bluuebunny/crossref_metadata_2025_split huggingface dataset:
1044 Feasibility of Anterior Abdominal Wall Hernia (Excluding Groin Hernia) Repair Under Local Anaesthetic
Authors: Naseer A , Elkorety M , Tan J , Rajput A , Bhatti T 
Published: August 2023

Abstract

Aim
Abdominal wall herniae (AWH) are usually performed under general anaesthetic, with limited literature on repair under local anaesthetic (LA). Local anaesthetic procedures may require higher surgical expertise which may compromise learning opportunities for trainees. We aim to explore the feasibility of performing AWH repairs under LA by evaluating patient satisfaction, impact on training opportunities and resource implications.

Method
Consecutive patients were counselled for AWH repair under LA and informed consent was obtained, with no exclusions based on BMI, type and size of the hernia. Surgery was performed by a trainee under supervision or a consultant. Ease of agreement to have surgery under LA, apprehension, pain and overall satisfaction with the procedure were assessed using a five-point Likert scale. Procedure duration and time to discharge were compared with the conventional general anesthetic procedures within the unit.

Results
Twenty patients underwent day-case AWH repair under LA. All patients agreed to surgery under LA. Nineteen (95%) patients reported no pain or apprehension during the procedure. Eighteen (90%) were happy or satisfied with the overall experience. Sixteen (80%) procedures were performed by a trainee. There was a median of 23 minutes less for theatre time and 62 min less for recovery time with LA. No postoperative problems were reported.

Conclusions
It is feasible to treat majority of abdominal wall herniae under LA, with high overall patient satisfaction, without compromising training opportunities. There are potential cost-savings by reduced theatre and recovery time utilization.
970 A Parisian Pain in the Groin; a Case of De Garengeot’s Hernia
Authors: Crompton R , McGuigan A , Neill A 
Published: August 2023

Abstract

Introduction
77-year-old gentleman presented with a four-day history of a painful right sided irreducible groin swelling. Background of previous bilateral mesh inguinal hernia repair thirty years prior. Differential diagnosis- recurrent incarcerated inguinal hernia.

Description
Emergency presentation with a painful right sided groin lump with history of previous inguinal hernia repair. Past medical history of AF on rivaroxaban, HTN and BPH. Patient systemically well with an irreducible lump in the right groin. CTAP showed recurrence of hernia in right inguinal region containing fat stranding and a 2cm-sized fluid-filled structure (suspected appendix). Taken to theatre the following day - oblique incision in right groin. Obvious femoral hernia identified. Haemorrhagic fluid and a necrotic appendix contained in hernia sac. Open appendicectomy performed through groin incision and femoral canal plicated using 2.0 prolene. No mesh used due to risk of contamination. Discharged day 2 post-op. Pathology confirmed acute appendicitis.

Discussion
Extremely rare case presentation. Femoral hernias account for 3% of all hernias and De Garengeot hernias only 1% of all femoral hernias. Furthermore, De Garengeot hernia with acute appendicitis accounts for only 0.01% of femoral hernias and are much more common in females than males with a 4:1 ratio. Femoral hernias are fifteen times more common in patients who have undergone previous inguinal hernia repair with 33% of men and 4% of women with De Garengeot hernia having undergone previous right inguinal hernia repair. Difficult pre-operative diagnosis given rarity with only 30% of cases diagnosed on pre-operative imaging-initial diagnosis Amyand hernia on CT imaging.
559 Hybrid Anatomy Teaching Sessions: A New Normal?
Authors: Nelson-Rowe E , Baskaran R , Mahesh S 
Published: August 2023

Abstract

Aim
To evaluate the synchronous provision of hybrid teaching for a near-peer surgical anatomy teaching programme.

Method
A monthly hybrid anatomy teaching programme was delivered with an attendee choice of either online via Zoom or in-person in a lecture theatre. The teaching, delivered by clinical medical students, covered core regional anatomy with clinical surgical relevance. Attendees provided anonymous feedback via a post-session questionnaire which contained five likert-scale questions and one open-ended question to explore the attendees’ preference and reasoning for their attendance choice. The data was analysed using Microsoft Excel.

