bluuebunny/crossref_metadata_2025_split huggingface dataset:
834 A 5-Year Retrospective Review of Intra-Operative Cholangiogram Utilisation: Do We Need a Pathway?
Authors: Bezzaa S , Kapsampelis P , Murabit F , Khalifa K , Gerogiannis I 
Published: August 2023

Abstract

Aim
Current guidance gives no clear consensus on using routine vs selective intra-operative cholangiograms (IOC) during laparoscopic cholecystectomy. This is a controversial area with underuse risking bile-duct injury but overuse wasting theatre time and resources. The study aimed to review our local practice of IOC.

Method
Data was collected from electronic records for all patients undergoing IOCs from 2017 to 2022 at a single District General Hospital (DGH). Statistical analysis was performed using R.

Results
Ninety-six patients underwent IOC (74 elective, 22 emergency). In 64 (67%), use of IOC was decided pre-operatively (planned), 28 (29%) was decided intra-operatively (unplanned), and unclear in four cases (4%). All patients underwent pre-operative imaging. Imaging was negative for choledocholithiasis in 61 cases (64%). Indications for IOCs were abnormal anatomy (18%), deranged biochemistry (32%), abnormal imaging (21%) and confirmed choledocholithiasis (7%). The indication for IOC was unclear in 21 patients (22%). IOCs revealed abnormal findings in 21 cases; 10 required post-operative ERCP/EUS, 6 required further imaging and three were referred to a tertiary centre (for potential bile duct injury). On average, elective cases with unplanned IOC lasted 28 minutes longer (95% CI 4 to 52, p = 0.013) than planned IOC.

Conclusions
Our study revealed that IOC indication was not documented consistently, and unplanned elective IOC cases lasted significantly longer. Therefore, we propose a local pathway to identify, pre-operatively, the patients who need IOC. This will result in safer patient care and less operating time and resources. Furthermore, dedicated IOC lists may help DGHs streamline theatre lists and improve efficiency.
1027 Small Bite vs Big Bite Closure Technique in Elective Oesophagectomy Patients
Authors: Williams G , Devashetty A , McLaughlin E 
Published: August 2023

Abstract

Aim
After primary closure of a midline laparotomy wounds the estimated incisional hernia incidence can be as high as 25%. For many years large bite closure has been the standard in mainstream surgical training. Evidence has emerged to suggest small bite closure may be superior. We looked to examine the incidence of incisional hernias for elective oesophagectomies in one centre where both small bite and large bite techniques are performed.

Method
A retrospective analysis of 117 patients was performed. Follow up was for a maximum of five years and involved a combination of radiological and clinical reviews. Primary outcomes were defined as incisional hernia rates & wound infections. Patient risk factors were recorded including age, co-morbidities such as cardiovascular or renal disease, diabetes, smoking, weight, steroid use and post-op complications.

Results
74 patients had big bite closures and 38 had small bite closures. Overall there were 6 incisional hernias, 3 in each group (7.8% vs 4%, p-value 0.2). There were higher rates of wound infection in the small bite groups but again this failed to reach significance (7.9% vs 2.7% p-value 0.11).

Conclusions
Overall both outcomes are lower than the national averages which may explain the difficulty reaching significance. However, the results do suggest there may be other factors involved contributing to outcomes between small bite and big bite closure including operator familiarity.
1254 Examining the Role of PET-CT in the Management of Oesophageal Cancer: A Single Institution Experience
Authors: O'Neill S , Fahy N , Elliott J , Mohan H , Carroll P , Muldoon C , Johnston C , Donohoe C , Ravi N , Reynolds J V 
Published: August 2023

Abstract

Aim
The role of PET-CT in oesophageal cancer is controversial. The aim of this study was to evaluate the utility of PET-CT in staging and response evaluation in oesophageal squamous cell carcinoma (SCC) and adenocarcinoma (AC).

Method
Patients undergoing curative-intent treatment were studied prospectively. PET1 was carried out at diagnosis and repeat scanning (PET2) was performed 2-4 weeks post-completion of neoadjuvant chemotherapy (nCT) or chemoradiation (nCRT). The association between PET parameters, histopathologic response and survival was determined using univariable and multivariable regression models.

