bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP2.4 - Appendicetomy in pregnancy: a retrospective analysis of 39 cases between 2012-2022
Authors: Fourie Amy , Manson Cameron , Johnston Magnus , Le Saint-Grant Alexander , Damaskos Dimitrios 
Published: September 2024

Abstract

Background
Acute appendicitis is the commonest surgical emergency in pregnant women. Physiological changes during pregnancy can obscure symptoms. Prompt diagnosis and surgical intervention is essential to minimise risks such as sepsis and preterm labour.

Objective
This study aims to evaluate how gestational age, type of imaging, surgeons' expertise, and antibiotics management affect the surgical outcomes in pregnant patients with acute appendicitis.

Methods
A retrospective analysis of 39 obstetric cases between 2012 and 2022 in the Royal infirmary of Edinburgh. Statistical methods for analysis including ANOVA were used to compare different surgical techniques, and correlation assessments to investigate links between gestational age and aspects of post-operative care.

Results
The study found that the surgical method significantly impacted post-operative recovery, with laparoscopic procedures leading to shorter hospital stays and decreased antibiotic use compared to open surgeries (p=0.001169 for hospitalisation length and p=0.01049 for antibiotic course, respectively). Surgeon grade did not significantly alter these outcomes. There was a moderate correlation between gestational age and both post-operative antibiotic duration (r = 0.3293) and length of hospital stay (r = 0.3640. The varied use of imaging techniques across different stages of pregnancy suggests there is no consensus of best practice.

Conclusion
The study identifies a need for consistent guidelines on treating pregnant women with appendicitis, particularly regarding antibiotic use. The results support the preferential use of minimally invasive surgery and value MRI as a non-invasive diagnostic tool, both contributing to a comprehensive, multidisciplinary approach required for these complex clinical scenarios.
SP3.6 - Do non-colorectal surgeons produce an inferior lymph node yield in emergency colorectal cancer resections?
Authors: Bisheet George , Mandal Piya , Campbell Timothy , Fernandes Roland 
Published: September 2024

Abstract

Introduction
Lymph node yield is a surrogate indicator of adequate resection and yields of 20 or more have been shown to be associated with better survival outcomes. There is controversy as to whether colorectal cancers should be operated on by non-colorectal surgeons in the emergency setting. This study explores whether there are differences in lymph node yield between colorectal and non-colorectal surgeons in the context of emergency Hartmann's procedures performed for malignancy.

Methods
A retrospective study was conducted at a 3-site Trust in South East England between 2012 and 2022. Theatre and Info flex Cancer records were used to obtain patients who had undergone a Hartmann's procedure for malignancy and their operating surgeon. The histology reports were then reviewed and statistical analysis was undertaken.

Results
346 patients were included in the study, in a 197:149 male-to-female ratio. The mean age was 73 (28-92 IQR). Histology confirmed malignancy in all the study participants. 11% (38/346) of the operations were conducted by non-colorectal surgeons (UGI, Breast, and Endocrine). The mean lymph node yield for the non-colorectal surgeons was 28 (24-33 IQR). The mean lymph node yield for colorectal surgeons was 29 (26-34 IQR). There was no statistical difference between the lymph node yield between colorectal and non-colorectal surgeons (p=0.671)

Conclusion
The study concluded that adequate oncological colonic resections could be conducted safely by non-colorectal surgeons in emergency settings.
SP3.11 - Beyond the microscope – Unravelling the Significance of Colorectal Cancer Histopathology Request Forms
Authors: Yi Ng Zoe Zhen , Pal Shreya , Pangeni Anang , Bagla Nipin , Shrestha Ashish 
Published: September 2024

