Study
Authors: Ng Shou Kee , Nemade Mitesh J , Adeoti Olayiwola M , Khan Khurram S 
Published: September 2024

Abstract

Aims
Glasgow-Blatchford Scoring (GBS) determines the need for further interventions in patients presenting with acute upper gastrointestinal bleeding (AUGIB). We aimed to study whether we can safely expand low-risk criteria to patients with GBS 2 and manage them as urgent outpatient.

Methods
A retrospective study of consecutive adult patients who had inpatient endoscopy for AUGIB in a single surgical unit from September 2021 to September 2022. Patient demographics, clinical and laboratory findings, GBS and endoscopic findings was analysed. Low-risk was defined as GBS 0-1 and high-risk as GBS ≥3.

Results
150 patients were identified; 79 (58.7%) were male and median age of 63 years (IQR 53-76). Median total length-of-stay was 3.7 days (IQR 1.9=7.8).
Similar to the low-risk group, patients with GBS 2 presented with lower range and frequency of symptoms as the high-risk group (p=0.0002). Severity correlated with admission haemoglobin (p=0.001) and urea count (p&lt;0.0001) but not relevant comorbidities (p=0.560) and admission observations (p=0.456).
The frequency of benign endoscopic findings in patients with GBS 2 were similar to the low-risk group with no malignant findings noted. This group also had similar rates of past and re-attendances for AUGIB and 30-day mortality of 0% to the low-risk group.

Conclusion
While our study has a small sample size, it suggests promising prospect that patients with GBS 2 may not need inpatient endoscopy. Future multi-centre studies are crucial to validate and strengthen this proposition. The potential advantages include decreased inpatient admissions, reduced healthcare costs, and alleviating pressures on emergency endoscopy unit.
ThP6.18 - 2 week wait referrals for suspected colorectal cancer in patients more than 85 years old. How many actually end up on the operating table?
Authors: Elzanati Hisham , Adetoye Moyinoluwa , Oyefeso Samuel , Alemam Ahmed , Masood Saad , Sangal Sam 
Published: September 2024

Abstract

Aims
To assess the outcomes of 2 week wait referrals for patients &gt; 85 years old for suspected colorectal cancer in a large university hospital

Methods
Retrospective review of records of patients &gt;85years old referred on the pathway between September to November 2023. Outcomes assessed were the number of patients that underwent investigation, cancers detected and whether they ended up having surgery.

Results
211 patients were referred. 43 were not investigated (20.4%), 95 had CT-colons (45%), 37 had CT-abdomen, 25 had flexible-sigmoidoscopy, 15 had CT Chest-abdomen-pelvis, only 10 had a colonoscopy (4.7%). 13 colorectal cancers were diagnosed (6.2%). Out of these only 3 agreed and were fit to proceed with surgery, 7 refused surgery and 2 were undecided while 1 passed away 2 weeks after the diagnosis was made. 5 incidental extracolonic cancers were diagnosed (2 pancreatic, 2 renal and 1 lung, 2 of which were metastatic) All the diagnosed colorectal cancers were FIT positive (100% sensitivity). 7 had no FIT test done and 14 were FIT negative.

Conclusion
The incidence of colorectal cancers in this group of patients is relatively small and most end up being not fit for investigation or surgery or refusing it themselves even when cancer is diagnosed. These patients should still have the right to be investigated and treated if they wish to but a pragmatic discussion needs to be made with them by the referring clinician before a referral is made as well as making use of the very high sensitivity of FIT testing to ensure optimal use is made of the limited resources available in our already stretched system.
ThP6.19 - Surgical Management in Sacrococcygeal Pilonidal Sinus Disease Depending on The Suggested Staging System
Authors: Al-Maliki Doaa , Saud Jasim Dager , Naji Alsabbagh Humam Abdulsalam , Azir Elia 
Published: September 2024

Abstract

Background
The ideal management of the PNS has not been established yet. However; The optimal method should cover rapid recovery and return to normal daily activities, low recurrence rate, be technically applicable with reasonable cost.

Aim
to evaluate outcomes with the use of a stage-based treatment approach.

Method
A cohort prospective analytical study was conducted at Basrah Teaching Hospital-Iraq, a total of 71 patients were operated based on the proposed staging system in the period between December 2018 to April 2022, the staging system (Stage I–IV) was defined by using the morphological extent. the collected data includes demographic, perioperative data, short and long-term outcomes.