Results
730 consecutive patients were studied. PET identified CT-occult M1 disease in 2.9% and synchronous neoplasm in 1.4%. Similar PET1 SUVmax values were observed in AC and SCC. The reduction in SUVmax was greater post-nCRT versus nCT (P = 0.021). SUVmax correlated with pT stage among patients treated with primary surgery (P&lt;0.001), however 32.3% with AC and 15.8% with SCC who were predicted node negative were pN+. Post neoadjuvant therapy, PET parameters showed modest associations with major pathologic response, but no parameter accurately predicted complete pathologic response. Among patients with a metabolic complete response (mCR), 90.9% with AC post-nCT, 84.1% with AC post-nCRT and 54.8% with SCC post-nCRT had residual disease. Lower preoperative SUVmax was independently associated with improved survival outcomes in AC, but not SCC.

Conclusions
PET-CT identified CT-occult M1 disease or synchronous neoplasms in 4.3% at initial staging. After neoadjuvant therapy, PET is poorly predictive of histopathologic response – most patients with an mCR have residual disease. Nonetheless, improvements in SUVmax may reflect a more favourable long-term outcome in AC.
76 Incidence of Incisional Hernia Post-Colorectal Liver Metastasis Resection - a Longitudinal Radiological Cohort Study
Authors: Mallalieu K , Lynch A , Adams S , Jones R , Walsh C 
Published: August 2023

Abstract

Aim
The aim of this study is to determine the incidence and time to development of incisional hernia (IH) in post partial hepatectomy (PH) for colorectal liver metastases (CRLM) patients to enable surgeons to prepare and accurately consent patients for the operations.

Method
The radiological images and reports of all patients undergoing hepatectomy for CRLM at a tertiary hepatobiliary surgical unit between December 2010 and August 2015 were retrospectively followed up for 5 years post-procedure. The primary outcome was the radiological incidence of an incisional hernia post-hepatectomy within 5 years of the procedure. Secondary outcomes included risk factors for the development of IH and time to hernia development and incidence of incisional hernia repair.

Results
249 patients, 164 men (66%), 85 women (34%); median age 65, IQR 59-73 underwent open hepatectomy. Incidence of incisional hernia 19.1% (n = 40) at a median of 8.5 months, IQR 4.75-12 months. High BMI was a risk factor associated with IH (P&lt;.0001), 95% CI 1.084 to 1.232. (10% (n = 4) of those with IH had radiological evidence of incisional hernia repair.

Conclusions
IH represents a significant risk for patients undergoing open hepatectomy for CRLM. IH has the potential to have large impact on patient’s quality of life and increases the risk to return to theatre, either for emergency operation in the event of incarcerated hernias or for planned elective hernia repairs. It is important to know accurate figures of incidence of IH to enable surgeons to adequately prepare and consent patients for open PH.
1304 Feasibility of Day-Case Laparoscopic Cholecystectomy in Paediatric Patients
Authors: Sabolic I , Khan M , Dada O , Soyombo O , Soccorso G 
Published: August 2023

Abstract

Aim
Standard approach for treatment of cholecystolithiasis is laparoscopic cholecystectomy (LC), however day-case laparoscopic cholecystectomy (DCLC) has not been established as standard procedure in paediatric population. This is to assess the feasibility and safety of DCLC in paediatric population focusing on post-operative outcomes as a measure of success and using a protocolised post-operative pain management approach.

Method
Data, which include demographics, surgeon (trainee/consultant), admission mode, length of stay, complications, and post-operative pain management as per hospital protocol were collected from the hospital database from 2016 to 2022. Patients who underwent DCLS were discharged within 23 hours. Telephone survey was conducted to investigate type and length of analgesia administered at home.

Results
31 patients underwent LC with a day-case rate of 77%. 63% were female. Mean age was 11 years (3 - 16). Obesity and haemolytic disorders were present in 29% and 8%, respectively. 96% were elective admissions. 20% had ASA I, 48% ASA II and 32% ASA III. Post-operatively, opioids with paracetamol/ibuprofen were administered in 96%, and in 80% as post-discharge analgesia. Post-discharge analgesia was administered 1 - 7 days, and 28% used oral opioid analgesia at home up to 3 days. Post-operative complications were present in 2 patients - 1 infected umbilical wound and 1 persistent dyspepsia. Six months readmission rate was 8% due to hypogastric pain treated conservatively. After a 3-month follow-up, all the patients were discharged.

