bluuebunny/crossref_metadata_2025_split huggingface dataset:
437 Migrated tubal sterilisation clip presenting as a subcutaneous gluteal foreign body 24 years later: A case report and literature review
Authors: Lakha Adil Siraj , Ang Andrew , Salih Sarmad Mohammed , Lewis Christopher 
Published: August 2023

Abstract

Introduction
The incidence of sterilisation clip migration is reportedly 25%. However, less than 1% of those who experience clip migration will present with pain, an abscess, or spontaneous extrusion. Here we present a rare case of sterilisation clip migration through the entire pelvic floor.

Case
A 66-year-old female was referred from community to the Surgical Emergency Unit with a possible metallic foreign body under the skin following an attempted routine gluteal cyst excision. The patient first noticed a lump under the skin 2 years ago which gradually became more apparent and tender over the previous 2 months. The patient denied recent trauma, had no co-morbidities and had a sterilisation procedure 24 years prior. Examination revealed a non-mobile solid structure just beneath the skin 5cm laterally from the anal verge. Inflammatory markers were normal and an ultrasound confirmed a 15x7mm foreign body in the subcutaneous tissues. The foreign body was excised easily under local anaesthesia, revealing a closed Filshie sterilisation clip. The wound was closed primarily, and recovery was uncomplicated.

Discussion
This is the first reported case of sterilisation clip migration to the subcutaneous gluteal region. A literature review revealed 35 case reports of sterilisation clip migration, mostly to the bladder.
Patients with a previous sterilisation procedure and suspected subcutaneous foreign body without trauma should elicit a high index of suspicion for migrated sterilisation clips. These clips can migrate through multiple layers of muscle and fascia, including the pelvic floor.
439 A review of the management of Anti-coagulation and anti-platelet medication in surgical patients in a University Hospital
Authors: Lee Chloe , Findlater Hannah , Ghazanfar Mudassar , Ganesh Radhakrishnan 
Published: August 2023

Abstract

Management of surgical patients on anti-coagulation and anti-platelet medication can be challenging. Balance between discontinuation, with thrombotic risk, and continuation or early re-initiation with risk of bleeding should be considered. In emergency setting patients are managed depending on clinical situation.

Aim
To review the management of anticoagulant or antiplatelet therapy in acute and elective surgical patients.

Methods
Method: Electronic data was retrospectively reviewed for both elective and emergency admissions to surgical ward during two weeks period. Data including age, sex, admission diagnosis, indication and nature of anti-thrombotic or antiplatelet medication, and thromboembolic or bleeding complications were collected.

Results
30 patients (19 male, 11 female) with a mean age of 74 (54-90) were reviewed. 22 patients were emergency admission and 8 were elective.
All elective cases had their medication withheld. Three patients developed complications including 1 rectal bleeding, 1 post liver biopsy bleed and 1 internal jugular vein thrombosis.
17 emergency patients had their medication withheld. 5 patients underwent surgery and 7 patients had endoscopic invasive procedures (ERCP). One patient developed bowel ischemia from arterial thrombosis following emergency open cholecystectomy. Among the 5 patients who continued the medication one patient had ERCP and others did not receive any intervention.

Conclusion
Patients on anti-coagulation and anti-platelet medication undergoing invasive procedure can develop thrombo-embolic or bleeding complication.
445 Endovascular treatment of acute mesenteric ischemia: An option to consider in patients unfit for major surgery
Authors: Philip Ken , Uzoma Chukwuebuka , Cota Allwyn , Rogers Angie 
Published: August 2023

Abstract

Introduction
The number of embolectomies for superior mesenteric arterial occlusion has increased over the years. Endovascular embolectomies in acute mesenteric ischemia continue to be performed only in a smaller proportion of cases despite multiple studies reporting promising results.