Results
Stage IV had the highest abscess drainage, drain insertion, and hospital stay. Concerning the short and long-term complications, the following frequencies were observed: Collection (9.85%), Infection (8.45%), and Dehiscence (4.22%), the collection and dehiscence were highest among stage R while the lowest rate of collection and infection was among stage III cases (6.67%, 6.67%) accordingly. Primary healing was recorded (91.5%) among the overall included patients with the higher rates of stage II-a (100.0%) with the lowest being among stage R (71.4%). Stage IV patients experienced the longest time for functional recovery and wound healing (14.25± 7.13, 13.25± 7.27) accordingly. The Recurrence rate was (2.81%) commonly observed among stage II-a (16.67%).

Conclusion
PNS is a recognizable condition in our locality and presents in different stages, thus this proposed staging system categorizes its extent and is a valuable tool in tailoring surgical approaches to each stage, Furthermore, it provides a common language for the surgeon to communicate about the disease.
ThP7.2 - Nonoperative versus Operative Management in Traumatic Liver Injuries: A Prospective LiPTA Multicentre Study
Authors: Lewis-Lloyd Christopher , Koh Amanda , Adiamah Alfred , Blackburn Lauren , Brooks Adam , Collaborative LiP TA 
Published: September 2024

Abstract

Aims
The liver is the most injured abdominal organ, with subsequent significant morbidity and mortality. Over the last 30-years liver trauma management has changed, with an increase in nonoperative versus operative approaches. However, contemporary UK data on how liver trauma is managed is limited.

Methods
This prospective, multicentre audit was conducted through the National Trauma Research and Innovation Collaborative at 18 participating major trauma centres and units across the UK between 01/01/2021-01/10/2021. Differences in demographics, physiology, injury mechanisms, complications, length of stay, and 30-day mortality were compared between patients undergoing definitive nonoperative, including interventional radiology, or operative management. Univariable tests were used to compare data where appropriate with adjusted odds ratios of 30-day mortality used to assess definitive management via a multivariable model.

Results
Of 266 patients, 76.69% underwent nonoperative management. Operative patients were significantly younger, median age 29 (IQR 20-41) vs. 34 (IQR 23-52) p=0.0146, sustained more penetrating compared to blunt injuries (62.90% vs. 9.80%, p&lt;0.0001), had more active bleeding on CT (32.65% vs. 5.97%, p&lt;0.0001), required massive transfusions (27.42% vs. 8.33%, p=0.0001), sustained more inpatient complications (29.03% vs. 1.96%, p&lt;0.001) and more physiologically unstable on admission. Operative compared to nonoperative management resulted in a significant 20-fold increase in 30-day mortality, (aOR 20.21, 95%CI 3.28-124.43, p=0.001).

Conclusions
These findings highlight the current approach to UK liver trauma management. Patients undergoing operative management have significantly greater morbidity and mortality yet may represent the severest of liver injures. Where appropriate nonoperative management should be used following liver trauma to reduce this.
ThP7.3 - Time of admission has no impact on outcome in trauma laparotomy
Authors: Green James , Dick Lachlan 
Published: September 2024

Abstract

Introduction
Trauma laparotomy outcomes are influenced by both patient and system factors. Out of hours (OOH) is associated with reduced staffing and on-site seniority which may impact patient outcomes. We aimed to establish if OOH laparotomy is associated with poorer outcomes.

Methods
A retrospective analysis was performed on all patients that underwent a trauma laparotomy at a major trauma centre between 2019 and 2023. Groups were divided into in-hour admission (IH) (08:00 - 20:00) and OOH (20:00– 08:00). The primary outcome was mortality and secondary outcomes included intensive care and total length of stay. Statistical analysis was performed to determine differences between groups.

Results
176 patients were included. The majority (62.5%) were OOH and penetrating the commonest mechanism of injury in both OOH (63.6%) and IH (57.5%). Comparing those admitted OOH and IH there was no difference inactivation of code red protocols (42.7% vs 39.4% p=0.663). ITU admissions (36.3% vs 43.9% p=0.318), length of ITU stay (mean days 9.1 ± 11.1 vs 15.7 ±17.4 p=0.068), total hospital stay (mean days 14.4 ± 25.3 vs 19 ± 25.4 p=0.204) or mortality (7.3% vs 4.5% p=0.469).

