bluuebunny/crossref_metadata_2025_split huggingface dataset:
WP1.1 - Examining the effectiveness of prescribing Tamsulosin before elective surgery for inguino-scrotal hernias - a case series
Authors: Carey Charles , James Stuart , Jaunoo Shameen 
Published: September 2024

Abstract

Aims
Urinary retention following surgery is a common issue that can result in significant morbidity and prolonged hospital admissions. Tamsulosin is commonly used to manage patients at risk of urinary retention in the community but its usefulness at preventing retention following surgery is currently unclear. This case series describes the effectiveness of using short courses of tamsulosin to prevent post-operative urinary retention at a single centre.

Methods
Males aged over 70 who underwent elective surgery for an inguino-scrotal hernia between January 2022 and January 2024 were included in this series. Inclusion also required the patients to be planned as day case procedures under general anaesthetic. Patients with a known history of prostatic disease and/or who were already taking Tamsulosin or another alpha-1 adrenoceptor inhibitor were excluded.

Results
67 patients who took 400 micrograms of Tamsulosin once daily for 2 days before and on the day of surgery were included in this series. The patients were aged between 70 - 89 years and all underwent elective open mesh hernia repairs under the same surgeon with the same materials. None of the patients suffered post-operative urinary retention and so were able to be discharged as day cases.

Conclusions
The absence of any instances of post-operative urinary retention in this series suggests that a course of Tamsulosin before elective inguino-scrotal hernia repair can effective as prophylaxis against the condition. This data alongside additional randomised control trials demonstrating the benefits of pre-operative Tamsulosin may result in it being used more widely.
WP1.2 - Does intraoperative urinary catheterisation decrease postoperative urinary retention after laparoscopic inguinal hernia repair? A systematic review and meta-analysis
Authors: Romman Saleh , Fagbemi Ona , Ghassemi Nader , Hajibandeh Shahin , Athwal Tejinderjit , Cheruvu Chandra , Hajibandeh Shahab 
Published: September 2024

Abstract

Aims
To evaluate comparative outcomes of laparoscopic inguinal hernia repair with and without use of intraoperative urinary catheterisation.

Methods
A systematic search of MEDLINE, CENTRAL and Web of Science and bibliographic reference lists were conducted. All comparative studies evaluating outcomes of laparoscopic inguinal hernia repair with and without use of intraoperative urinary catheterisation were included and their risk of bias were assessed using their risk of bias were assessed using ROBINS-I tool. Postoperative urinary retention was analysed as the primary outcome parameter and an odds ratio (OR) was determined using Random-effects modelling.

Results
We included 6 comparative studies reporting a total of 8,675 patients who underwent laparoscopic inguinal hernia repair with (n=3,318) and without (n=5,357) use of intraoperative urinary catheterisation. There was no significant difference in postoperative urinary retention between the two groups (4.3% versus 3.7%, OR 0.93; 95% CI 0.55-1.58, p=0.80). There was significant heterogeneity among the included studies (I2: 75%, p=0.001). Results of sensitivity analyses were consistent with the results of the main analysis.

Conclusions
Meta-analysis of best available evidence (level 2a) demonstrated that use of intraoperative urinary catheter has no advantage in prevention of postoperative urinary retention following laparoscopic inguinal hernia repair. Future randomised controlled trials are required to control for confounding factors that increases the risk of urinary retention.
WP1.11 - Total Extra Peritoneal (TEP) Inguinal hernia repair is safe and feasible for recurrent inguinal hernia post Total Extra Peritoneal repair "TEP on TEP is possible”
Authors: Zino Samer , Alaeq Ali , Costello Amy , Djoudi Assia 
Published: September 2024

Abstract

This abstract share our experience in surgical management of recurrent inguinal hernia post total extra peritoneal (TEP) repair by utilizing the same approach TEP.

Methods
Two patients with recurrent inguinal hernia post TEP were consulted for laparoscopic VS open approach, and both opted for the laparoscopic approach, understanding the higher risk of conversion.