Conclusions
LC can be performed safely as a day case procedure with excellent outcomes using a standardised post-operative and post-discharge pain management protocol.
235 Late Start Times Do Not Disproportionately Prolong Operating Times in Major Head and Neck Reconstruction
Authors: Stark D 
Published: August 2023

Abstract

Introduction
Operating start time delays are deemed as having a detrimental effect on theatre efficiency, subsequent delays, costs, and potentially outcomes. This study assessed the significance of delayed operating start times on major head and neck reconstruction cases and whether later starts led to disproportionately later finishes. Focus was placed on free osteocutaneous fibula flap reconstruction due to long operating times, difficult anaesthesia, frequently overrun and the perception of increased morning efficiency.

Method
Single centre identification of 26 patients using coding informatics that were diagnosed with an intra oral malignancy or osteoradionecrosis requiring reconstruction with a free osteocutaneous fibula flap. Data was manually retrieved between 2015 to 2020 from electronic patient records and statistical analysis was completed using Microsoft Excel.

Results
Total number of patients collated was 27, however 1 was excluded due to insufficient electronic logging of patient data. The total mean age was 64.8 (40-79), 50% were male (13) and 50% were female (13). The mean start time was 9:57, end time was 18:52 and duration was 10:50 (4:46 to 13:42).
For surgery start times before 10:00 a.m. the mean start time was 9:31, end time was 20:16 and duration was 10:46 (8:30 to 22:56). For surgery start times after 10:00 a.m. the mean start time was 10:22, end time was 19:25 and duration was 10:54 (10:01 to 00:51).

Conclusions
Delayed operating start times have minimal significance on theatre efficiency and don’t disproportionally prolong operating times in major head and neck reconstruction cases.
266 Malignant Melanoma: Highlighting Delays in the Pathway from Biopsy to WLE (Wide Local Excision) + SLNB (Sentinel Lymph Node Biopsy)
Authors: Davies M , Kyle D , Alrawi M 
Published: August 2023

Abstract

Aim
To highlight delays in the malignant melanoma (MM) pathway for patients undergoing a Wide Local Excision (WLE) and Sentinel Lymph Node Biopsy (SLNB). Aiming to evaluate if Trust standards are met, to provide a 31-day clock from time of clinic discussion for WLE and SLNB, to date of operation. In particular, comparing pre- (2019) and post-COVID (2022) waiting times.

Method
Retrospective data collection of patients with a MM diagnosis AJCC (American Joint Committee on Cancer) 1B-2C requiring WLE and SLNB, who were operated on between January-December 2019 and January-October 2022. All operations were performed at the Royal Victoria Infirmary, Newcastle. The following parameters were collected: AJCC grade; SLNB site and result; date of: initial biopsy, biopsy result, skin cancer multidisciplinary meeting (MDT), clinic discussion, and operation. Exclusion criteria: AJCC 1A and 3, incomplete original biopsy (i.e. initial 2-week wait clock had not stopped), incomplete documentation of clinic discussion date, extreme delays (3 patients &gt;140 days, due to acute illness and initially declining operation).

Results
The average time from clinic discussion to operation was 35 days in 2019, compared to 53 days in 2022 (p-value &lt;0.05). 56% (n = 79) of 2019 patients underwent their operation within the 31-day target, compared to 13% (n = 14) of 2022 patients, p&lt;0.05. This statistically significant difference was irrespective of AJCC grade and SLNB site.

Conclusions
Statistically significant decrease in the percentage of patients meeting the 31-day target in 2022, compared to 2019. Delays were affected by an increase in number of MM referrals and limited capacity for operating.
313 Preoperative CT Imaging: A Tool to Predict Incisional Hernia Outcomes Following Abdominal Wall Reconstruction
Authors: Frommer M L , Faderani R , Pérusseau-Lambert A , Kanapathy M , Malhotra A , Khosh Zaban M , Floyd D , Butler P E M , Ghali S 
Published: August 2023

Abstract

Aim
Abdominal wall reconstruction (AWR) is a surgical technique used to manage recurrent incisional hernias, which cause significant morbidity and are difficult to treat. In this study, we sought to determine whether subcutaneous abdominal fat thickness (AFT) measured at the xiphoid process, umbilicus, and pubic tubercle using preoperative CT scans could predict postoperative outcomes in patients undergoing AWR.

Method
A retrospective cohort study was conducted on all patients who underwent AWR at our institution between 2009 and 2021 with a minimum follow-up of 12 months. Using preoperative CT scans, AFT was measured at the xiphoid process, umbilicus, and pubic tubercle, as well as the hernia dimensions. Demographic, operative, and surgical outcome data were also collected and analysed using statistical tests.