Case description
An 85-year-old lady presented to the emergency surgical unit with an acute onset of severe abdominal pain and vomiting.
She has a background of atrial fibrillation and hypertension and has been a chronic smoker for the past 50 years. One month before her presentation, she stopped taking her anticoagulation due to intermittent per-rectal bleeding attributed to diverticular disease.
Initial CT demonstrated an SMA embolus extending from the first bifurcation approximately 4.5cm distally. In addition, there were features of bowel ischaemia with abnormal thickening of the small bowel loops in that vascular territory. She was deemed too frail for a laparotomy by the surgical and anaesthetic team, and the patient preferred to explore a non-operative approach.
Despite treatment dose anticoagulation, her clinical condition deteriorated, with a rise in inflammatory markers, intolerance of food, and worsening abdominal pain. Unfortunately, thrombolysis was not an option because of the large size of the embolus and PR bleeding.
She underwent an endovascular vacuum-assisted thrombectomy. The procedure achieved near-complete revascularisation, and the patient sustained a good recovery and was discharged on day 8 of admission.

Discussion
Available literature has shown promising results with endovascular treatment of acute mesenteric ischemia. The successful revascularisation, in this case, confirms that endovascular techniques are a viable option to consider in acute mesenteric ischemia.
452 Impact of COVID-19 on the closure of temporary ileostomies following colorectal surgery
Authors: Hughes Rebecca , Massie Eleanor , Renwick Andrew , Vella Mark , Moug Susan 
Published: August 2023

Abstract

Aims
Temporary defunctioning ileostomies are created in emergency general surgery and elective colorectal surgery with the aim of reversal in the near future. Ileostomies come with associated morbidity. There is a nationwide delay to closure of ileostomies in the UK for a variety of reasons and Covid-19 has had a further significant impact on surgical waiting lists. We aim to assess the length of delay to reversal of ileostomy and whether there is greater morbidity associated with delayed reversal.

Methods
All reversal of ileostomy patients referred to the National Waiting Times Centre over a one year period between November 2021 and November 2022 we included. Demographics and details of index surgery were collected, as well as reversal peri-operative details, complications and length of stay.

Results
Twenty-three patients underwent reversal of ileostomy. Mean age 60.4 years. Mean number of days from index procedure to reversal was 648 days (range 99 – 2136). Reasons for delay were; adjuvant chemotherapy (n=6), waiting list/Covid-19 delays (n=13), patient preference/no reason documented (n=4). There were 7 end ileostomies who underwent laparotomy and 16 loop ileostomies reversed. Mean length of stay was 7.04 days (range 2-19 days). 7 patients had ileus following reversal, 3 had an anastomotic leak requiring return to theatre, 1 returned to theatre for bleeding and 1 developed Clostridium difficile.

Conclusion
Half of this cohort of patients who were referred as ‘long-waiters’ to the National Waiting Times Hospital developed a complication following reversal of ileostomy. This cohort of patients waited on average 377 days longer than pre-Covid-19 waits (Close-IT).
491 Quality of Operation notes - Fit for purpose?
Authors: Vinodkumar Narayanan , Amin Dylan , Rajasingh John , Opaluwa Abdu , Abdelwahed Ahmed , Sharma Abhay 
Published: August 2023

Abstract

Aims
Every doctor should maintain accurate and contemporaneous records. Operation notes with accurate documentation are crucial for providing good medical care. This responsibility lies with the primary surgeon. The aim was to assess the quality of operation notes in accordance with standards by RCS guidelines ‘Good surgical Practice.’

Methods
120 General Surgery operation notes (Electronic and handwritten) were randomly identified over a period of 2½ months. This covered both elective and emergency operations. Reviewers collected the data from the operation notes and the analysis was completed by clinicians. The parameters that were evaluated were Name, Hospital number, Date, Time of the operation, Elective/Emergency, Procedure, Name of the surgeon, Assistant, Anaesthetist, Incision, Operative diagnosis, Findings, Complications, Details of tissue removed, Additional procedures, Name/serial number of prostheses, DVT prophylaxis, Antibiotics, Blood loss, Details of closure/suture material, Post-op instructions and signature.

Results
Of the above parameters, 6 met a standard of 100%, 7 a standard of ≥ 90%, 7 a standard of 50-89% and 2 achieved a standard of &lt; 50%.

