bluuebunny/crossref_metadata_2025_split huggingface dataset:
312 First Experience in Laparoscopic Surgery in Low- and Middle-Income Countries: A Systematic Review
Authors: Bawa J , Baker O , Ashcroft J , Troller R , Fearnhead N 
Published: August 2023

Abstract

Aim
This study aims to report the challenges and benefits of introducing laparoscopic surgery in low-and-middle-income countries (LMIC) as well as to identify solutions to these challenges for countries with limited finances and resources.

Method
MEDLINE, EMBASE and COCHRANE databases were searched for studies reporting first experience in laparoscopic surgery in LMIC. Included studies were published after 1996 with full text available in English. Exclusion criteria were studies considering only open surgery, ENT, endoscopy, arthroscopy, hysteroscopy, cystoscopy, transplant, or bariatric surgery.

Results
Ten studies from eight LMIC were eligible for inclusion in the final analysis, totalling 2640 patients. Most reported challenges were related to costs, including affordability of equipment and training programmes, and equipment problems such as faulty equipment and access to surgical kits. Training-related challenges were reliance on foreign trainers and lack of locally trained surgeons and theatre staff.
The benefits of introducing laparoscopic surgery were economic and clinical, including reduced hospital stay, complications and morbidity/mortality. The introduction of laparoscopic surgery also provided training opportunities for junior doctors.

Conclusions
Despite initial challenges, many studies described the benefits of introducing laparoscopic surgery. Centres proposed practical solutions to these challenges to ensure the sustainability of laparoscopic surgery in LMIC.
917 Building Virtual Reality Into Global Surgical Training: An Innovative Approach Applied in Uganda
Authors: Narang K , Please H , Rowe A , Dhanda J 
Published: August 2023

Abstract

Aim
Virtual Reality in Medicine and Surgery (VRiMS) is an academic working group devoted to creating technology-based solutions in post-graduate surgical and medical education. Based at Brighton and Sussex Medical School (BSMS) with funding from Health Education England they use ‘Extended Reality’ including fully immersive Virtual Reality (VR), Augmented Reality (AR) which overlays digital information onto real-time visualisation, and 360-degree video which offers a partially immersive experience. Benefits include reduced costs of delivering education, improving trainees’ experiences, and improving accessibility to surgical opportunities.

Method
VRiMS utilizes 360-degree video of cadaveric teaching streamed via low-tech cardboard headsets to deliver a novel teaching modality in Low- and Middle-Income Countries (LMICs). Uganda was the first location of a proof-of-concept course over 4 days delivered in 3 modalities: in-person - 10 delegates from East Africa provided scholarships (funded by Saving Faces) to travel to Brighton; 79 delegates attending virtually at a conference centre in Kampala; and over 1000 delegates globally attending remotely from a diversity of nations. Qualitative data was gathered for thematic analysis.

Results
Feedback was very positive, and barriers identified included requirements of a smart phone and sufficient internet. Ongoing links were developed with other LMIC units, with a recent conference run in Kenya.

Conclusions
VRiMS aims to ensure scientific validity in the projects being run, and analysis of the courses have given actionable insights into the experiences of surgical trainees both in the UK and in LMICs, showing that Extended Reality has enormous potential to benefit trainees worldwide.
940 The Metaverse as a Potential Solution for the Delivery of Global Health Education
Authors: Narang K , Please H , Dhanda J 
Published: August 2023

Abstract

Aim
We describe a novel approach to the delivery of global health education (GHE) via the utilisation of the Metaverse. In 2015, the Lancet Commission on Global Surgery identified that the global burden of disease amenable to surgical intervention is substantial and growing. Virtual Reality in Medicine and Surgery (VRiMS) is an academic working group based at Brighton and Sussex Medical School (BSMS) devoted to creating technology-based solutions in surgical and medical training and education.

Method
10 East African surgeons were selected to attend a 5-day cadaveric dissection course in-person in Brighton, on fully funded scholarships. A parallel conference was also run in Kampala, Uganda and &gt;1000 delegates attended remotely from 61 different countries.
A proof of concept of the metaverse was created using the software Spatial. Delegates from the in-person course in Brighton and Kampala used Oculus and PICO headsets in order to access and interact within the metaverse build.
Both a quantitative and qualitative approach was implemented for data collection utilising a survey as well semi-structured interviews.