Results
The results showed that 9 out of 101 patients (8.9%) experienced hernia recurrence. Smoking was significantly associated with an increased risk of hernia recurrence (p&lt;0.001) and had a predictive odds ratio (OR) of 18.27 (p = 0.041). Increased AFT at the xiphoid (p = 0.005), umbilicus (p&lt;0.001), and pubic tubercle (p&lt;0.001) were also associated with hernia recurrence and additionally with risk of infection. However, only AFT at the pubic tubercle reached significance in the multivariate logistic regression model predicting recurrence (OR = 1.10; p = 0.030) and infection (OR = 1.04; p = 0.021).

Conclusions
In conclusion, smoking and increased subcutaneous abdominal fat thickness at the pubic tubercle are significant risk factors for recurrence and infection in patients undergoing abdominal wall reconstruction, and preoperative optimisation should focus on reducing these factors.
404 Imaging for Plastic Surgery Trauma Referrals – Does It Reduce Unnecessary on the Day Patient Transfers?
Authors: Drury D 
Published: August 2023

Abstract

Aim
To determine whether requesting images for plastic surgery trauma referrals reduced the number of patients transferred to hospital for on the day assessment and management.

Method
Two data collection periods between 31/08/22 - 18/09/22 (round 1) and 24/10/22 – 17/11/22 (round 2) were undertaken. For round one on call plastic surgery SHOs were asked to keep track of all trauma referrals outside of their base hospital which they accepted for on the day review. Once the patient had been reviewed SHOs were asked whether they felt the patient required on the day management or if the patient could have been safely triaged to be seen the following day. During round two SHOs were additionally asked to request images from the referrer were able and to note whether this altered or confirmed their initial management plan.

Results
Round one: 15 patients were transferred for on the day review with 80% deemed as requiring on the day management whilst 20% did not. Round two: 13 patients were transferred for on the day review with 92% deemed as requiring on the day management whilst 8% did not. Images were sent for 9 patients, altered the initial decision in three cases and confirmed the initial management in 6.

Conclusions
Requesting images for plastic trauma referrals can reduce the number of patients unnecessarily seen on the day, reducing patient stress, and making better use of hospital resources.
516 The Livingston Nexobrid Pain Protocol - Further Experience in 80 Patients
Authors: Warwick A 
Published: August 2023

Abstract

Introduction
Our unit has employed Nexobrid in the debridement of burns. It is a painful process yet there is no formal analgesia protocol in the literature. The team in Livingston developed a successful bedside pain protocol which is fast acting, long lasting and has a quick recovery time. It is administered by the Acute Pain Team nurses and reduces the need for invasive techniques and specialist medical staff.

Method
A Fentanyl based Patient Controlled Analgesia (PCA) protocol with clinician administered boluses is used in this unit. Patients’ pain scores were documented throughout the procedure, as well as their perception of their worst pain and their overall satisfaction with the treatment. All patients undergoing enzymatic debridement outwith the ITU environment utilised this protocol.

Results
Eighty patients undergoing Nexobrid burns debridement were included in this study. The PCA ran for around 4 hours. Pain was most severe on removal of the enzyme however after bolus analgesia, the mean score at this point was 3/10. Patient satisfaction with the treatment was reported as “very satisfied” or “satisfied” in 95% of cases. No complications were reported.

Conclusions
Addressing the significant psychological element of the pain response was an important role of the Pain Nurses in preparing patients for the debridement process.
The analgesia protocol is safe, easy to administer and remains well tolerated, providing a high level of patient satisfaction and low rate of complications in the enzymatic debridement of burns. The role of the Pain Nurse in this protocol is important.
544 Effect of Tranexamic Acid on Microvascular Thrombosis in Autologous Free Tissue Transfer
Authors: Leow S H , Arnaout A , Ridha H 
Published: August 2023

Abstract

Aim
The use of Tranexamic Acid (TXA) has been shown to be effective in reducing haemorrhage and mortality in numerous surgical settings and has a wide range of proposed benefits linked to anti-inflammatory effects which promotes healing and reduces pain and discomfort. However, the surgical community has been reluctant to incorporate TXA use into mainstream practices in microvascular surgery due to possible risk of thromboembolic events. Hence, we aim to report our experience with the use of TXA in microsurgical reconstruction.

