bluuebunny/crossref_metadata_2025_split huggingface dataset:
WP4.16 - Gallstone ileus as an infrequent cause of bowel obstruction- a review of small cohort
Authors: Kumar Shashi 
Published: September 2024

Abstract

Introduction
It is uncommon cause of small bowel obstruction, presents 1 – 5% of adult population. It is a rare complication of chronic cholecystitis which lead to cholecysto-enteric fistula and impaction of gall stone in GI tract leading to mechanical bowel obstruction. Our aim is to report the natural history and management of this condition in District Hospital.

Method
Retrospective 10 years of data was collected with CT findings of intestinal obstruction with gall stone ileus. It included 10 patients over 10 years whose medical records were evaluated retrospectively.

Results
Majority of patients were female (90%, n:9) with mean age of 81.6 years (range 61-96) although 90% of population were above 70 years. Presenting complaints were mostly pain and vomiting. Onset of symptoms between 2- 7 days. The site of obstruction was mostly ileum (n=9) with exception of one case in sigmoid proximal to stricture and size of stone was ranging ffrom2.5 to 4 cm, moreover most of the patients had previous history of gall stone (n=7) with one post cholecystectomy status. During routine investigations 50 % of patients had deranged LFT &AKI and 50-60% had raised inflammatory markers (WBC,CRP).Intervention as Enterolithotomy was the preferred approach (n=8,2 lap ,7 open) and non operative management was performed in two cases.The mean post op length of stay were 10 days in open and 5 days in Lap respectively.

Conclusions
Elderly female patients are more prone to have gallstone ileus particularly with a past medical history of gall stone and the preferred management option is Enterolithotomy which could be open or laparoscopic depending on expertise of the Surgeon.
WP5.17 - Stoma reversal after emergency surgery – an analysis of post-operative outcomes and the importance of timing
Authors: MacDonald Scott , Gallagher Anna , McNicholl Lauren , Moug Susan 
Published: September 2024

Abstract

Introduction
Approximately 20,000 people in the UK undergo stoma formation annually(1), with 20% being emergency procedures(2). The reversal rate for these stomas is widely variable, with restoration of continuity being reported in 33-70% of patients(3). Previous research in the elective setting has demonstrated that delayed reversal leads to increased complications and reduced quality of life, but there is a lack of evidence in the emergency cohort.

Aim
To describe post-operative outcomes of stoma reversal after emergency formation, and to determine whether those reversed within a ‘standard’ timeframe have better outcomes than those with ‘delayed’ reversal.

Methods
A retrospective review of a prospectively maintained national emergency laparotomy database (ELLSA) from 4 hospitals over a 3-year period (Dec ’19 - ’22) was performed in Dec ’23. All patients undergoing stoma reversal by time of follow-up were included. Those reversed within 18 months of index procedure were classified as ‘standard’.

Results
455 patients were identified (Median follow-up 31 months), 95 of whom had died and 34 had a pre-existing permanent stoma. Of the remaining 326, 34.4% underwent reversal (Median age 59; median time to reversal 458 days; 55% ileostomies). 56% of those underwent ‘standard’ reversal (62% ileostomies, p=0.08), and had reduced length of stay (6 days v 7 days, p=0.041) and reduced post-operative ileus rates (23.8% v 44.9%,p=0.019) than those undergoing ‘delayed’ reversal.

Conclusion
The majority of stomas formed in the emergency setting remain permanent. Prompt reversal of an emergency stoma should be undertaken to reduce complication profile and length of stay. Further work to identify risk factors associated with non-reversal should be undertaken.
WP6.7 - Decolonising the roots of a UK undergraduate surgical curriculum
Authors: Khera Goldie , Tansie Awa 
Published: September 2024

Abstract

Aim
To review our UK undergraduate medical school curriculum, by considering the legacies of the British and European empires and how they continue to affect how we perceive, structure and teach our surgical course.

Method
We developed a medical student led focus group to assess the existing taught surgical curriculum and monitor progression over time in both recognizing the impacts of colonialism and initiating a transformation of teaching towards equity, inclusivity and decolonisation. We encouraged open discussions about awkward traditional teaching and imagery. Facilitating the dialogue with both surgical faculty and medical students.