Results
Feedback was positive and highlighted the interactivity of the platform, the multiple types of content which could be accessed and the level of immersion it provided. The majority of delegates felt that the metaverse could be beneficial in the delivery of medical and surgical education globally.

Conclusions
The Metaverse could be a novel approach in tackling issues in global health and global surgery and extensive future work related to its validity as an educational resource could be beneficial to trainees worldwide.
1020 Pre-Operative Investigation of Symptomatic GORD Patients and Hiatus Hernia: Are We Doing Too Many?
Authors: Sivakaran A , Sufi P 
Published: August 2023

Abstract

Aim
To evaluate the clinical utility of diagnostic tests such as upper endoscopy, barium swallow, oesophageal manometry and pH studies that are commonly performed in patients prior to undergoing a hiatus hernia repair and determine whether one or more of these investigations can be omitted in our practice.

Method
A retrospective analysis was conducted on 215 patients from September 2012 to August 2022 with symptoms of gastro-oesophageal reflux disease (GORD) undergoing hiatus hernia repair. Endoscopy was used as the gold standard to evaluate the performance of oesophageal manometry and barium swallow findings in diagnosing hiatus hernia (HH).

Results
Endoscopy had the highest detection rate of HH (76.9%), followed by barium swallow which had a higher detection rate of HH (51.8%), specificity and positive predictive value compared to manometry studies (42.1%), however, this did not reach statistical significance (p = 0.07). There was no significant difference between endoscopy and barium swallow (p&lt;0.05) and oesophageal manometry and endoscopy (p&lt;0.00001) in the detection of HH.

Conclusions
All three investigations appear to be useful for the detection of GORD and hiatus hernia prior to treatment. However, the routine use of manometry pH studies may not be crucial and therefore could be performed selectively in patients. Further prospective analysis comparing preoperative and intraoperative findings could be carried out for each diagnostic test to assess whether the significance of our results is applicable to all populations and to determine whether one of these tests can be safely omitted or performed more selectively.
903 Operative Records at Emergency Inguinal Hernia Repair: Improvements Might Avoid Future Litigation
Authors: Mohamud M F 
Published: August 2023

Abstract

Background
Chronic groin pain (CGP) after inguinal hernia repair is a multi-factorial problem of variable incidence. The literature is concentrated on the management of CGP after elective repair where litigation for pain accounts for up to 40% of claims for negligence.

Method
Computerised surgeon-typed operative reports of all emergencies inguinal hernia repairs in a single DGH over two years were scrutinised. Specifically looking for the descriptions of the handling of the spermatic cord and the nerves of the canal.

Results
Forty-three repairs were performed by surgeons in training using an open approach. The majority were primary hernias (37/43; 86%) and the repair was usually augmented with prosthetic mesh (88%). Cord handling was described in 35 patients (81%) but identification of the ilio-inguinal nerve was documented in only three. No report mentioned ‘seeking but not finding’ the nerve(s).

Conclusions
Surgeons in training seem to disregard documenting the status of nerves at urgent/emergency repair. Lawyers can be forgiven for arguing negligence if operative records omit observations on vital structures prone to ‘inadvertent’ damage. This needs to be emphasised to all those concerned with the emergency repair of inguinal hernias.
755 Management of Perforated Peptic Ulcer in Laparoscopic Era
Authors: Albirnawi H , El-Bernawi H 
Published: August 2023

Abstract

Aim
We want to share our initial experience in treating Perforated Peptic ulcer by mini-invasive techniques.

Method
Retrospectively, data was collected by looking at surgical files for patients who were admitted with perforated peptic Ulcers under an experienced consultant surgeon between 2016 and 2021 at Benghazi Medical Centre in Libya. Only patients were managed laparoscopically were included and were managed by the same surgeon.