Method
We performed a retrospective single-centre cohort study including any patients who underwent autologous free flap tissue transfer at a district general hospital, from 1 January 2016 to 20 April 2022. The Chi-squared test was used to determine if there were any significant differences between the proportion of patients who developed any evidence of microvascular thrombosis, flap failure, or return to theatre. Univariate logistic regression was used to calculate odds ratio.

Results
The treatment group (N = 160) received TXA (1g intravenous) at the time of general anaesthetic induction as per the senior author’s routine practice, while the control group (N = 80) did not receive TXA at any point of the hospital admission, according to the normal practice of other surgeons. No differences were found between the proportion of patients who developed flap failure, venous congestion or were returned to theatre between the TXA and control group.

Conclusions
Our study shows that TXA administration did not increase microvascular thrombosis in free flap reconstructive surgery, contributing evidence that TXA is safe to use in microvascular surgery.
675 Are Postoperative Outcomes in Flap Operations Affected by Obesity?
Authors: Meenu A , Karanth V , Kumar N C S , Acharya A 
Published: August 2023

Abstract

Aim
To explore the outcomes of flap surgeries and how obesity affects them. To find if there is a correlation between CBC indices (also inflammatory markers) with flap survival.

Method
All flap surgeries on adults in the collaborating departments in an Indian tertiary care hospital from 2021-2022 excluding finger flaps were prospectively analyzed. Data of 90 patients including postoperative complications, preoperative Neutrophil-Lymphocyte Ratio (NLR) were recorded.BMI is calculated to classify patients based on Asia-Pacific guidelines where BMI&gt;25 is obese, 23-24.9 is overweight, &lt;18 is underweight.Chi square tests were used to assess association between obesity, NLR and early (within 7 days of surgery) &late (beyond 7 days) postoperative complications -flap loss, wound dehiscence, surgical site infection. Multiple regression model and ANOVA test were also done with these variables.

Results
There is significant association between patients’ obese or overweight habitus and postoperative surgical site complications. 38% early (p = 0.001) and 36% late (p = 0.044) complications happened in obese patients alone.
There is significant association between NLR and early postoperative complications (p = 0.002).60% with high NLR values had severe early postoperative complications, compared to 16.7% of patients with normal NLR and 21.1% with mildly raised NLR.
Obesity and high NLR [NLR 10-18 or moderate stress, NLR&gt;18 or severe stress] independently have significant correlation (0.038 for obesity, 0.015 for NLR) with early postoperative complications.

Conclusions
Obesity combined with high preoperative NLR is a quick, inexpensive predictor of poor early postoperative flap survival.
1224 A Systematic Review Exploring the Mechanisms Behind Autologous Lipotransfer for Radiation-Induced Fibrosis
Authors: Pattani N , Sanghera J , Langridge B , Frommer M , Abu-Hanna J , Butler P 
Published: August 2023

Abstract

Aim
Radiation-induced fibrosis (RIF) is a recognised consequence of anti-cancer radiotherapy, especially after multiple and prolonged dosing regimens. There is no definitive treatment for late-stage RIF, although the use of autologous fat transfer (AFT) has shown promise. However, the exact mechanisms by which AFT improves RIF remain poorly understood. We aim to explore existing literature on the effects of AFT on both in-vitro and in-vivo RIF models, and to collate potential mechanisms of action.

Method
PubMed, Cochrane reviews and Scopus electronic databases from inception to January 2022 were searched. Our search strategy combined both free-text terms with Boolean operators, derived from synonyms of adipose tissue and RIF.

Results
The search strategy produced 2645 articles. Of these, 76 underwent full-text review for eligibility, yielding 26 for final analysis. Eight conducted in-vitro experiments utilising a co-culture model, whilst 21 conducted in-vivo experiments. AFT interventions included adipose-derived stem cells (ADSCs), stromal vascular function, whole fat and microfat. Notable findings include downregulation of fibroblast proliferation, collagen deposition, epithelial cell apoptosis, and proinflammatory processes. AFT suppressed hypoxia and pro-inflammatory interferon-γ signalling pathways, and ADSC-treated tissue stained strongly for anti-inflammatory M2 macrophages. Although largely proangiogenic initially, studies show varying effects on vascularisation. There is early evidence that ADSC subgroups may have different functional properties.

Conclusions
AFT functions through pro-angiogenic, anti-fibrotic, immunomodulatory, and extracellular matrix remodelling properties. By characterising these mechanisms, relevant drug targets can be identified and used to further improve clinical outcomes in RIF. Further research should focus on ADSC sub-populations and augmentation techniques such as cell-assisted lipotransfer.