Results
A total of 45 participants attended in-person and 90 participants online across four teaching sessions. Majority of the participants were pre-clinical medical students. Likert scale analysis showed that ∼88% of participants found the session content helpful in addition to an increase in subject confidence by ∼25% across all sessions. Thematic analysis demonstrates in-person sessions as being more sociable, interactive with the ease to ask questions and pay attention, plus appreciation of provided refreshments. Online sessions are shown to be more convenient and practically accessible to students. The strongest theme highlighted was the ability to choose whether to attend in-person or online.

Conclusions
A mixed-model approach to surgical anatomy teaching serves to be beneficial to students. While both in-person and online teaching have their merits, the ability to choose between the two serves as the strongest factor among students in attending teaching. Future teaching sessions should be conducted with a mixed-model approach with added in-person incentives for students.
4 A Quantitative Image Analysis Study of Modified Kessler Extensor Repair
Authors: Kathiravelupillai A , Smith C , Pearl R 
Published: August 2023

Abstract

Aim
The aims of this study were to compare and measure the amount of 4.0 Prolene suture material at the tendon repair site with 2 types of knot placement in a modified Kessler technique, as placement of suture knot can impact extensor tendon healing.

Method
Thirty-two extensor tendons of 2 fresh frozen cadaveric hands were divided and repaired using the modified Kessler technique with either intratendinous or extratendinous knot placement of a 4.0 Prolene suture. Tendon repairs were sectioned, and cross-sectional photographs were analysed using quantitative image analysis.

Results
Comparison of percentage change in tendon dimension surface area showed no significant difference (p = 0.4750) between intratendinous and extratendinous knot placement to demonstrate consistency of repair. Quantitative image analysis revealed suture material occupied a significantly (p = 0.0103) larger percentage of tendon cross sectional area in intratendinous than extratendinous knot placement. In both groups this represented &lt;10% of the total cross-sectional area of the tendon at the repair site (7.49% vs 2.92%). There was no significant relation between digit, tendon or repair zone and percentage of repair zone occupied by suture material.

Conclusions
Intratendinous knot placement occupies a larger proportion of tendon cross sectional area than extratendinous knot placement, though this is still comparatively small when a 4’0 monofilament suture is used.
23 Pancreatoduodenectomy for Malignancy: Which Patients Are High-Risk?
Authors: Russell T , Labib P ,   RAW Study Collaborators, Aroori S 
Published: August 2023

Abstract

Aim
In the absence of metastases, pancreatoduodenectomy (PD) is indicated in fit patients with a resectable pancreatic head/periampullary cancer. Surgeons should have a sound understanding of its complication profile for consenting purposes and to benchmark their complication rates. This study aimed to calculate the overall incidence of PD complications and identify risk factors.

Method
A multicentre retrospective cohort study of PD patients with confirmed malignancy was conducted (29 centres from 8 countries). The incidence and severity of all recorded complications was calculated. Patients who experienced any complication, major morbidity, clinically relevant postoperative pancreatic fistula (CR-POPF), post-pancreatectomy haemorrhage (PPH) and 90-day mortality were compared to those who did not experience these outcomes.

Results
In the 1348 included patients, overall morbidity and 90-day mortality were 53% and 4%, respectively. In total, 1340 complications were recorded; 72%, 18%, 6% and 4% of these were Clavien-Dindo (CD) grades I-II, III, IV and V, respectively. CR-POPF, PPH, chyle leak, bile leak and gastro-jejunal leak affected 8%, 6%, 4%, 3% and 2% of patients, respectively. Following a multivariable analysis, high body mass index (BMI, p = 0.007), American Society of Anesthesiologists (ASA) grade &gt;II (p&lt;0.0001) and a pylorus-resecting approach (p = 0.005) correlated with overall morbidity. In addition, ASA grade &gt;II patients were at increased risk of major morbidity (p&lt;0.0001) and a raised BMI correlated with CR-POPF (p = 0.001).

Conclusions
In our study, over 50% of PD patients experienced morbidity. However, most complications were CD grade I-II. High BMI, ASA grade &gt;II and a pylorus-resecting approach were all associated with the studied adverse outcomes.
162 Utilisation of Dissections vs Prosections in Anatomical Education and Its Relevance in Pursuing Surgical Training: A Comparative Study on Students' Perspectives at a Northern Irish Medical School
Authors: Roy S , Ahluwalia A , Shah M H 
Published: August 2023

Abstract

Aim
This study investigates medical students’ opinions regarding their memorisation, retention and implementation of anatomical learning by comparing prosection and dissection studies offered at the university. Furthermore, we also investigated its significance in students considering the surgical training pathway in the future.