Result
The first case of 62y male with recurrent left inguinal hernia after bilateral TEP. The second case of 69y male with recurrent left inguinal hernia post lap TEP repair.
Standard three lower midline ports technique, no balloon spacer was used. The first and most important step was developing the plane above the previous mesh. 20 ml of 1 % xylocaine and 1/200000 was instilled in the extra peritoneal space to minimize oozing. Separating the previous mesh from the inferior epigastric artery and posterior wall of rectus muscle, down into bony lard marks and cord structures was performed using suction and sharp dissection with minimal diathermy. All landmarks were exposed in the three zones, before utilizing anatomical mesh. Both patients stayed overnight and operation time was 84 and 90 minute respectively. Three months follow up showed no recurrence or significant pain.

Conclusion
To our knowledge, this is first study describe the use of TEP on TEP. It suggests that TEP should not be excluded in patients with previous posterior mesh repair, emphasizing the importance of proper consultation. The abstract calls for further cases and studies to assess the efficacy and safety of this approach.
WP2.5 - Impact of repeated phlebotomy in long-stay patients and patients requiring total parenteral nutrition
Authors: Noureldin Khaled , Ramesh Kirtika , Aghwa Hisham , Aslam Jabeen , Mohamed Mustafa 
Published: September 2024

Abstract

Introduction
Blood tests are an essential for patient management. Repeated tests can be associated with harm. The study aimed to assess the consequences of repeated phlebotomy in patients with a long hospital stay or requiring total parenteral nutrition (TPN).

Methods
Retrospective data was collected from general surgical patients with a length of stay (LOS) of at least 14 days, over a period of 6 months. Biochemical parameters including haemoglobin were recorded on day of admission, day 14 and day 21. Complications following phlebotomy were also noted.

Results
133 patients were identified. 84 patients had a LOS &gt;21 days. The longest inpatient stay was 92 days. The most common pathologies were related to lower gastrointestinal disease at 45 cases. TPN was required in 35 cases.
Average blood loss as a result of blood sampling was 325 ml/admission (105ml-850 ml), with associated average drop in haemoglobin of 20%. In 6 cases, haemoglobin dropped &gt;40%. Rate of testing per admission length was 1every two days. (45 times as a peak)
The most common complications noted were technical ( lab errors/ inadequate sampling). Other physical and psychological factors. A Full set of blood tests costs 150£.
In our intervention, 4ml paediatric blood vacutainers (to 13 ml adult’s) were trialled in 10 cases. The results were very comparable. Potential 60% reduction in blood loss was noted.

Conclusion
careful clinical judgment and controlled approach with restricted practice towards phlebotomy is mandatory .It can be harmful, if not clinically required. Plus it’s expensive costs. Paediatric blood vacutainers can be a beneficial alternative in those requiring regular blood sampling.
WP2.6 - Improving theatre utilisation and reducing waiting list times – could ‘standby’ patients be the answer?
Authors: Conroy Soraya , Kirkley Kirstie , Case Valerie , Butcher Katrina 
Published: September 2024

Abstract

Aims
With the NHS waiting list at a record high of over 7.3 million patients, it has never been more important to maximise theatre productivity. We piloted a ‘standby patient’ initiative for patients awaiting elective day-case procedures, with the aim of optimising theatre utilisation, reducing waiting lists, improving hospital revenue and ultimately patient care.

Methods
The principle of a ‘standby’ patient is to reduce the rate of ‘on the day’ cancellation and utilise theatre time. Suitable patients were offered the opportunity to be on ‘standby’ for selected day case lists. If list capacity allowed, the patient was called in. If postponed, they were offered a dedicated date. A patient questionnaire was also conducted to gain an understanding of the ‘standby’ patient experience.

Results
Between May and November 2023, 12 ‘standby' patients were identified, average waiting list time of 44 weeks. Cases included hernia repairs and laparoscopic cholecystectomies. 6/12 were operated on their standby slot, 1 patient cancelled, and 5/12 were postponed but had surgery within an average of 6 weeks. This earnt the trust approximately £15240 in additional tariff. 10/12 patients responded to the patient questionnaire with all reporting either good or excellent experience of the initiative. Positive comments included ‘good communication’ and ‘excellent standard of care’.