Abstract
Accurate histopathology reporting of colorectal cancer resected specimens (CCRS) is crucial for optimal patient care. The adequacy of clinical information provided by surgeons influences the quality of documentation. This audit aims to identify if histopathology request forms for CCRS in our trust meets national standards, as published by The Royal College of Pathologists.
A retrospective study encompassing 40 consecutive histopathology request forms following colorectal cancer resections was conducted over 4 months (June to September 2023), where we assessed local adherence to national guidelines. The guidelines address a range of information from the surgical details to the patient’s medical background.
Among the 40 request forms, 87.5% (35) were completed by consultants and 12.5% (5) by registrars. The information predominantly included were details on tumour site (98%) and nature of the resection (98%). Details on surgical procedure through a diagram and method of approach, were provided in 45% (18) and 48% (19) of the forms. Conversely, details on the pre-operative stage of tumour and types of therapy given was discerned in less than 25% of the forms. Only 3% (1) included information regarding presence of iatrogenic specimen defect and if specimen included other tissues or organ. Alarmingly, none addressed patient hereditary conditions or presence inflammatory bowel disease.
The current histopathology request forms for CCRS lack information to facilitate comprehensive histopathological analysis. Addressing this necessitates raising awareness on national guidelines available. Additionally, a new structured form has been implemented in our trust, with the aim of encouraging surgeons to provide more comprehensive information.
SP5.9 - A cost-benefit analysis of a digital post-operative integrated care plan app for surgical patients
Authors: Chacko Anil , Moore Melanie , Vlazaki Myrto , Kelkar Ashish 
Published: September 2024

Abstract

Aims
To study the cost-benefit analysis of a digital post-operative integrated care plan app for surgical patients.

Methods
1. Preliminary data from patient survey - we designed a questionnaire to assess patients’ views of the Post Op app.
2. Estimates for NHS services cost - derived from the King’s Fund latest report (2023) and the NHS Digital National schedule of reference costs (2017, 2021-22).
3.Estimates for travel-associated costs - We assumed a total cost per mile of 16p, and also assumed the patients would need to pay an average cost of £1.6/h for hospital parking for an average of 3h per visit. We assumed a carbon emission of 221.4 grams per mile (Department for Transport data).
4.Modelling approach - We used a conservative modelling approach simulating different patient groups with varying levels of postoperative anxiety/complications.

Results
Taking into account avoidable presentations to ED, costs borne by the patients, lost productivity, environmental costs, avoidable re-operations and the costs related to antibiotic tolerance/resistance, the lower boundary of total savings from a digital post-operative follow-up tool equates to £58,739 per 100 patients and the upper boundary is £79,949 per 100 patients.

Conclusion
Post Op application provides excellent support for most patients in the immediate postoperative period and is likely to result in a significant reduction in the number of contacts patients make with the GP or hospital, and with the Emergency Department resulting in significant cost saving for both the service and the patients. Furthermore, earlier recognition, monitoring and appropriate treatment of SSIs provides further savings whose magnitude is likely underestimated.
SP6.3 - Comparison of three new wireless non-radiation techniques for localization of non-palpable breast cancer - an updated systematic review and pooled meta-analysis
Authors: Subramanian Kumaresh Timma , Elnour Abdolazeem , Kurup Vijay 
Published: September 2024

Abstract
The method for finding non-palpable breast cancers has evolved due to technological advancements. New wire-free techniques have made implantation and retrieval easier with improved oncological outcomes. Although some evidences are available as to reduced requirement for re-operation with wireless techniques when compared to wire, in current clinical practice, the choice of selection amongst wireless technique depends on clinician preference and there is a lack of consensus. The objective of current systematic review and meta-analysis is to assess the clinical effectiveness between three new wireless non radiation localisation techniques, such as Magseed (Magnetic seed), Radiofrequency identification tag (RFID) and Savi-scout reflector localization from published literature over the last 3 years. Literature search as per PRISMA guidelines revealed twenty-six studies from 2020 to 2022 involving 6275 innovative agents analysing the 3 groups were identified. Statistical analysis using Medcalc software showed a pooled positive margin rate of 12.28% (95% CI, 10 -15%) and a re-excision rate of 11.29% (95%CI, 9 -14%) for all 3 innovative technique combined whereas studies that compare innovative techniques with wire, showed higher positive margin rate of 14.87% (95% CI, 12-18%) and re-excision rate of 16.23% (95% CI, 14-18%) for wire localization, along with considerable heterogeneity. In sub group analysis with Kruskal-Wallis test, there were no statistical significance for margin (p 0.797) and re-operation (p 0.464) rates between each group. Consolidated insertion and retrieval success for innovative group were 98.13% and 99.13% respectively. To establish the best localization approach, future RCT's will be required to assess quantitative cost-effective analyses.
SP9.8 - Assessing the quality of guidelines for the management of Gastro-Intestinal Stromal Tumour
Authors: Askari Alan , Ebrahim Saarah , Al Habsha Osama , Zuberi Sharukh , Raja Haseem , Jambulingam Periyathambi , Rashid Farhan 
Published: September 2024