Results
These are some of root cause themes that students reviewing the surgical curriculum highlighted-Unconscious bias relating to perceived race, class and UK as well as global ethnicity.Using a range of ethnically diverse skin tones for clinical images.Discussing how Eurocentric medical teaching has affected or suppressed minorities.Using a range of ethnically diverse British names.Highlight gaps in research investigating cultural disparities.Highlight why disparities exist between different communities regarding the incidence and survival of cancer due to a range of social and economic factors.

Conclusions
A student led group, supported by senior clinicians enabled this discourse to take place and to be taken seriously enough for change to begin.
Encouraging students to challenge dogmas and provide a framework of understanding to provide equitable patient care.
Shining a light onto all corners of our surgical course. Accepting as well as explaining the issues of the past to guide future curriculum development.
WP6.15 - A dedicated teaching programme in Colorectal Surgery: continuing education beyond medical school
Authors: Abishek Joshua , Massias Samuel , Tamanna Rezuana , McCarthy Deirdre , Bland Carol , Mallappa Sreelakshmi 
Published: September 2024

Abstract

Background
The UK Foundation Programme (UKFP) Curriculum illustrates the need for educational progression for doctors in their first two years of work. Although UKFP recommends use of departmental teaching for this, there is limited guidance on structured and learning-objective focussed training. We designed a colorectal surgery lecture series to create a reproducible teaching programme with defined learning outcomes.

Methods
We developed a 6-part lecture series aimed at FY1 doctors working in General Surgery at our Teaching Hospital. Teaching was in the form of 30-minute powerpoint presentations, with 15 minutes for questions, at weekly departmental teaching meetings. Lectures were delivered by FY2 doctors and members of colorectal multidisciplinary team (Enhanced Recovery CNS, Stoma Care CNS). Each session was supervised by a Colorectal Consultant. Feedback was obtained using a 10-point Likert scale questionnaire, assessing various domains.

Results
FY1 trainees indicated an increase in their knowledge with each lecture. Furthermore, the domains of relevance (mean score 9.53±0.80); teaching style (mean score 9.66±0.94); and audiovisual aid (mean score 9.68±0.70) were all rated highly. Lecture duration was rated as perfect length (mean score 5.86±1.80).

Conclusion
We have demonstrated that weekly departmental teaching can be utilised to enhance training for FY1 doctors within a challenging surgical subspecialty. Feedback revealed high satisfaction, facilitating improvement in knowledge and thus empowerment in undertaking clinical duties. Strengthened by this positive outcome work is in progress to introduce this format of structured teaching into departmental teaching meetings in all disciplines of medicine and surgery across our Trust.
ThP1.4 - Evidence-Based Perioperative Improvements in Microvascular Breast Free Flap Reconstruction: An Audit-Centric Evaluation & Retrospective Cohort Study
Authors: Yen Wai Jasmine May , Jasionowska Sara , Awad Laura , Walker Ciara , Langridge Benjamin , Nikkhah Dariush , Hamilton Stephen 
Published: September 2024

Abstract

Aim
This audit aimed to evaluate and improve the results of microvascular breast free flap reconstruction by implementing an enhanced perioperative care approach.

Method
All microvascular breast free flap reconstructions between June to August 2023 were included. Additionally, a three year retrospective review was conducted in adherence to ABS and the BAPRAS guidelines. Our team plans to introduce an evidenced-based modified Enhanced Recovery After Surgery (ERAS) protocol via MDT collaboration with a focus on pre-operative and post-operative care to improve postoperative outcomes.

Results
During June – August 2023, 22 flaps were performed with an average length of stay (LOS) of 5.47 days (target &lt;3d). There were no unplanned readmissions, an 18% return to theatre (RTT) rate and a total complication rate of 18%. Over the past three years, out of 323 flaps, there was a 13% RTT rate with no unplanned readmissions. Suggested modifications to reduce length of stay include pre-surgical counselling and nutritional loading. Post-operatively, using a multi-modal opioid sparing analgesia (MOSA) regime, along with laxatives, early mobilisation and feeding has proven to enhance recovery. Pre-admission patient optimisation, VTE and perioperative antibiotic prophylaxis have been shown to reduce rates of flap failures and post-operative complications. Effective wound care, post-discharge support and physiotherapy are also crucial in accelerating recovery and preventing readmissions.