Method
Medical students at QUB were sent a 10-item survey weighing their preference for dissection and prosection in the retention and application of anatomical knowledge along with its relevance in pursuing surgery. The survey was distributed amongst Year 1 - 5 medical students in an online format, with answers recorded over the span of two weeks.

Results
26 QUB medical students across preclinical/clinical years answered the survey, 53.85% of whom preferred dissections for identification, memorisation and employment of information regarding anatomical structures. Students who chose dissection agreed that the process offered more interaction, with deeper knowledge about spatial organ recognition. Meanwhile, prosections were chosen by students who believed focusing on isolated organs helped in mapping their knowledge to relevant learning outcomes.
Moreover, 42.11% of respondents found both learning methods helped visualise anatomical concepts outside a medical environment. However, dissection helped most students draw links between pathology and its anatomical basis. Finally, 84.21% considered dissection to play a major role in viewing surgery as a future career.

Conclusions
While there is an observable difference in respondents' perspectives, the survey indicates an overall preference for dissection in anatomical lab practices. The practice appealed to students better due to its greater interactive experience and tactile approach, with respondents agreeing that dissection mimics true surgical craftsmanship.
641 Impact of Frailty on Patient Outcomes After Cardiac Surgery: An Updated Systematic Review and Meta-Analysis
Authors: Elhadi M , Faraj H , Khaled A , Khaled A , BenGhatnsh A , Msherghi A 
Published: August 2023

Abstract

Aim
To determine the impact of frailty on patient outcomes after undergoing cardiac surgery.

Method
An analysis of frail versus non-frail patients who had undergone cardiac surgery was conducted using data from Pubmed/Medline, EMBASE, Cochrane, Web of Science, Scopus, and grey literature, all searched in April 2022. The primary outcomes of early postoperative mortality and major adverse cardiovascular events (MACE) were examined, as well as secondary outcomes, including long-term mortality and complications. Data were analyzed using R version 4.0.3.

Results
A total of 22 studies, including 102,323 frail and 2,187,814 non-frail patients, were included in the analysis. Frailty was found to be significantly associated with higher early mortality (RR: 2.93; 95% CI, 2.19–3.93; P &lt; 0.01; I2 = 17.2%) and MACE (RR: 2.07; 95% CI, 1.21–3.55; P = 0.03; I2 = 22.9%) compared to non-frail patients. Frailty was also associated with a higher risk of acute kidney injury and renal impairment (RR: 3.67; 95% CI, 2.85–4.73; P = 0.03; I2 = 3.9%). In the long term, a higher mortality rate was observed in frail patients (RR: 2.93; 95% CI, 1.69–5.07; P = 0.02; I2 = 22.4%). However, no significant differences were found in pneumonia, respiratory complications, sepsis, or reoperation rates between frail and non-frail patients.

Conclusions
Frailty is associated with higher mortality and MACE in patients undergoing cardiac surgery and a higher risk of acute kidney injury. Frailty should be considered an important factor in preoperative risk assessment and perioperative care for these patients.
999 The Incidence of Foetal Scoliosis and the Chances of Successful Delivery
Authors: Saha P , Walter S , Barkham B , Ajayi B , Lui D 
Published: August 2023

Abstract

Aim
Foetal scoliosis can be detected on antenatal ultrasound and may be associated with other spinal abnormalities such as hemivertebrae. Little is known regarding its incidence and implications.

Method
The computerised foetal medicine ultrasound database at a tertiary hospital was retrospectively analysed using the search terms “spine” and “scoliosis”, between 1997 and 2021. The reports were manually reviewed, and patients removed that showed no abnormalities. Demographics of the mother, pregnancy and outcome data were collated.

Results
During the 24-year study period, 600,000 antenatal ultrasound scans were available. A duplicate rate was calculated, resulting in a total population of 378,000 foetuses. Initial results yielded 195 scans, and after removal of duplicates and manual checking of reports, there were 123 cases of confirmed spinal deformities, with an incidence of approximately 0.33 per 1000 foetuses (1 in 3000). Of the 123, there were 59 (48%) that reached term and 64 (52%) which did not. Of those that survived to term, 36/59 (61%) had normal development and no other concerns. The remaining patients had other non-fatal abnormalities, including VACTERL association in 5 cases (8.4%). Of those that did not survive, only one patient did not have other significant abnormalities. In most cases, there were multiple significant abnormalities, and the decision was taken for termination of pregnancy (52 cases, 81%).