Conclusion
Although a larger proportion of trauma laparotomies occur in the OOH period, no statistical difference was found in any patient outcomes. This is likely due to established processes in our mature trauma model.
ThP7.13 - A systematic review of the perioperative outcomes of surgical fixation versus conservative approach for severe rib fractures
Authors: Singh Anurag , Khan Nida , Swaminathan Christie , Janakan Gnananandan , Sajid Muhammad 
Published: September 2024

Abstract

Objective
The objective of this meta-analysis is to compare the patient outcomes for severe rib fractures being managed by operative or non-operative treatment.

Methods
Studies reporting patient outcomes in patients undergoing surgical fixation or conservative approach were selected from medical electronic databases and meta-analysis was conducted by following the guidelines of the Cochrane Collaboration using statistical software RevMan version 5.

Results
Three studies on 258 patients reporting patient outcomes were included. In the random effect model analysis, the total hospital stay [mean difference -1.44, 95%, CI (-2.88, 0.00), Z = 1.96, p = 0.05] was comparable between the two groups with no heterogeneity among included studies. The intensive care stay [mean difference -2.36, 95%, CI (-5.92, 1.21), Z = 1.30, p = 0.20] and mortality [odds ratio 1.08, 95%, CI (0.11, 10.31), Z = 0.07, p = 0.94] was comparable between the two groups but with moderate heterogeneity among included studies. Pneumonia was more common in patients of the non-operative group [odds ratio 0.35, 95%, CI (0.15, 0.82), Z = 2.41, p = 0.02] with no heterogeneity among included studies.

Conclusion
Pneumonia was more common in patients in the patients managed with the conservative approach. Other patient outcomes were comparable between the two groups. Due to the paucity of data, multiple other crucial variables could not be assessed and a major multi-centre randomised control trial is needed to confirm the findings of this meta-analysis.
ThP7.14 - CSF Leak or Ear Wax? Logical Thinking in Emergency Management of a Collapsed Patient With Heat stroke
Authors: Hern Daniel 
Published: September 2024

Abstract
A man in his 60s presented to RESUS by ambulance on the hottest day of the year with suspected STEMI and collapse at home.
The patient was intubated and unresponsive (GCS 5), with global rigors. Hospital ECG showed sinus tachycardia. Body temperature was in excess of 41°C, confirmed on central temperature monitoring. Bilateral clear fluid was noted to be discharging from both ear canals.
Query CSF leak was indication for CT head, which was unremarkable. Considering this, efforts were focused on optimising body temperature. This was done with the use of ice packs and fans as well as continuous misting of cool water over the exposed patient. Improvement was shown with temperatures decreasing to 38°C.
In questioning the cause of the “clear fluid,” a swab of it placed on an icepack swiftly returned the fluid to its natural consistency of ear wax. As a result of the extraordinarily high body temperatures, ear wax had melted in both ear canals and started to leak out, giving the impression of a CSF leak.
This was simply identified at the bedside to refute the idea of a CSF leak. As CSF leak was the indication for a CT head, this could have been avoided with rapid cooling initiated earlier.
Unfortunately, this patient later died due to heat stroke.
Whilst avoiding the delay of a CT head most likely would not have changed the prognosis for this patient, it is useful to note the importance of logical thinking in an emergency setting.
ThP7.15 - An audit to assess the usefulness of investigations for patients with acute appendicitis
Authors: Sultana Emiko , Kausar Maria , Amin Amina , Kumar Harish 
Published: September 2024

Abstract

Introduction
The NICE guidelines recommend that acute appendicitis should be diagnosed clinically. In our hospital, many patients initially have an ultrasound or a CT scan before being taken to theatre. We aimed to assess the usefulness of investigations in diagnosing acute appendicitis. The objective will be to look at the clinical, radiological, operative, and histological diagnosis and identify if these are coherent.

Methods
A single centre retrospective study was carried out on all patients who underwent an appendicectomy between December 2022 and May 2023. Data was collected about the patient demographics, their presenting symptoms, clinical examination findings, blood test results, and whether they had radiological investigations and the respective results. This was then compared to the operative diagnosis and histological diagnosis.