Conclusion
Implementing these ERAS modification to our current protocol is predicted to significantly improve post-operative recovery, thus improving surgical outcomes. This underscores the potential for continual improvement in patient care through an efficient evidence-based perioperative pathway.
ThP1.10 - Expression Pattern of Arginase In Tumour Tissue In Male Breast Cancer
Authors: Raj Nirmal , Huda Farhanul , Basu Somprakas , Khare Vidhu Shekhar , Amulya Kanmatha Reddy , Chowdhury Nilotpal 
Published: September 2024

Abstract

Aim
To study the expression pattern of arginase in tumor tissue of male breast cancer (MBC) by immunohistochemistry (IHC).

Methods
We retrospectively analysed the data of 21 MBC patients who were treated in our centre from January 2018 to March 2022. Immunohistochemical analysis of arginase expression was performed in tumor and lymph node tissue with primary arginase-1 antibody (1:300 dilution).

Results
The mean patient age was 57 years (33–81 years). 10 patients (48%) had metastatic disease at presentation, while early breast cancer (EBC) and locally advanced breast cancer (LABC) constituted 19% and 33%, respectively. Invasive ductal carcinoma was the predominant histology, with luminal being the major subtype. Modified radical mastectomy was done in 9 patients (43%), and palliative chemotherapy was given to all metastatic patients. IHC analysis revealed a lack of arginase expression in the tumor tissue even though it was expressed in the surrounding neutrophils.

Conclusion
Contrary to the majority of existing literature, ours was an IHC-based study, which provides a more accurate estimation of arginase expression at the cellular level. The lack of arginase expression obtained in our study may point towards the non-expression of the enzyme in MBC. This suggests that arginase is not a tissue biomarker in MBC. Taking other studies with protein expression into account, arginase should be treated, if necessary, only as a blood biomarker.
ThP1.12 - Axillary Node Clearance Following Positive Sentinel Node Biopsy: Is it Always Necessary?
Authors: Usoro Angel , Othman Sal , Reid Judith , Elgammal Suzanne 
Published: September 2024

Abstract

Aim
The study was carried out to determine what proportion of patients have residual disease on completion Axillary node clearance (ANC) following positive nodes on prior Sentinel node biopsy (SNB) and assess for correlation between possible predicting factors such as neoadjuvant chemotherapy and the absence of positive nodes at ANC.

Methods
Operation records of patients who had surgery for breast cancer were used to identify all patients who had Axillary node clearance done from 2020 to 2023. Patients who did not have SNB prior to ANC were excluded.

Results
Less than 45% of patients had residual disease on completion ANC. Data was evenly spread between ductal carcinoma and lobular carcinoma on biopsy. There was no significant correlation found between number of positive nodes found at SNB and positive nodes at ANC. More than 50% of patients who had neoadjuvant chemotherapy prior to procedure were node-negative on completion ANC.

Conclusion
Management of axillary disease post positive SNB remains debatable. Use of neoadjuvant chemotherapy may reduce the need for completion axillary node clearance.
ThP3.7 - Evaluating the Effectiveness of Internal Vetting for General Practitioners Referrals with Urgent Suspicion of Oesophago-Gastric Cancer
Authors: Agiotakis Stefanos , McDowall Neil , Khan Khurram S 
Published: September 2024

Abstract

Aim
The NHS faces substantial pressure on surgical clinic waiting times especially for urgent suspicion of cancer (USOC). This study audits the effectiveness of internal vetting process and the clinic waiting time for patients referred as USOC for oesophago-gastric cancer.

Methods
This was a retrospective cohort study of all consecutive USOC referrals with suspected oesophago-gastric cancer who had clinic appointment in a single surgical unit between April to September 2022. All patients who fulfilled the Scottish referral criteria for USOC were included. Patients demographics, the urgency of clinic slot utilised and waiting time to clinic were analysed. This study was registered with Clinical Quality Project (LanQIP 14749).

Results
275 patients were included; median age was 63 years (IQR 52-73) and 153 (55.6%) were female. 94 (34.2%) patients were appointed as USOC, 120 (43.6%) as urgent and 61 (22.2%) as routine clinic slot. Overall, the median time for clinic appointment was 42 days (IQR 31-63). The median time to clinic was 47, 42 and 21 days for USOC, urgent and routine clinic appointments, respectively. 21 (7.6%) patients did not attend clinic. Of the patients who attended the clinic, 200 (78.7%) had endoscopy requested.