Results
In the period of 2016 until 2021, 18 patients with perforated peptic ulcers were treated laparoscopically in our hospital.All were men except three women, age ranged from 23 years to 56 years. Laparoscopy was attempted in all patients , none of the cases were converted to open , 14 patients of perforations were located in the first part of duodenum (80%) and 4 were pre-pyloric , simple closure with omental patch were enough to close the perforation, copious peritoneal lavage with normal saline access to all abdominal compartments is very easy and never can be reached in open surgery. Mean operative time was 90min (60-120 min). the hospital stay ranged from 3 to 7 days. with no morbidity, leak , and no mortality within 30 days.

Conclusions
We shared our experience for management of perforated Peptic ulcer at Benghazi Medical Centre, by managing 18 patients with perforated viscus Laparoscopically. Laparoscopy is safe and permits successful primary suture closure of perforated duodenal and gastric ulcer and provides excellent access to different regions of the abdomen for better lavage. Furthermore, it confers benefits on patients in the form of reduced postoperative pain, and early recovery.
172 Embryological and Developmental Understanding in Improving Outcomes of Canine Exposure
Authors: Gupta A , Ganesan K 
Published: August 2023

Abstract

Aim
85% cases of canine impaction are palatal. This presentation reviews the surgical factors to consider in predicting outcomes for canine exposure.
Age - Apexogenesis of the canine root completes by 16 years. Exposures should be considered before root completion. Where the patient is over 16y, a bracket & chain should be considered.
Vertical level of impaction - Mcsherry’s rule of thirds suggests the Orthopantomogram can be used to grade the vertical level of impaction. Grade 2 and 3 impactions will most likely require a closed approach.
Role of the follicle – The follicle is a source of RANK, CSF-1 and progenitor cells involved in bone remodelling and formation of root-bone surface. Therefore, during surgical exposure, the follicle should not be stripped. Ankylosis may occur from radical removal of dental follicle as bone deposition occurs in the created space. Orthodontic mobilisation should be considered within 4-6 weeks of exposure whilst the woven bone is to mineralise.

Method
Surgical outcomes were reviewed to assess these theories. Data was collected for the canine exposures done in the department over a 7-year period. The re-exposure rates is compared to the National re-exposure rate reported by Spencer et al.

Results
Over 500 palatal canines were exposed. 90% were successfully aligned. 0.6% cases required re-exposure. Spencer et al. reported a re-exposure rate of 3% for open exposures.

Conclusions
By applying the follicle preservation theory and considering age and level of impaction in surgical decision making, our service demonstrates that canine exposure can be carried out with predictable outcomes.
386 Fibrous Histiocytoma of the Hard Palate – Clinico-Pathological Description of a Rare Tumour with Literature Review
Authors: Sawhney S , Zhou Z M , Amin A , Mumtaz S , Lee J , Proctor I 
Published: August 2023

Abstract

Introduction
Fibrous histiocytoma (FH) is a commonly reported soft tissue tumour which can occur ubiquitously in the body. However, its presence is incredibly rare in the oral cavity. When they do occur, they usually present as painless nodular growths with sessile base in the buccal mucosa. Diagnosis is confirmed through clinical, histopathological and immunohistochemistry analysis.

Method
The description of this condition is undertaken by presentation of a clinical case & findings, histopathological and immunohistochemical features, literature review and relevance to the oral and maxillofacial surgeons and pathologists.

Results
A 66-year-old man presented with an exophytic smooth mass of the hard palate affecting his ability to eat. The lesion was excised with a 2 mm margin and sent for histopathological evaluation. This was reported to have contained mixed population of histiocytes, foamy macrophages/xanthoma cells and plump spindle shaped cells arranged in storiform pattern confirming benign FH. Only 59 cases of the oral variant of this lesion have been published in literature and only 7 of these cases were found on the palate. There is a slight male predilection and occurrence between 3rd and 4th decade of life. The risk of recurrence after excision can be between 5-10% cases mainly due to incomplete excisions. Malignant transformation is rare.

Conclusions
Oral FH is an uncommon diagnosis for a soft tissue palatal lesion. Clinicians should have sufficient awareness of these rare lesions and consider them in the surgical sieve when dealing with soft tissues lumps of the oral cavity.
995 Cavernous Sinus Thrombosis Secondary to Dental Neglect
Authors: Falls D , McEvoy C , Mentias Y , Wilson A 
Published: August 2023

Abstract

Background
Cavernous sinus thrombosis is a rare, potentially life-threatening condition often caused by a cervicofacial bacterial infection. Prompt diagnosis and management improve prognosis and help prevent permanent complications.