Results
169 patients were taken to theatre for an appendicectomy with a median age of 24 (IQR 15-43) and 51.5% were male. Blood tests were done in all patients and imaging was done in 50.9% patients. Amongst the investigations, CT scans were the most accurate in diagnosing appendicitis (91.5% accurate), followed by bloods (65.5% accurate). US scans were the least reliable as it only accurately picked up 57.1% of the histologically proven appendicitis and reported 52% of appendicitis on histology as normal.

Conclusions
History, clinical examination, blood tests, and CT scans are reliable tools for diagnosing appendicitis pre-operatively. Investigations such as US Abdomen are not suggested for diagnosing appendicitis. Patients with clinically suspected appendicitis with raised inflammatory markers should be taken to theatre regardless of normal US Abdomen results.
ThP8.2 - Degree of Lymphatic dysfunction in severe obesity
Authors: Maharjan Surina , Sivakanthan Mathumie , Peters Adrien , Odiase Ruth , Gambhir Raghvinder Pal Singh 
Published: September 2024

Abstract

Aim
Obesity can affect the lymphatic system through a multitude of ways with patients presenting to lymphoedema clinics. The aim of this present study is to assess the degree of lymphatic dysfunction through Lymphoscinigraphy (LSG) scans in severely obese patients.

Methods
All obese patients who presented with leg swelling and underwent LSG scans were included in the study. Based on NICE guidelines they were graded as class 1 (BMI of 30-34.9 kg/m2), class 2 (35-39.9 kg/m2) and class 3 (40 kg/m2 or more). Severity of their Lymphoedema were categorised as mild (uptake 5-8%), moderate (uptake 2-5%), and severe (Uptake &lt;2%) in accordance with the worst affected leg. These two variables were then compared.

Results
Of the 133 patients with BMI provided, the average BMI was 37.18Kg/m2. 54.89% of patients with BMI provided were classed as Obese.19 (26.03%) of these patients were classed as class 1 obesity and of these 68% had severe Lymphoedema. 14 (19.18%) were classed as class 2 obesity and 28% had severe Lymphoedema. 40 (54.79%) were classed as class 3 obesity and 28% had severe Lymphoedema.

Conclusion
Majority (75%) of obese patients had lymphatic dysfunction on LSG scans. Majority (62%) had mild to moderate Lymphatic dysfunction. Only 38% of patients with severe Obesity (40 kg/m2 or more) had severe Lymphatic dysfunction. Lymphoedema in Obesity is often not constitutional lymphoedema.
ThP8.4 - Initial Results of CAC (Cyanoacrylate Closure) of lower limb truncal venous incompetence
Authors: Naseer Afifa , Elkorety Mohamed , Belbase Sushen , Jayawardena Panduka , Jamil Sanober , Bhatti Tahir 
Published: September 2024

Abstract

Aims
We have tried CAC in our unit, as an emerging new treatment. We present our initial experience on efficacy and safety of the technique.

Methods
Venous trunks were treated with n-butyl Cyanoacrylate (Variclose® by biolas) as per IFU. Clinical and doppler US follow-up at three months was carried out. Data was captured prospectively.

Results
Eighty-six venous trunks (79 GSV, 5 SSV, 2 ATV) in 82 limbs of 65 patients were treated. Median length/ diameter of LSV treated was 32 /0.7 cms; 15/5 cms for SSV. Median volume of glue used was 1.83 mls.
Eighty-two out of eighty-six (96%) trunks were successfully treated with complete primary occlusion. Four(4.5%) trunks did not demonstrate total occlusion at primary treatment. There was no extension of thrombus into deep veins and no immediate adverse reactions.
On doppler US at 3 months, 58(70.7%) trunks demonstrated total occlusion. Twenty-four (29.3%) trunks were only partially occluded. which were deemed not suitable for thermal endovenous treatment.
Nine (11%) patients had adverse events. One had pulmonary embolism two days after treatment. Five limbs developed erythema and swelling in the thigh which took few weeks to settle. Two patients had exaggerated thrombophlebitis of the treated GSV requiring hospital admission.

Conclusion
There is a high rate of primary occlusion of the treated trunk which does not appear to be maintained at short term follow up. There is glue associated adverse reactions and potential serious complications. It may limit the options of subsequent treatment where the glue treatment has not been successful.