Conclusions
There are certain parameters that need improvement to achieve a standard of 100%. Actions have been taken to raise awareness of the essential requirements of operation notes, to facilitate compliance to the guidelines as well as reminders to ensure adherence to the process. This will further improve the quality of the operation notes. A re-audit subsequent to these above measures will furnish us with more information.
520 The role of abdominal drains in Laparoscopic Appendicectomy: a prospective study of 260 patients
Authors: Hume Grace , Burford Charlotte , Shah Ankur 
Published: August 2023

Abstract

Aims
Guidance regarding the use of antibiotics and drains following laparoscopic appendicectomy remains unclear. We aim to describe current practice at our unit with the view to forming a local guideline.

Method
A prospective review of all adult patients undergoing laparoscopic appendicectomy at our unit between July 2021-July 2022 was performed. Data was collected from electronic patient records and theatre software, including patient demographics, blood and imaging results and drain and antibiotic details where applicable.

Results
260 patients underwent laparoscopic appendicectomy (53.1% female) with a median age of 38 years (IQR 30.75). 87.7% were positive for appendicitis on histology.11.2% were discharged within 23 hours from admission. The median length of stay was 2 days (IQR 2). 70.7% received postoperative antibiotics with a median duration of 5 days. 25.4% had a drain inserted and had a significantly longer inpatient stay (3 vs 2 days, p&lt;0.001). Those with drains had a higher median CRP compared to those who did not (137 vs 38, p=&lt;0.001) and this association remained significant on multivariate analysis when controlling for white blood cell count and lactate (p&lt;0.001). Patients who had post-operative antibiotics or a drain were not more likely to re-present following discharge (p=0.586 and p=0.169 respectively).

Conclusions
In our cohort drains did not reduce likelihood of complications but increased length of time in hospital. Further research is needed to identify specific patients, if any, who would benefit from drain use.
557 Laparoscopic versus robotic cholecystectomy: a meta-analysis to differentiate between postoperative outcomes
Authors: Singh Anurag , Kaur Mandeep , Swaminathan Christi , Sains Parv , Singh Krishna , Shafique Muhammad 
Published: August 2023

Abstract

Objective
Robotic cholecystectomy (RC) may be an option to replace conventional laparoscopic
cholecystectomy (LC) due to several reported advantages. The objective of this study is to compare the postoperative surgical outcomes in patients undergoing RC versus LC.

Materials and methods
RCTs reporting postoperative outcomes in patients undergoing RC versus LC were selected from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5.

Results
Two RCTs on 196 (113 patients in RC group and 83 patients in LC group) patients were found suitable for meta-analysis according to the inclusion criteria. In the random effects model analysis, the duration of operation [standardised mean difference -15.83, 95%, CI (-22.99, -8.67), Z = 4.33, p &lt; 0.0001] was shorter in the LC group. However, the risk of bile leak [standardised mean difference 3.15, 95%, CI (0.69, 14.44), Z = 1.48, p = 0.14] and postoperative complications [standardised mean difference -0.48, 95%, CI (0.10, 2.33), Z =0.91, p = 0.36] were statistically similar between RC and LC groups. There was no heterogeneity (Tau 2 = 0.09; Chi 2 = 1.06, df = 1; (p = 0.30; I 2 = 6 %) between included RCTs.

Conclusion
RC failed to prove any clinical advantage over LC for postoperative outcomes including longer duration of operation. These findings are insufficient to draw a stronger conclusion due to the paucity of RTCs and a major multicentre RCT is required to strengthen the existing evidence.
563 Retrospective analysis of the role of intravenous fluids in the prevention of Post-ECRP pancreatitis
Authors: Johnston Magnus , Apollos J , Dhaif A , Alexander L 
Published: August 2023

Abstract

Background
Recent guidelines from the American Society for Gastrointestinal Endoscopy (ASGE) recommend the ‘conditional’ use of intravenous fluids in prevention of those at moderate to high risk of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis.
The aim of this study was to appraises the rates of post-ERCP pancreatitis following the administration of procedural and post procedural ERCP intravenous fluids (Hartmans) within a years period in a large district general hospital.