Conclusions
Although General Practitioners made appropriate referrals, a noteworthy portion of patients were reassigned to urgent or routine clinic slots. Nevertheless, those downgraded in urgency received prompt clinic reviews. This can be attributed to the strategic use of less urgent slots, ensuring timely assessments for patients with urgent suspicion of oesophago-gastric cancer.
ThP3.8 - General Practitioner Compliance to Scottish Referral Guidelines for Urgent Suspicion of Oesophago-gastric Cancer
Authors: McDowall Neil , Agiotakis Stefanos , Khan Khurram S 
Published: September 2024

Abstract

Aim
The referral guidelines in Scotland stipulate that patients with urgent suspicion of cancer (USOC) should commence treatment within 62 days of diagnosis from the date of primary care referral. In this study, we assessed the adherence of general practitioners (GPs) to the Scottish Referral Guidelines for USOC.

Methods
This was a retrospective cohort study of all consecutive USOC referrals from GP who were given clinic appointment for Upper GI Surgeons in a single centre for suspected oesophago-gastric cancer between April to September 2022. Patient’s electronic case notes were analysed and the referral indication audited against the Scottish referral guidelines. This study was registered with Clinical Quality Project (LanQIP 14746).

Results
361 patients were identified, median age was 63 years (IQR 52-72) and 200 (55.4%) were female. Median Scottish Index of Multiple Deprivation was 4 (IQR 3-7). 138 (38.3%) were referred for dysphagia. 5 (1.4%) were vetted straight to the test and had endoscopy prior the clinic consultation.
275 (76.2%) of the GP referrals for USOC were compliant with the Scottish referral guidelines. Median time from the referral to the clinic consultation was 44 days (IQR 31-63). 35 (9.7%) of patients did not attend the clinic.

Conclusions
The criteria outlined in the Scottish referral guidelines for USOC provide clear parameters for clinic referrals. Our findings reveal that the majority of GP referrals align appropriately with the USOC criteria. Increasing education and awareness among GPs can further enhance compliance with these guidelines and reduce pressure on the clinic waiting time.
ThP3.10 - Initial experience with laparoscopic single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) in Class IV (BMI 50-60kg/m2) and Class V (BMI &gt; 60 kg/m2) Obesity
Authors: Ahmed Awais , Lu Yanqiang , Davies Sian , Sharples Alistair , Rao Vittal , Marimuthu Kanagaraj , Salgaonkar Hrishikesh 
Published: September 2024

Abstract

Aims
Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is a simplification of the duodenal switch (DS) in which alimentary limb is eliminated, and common channel is lengthened from 200 to 300 cm is gaining recognition as effective procedure in Class IV (BMI 50-60 kg/m2) and Class V (BMI &gt;60 kg/m2) obesity. The aim of study is to discuss the surgical technique and analyse initial outcomes after introduction of SADI-S in our department for management of Class IV and Class V Obesity.

Methods
This is a retrospective cohort study of consecutive patients who underwent SADI-S at a tertiary level teaching hospital in NHS. Only patients who underwent single stage SADI-S procedure with minimal follow-up of 30 days were included in study. Patients who underwent Sleeve gastrectomy first, followed by duodenal switch in second stage as part of two-stage strategy were excluded.

Results
Total 14 patients, 2 (14.2%) males and 12 (85.8%) females were included in study. The median pre-op BMI was 56.1 (51.95-69) kg/M2 and median Pre-op weight was 149.2 (121.8 – 163.2) kg. 9 pts had diabetes, 11 pts OSA on CPAP, 8 pts HTN, 6 pts fibromyalgia etc. 1 patient had sleeve staple-line bleed which was managed conservatively with fluids and blood transfusion. No re-operations, mortality or re-admissions were recorded. Median length of stay was 2 days.

Conclusion
SADI-S is a promising surgery in Class IV and Class V obesity patients with low postoperative morbidity. The postoperative recovery and protocol is similar to standard procedure like sleeve gastrectomy and Roux-Y-gastric bypass.
ThP3.15 - Trends in ERCP in a new city teaching hospital; is there a learning curve for a unit?
Authors: McNickle Luke , Wohlgemut Jared , Glen Paul 
Published: September 2024

Abstract

Aims
Describe trends in volume, demographics, and complications over time for endoscopic retrograde cholangiopancreatography (ERCP) in a new endoscopy unit.

Methods
Prospective recording of all ERCPs in a new city teaching hospital commenced when the unit opened in 2015. This registry recorded patient demographics, indications, procedural data and complications. We analysed annual trends over time using linear regression.