Conclusions
This study represents the largest database review of antenatal scans for spinal abnormalities. The incidence of foetal spinal deformity is approximately 1 in 3000, and prognosis is generally determined by the presence of other significant abnormalities.
81 Audit of Use of Oakland Score on Patients Presenting with PR Bleeding and Effect on Admissions with Retrospective Application
Authors: Todd J , Wilkin R 
Published: August 2023

Abstract

Aim
To audit use of the validated Oakland Score for safe discharge of patients presenting to ED with PR bleeding and assess the effect of the Score on patient admissions.

Method
Retrospective audit of patients presenting to ED with PR bleeding between 1 Jan 22 - 30 Jun 22. Notes were reviewed and Oakland Score calculated. Threshold discharge scores of 8 and 10 were used to determine the effect on admission numbers. 88 patient notes were reviewed, 75 were included.

Results
0/72 patients had an Oakland Score on initial clerking. Retrospective application of the Oakland Score with a threshold of 8 would have increased admissions by 20/37 (54%). An admission threshold of 10 would have increased admissions by 3/37 (8.1%).
A threshold score of 8 suggests 27/37 patients were inappropriately discharged (73%) and 7/38 (18%) could have been safely discharged rather than admitted. 41/75 (55%) were admitted or discharged correctly.
A threshold score of 10 suggests 18/37 patients (47%) were inappropriately discharged and that 15/38 (39%) could have been safely discharged rather than admitted. 42/75 (56%) were admitted or discharged correctly.

Conclusions
PR bleeding represents a significant number of patients presenting acutely to general surgery. Discharge and admission of patients presenting with PR bleeding is inconsistent and subjective. Introduction of the Oakland Score would provide objective criteria for safe discharge and appropriate admission. An admission threshold of 10 has a 91% confidence in safe discharge and would not result in a large increase in admissions of otherwise healthy patients.
232 Skin Cancer Histopathology Requests Within a Plastic Surgery Service
Authors: Stark D , Hendrickson S 
Published: August 2023

Abstract

Aim
To ascertain whether plastic surgeons include adequate information on skin cancer histopathology request forms to aid accurate and timely histopathological diagnosis.

Method
We completed a prospective closed loop audit on histopathology request documentation at a single centre over two two-week periods. The standards were agreed following multi-disciplinary discussion (dermatology, plastic surgery, and pathology) and based on the Royal College of Pathology dataset. Mandatory information was differentiated from desirable information. A poster intervention was introduced that illustrated the guidance. Inclusion criteria consisted of excision biopsies and wide local excisions performed under local anaesthetic in minor operating rooms.

Results
Pre-intervention data included 45 lesions excised from 33 patients. A description of the lesion was documented in 26%, provisional diagnosis in 91%, lesion progression in 11%, surgical margins at the periphery in 56%, margins at deep in 16% and relevant past medical history (previous chronic lymphocytic leukaemia diagnosis and previous radiotherapy on that site) in 9%.
Post-intervention data included 45 lesions from 40 patients. There was improved compliance with all standards. A description of the lesion was documented in 76%, provisional diagnosis in 98%, lesion progression in 33%, margins at the periphery in 78%, margins at deep in 38% and relevant past medical history in 29%. Site and laterality were documented in all patients in both cohorts.

Conclusions
We observed improved documentation following a simple educational intervention. Further studies should aim to understand the impact this has on laboratory turnaround times, and further improve adherence to agreed guidance by incorporating mandatory fields in the request form.
286 Two-Cycle Audit on Post-Tonsillectomy Analgesia
Authors: Thamer M , Soltan I , Ojha S , Sinclair T , Saunders M , Gaskin J 
Published: August 2023

Abstract

Objective
To assess whether children undergoing tonsillectomy were receiving adequate analgesia postoperatively and comparison made against national standards. Implementation of new ibuprofen dosage guidance, reducing opioid prescribing, and assessment of whether this impacts re-admission rates for post tonsillectomy pain and bleeding.

Method
Retrospective audit of tonsillectomies performed over a 5-month period in 2021 and prospective audit over the same time period in 2022, with new ibuprofen prescribing guidelines (7.5mg/kg QDS compared with 5mg/kg TDS previously) and effect on reduced opioid prescribing.

