bluuebunny/crossref_metadata_2025_split huggingface dataset:
1229 Spontaneous Heterotopic Pregnancy Resulting in Tubal Rupture and Complete Spontaneous Abortion: A Case Report in Tiko, Cameroon
Authors: Takoutsing B D 
Published: August 2023

Abstract

Aim
To present a case report of the management and early outcome of a first-trimester spontaneous heterotopic pregnancy (HP) in a low-resource setting.

Method
This piece of work has been reported according to the Surgical CAse REport guidelines.

Results
A 24years old G2P0010 at 11 weeks of gestation with a history of one induced abortion and a family history of twin pregnancies presented with an acute abdomen, associated with vaginal spotting in an afebrile context. Recurrence of the vaginal spotting and increase in the severity of the abdominal pain prompted an obstetrical ultrasound which showed retained products of conception, as well as the presence of a left adnexal mass suggestive of an extrauterine gestational sac at approximately 6 weeks of gestation. There was spontaneous expulsion of retained products of conception. The deterioration of the haemodynamic stability of the patient prompted an emergency laparotomy to be done after a repeat ultrasound suggestive of a ruptured left ectopic pregnancy (EP), and optimisation of the patient. Evacuation of 700ml of dark red haemoperitoneum and salpingectomy was done. The patient was transfused, post-salpingectomy counselling done and was discharged on oral analgesics, blood tonics and antibiotics on day 6 Post–operation.

Conclusions
HP should be suspected in first trimester bleedings especially if associated with an acute abdomen. An ultrasound should be performed on all patients presenting with clinical manifestations of abortion to help in the early diagnosis and treatment of a concurrent EP. Laparotomy is relatively safe in the context of abortion and shock secondary to haemoperitoneum.
1280 Novel Technique of Assessing Intestinal Mucosa in Acute Mesenteric Ischaemia Using a Paediatric Colonoscope
Authors: Harris Y , Hamilton D , Shalli K 
Published: August 2023

Abstract
Acute Mesenteric Ischaemia (AMI) is a surgical emergency associated with a high morbidity and mortality. Treatment of AMI varies from conservative measures to interventional such as embolectomy or laparotomy and the resection of non-viable bowel. Management is primarily guided by computed tomography findings which, though useful, is limited in the accurate assessment of viable bowel.
This case report describes the novel technique of using a paediatric colonoscope to assess intestinal mucosa in a 56-year-old female with AMI. This technique provided a further investigation that allowed for endoscopic mucosal assessment in a young patient with catastrophic AMI on computed tomography. In this case, this allowed for the accurate visualisation of length of viable bowel, thereby guiding further management as to whether laparotomy and bowel resection would be successful in this cohort of patients.
1300 An Unusual Presentation of Gastric GIST With Double Duct Sign
Authors: Chang L M Y , Wilkins A , Brown A , Mitton D 
Published: August 2023

Abstract

Background
Gastrointestinal Stromal Tumour (GIST) most commonly arises from the stomach or small intestine, and commonly presents with mass effect or gastrointestinal bleeding. In this unusual case, imaging demonstrated a double duct sign prompting pancreatic MDT referral.

Case Presentation
A 65-year-old gentleman with a background of rheumatoid arthritis and COPD reported a 2-month history of anorexia and one stone weight loss during a rheumatology clinic follow-up. He was found to be anaemic but markers for his rheumatoid arthritis showed the disease was well controlled and imaging was performed to exclude malignancy. CT Thorax, Abdomen and Pelvis revealed a double duct sign with lung opacification, suggesting pancreatic cancer with lung metastasis. He was immediately referred to the pancreatic Multi-Disciplinary Team and underwent an Endoscopic Ultrasound which showed a 12cm cyst extending from the pelvis to the gastric body. Biopsy confirmed that this large thick-walled cyst was a Gastrointestinal Tumour (GIST). Staging PET scan was negative for metastatic disease. He underwent a laparotomy and GIST excision with a cuff of normal stomach removed. Post-operatively, his recovery was prolonged due to exacerbation of his COPD however he eventually recovered well and was discharged on day 11. There were no other post operative complications.