Abstract

Introduction
Gastro Intestinal Stromal Tumours (GISTs) are tumours of the gastro-intestinal tract that arise from connective tissue and they have potential for malignancy. A number of guidelines exist in their management. The aim of this study is to assess the quality of these guidelines.

Methods
A search of the literature was undertaken for appropriate guidelines pertaining to the diagnosis and management of GISTs. The AGREE II checklist was used to assess the current GIST guidelines.

Results
A total of nine guidelines were included in this study. The overall median score across all guidelines was 68% (lowest; 50%, highest 89%). Guidelines tended to score highly in Domain IV (Clarity of Presentation, median score 76%) as well as Domain VI (Editorial Independence, 67%) and Domain I (Scope and Purpose, 61%). However, lower scores were noted in the Domain V (Applicability, 39%), Domain III (Rigor of Development, 52%) and Domain II (Stakeholder Involvement, 56%). None of the guidelines scored a unanimous ‘Yes’ vote for clinical usage, and all needed some level of modifying.

Conclusion
Whilst some of the current guidelines for the management of GISTs is of a high quality, there is a need for improvement with regards to the quality of the methodology used to formulate the guidelines and how they can be implemented in daily clinical use.
WP1.5 - Outcomes of inguinal hernia repair in adolescents by both paediatric and adult surgeons- a retrospective observational study
Authors: Kuronen-Stewart Cameron , Fitt Beth , Clyde Danielle , Faulkner Elizabeth , Damaskos Dimitrios , Cullis Paul 
Published: September 2024

Abstract

Aims
Adolescent inguinal herniae are repaired by both paediatric and adult surgeons, but there is significant variation in operative technique. We aim to report both adult and paediatric practice, and to compare outcomes amongst different repair techniques.

Methods
Data were collected from records of patients aged 12-18 who underwent inguinal hernia repair in adult or paediatric services within our region between 2000 and 2023.

Results
116 inguinal herniae in 106 adolescents were identified. 66% were repaired by paediatric surgeons. 85% were male. Median age was 14.1 years. Median length of follow-up was 15.0 years. 71% herniae were right-sided and 9% bilateral. 98% were indirect. 3% were incarcerated.
72% underwent open repair. Herniotomy with high ligation of the sac was the most common open operation in adult and paediatric practice.
28% herniae were repaired laparoscopically (64% by adult surgeons). Adult surgeons most commonly utilised total extraperitoneal repair, and paediatric surgeons most utilised closure of the deep ring.
4% recurred (all operated on by paediatric surgeons). 4% of patients developed chronic pain (80% from adult services). Only 1 of 5 patients with chronic pain had mesh repair. Logistic regression showed no independent variables predictive for recurrence or chronic pain.

Conclusions
There is significant variation in practice between adult and paediatric surgeons in adolescents with inguinal herniae. Recurrence was more common after repair by paediatric surgeons whilst post-operative chronic pain was less common. Paediatric and adult surgeons could learn from each other to optimise outcomes. This study also raises the question of who should be doing these procedures.
WP1.6 - Intraoperative fascial traction for the treatment of large hernias - results of a multicentre study
Authors: Woeste Guido , Meier Hansjörg , Sardoschau Nihad , Kiehle Adrien , Niebuhr Henning 
Published: September 2024

Abstract

Background
The incidence of incisional hernias after median laparotomy is about 20%. Intraoperative fascial traction (IFT) is a new technique for treatment of large hernias.