Results
There were approximately 110 tonsillectomies performed in each cycle. For the first retrospective cycle, 95% were prescribed inadequate ibuprofen, with a mean dose of 5.5mg/kg. All patients who were readmitted with pain/haemorrhage had ibuprofen prescribed at a TDS frequency. There were 6% of cases presenting with bleeding, none returned to theatre. Coblation was used in about 40% of cases (extracapsular and intracapsular). For the second prospective cycle, 55% of patients have been prescribed the correct ibuprofen dosage of 7.5mg/kg QDS, with reduced opioid prescribing. No patients were re-admitted with post-operative pain and only a low number of patients presented with post-tonsillectomy bleeds.

Conclusions
Changing the dosing of ibuprofen to 7.5mg/kg QDS and ensuring departmental consistency has resulted in adequate analgesia dosing with no admissions for poorly controlled pain post-tonsillectomy. We feel a secondary impact is on reduced bleeding rates.
369 Should We Be Group and Save Testing for Laparoscopic General Surgical Procedures? a Retrospective Audit of Transfusion Rates at a District General Hospital
Authors: Atkins W , Ibrahim A , Dighe S 
Published: August 2023

Abstract

Introduction
The risk of bleeding in surgery makes the requirement for transfusion a pertinent consideration for all clinical staff involved in the care of surgical patients. Group and save testing allow for appropriate blood to be dispensed, but each Group and Save sample costs approximately £20 per sample and 116g of CO2 per test.
Historically the reported transfusion rate for laparoscopic surgery has been low. This audit aimed to ascertain the overall transfusion rate in laparoscopic surgery at a District General Hospital and use the data to inform practice regarding group and save requirements before surgery.

Method
A retrospective audit was undertaken incorporating all elective and emergency laparoscopic procedures undertaken at one trust between January 2020 and October 2021. Colorectal and Gynaecological procedures were excluded. Analysis was then undertaken with records from clinical coding and the hospital blood bank to determine how many patients received transfusion intra-operatively or within 72 hours of their procedure.

Results
1794 laparoscopic procedures were included in the data set. Procedures included were laparoscopic cholecystectomy, laparoscopic appendicectomy, diagnostic laparoscopy, and laparoscopic hernia repair. Of these procedures 93.8% were performed on adults. Following analysis, 2 patients in the data set were found to have received transfusion within 72 hours of their procedure (0.11%).

Conclusions
The low transfusion rate in this study is comparable to other rates reported in the literature. This resulted in a local change in trust policy for elective and emergency laparoscopic surgery, reducing or eliminating the group and save requirement for most procedures.
414 Has Routine Purulent Peritoneal Fluid Aspirate Culture Results During Appendicectomy Helped in Patients’ Management?
Authors: Kalu U A , Walshaw J , Ravi V , Yassin S , Eltom M , Jayawardane G 
Published: August 2023

Abstract

Background
Intra-operative purulent peritoneal fluid aspirate for microscopy, culture and sensitivity during appendicectomy is routinely practiced aiding post-operative management of patients if the patients get unwell requiring a change of the prescribed pre-operative antibiotics. As at the time of this audit, there was no guideline in the NHS regarding the routine purulent peritoneal aspirate for culture during appendicectomy. This necessitated the need to carry out this audit.

Aim
To evaluate if there is/ are benefit(s) from the routine purulent peritoneal fluid aspirate culture results during appendicectomy.

Method
This was a retrospective review of medical records with operation notes of all the patients who had appendicectomy with purulent peritoneal fluid that were aspirated for microscopy culture and sensitivity in the last 3 years (May 2019 to April 2022). The data were analysed using SPSS version 22.

Results
There were 127 patients that had appendicectomy and 73 (57.5%) patients had purulent peritoneal fluid culture results. Seventy-one (71.2%) of the patients had positive culture result from the purulent peritoneal fluid while there was no growth in the culture result in 28.8% of the remaining patients. Re-operation and ultrasound drainage were avoided in 13 patients out of 17 patients with post-operative intra-abdominal collections due to the change of the pre-operative antibiotics following the routine peritoneal fluid culture results.

Conclusions
The routine purulent peritoneal fluid culture results during appendicectomy was beneficial in 28.8% of the patients that required change of the pre-operative antibiotics due to the culture results.