Conclusions
GIST are rare tumours, making up less than 1% of all gastrointestinal tumour. Patients with GISTs that are primary and localised can achieve a curative outcome through surgery alone. The prognosis of GIST tumours is favourable, with 5-year survival rates at 83%. This case demonstrates the value of pre-operative endoscopic ultrasound.
77 Malignancy Incidence in the Residual Rectum of Ibd Patients After Colectomy: Systematic Review and Meta-Analysis
Authors: Georganta I , McIntosh S , Boldovjakova D , Parnaby C , Ramsay G 
Published: August 2023

Abstract

Aim
The primary objective of this study is to estimate the incidence of rectal carcinoma in patients with an Inflammatory Bowel Disease diagnosis, who have had a total colectomy preserving the rectum. The secondary objectives are to identify the risk factors associated with malignancy occurrence and to explore the current recommendations for screening processes for these patients.

Method
A systematic review in 5 databases was conducted to identify studies adhering to the PICO criteria. The included studies were critically appraised, and the relevant data was extracted. Malignancy incidence was estimated from the reported information and risk stratification was analysed using RevMan. A narrative approach was undertaken for the exploration of the existing screening guidelines.

Results
A total of 24 studies were included. The pooled incidence of rectal carcinoma across 23 studies was calculated to be 1.3%. Subgroup analysis showed an incidence of 0.7% and 3.2% for patients with a rectal stump and ileo-rectal anastomosis respectively. Patients with a history of a colorectal carcinoma were more likely to have a subsequent diagnosis of rectal carcinoma (RR 7.2), similarly to patients with a history of colorectal dysplasia (RR 5.1). Ten studies reported frequent surveillance using endoscopy and rectal biopsies. No studies recommending screening guidelines for the target population could be identified.

Conclusions
The overall risk for malignancy incidence was estimated to be 1.3% which is lower than previously quoted. Due to the paucity of good quality of literature in this field, it is not possible to suggest further guidance for this cohort of patients at present.
205 Single-Centre Review on Incisional Hernia After Laparoscopic Anterior Resection: What Is the Ideal Incision for Specimen Extraction?
Authors: Win M , Htet W , Ngo V , Jeyam T , Rajaganeshan R 
Published: August 2023

Abstract

Aim
Midline incision was reported as the common site of incisional hernia (IH) after hand-assisted laparoscopic anterior resection (LAR). There is no consensus on the ideal site for specimen extraction. Our aim was to compare the rate of IH at various specimen extraction sites at our institution.

Method
We retrospectively reviewed data of 90 cases of LAR from May 2015 to February 2018. Patients were divided into three groups such as Pfannenstiel, iliac fossa (ILF) and midline. Age, sex, BMI, diabetes, steroid use, smoking, wound infection, hernia, post-operative hospital stays (HS) and length of follow up (LOF) were compared among these groups.

Results
There were 13, 44 & 33 patients in Pfannenstiel, ILF and midline groups. There was no significant difference in age, gender, BMI, smoking, steroid use, and mean LOF among groups. Patients in the ILF group had the highest prevalence of diabetes (27%), mean BMI of 28.91, rate of wound infection (16%), and incidence of incisional hernia (16%). The midline group had the highest mean age of 72.45 years and the longest HS of 11.45 days (p &lt; 0.003). At 49-month follow up, none of the Pfannenstiel group developed wound infection or IH (0%). However, there was no strong association between hernia and type of incision (p 0.248).

Conclusions
Although Pfannenstiel incision was found to have the lowest rate of IH, the analysis was not significant due to the small sample. We suggest future studies to have larger samples with proper randomization to propose that Pfannenstiel is the ideal incision for specimen extraction.
311 A Twist in the Tale - Study of the Management of Sigmoid Volvulus (SV)
Authors: Winder J , Rooney P , Ninkovic-Hall G 
Published: August 2023

Abstract

Aim
As SV has no current NICE guidance, nor large UK reviews, there is a requirement to outline best practice in the management. A review was undertaken of SV cases to determine how variation in management affects outcomes.

Method
Forty five patients (35:10 M:F) (median age 79 years, 29-93) with SV contributing 95 admissions 2017-2019 were studied using electronic notes and imaging. Estimated costs per patient were calculated using national tariff documents.

Results
Two groups were identified: conservative (non-operative management) (n = 39) and operative (n = 6), with a 90-day mortality of 41.02% and 16.67% respectively. Mean total days in hospital for each patient was 28.49 (range 1-215), 18.17 for operative and 30.08 for conservative. Nineteen patients had readmissions for SV 2017-2019, 30 in 2013-2021. No readmissions occurred post-surgery. Estimated cost of SV admissions 2017-2019 was £934,151, with no significant difference in cost for operative versus conservative.
Rigid sigmoidoscopy was performed in 65.26% (n = 62) of admissions, 38.71% (n = 24) were successful. Flexible sigmoidoscopy was performed in 61.05% (n = 58) of admissions, 17 without rigid. Decompression was achieved in 72.41% (n = 42) with flexible more successful than rigid sigmoidoscopy (p = &lt;0.0001).