Conclusion
Intravenous fluids may have benefit in reduction of post-ERCP pancreatitis rates however further study is required. On balance, given the relative potential benefit vs harm, cost effectiveness and feasibility we would recommend the routine use of procedural and post procedural ERCP intravenous fluids.
566 The compliance of the surgical unit with regards to the NICE guideline recommendation for extended VTE for post-operative colorectal cancer patients in both elective and emergency settings
Authors: Elwes Caitlin , Arun Chokkalingam , Oyewole Bankole 
Published: August 2023

Abstract

Aims
This audit assessed the compliance of the surgical unit with regards to the NICE guideline recommendation for extended VTE for post-operative colorectal cancer patients in both elective and emergency settings. The audit reviewed the various factors for non-compliance and posits action plans to improve compliance.

Methods
Data was collected over a 3 month period for all consecutive elective and emergency colorectal cancer resections. The operation notes, discharge summaries, drug charts and clinical notes were reviewed and data collated and analyzed with the Microsoft Excel application.

Results
30 cases met the inclusion criteria, 25 elective and 5 emergencies. Within 24 hours of admission, only 47% of all cases were prescribed mechanical prophylaxis but 93% prescribed pharmacological. Whilst 70% of cases had VTE prophylaxis written in operation notes, only 10% of these stated the 28 day extended VTE requirement. Cases that had received the recommended 28 day extended VTE post operatively was found to be 83% with 17% of cases receiving fewer than 28 days post operatively.

Conclusions
The deficits found in this study could be due to a number of factors that include but are not limited to lack of education of post operative VTE requirements for colorectal cancer, lack of clear documentation of requirements and incorrect prescribing at admission and discharge.
595 Audit of IV fluids prescription and administration on adult surgical in-patients
Authors: Babiker Mohammed , Garnett Joseph , Dawson Angus , Hassoun Omar , Jones Keira , Apollos Jeyakumar , Johnston Magnus 
Published: August 2023

Abstract

Aim
Is to measure the conformity of the practice with the guidelines issued by NICE (National Institute for Health and Care Excellence), GIFTASUP (Guidance on Intravenous Fluid Therapy for Adult Surgical Patients) and the local hospital policies.

Methods
NICE guidelines and GIFTASUP recommendations were reviewed. Data collected from medical records of 40 in-patients on surgical wards. The records with incomplete information were excluded from the analysis. The data was then analyzed using Excel sheets, and the results were reviewed and compared against the guidelines mentioned above. The variables measured during the audit were the level of prescriber, indications, type of fluid, rate of administration, pre-checking of U/Es, and complications.

Results
The results showed that the majority of the IV fluids were prescribed by FY1s (40%) and ANPs (20%). The majority of the prescriptions were for maintenance purposes (63%). The most commonly used fluid was 0.18% NaCL/4% Dextrose (35%) followed by Hartmann's (30%). The most common rate of administration was 150ml/hr (35%) and only 10% of the U/Es were pre-checked. The commonest complication recorded was hypo-natraemia (15%), followed by hypo-kalaemia (5%) and total 25% of patients suffered complications.

Conclusion
The audit revealed that there were issues with documentation, type of fluids used and the rate of administration and complications. These findings can be used to improve the practice of IV fluid prescription and administration, ensuring that it is in line with the guidelines and policies, resulting in better patient outcomes.
600 Longer than expected stay in elective general surgical patients - understanding the dynamics
Authors: Arifuzaman Mohammed , Bhattacharya Sayan , Hammad Ahmed 
Published: August 2023

Abstract

Aims
To find the number of patients listed as elective day case or elective inpatient in general surgical department. To understand the dynamics of the day case surgeries and the predictors of lengthy stay.

Methods
Retrospective analysis of all the elective patients listed in general surgery from December 2021 to May 2022. The age, sex, list number of the patient in the theatre list, surgical time, anaesthetic time and ASA grade were compared against the length of stay. A total of 181 patient studied. Type of surgery listed and reason for longer stay collected from the evolve notes of the patients. Elective surgical patients were included and emergencies excluded. Statistical analysis done on StatsDirect 3.

Results
A total of 181 patients studied and 163 (90 %) were listed as day case (DC) and 18 (10%) as inpatient (IP). Median post-op day (POD) discharge for IP was 1 and DC was 0. Median age for IP was 57.5 years and DC was 49 years. Median surgical time was 85.5 minutes for IP and 72 minutes for DC. Median anaesthetic time was 34.5 minutes for IP and 31 minutes for DC.