Materials and methods
In this study data from five hospitals using IFT between 12/2020 and 9/2023 was analysed. In all cases the Fasciotens®Hernia System was applied. When fascia closure was not possible, transversus abdominis release (TAR) was performed. All patients underwent a standardized clinical and ultrasound examination during follow-up. Quality of life was assessed using the HerQLes questionnaire.

Results
A total of 96 patients were included in the study (HH-62, DA-11, SB-10, D-9, L-4). The age was 59.9±14.1 years, 41% were female, BMI was 31.0±7.3kg/m², hernia width was 15.7±5.1cm. 88.5% underwent pretreatment with botulinum toxin (BTX). A TAR was performed in 28.1% cases. Bridging was necessary in 5.2%. Length of stay was 8.3 days.
In the postoperative course, 39/96 (40.6%) patients experienced a complication: 20.8% seroma, 9.4% wound infection, 4.2% haematoma, 2.1% intestinal injury, 1.0% wound dehiscence, 3.1% pneumonia and 2.1% urinary tract infection. No patient died. The incidence of wound infections was higher in patients with additional TAR (11.1% vs. 8.7%).
During the mean follow-up of 15.7±12.6 months 2 hernias at the border of the mesh were recognized. The HerQLes summary score was 64.5.

Conclusion
This multicentre study shows a low incidence of wound infection and recurrences using IFT. The fascia closure rate is high when combining IFT with BTX pretreatment.
Further randomised studies of IFT should follow to support these data.
WP1.14 - Evaluation of mesh closure of laparotomy and extraction incisions in open and laparoscopic colorectal surgery: A systematic review and meta-analysis
Authors: Albendary Mohamed , Issa Mohamed , Mohamedahmed Ali Yasin 
Published: September 2024

Abstract

Background
In colorectal surgery, postoperative evisceration and incisional hernia (IH) were not only noted after open procedures, but also at extraction incision (EI) sites used in laparoscopic resections. Few techniques, including using different sutures, closure techniques, and surgical meshes, have been evaluated in the literature to prevent the occurrence of IH and postoperative wound failure. This systematic review investigates the efficacy and safety of using prophylactic mesh on closure of midline laparotomy or extraction incision (EI) in colorectal oncological and non-oncological resections.

Method
Literature databases, including PubMed, Cochrane, Science Direct and Google Scholar, were searched for studies comparing the use of prophylactic mesh to conventional suture closure in colorectal operations, either in laparotomy closure in open surgery or EI closure in laparoscopic procedures, regardless of the indication; oncological and non-oncological. Primary endpoints were identified as incisional hernia (IH), and postoperative evisceration. Other outcomes included surgical site infection (SSI), seroma formation and length of hospital stay (LOS).

Results
Six studies fulfilled the inclusion criteria and studied 1,398 patients. Occurrence of IH was significantly reduced on using mesh closure compared to suture closure (OR 0.23, P=0.00001), while there was no statistically significant difference in evisceration rate (OR 0.51, P=0.25). Additionally, no notable difference was identified between both groups in terms of SSI (OR 1.20, P=0.54), postoperative seroma (OR 1.80, P=0.13), and LOS (MD -0.54, P=0.63).

Conclusion
The use of prophylactic mesh on closing laparotomy incision or EI for open and laparoscopic colorectal resections reduces the risk of developing IH. There were no significant safety concerns; however, further randomised trials may provide more creditable results.
WP3.3 - Surgical Management of multiple mega large stones of a congenitally low inserted Cystic Duct – A Case Report
Authors: Elfeky Mohamed , Al-Maliki Doaa , Elkhalifa Ahmed , Abdulla Samir 
Published: September 2024

Abstract

Introduction
Low cystic duct insertion is uncommon, and the presence of multiple large stones in the cystic duct with normal laboratory investigation is rare. The infrequency with which it is encountered and the management done makes this an interesting presentation.