Results
4504 ERCPs were performed during the study period (1/6/15-31/5/23), with a female predominance of 58%. Median age (70 years, interquartile range 59-80) was unchanged over the study period, however the proportion under 30 years had decreased over time (4%-1%, slope -0.93, p=0.042). Total number of procedures per year has decreased over time (peak 628 in 2016, falling to 438 in 2022). The proportion performed for stone disease has fallen over the study period (80%-71%, slope -0.07, p=&lt;0.001). Though not a statistically significant difference, the rate of ERCP pancreatitis has had a clinically significant decrease over time (5.4%-3.9%, slope -0.033, p=0.32).

Conclusion
A number of changes in practice have occurred since three units were merged into one unit. We routinely give diclofenac and IV fluids post-procedure. We now preferentially treat younger stone patients with laparoscopic cholecystectomy and common bile duct exploration. This results in an evolving use of contemporary ERCP with an older patient cohort with an increased indication of cancer and other reasons and fewer total numbers. These factors will contribute to a lower incidence of pancreatitis post-procedure but cannot discount a learning curve effect for a new unit.
ThP5.14 - Assessing Adherence and Cost Implications of NICE Guidelines for Intravenous compared to Oral paracetamol use after Resuming Oral Diet Following Liver and Pancreas Resections
Authors: Aziz Tariq , Rehman Zak , Mukhtar Talha , Froghi Farid , Kotelis Nikolaos 
Published: September 2024

Abstract

Aim
For post-operative pain management NICE recommends not to offer intravenous paracetamol unless the person cannot take oral medicine [NG180] 1.6.6. Despite this recommendation, many patients continue to receive intravenous paracetamol whilst on oral diet. This audit aims to assess the adherence and cost implications of NICE guidelines for switching from IV to oral paracetamol once oral diet resumes following liver and pancreas resections.

Method
Data for 176 patients undergoing major liver or pancreas resections at the Royal Free Hospital London (January 2022 to October 2023) was collected retrospectively. This included the number of IV and oral paracetamol doses, resumption of oral diet post-operatively, and the total number of IV paracetamol doses whilst oral diet resumed. Costings for IV and oral paracetamol were established, and the total cost was calculated per patient. After a departmental presentation, the audit cycle was completed.

Result
The analysis of the initial dataset disclosed that 69% of patients were administered IV paracetamol while on an oral diet, incurring a cost of £9412/100 patients, in contrast to £18.5 for oral paracetamol. Following the intervention, there was a noteworthy enhancement in adherence to guidelines, reducing the average days of IV paracetamol administration after resuming oral diet from 4.08 days pre-intervention to 2.06 days post-intervention.

Conclusion
This improved adherence showed almost 50% cost reduction compared to first audit. In addition to this we can also expect early patient mobilization, enhanced recovery, and prompt discharges. This audit provides valuable insight into optimizing postoperative pain management strategies and resource utilization.
ThP6.7 - Early assessment by a specalist geriatric team reduces length of stay in unplanned surgical admissions
Authors: Ramdin Ashling , Rothnie Alex , Hamza Mohamed , Satar Iman , Cross Jason , Thin Katie , Mamidanna Ravi 
Published: September 2024

Abstract

Intro
A comprehensive geriatric assessment (CGA) performed by the Perioperative medicine for Older People undergoing Surgery (POPS) team has been shown to reduce length of stay(LOS) for unplanned hospital admissions in the older population. This study investigates whether timing of POPS review reduces LOS for older adults admitted under the acute general surgical team.

Methods
We performed a single centre, prospective study of all older adult patients (aged 65 or above) admitted acutely to the general surgical team between August 2022 and September 2023. Timing of POPS review and LOS was calculated, and Mann Whitney-U test was performed.

Results
Three hundred and nine patients were identified. Of these, 207 patients were reviewed by POPS within 48 hours (early) and 151 of these patients were reviewed within 24 hours (very early) of admission. There was a statistically significant difference (p&lt;0.001) in LOS between those who were assessed by POPS within 48 hours [Median 5 days (IQR 3,9)] versus those beyond 48 hours [Median 9 days (IQR 6,19)]. Very early POPS review (less than 24 hours) resulted in a statistically significant reduction in length of stay compared to POPS review between 24 and 48 hours [Median 5 days (IQR 2,8) versus 6 days (IQR3,9)] p&lt;0.02.

Conclusions
POPS review within 48 hours reduces length of stay for older patients who have had an acute general surgical admission. Furthermore, this data suggests that very early POPS review (within 24 hours) is associated with a shorter hospital admission. Further research into this will help service planning.