Discussions
Overnight observation is the most common reason for the patients to stay in longer seen in 71.4 % patients. Late presentation to ward is the second most common reason, seen in 25 % patients. Median POD discharge for patients with overnight observation and drain is 2. Patients with documented overnight observation + drain + weekend results in POD 4 discharge. Drain – median POD 2 (min 1 max 12). NG – median POD 5 (min 2 max 6).
626 To assess the appropriateness of colonoscopy in patients below the age of 60 in a District General Hospital
Authors: Zaidi Syed , Zaidi Abbas 
Published: August 2023

Abstract

Aim
To assess the indications of colonoscopy on the basis of symptoms in patients below the age of 60 using Epage 2 guidelines. Correlate them with colonoscopic and pathologic findings to determine the appropriateness to improve patient selection in district general hospital.

Methods
This is a retrospective study including 296 patients below the age of 60. They were referred from Gastroenterology and Surgical department. Data includes age, sex, indications, colonoscopic and pathologic findings. The Epage 2 online guidelines were used.

Results
43% of patients were male and 57% were female. The most indication for colonoscopy was abdominal pain and bleeding PR (20% each) and diarrhoea (19.6%). Colitis was found in only 14.9%, with diverticulosis 11%, polyp 4% and haemorrhoidal disease 6%. Using the EPAG 2 Criteria 80.5% were appropriate indications, 12.5% were uncertain and only 7% were inappropriate indications.

Conclusion
This study confirmed that the majority of indications for colonoscopy were appropriate. Cancer was only found in 2% of patients and majority of the colonoscopy findings were normal. The most common diagnosis in this age group was colitis (14.5%).
634 Dehisced Functioning Stoma Healed with Novel use of Negative Pressure Wound Therapy
Authors: O'Malley Paula , Shields Conor 
Published: August 2023

Abstract

Background
Three years following bowel resection and colostomy formation for colorectal cancer a 62 year old man developed a parastomal hernia. On Day11 following laparoscopic repair and stoma formation the midline and stoma wounds dehisced. The stoma had a superficial wound extending 1cm but the lateral edge of this wound had a cavity 4x5x10cm. This wound presented challenges regarding the adherence of both dressings and the stoma bag.

Aim
During an exploration under anaesthesia, no purulent fluid or mesh was located in the cavity. Initially dressed with betadine wick and a JVAC drain, however, the moisture led to repeated stoma bag detachment and leakage of faeces into the wound.

Method
Consequently, to speed up healing and contain the faeces, negative pressure wound therapy (NPWT) was used around the stoma. The peristomal area was dressed with hydrofibre and hydrocolloid to provide a base, the cavity with polyvinyl alcohol foam, the stoma protected with Fistula Funnel (3M, San Antonio, Texas) and polyurethane granufoam applied around the wound with a pressure of -150mmHg. Following application of the NPWT a hole was cut to allow stoma contents to be evacuated and a stoma bag applied.

Result
Within three weeks the cavity was 3x4x1cm and NPWT discontinued.

Conclusion
The use of NPWT is contraindicated over exposed organs and the need for an occlusive dressing presents active outflow of contents. However the use of a soft, flexible silicone funnel allowed a complex wound to be healed in weeks, when conventional treatment wound have taken months.
Executive decision-makers: a scenario-based approach to assessing organizational cyber-risk perception
Authors: Parkin Simon , Kuhn Kristen , Shaikh Siraj A 
Published: August 2023

Abstract
The executive leadership in corporate organizations is increasingly challenged with managing cyber-risks, as an important part of wider business risk management. Cyber-risks are complex, with the threat landscape evolving, including digital infrastructure issues such as trust in networked supply chains, and emerging technologies. Moreover, engaging organizational leadership to assess for risk management is also difficult. This paper reports on a scenario-driven, workshop-based study undertaken with executive leadership to assess for cybersecurity and cyber-risk perception related to preparation for, and response to, potential incidents. The study involves leadership members at a large public–private organization. Our approach utilizes scenarios, which are structured in their design to explore and analyse aspects of business risk, risk ownership, technological complexity, and uncertainty faced by an organizational leadership. The method offers a means to engage with leadership at real-world organizations, capturing capacity and insights to manage business risks due to cyberattacks.