Case presentation
A 61-year-old female with incidental gall stones and possible CBD/cystic duct stones on a CTAP during a workup for management of an incisional hernia of the abdomen. The patient initially presented with abdominal pain that was thought to be due to the incisional hernia. On examination, the patient had a soft abdomen with no jaundice and normal laboratory investigations. MRCP scan demonstrated multiple gall stones and cystic duct stones suggestive of Mirizzi syndrome. The patient underwent laparoscopic repair of the incisional hernia and cholecystectomy with an on-table cholangiogram. Cholangiogram showed a low inserting cystic duct joining the common hepatic duct at the sphincter of Oddi with an almost nonexistent common bile duct and a cystic duct containing multiple mega-large stones. The cystic duct was explored and stones were milked out except the most inferior stone which was impacted at the sphincter of Oddi. This was dislodged with a Fogarty catheter and all stones were retrieved. Completion cholangiogram demonstrated complete clearance of the biliary tree with dye entering the duodenum. The patient recovered well postoperatively with no complications at 1 month post-operative.

Conclusion
This case illustrates a rare presentation of large cystic duct stones in the presence of abnormal anatomy and provides an option for surgical management.
WP3.5 - Laparoscopic cholecystectomy: analysis of indications, time to surgery (TTS) and complications
Authors: Li Aleksandra , Gurung Ishani , Yiu Jonathan , Halme Helmi 
Published: September 2024

Abstract

Aims
Our aims are to establish whether current waiting times for cholecystectomy in our local trust between 01/2021 and 01/2022 are in line with NICE guidelines and compare with average national waiting times. We aim to establish the indications for cholecystectomy (CBD stones, cholecystitis, biliary colic, pancreatitis) and compare waiting times and readmission rates during the waiting period; estimate the rate of conversion to open/subtotal cholecystectomy and any subsequent complications.

Methods
Data collection and analysis for the period of 01/2021 – 01/2022: average waiting times, rate of conversion, indications, complications.

Results
269 patients were analysed after exclusions. Of these, mean waiting time from booking to TTS for uncomplicated biliary colic was 63.26 days. The median TTS from booking was 14 days for hot gallbladders.
Of patients diagnosed as biliary colic, the TTS following an acute hospital admission was 63.26 days. Similarly, the patients referred via GP to the outpatient surgical clinic for the same diagnosis was 78.88 days.
5 patients who were referred routinely via GP to the outpatient surgical clinic had complications requiring an acute surgical admission during the waiting period. The rate of conversion to open was 0% during the 1-year period. 2 patients had subtotal cholecystectomies, one of which had persistent bile leak managed with drains and subsequent ERCP.

Conclusion
The median TTS for hot gallbladder is in line with national standard.
There is a tendency to opt for subtotal cholecystectomy as bail out as compared to the previous years.
WP4.2 - Covid positivity: the pandemic surgical referral telephone triage legacy lives on
Authors: Court Emma , Alexander Rod , Henwood Gemma , Spearman John 
Published: September 2024

Abstract

Introduction
Covid restrictions provided opportunities for novel approaches to patient assessment. Innovative telephone triage of surgical referrals at Great Western Hospital, a UK District General Hospital, resulted in reduction in those patients reviewed and discharged the same day from 56% to 23.6%. Furthermore, 28.4% of admissions were avoided by triage.
This novel work was adapted for the Ambulatory Emergency Care (AEC) department of Yeovil District Hospital, in response to exponential increases in Primary Care and Emergency Department referrals.

Aims
To develop a telephone triage system to get the right patient to the right place at the right time, reviewed by the right team.

Methods
Over the two-week study period (18/9–29/9/2023) a dedicated triage telephone line enabled a discussion between referring clinician and an experienced surgeon. Four outcomes were offered:AdviceOutpatient review within 1 weekHot clinic review within 24-48 hoursSame-day review by the on-call team
Prospective referral data (18/9–29/9/2023) and retrospective non-triage data (1/9–14/9/2023) were gathered. Triage effects were measured by outcome comparison with non-triage data.

Results
A total of 193 patients were discussed. 48% were Emergency Department referrals, 25% from General Practitioners. Same-day reviews reduced by 35%. Overall, the on-call workload decreased by 68%. Return to AEC for review reduced by 99%. Reduction in average time spent by patients in AEC from 6.9 to 1.29 hours, saved up to 6 bed-days per day and facilitated significant cost savings.

Conclusions
Novel approaches can be cost effective and positively impact patient care.