Conclusions
SV patients are mostly male, older, co-morbid and managed conservatively. Mortality is high but reduced in patients managed surgically. Without surgery, patients had multiple admissions, decompressions, and long hospital stays, leading to increased costs. This project recommends the consideration of surgery in order to improve patient outcomes. A prospective large-scale study is required to improve data.
451 An Assessment of Clinical Outcomes of Combined Seton Placement and Infliximab in Perianal Fistulising Crohn’s Disease
Authors: Rao E , Annavarapu S 
Published: August 2023

Abstract

Aim
Perianal fistulising Crohn’s disease (PFCD) is a severe, disabling complication that causes increased morbidity and occurs in approximately 30% of Crohn’s patients. It has a detrimental impact on patients' lives and their abilities to complete their activities of daily living.
The NICE guidelines and various studies demonstrate that combined therapy accelerates primary closure of the perianal fistulae. We assess the clinical outcomes (response rate and recurrence risk) of combined use of Seton placement with anti-TNF therapy (Infliximab) in the treatment of PFCD via a metanalysis of multiple scientific studies over the last 20 years.

Method
Electronic databases, PubMed and Google Scholar, were used for literature search. Key terms (such as perianal fistula, Crohn’s disease, Seton placement, Infliximab) were applied. Of the 34 articles obtained, analysis of the key findings from four peer-reviewed primary sources are presented.

Results
In all studies, best clinical outcomes were obtained when abscess drainage was done in conjunction with induction therapy with Infliximab (5mg/kg) at 0, 2 and 6 weeks. Reguiero et al (2003) obtained 100% fistula closure rates in patient group receiving combined therapy (9/32) as compared to 89% the patient group receiving Infliximab alone (23/32, 89%); other studies also found improved response rates of the fistula in their patients, ranging from in 66% to 77%.

Conclusions
Overall, from the results of the studies, combined use of Seton placement and infliximab significantly improve clinical outcomes in patients with complex PFCD as measured through the reduction in recurrence risk and improved fistula closure rate.
588 Can the Heald Anal Stent Help to Reduce Anastomotic or Rectal Stump Leak in Elective and Emergency Colorectal Surgery? a Case Series
Authors: Jones M , Bunni J , Moran B , Heald B 
Published: August 2023

Abstract

Aim
Anastomotic and rectal stump leaks are feared complications of colorectal surgery. Diverting stomas are commonly used to protect low rectal anastomoses but can have adverse effects. Studies report favourable outcomes for trans-anal drainage devices instead of a diverting stoma. Our aim was to analyse the outcome of a “Heald anal stent” in reducing anastomotic or rectal stump leak after elective or emergency colorectal surgery.

Method
This was a single centre retrospective analysis of patients in whom a Heald anal stent had been used to “protect” a colorectal anastomosis or a rectal stump, in an elective or emergency context, for both benign and malignant pathology. Intra and post-operative outcomes were checked using clinical and radiological records.

Results
The Heald anal stent was used in 93 patients over 4 years. 46 (49%) cases had a colorectal anastomosis, and 47 (51%) had an end stoma with a rectal stump. There were 56 (60%) elective and 37 (40%) emergency cases. In 54 (60%) patients the pathology was benign, and 39 (42%) had malignancy. High anterior resections and Hartmann’s procedures were the most common operations in which the stent was used, comprising 22 (24%) and 20 (22%) of the total. There were no anastomotic or rectal stump leaks.

Conclusions
The Heald anal stent is a simple and affordable adjunct in decreasing anastomotic and rectal stump leak, by reducing intraluminal pressure through facilitating drainage of fluid and gas. We recommend the stent in operations involving colorectal anastomoses and in patients with a residual rectal stump.
1289 A Superior Approach? the Role of Robotic Surgery in Inflammatory Bowel Disease
Authors: Grewal C , Karri R , Yassin N 
Published: August 2023

Abstract

Background
This study compared the short-term outcomes of robotic and laparoscopic surgery for IBD patients to assess the efficacy of using robotics in minimally invasive surgery. The goal was to explore whether robotics is a superior surgical technique with better outcomes.