Clinical case
A 54-year-old man with a background of alcohol excess attended the emergency department following a collapse at home. He presented with a potassium of 1.5 and a firm right parotid swelling with associated facial nerve weakness and was admitted to ICU for management of severe sepsis and electrolyte disturbance.
CT imaging out of hours showed swelling of right parotid and submandibular areas and generalised oedema parapharyngeally.
Further clinical examination by the maxillofacial team noted a right sided 6th nerve palsy, raising concern about intracranial spreading infection from a dental source and MRI was requested. The patent continued to deteriorate and developed bilateral chemosis and proptosis. MRI scan confirmed bilateral cavernous sinus thrombosis and right cerebral hemisphere subdural collection and the patent was transferred to a neurosurgical unit for a craniotomy, temporal lobe washout and dental clearance.
Upon further review of imaging by a specialist head and neck radiologist the cavernous sinus thrombosis was noted on the initial scans.

Conclusions
Raise awareness of this condition and its management – much rarer more now due to antibiotics in developed world.
Importance of thorough clinical examination to pick up subtle signs such as cranial nerve palsies.
Vital to have multidisciplinary involvement in diagnosis and management; both radiology to help with diagnosis and neurosurgery, ENT and maxillofacial to carry out surgery as required.
1123 Incidence of Electrolyte Abnormalities in Patients Recovering Form Maxillofacial Resection and Free Flap Reconstruction
Authors: Ridley S , Uthayakumaran M 
Published: August 2023

Abstract

Aim
Recovery from resection of head and neck malignancy is fraught with potential complications. Among these are electrolyte disturbances. The majority of junior trainees in Oral & Maxillofacial surgery have qualified in dentistry and will have had little exposure to this topic. We aim to examine the incidence of disturbances in Serum Sodium, Potassium, Calcium, Magnesium and Phosphate. This information will aid in prioritising information for robust induction and educational programmes in Maxillofacial oncology centres.

Method
Patients were identified in a single centre from January to November 2022 from theatre records. All patients were adults who underwent resection for Head and Neck malignancy with free flap reconstruction. A total of 65 patients were included. The electronic pathology system was integrated for results.

Results
The most common abnormal result was hypophosphatemia (&lt;0.8 mmol/L) present in 53 patients (81%). The next most common was hypocalcaemia (&lt;2.2 mmol/L) which was present in on 46 patients (71%) Potassium imbalances were seen in fewer patients, with 10 being high (&gt;5.3 mmol/L and 17 low (&lt;3.5mmol/L). Least common were issues with Sodium, being high (&gt;145mmol/L) for 9 patients (14%) and low (&lt;135 mmol/L) for 14 patients (21%).

Conclusions
Electrolyte abnormalities are commonly encountered when caring for Maxillofacial Head & Neck cancer patients. Prior to surgery many patients have undergone a period of malnutrition due the pain. This makes them high risk of re-feeding syndrome once nutrition is started. Induction programmes should familiarise dental core trainees with the trust’s Re-feeding guidelines and when to escalate more severe problems.
192 Preserving Glenoid Subchondral Bone in aTSR
Authors: Giannas E , Zhang J , Haar R , Tancak M , Hansen U , Sankey A , Emery R 
Published: August 2023

Abstract

Aim
Glenoid loosening remains a major concern in anatomical Total Shoulder Replacement (aTSR). Preoperative planning software and patient specific guides allow implantation optimization in aTSR. This study aims to examine and compare the amount of bone resected with prescribed adjusted angles to respecting the subchondral plate with minimal resection, using a freehand technique.

Method
Two groups of shoulder CT scans were assessed, normal and osteoarthritic of patients who had undergone aTSR. Preoperative planning software was used to place the glenoid component in prescribed adjusted angles, with neutral (0o,0o), retroverted (-10o,0o) and inclined alignment (0o,10o). This was then compared to positioning the component using a freehand technique, whereby the component was placed in a position to maintain the subchondral plate with minimal bone loss and respecting the integrity of the vault.