Conclusion
The standby patient initiative is well received by patients, and provides a cost-effective solution to optimise theatre utilisation, reduce waiting list times, and improve patient care. Following this successful pilot, we plan to introduce the standby patient across further surgical lists within the trust.
WP2.16 - Hartman’s Reversal; A comparison of conventional vs minimally invasive surgical approach
Authors: Salam Ammara , Osunlunsi Oluwafemi , Isknadar Amir , Waraich Naseem 
Published: September 2024

Abstract

Background
Hartman’s procedure is a safe operation for emergency colonic resections. Hartman’s reversal, however, is a technically challenging operation with high morbidity. Hence, almost half of the patients choose to live with lifelong stoma. Hartman’s reversal can be done open or laparoscopic, with single incision laparoscopic surgery (SILS) as an emerging minimally invasive technique. We will discuss the different surgical techniques along with their results and challenges.

Methods
This is a single centre retrospective study done at District General Hospital. All the Hartman’s reversals done between July 2021 to July 2023 were included in the study. Demographics, primary disease, interval between primary operation and reversal, post-operative complications and hospital stay was calculated.

Results
A total number of 19 Hartman’s reversal operations were done between July 2021 to July 2023. Average age of the patients was 61.8 years. The pathology was cancer in 7 patients and 12 cases were benign. The average interval between Hartman’s procedure and reversal was 23.2 months. Only 3 (15.7%) patients had a co-morbid. Out of 19 Hartman’s reversals done, 11 (57.89%) were done open, 5 (26.3%) SILS, 1 (5.2%) laparoscopic, and 2 (10.5%) laparoscopic converted to open. The complication rate in open cases was 61.5% vs 33.33% in laparoscopic/SILS. Average length of stay (LOS) was 10.38 days in open vs 9.19 days in laparoscopic group.

Conclusion
The limitations of this study are single centre and low sample size. The length of stay is slightly better in minimally invasive group, and much better post-operative outcomes. We suggest a multicentre study can help establish more reliable results.
WP3.15 - National Emergency Laparotomy (NELA) deaths within 90 days: A cohort study
Authors: Gok M A , Bughio M , Zaidi M , Mathieson N O M , Sadat M M , Khan U A , Riaz Komal 
Published: September 2024

Abstract

Aims
NELA is committed to enhancing quality of care of patients undergoing emergency laparotomy. NELA care pathways include: initial clinical assessment, resuscitation, prompt diagnosis, early surgery, peri-operative care. NELA emphasizes the importance of identifying high risk patients, who are associated with significant morbidity & mortality. Aim of study is to review the NELA 90-day deaths.

Methods
Cohort study of NELA deaths within 90 days, from Jan'2014 to Jan'2024 at single centre. Descriptive demography, outcomes were evaluated. NELA survivors beyond 90 days were controls.

Results
90 Day (n = 113) Others (n = 751) Mann Whitney U (p value) Age(yrs) 74.3 66.6 &lt; 0.0001 Sex(M:F) 58 : 55 334 : 417 NS ASA 3 2 &lt; 0.0001 BMI(kg/m2) 25.1 25.7 NS Lap(n) 16 218 Ns Open(n) 97 533 &lt; 0.01 Op time(mins) 120.2 119.1 NS LOS(days) 17 12 NS ITU/HDU 70 318 &lt; 0.001 ITU stay(day) 3 2 &lt; 0.05 Lactate(mmol/L) 3.0 1.9 0.0002 WCC(x109/L) 13.2 12.3 NS CRP(mg/L) 93.6 68.8 &lt; 0.0001 Physiological score 28.2 21.6 &lt; 0.0001 Operative severity score 20.0 16.4 &lt; 0.0001 Pre possum score 29.4 11.9 &lt; 0.0001 PP mortality score 23.4 6.1 &lt; 0.0001 PP morbidity score 82.9 63.5 &lt; 0.0001 Survival Rate (%) 1styear 81.4 5thyear 63.0 10thyear 50.7

Conclusion
90-day NELA mortality rate is 13.1 %. NELA deaths occurred in older, frail, multi-comorbid & higher ASA status Patient survival appears to plateau out beyond 90-days (natural deaths). NELA risk scores were greater amongst the 90-day deaths. NELA risk scores can identify high risk patients, where early collaborative senior assessment by consultant surgeons, anaesthetist and intensivists may identify and allocate appropriate surgical & critical care intervention.
WP3.17 - Rationalising the use of Abdominal X Ray to ensure the best utilisation of clinical radiology services
Authors: Jatania Jignesh , Barber Margaret , Locurcio Lino , Hewitt Peter 
Published: September 2024

Abstract

Aim
To rationalise indications for Abdominal Xray (ABXR).