Method
A retrospective review of of all patients who underwent robotic and laparoscopic surgery for IBD was conducted from 2018-2022 . Demographics, peri, intra and post-operative data were analysed.

Results
This study included 42 surgeries for IBD patients, of which 24 were robotic and 18 were laparoscopic. Right hemicolectomies accounted for 63% of robotic surgery, with stomas formed in 38% of procedures. Amongst laparoscopic procedures, 44% underwent total colectomies and 39% had right hemicolectomies, with 78% requiring stomas. The median operative time for robotics was 30 minutes shorter than laparoscopic procedures. On average, hospital stays were 3 days less for robotic patients. There were 3 cases (17%) of patients returning to the ward within 30 days after laparoscopic surgery, compared to 1 case (4%) after robotic surgery. However, there were 2 cases (8%) of Grade 3 complications after robotic surgery and 1 case (6%) after laparoscopic surgery. One patient in each group required surgery within 30 days, but no cases necessitated conversion to open surgery and there were no deaths.

Conclusions
This study suggest that robotic surgery can be a safe and effective option for IBD patients, with shorter operating times and hospital stays compared to laparoscopic surgery. Overall, these findings suggest that robotic surgery may be a superior approach to minimally invasive surgery for IBD patients.
103 Outcomes and Complications of Simple Layered Closure of Persistent Tracheocutaneous Fistula After Tracheostomy in Childhood
Authors: Wong T , Macpherson O , Docherty S , Gray J , Clement A , Kubba H 
Published: August 2023

Abstract

Aim
Up to half of all children with a tracheostomy develop persistent trachea-cutaneous fistula (TCF) after decannulation. Surgical closure of it is technically easy but post-operative complications can be immediate and life-threatening. We reviewed our experience in TCF closures to identify potential risk factors for complications.

Method
Retrospective case records review of all children (0-16 years) who underwent surgical TCF closure between January 2010 and December 2021 following the development of a persistent TCF after decannulation of a tracheostomy.

Results
67 children were identified. They ranged in age from 14 months to 16 years (median 3 years 10 months) at the time of the TCF closure. Major medical comorbidities were present in 90%. Pre-operative pulse oximetry with the fistula occluded was used in 29 children (43%). An underwater leak test was performed in 28 (42%). A non-suction drain was used in 29 children (43%). Prophylactic antibiotics were prescribed for 30 children (45%). Post-operative complications occurred in 15 children (22%): life-threatening air leak occurred in the immediate post-operative period in 2 children (3%) and respiratory distress in 3 children (4%) in the recovery area immediately after surgery. None required re-tracheostomy. Three children suffered post-operative pneumonia (4%), and wound infections occurred in 8 children (12%). We were unable to show a significant association between patient or surgical factors and complications.

Conclusions
Further analysis of the potential associations between patient factors, surgical factors, and complications is necessitated in guiding future practice.
204 Transoral Laser Microsurgery Versus Radiation Therapy in the Management of Early Glottic Carcinoma: Which Modality Is More Cost-Effective Within the NHS?
Authors: Mallick S , Addison A 
Published: August 2023

Abstract

Aim
To determine whether trans oral laser microsurgery or radiotherapy is the more cost-effective modality in treating patients with T1b-T2 glottic tumours

Method
Ten-year data was retrospectively collected from all patients who presented with T1-T2 glottic cancer. The individual components of the cost associated with trans oral laser microsurgery and radiotherapy were ascertained. The total cost was calculated and the average cost of each modality per patient was compared.

Results
Theatre operating fees were the most significant cost associated with trans oral laser microsurgery, whereas delivery of radiotherapy per fraction was the most significant cost in radiation treatment. The cost for trans oral laser microsurgery was estimated to be £1120.34 whereas the cost of radiotherapy was £3754.6.

Conclusions
Trans oral laser microsurgery appears to be more cost effective compared to radiotherapy in early glottic cancer management.
797 Short-Term Review of the Presentations and Outcomes of Vocal Fold Palsy Cases Identified at a Large DGH
Authors: Dar T , Hunt J , Panesar J , Sood T , Tornari C 
Published: August 2023

Abstract

Aim
Due to the convoluted course of the recurrent laryngeal nerves, vocal cord palsy can be a manifestation of pathologies that cross multiple surgical and medical specialties. The primary role of the vocal folds is that of airway protection. Therefore, it is important that all relevant clinicians understand this clinical scenario in order to prevent aspiration pneumonia in their patients.