Results
The number of CT scans was 68, 34 normal and 34 osteoarthritic. The freehand technique resulted in statistically superior cortical bone seating in the osteoarthritic group with a mean (standard deviation) of 53.27% (14.32), while neutral alignment resulted in 36.68% (10.81), retroversion 40.40% (13.06), and inclination 39.34% (13.52), p&lt;0.001. Similarly in the normal scans, cortical bone seating in the freehand scenario was 46.71% (15.96), neutral 25.65% (12.27), retroverted 26.73% (15.03), and inclined 32.93% (12.12), p&lt;0.001.

Conclusions
The freehand method for positioning the guidewire resulted in significantly superior cortical bone seating, when compared to prescribed adjusted angles. Applying this technique in the clinical setting may achieve superior glenoid component seating and hence reduce the risk of aseptic loosening in aTSR.
427 Systemic Imaging for Early Laryngeal Cancer; a Single Centre Review of Guideline Application in Contemporary Clinical Practice
Authors: Tagdiwala P , Stimpson P 
Published: August 2023

Abstract

Aim
Early-stage laryngeal cancer (T1 and T2) has low rate of locoregional and distant metastasis. Therefore, National Institute for Health and Care Excellence (NICE) guidelines were updated in 2016 and recommended to no longer offer systemic staging for early laryngeal cancer because systemic imaging was not deemed to be cost effective. Our study aims to evaluate (1) if NICE guidance on the role of systemic imaging in the assessment and management of early laryngeal cancer is being followed in our centre (2) assess the impact of this practice on our patients (3) perform a cost analysis relevant to our institution.

Method
We retrospectively reviewed all laryngeal cases at a major H&N cancer centre between 01/01/2020 and 01/01/2022. The following information was collected for all the patients: neck/systemic imaging modalities performed on patients, demographics, site of original laryngeal tumour and any metastatic disease detected by systemic imaging. Next, we performed a cost analysis based on the cost analysis method undertaken by NICE.

Results
Our results showed n = 83 patients had laryngeal cancer between 01/01/2020 and 01/01/2022. Of which n = 30 had T1N0 and T2N0 disease. Systemic imaging found no metastatic disease, however n = 2 primary lung tumours and n = 1 lung infection was detected. The total cost for systemic imaging was £4,207.12 and total cost for neck imaging investigations it was £12,335.07.

Conclusions
Our study concludes NICE guidance is not being followed at our centre. Systemic imaging provides little benefit to patients and is an expensive practice.
453 The Optimal Timing of Colectomy for Acute Severe Ulcerative Colitis
Authors: Ryan E , Tyrrell-Price J , Phillips J 
Published: August 2023

Abstract

Aim
Acute severe ulcerative colitis (ASUC) is a medical emergency which, if left untreated, can be fatal. Some cases require colectomy. The timing of this operation is important to reduce post-operative morbidity. The primary study aim is to assess whether the timing of this operation impacts upon post-operative outcome. The secondary aim of this study is to determine whether pre-operative blood albumin level may be able to predict post-operative complication rates.

Method
All patients who underwent colectomy and ileostomy formation for ASUC at Bristol Royal Infirmary between 2010-2020 were identified. Patient demographic information, duration of pre-operative hospital stays, blood results and post-operative complications up until the most recent follow up were recorded. Patients undergoing elective colectomy for ulcerative colitis were analysed separately.

Results
Twenty-one ASUC admissions were identified who were all treated with intravenous steroids for a median of 9 (range 1-18) days before colectomy. 16 patients (76%) received either ciclosporin or infliximab rescue therapies. Median admission CRP was 41 (range 4-231). Median admission blood albumin was 29 (range 16-38). &lt;30-day and &gt;30-day post-operative complication rates were 52% (11/21) and 25% (5/20) respectively.

Conclusions
Previous literature shows significant association between the length of pre-operative medical therapy and post-operative complications. Surgeons can learn from them, so far, negative findings of our study. A surgeon’s own clinical judgement is the most important factor in the decision of when to take an ASUC patient to theatre. Biomarkers can aid a decision but cannot be used as a solitary justifier for the timing of colectomy.