Method
All patients undergoing ABXR from 1st September 2022 to 31st December 2022 were included timing the Xray, requesting department and grade of doctor noted
We compared the indications of the request and whether patients proceeded to CT scan.
Based on the iRefer recommendations Grade C as well as need of CT, inappropriate requests were identified and ones that could be avoided.

Results
279 patients underwent ABXR
184 Xrays were done during in hours(IH) (0800-2000hrs)
175 requests originated from A&E, 103 from Wards and 1 from GP.
137/279 ABXR were requested for obstruction. 37/279 for Foreign Body.
Other common IH requests included identifying retained capsule, post enteral tube placements as well as diagnostic/therapeutic gastrograffin result. IH request also included identification of renal stones following CT KUB.
134/279 concurred with Recommendation A/B and 145/279 Recommendation C of iRefer guidelines.
62/279 patients underwent post ABXR CT scan.
70% (43/62) were to rule out obstruction for which in the majority ABXR would not be indicated. Of these 49% (21/43) were normal and 51% (22/43) showed obstruction.
45/62 of the patients who underwent CT had an avoidable ABXR.
In total 144 ABXRs could have been avoided. 1 request was from GP and hence could not be commented on.

Conclusions
Avoiding abdominal Xray will improve patient care, bypassing inadequate tests and moving straight to CT where clinically appropriate. Rationalising the use of ABXR will minimise overburdening clinical radiology services and decrease unnecessary exposure of radiation to patients.
WP5.15 - A review of emergency general surgery (EGS) admissions via the direct access pathway (DAP) in a district general hospital in United Kingdom
Authors: Pal Shreya , Yi Zoe Ng Zhen , Sunwar Semosh , Pangeni Anang , Nahid Md Abu Kamal , Shrestha Ashish 
Published: September 2024

Abstract

Aims
Emergency surgical presentations require urgent attention by surgeons to ensure appropriate treatment, However, increased waiting time in A&E often leads to delayed diagnosis and subsequently delayed management.
A direct access pathway (DAP) to Surgical Emergency Assessment Unit (SEAU) helps minimize these delays and subsequently improve patient outcome.

Methods
A retrospective observational study of Emergency General Surgery (EGS) admissions from May 2023 to December 2023 was performed. Structured DAP referral proforma was implemented for patients to be directly referred to SEAU from A&E triage. Factors taken into consideration were - initial presentation, source of referral, time of initial assessment and patient outcome.

Results
A total of 265 patients were channeled through DAP referrals during the study period, of which 96.6% were appropriate referrals. The main source of the referral the A&E (52.4%), while the UTC-GP and GP constituted the remaining (47.6%). The most common clinical presentations were abdominal pain (32.4%), followed by subcutaneous abscess (17.3%). The median watiting time for initial assessment by the surgical team was 60 minutes. In terms of outcomes - 15 % patients were admitted, 14.7% were discharged after intervention, 35.8 % were discharged without intervention and 28.6% were planned to return for investigations or interventions.

Conclusion
The DAP for EGS admissions has enabled surgical emergencies to be addressed more promptly, and thus seen to have improved patient outcome as a result of avoiding unnecessary steps and delays before being reviewed by the surgical team through A&E pathway.
WP5.18 - Quality Improvement Project – Assessing current practice of percutaneous cholecystostomy tube (PCT) management in a DGH and proposal of local guidelines
Authors: Sharmin Afroza , Hammett Claire , Hamdan Mohammed 
Published: September 2024

Abstract

Rationale
The absence of evidence-based guidelines for Percutaneous Cholecystostomy Tube (PCT) management has led to a lack of standardization in its care across NHS Trusts. Existing literature provides varied recommendations. Davis et al.(1999) suggested allowing 7-10 days for tract maturation, although they did not describe how this was evaluated. Other authors recommended proposals based on their local practice.