Method
We reviewed eight months of referrals and diagnoses of patients with vocal cord paresis or palsy. This was in the setting of a tertiary Head & Neck service within a large DGH. We assessed the aetiology, management, and outcome of these cases.

Results
Eleven new cases were identified over the course of eight months. One was due to intrathoracic vascular pathology; one breast cancer; two from head & neck cancer; one bilateral palsy due to upper-GI cancer surgery; four from thyroid-related pathology; one lung cancer; and one idiopathic. To date, ten of eleven cases appear permanent in nature. One patient underwent in-clinic injection laryngoplasty. Two patients (18%) died within six months of diagnosis, both predictable deaths based on baseline pathology.

Conclusions
Our experience demonstrated the relevance of ENT (Head & Neck), Vascular, Breast, Upper-GI and Thoracic surgeons as well as medical colleagues in Endocrinology, Respiratory Medicine, and Rheumatology. We present diagnostic and management strategies to help surgical trainees across the specialties identify, manage, and refer patients to prevent complication, improve quality of life and provide access to relatively novel procedures such as awake (local anaesthetic) injection laryngoplasty.
880 Otolaryngology (ENT) Surgeons’ Understanding of Radiation Doses to the Eyes
Authors: Tidswell P , McKenna J 
Published: August 2023

Abstract

Aim
Computed tomography (CT) scanning is an invaluable asset in ENT diagnostics. This snapshot study aimed to assess the knowledge ENT surgeons have regarding dose equivalence and dose accumulation of commonly requested.

Method
A sample of 302 dose length products (DLPs) for CT neck with and without contrast, CT sinuses and CT temporal bones were taken from anonymous data in Swansea University Health Board. ENT surgeons were asked to rank the mean doses, state a numerical dose and maximum scan number for each.

Results
From highest to lowest dose, the CT scans rank as follows: 1. Neck with contrast, 2. Neck, 3. Temporal bones, 4. Sinuses. CT neck with contrast was correctly ranked by 62.5% of surgeons, CT neck by 50%, CT sinuses by 12.5%, and CT temporal bones by 37.5%. Seniority of the surgeon did not affect the accuracy of their rankings.
While there is no maximum dose for patients, the maximum doses for bystanders were used to calculate dose equivalence to assess the impact of the scans. The maximum dose would be reached after having 3 CT temporal bones, 2 CT neck, 1.7 CT neck with contrast, and 7 CT sinuses. 84.3% overestimated the maximum number of scans, 12.5% underestimated the maximum, and 3.1% correctly estimated the maximum.

Conclusions
Radiation doses to the lens are poorly understood by ENT surgeons of all levels and while patients can receive as many scans as necessary to provide diagnostic value, it is important to understand the relative risk patients face by undergoing these scans.
886 Assessment of Urgent Neck Lump Referrals to a North West ENT Clinic
Authors: Brenac S , Srinivasan V 
Published: August 2023

Abstract

Aim
NHS cancer diagnostic services are under immense pressures due to high referral numbers. We assessed the volume of urgent neck lump referrals to ENT clinic at a North West hospital, determining the number of cancers and benign cases and calculating the average time to diagnosis and treatment for those with cancer.

Method
We retrospectively reviewed 616 urgent referrals to ENT via the 2-week wait suspected cancer pathway between October 2021 – March 2022, including only primary care referrals for neck, thyroid, or salivary gland lumps.

Results
Of 616 urgent referrals, 46.8% were for neck, thyroid or salivary gland lumps. Primary care accounted for 85.8% of referrals, the majority being female (71.3%). The cancer pick-up rate (thyroid/head and neck/lymphoma) was 10.1%. Benign neck pathology accounted for 57.1% of cases, and in 22.7% of cases no abnormalities were detected. Only 28% of those found to have cancer had an ultrasound scan (USS) prior to clinic. Average time to diagnosis for those with cancer was 46.5 days (58 days for thyroid cancer), and average time to treatment was 62 days (78 days for thyroid cancer).

Conclusions
This audit highlights the strain that cancer diagnostic services are under. In our case, approximately 31.6% of patients could have been downgraded from the cancer pathway if USS was used as a vetting tool prior to clinic. To help relieve the burden on cancer pathways and improve average time to diagnosis and treatment for those found to have cancer, we suggest patients have USS within 7 days of referral.