Aim
To establish standardized care following PCT insertion at our DGH, focusing on improving efficiency and ensuring uniformity in performance.

Methods
A retrospective cohort study was conducted, reviewing the period between January 2021 to December 2022. 68 patients were identified to have PCT insertions.

Results
Findings revealed 24% (16/68) had no documented discharge plan. 57% (39/68) of patients had a planned Surgical Assessment Unit review within a wide timeframe (4-49 days). A tubogram was arranged for 47 of 68 patients (69%) meaning the rest had no fluoroscopic examination before PCT removal. This was performed on average at 4.8 weeks and (range 1-10 weeks). 31% (21/68) had no UGI clinic review. The mean PCT removal time was 9.4 weeks with some outliers ranging between 0.5 to upto 40.5 weeks.

Conclusion
While some patients had PCT in-situ for longer than necessary, in two cases PCTs were removed prematurely, though no complications were recorded. The observed practice variability prompted the introduction of a local pathway, with recommendations from UGI consultants. This initiative should help prevent delays in patient care, particularly considering that the rotating junior doctors usually will lack familiarity with the management of such cases.
WP6.11 - Systematic Review and Meta-Analysis of Written Interventions Used In the Informed Consent Process
Authors: Clements Joshua Michael , Clements Jake Simon , Clarke Mike , Kirk Stephen 
Published: September 2024

Abstract

Aim
Written interventions are the earliest and most prevalent mode of information provided to patients in clinical practice. They are used as an adjunct to the verbal discussions between clinician and patients during the informed consent process. This review aimed to assess the effects of these interventions.

Method
This was a subgroup analysis from a larger systematic review and meta-analysis conducted according to the predefined protocol developed and registered on PROSPERO (CRD42023380406). . Five databases were searched using pre-defined search criterion in December 2022 for randomised trials of written interventions designed to improve the informed consent process. Adults &gt; 18 years with the capacity to consent were included. The Cochrane risk of Bias (RoB) tool was used to assess study quality. Effect measurements were assessed using standardised mean differences and risk ratios for continuous variables and dichotomous variables respectively.

Results
35 studies (37 intervention arms) contributing 3600 patients met the inclusion criteria. All but one study were conducted in an elective setting across a variety of surgical, radiological, endoscopic, oncological, and medical disciplines. Statistically significant improvement was demonstrated, in short (SMD 0.88, 95% CI 0.29 to 1.47, I2 = 81%) and long-term knowledge (SMD 0.38, 95% CI 0.14 to 0.62, I2 = 66%). There was no difference in immediate knowledge, satisfaction, or anxiety with the informed consent process.

Conclusions
This review provides a global overview of the impact of written interventions which has demonstrated improvement in short and long-term knowledge. These readily accessible intervention types should be considered as an adjunct during informed consent consultations to better inform decision making.
WP6.17 - Assessing the value of a general surgical handbook to improve confidence levels in foundation year one doctors
Authors: Brown Denise , George Jayan , Savage Daniella , Yeluri Sashidhar 
Published: September 2024

Abstract

Aims
Evaluate the surgical handbook with former foundation year one (FY1) doctors in general surgery. Identify areas where further support could be given to improve confidence levels.

Methods
FY1 doctors from August 2022 – July 2023 who rotated through general surgery were invited to evaluate the guide in January 2024. Twenty questions used Likert scales (1 to 5: not at all confident to very confident; not useful to very useful) to assess the management of the general surgical patient having read the guide. Four questions assessed the overall value of the guide and a further four questions focused on how to improve the guide; including, individual sections needing further development. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results
32% (10/31) completed the survey.
100% (10/10) found the guide helpful and felt it would enhance their general surgical experience.
90% (9/10) felt the guide would have a positive effect on their morale through their rotation.
Modal scores ranged from four to five for how confident FY1 doctors are in managing different aspects of general surgery having read the guide.
Overall, the guide was seen as very useful.
Areas where the guide could be improved include; post bariatric surgery, post-surgery nutrition and pancreatitis.

Conclusions
Evaluation of the surgical guide was very positive. This guide could be used to help enhance the general surgical rotation of FY1 doctors.