bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP-664 Remnant of stomach strangulation post Roux-en-y gastric bypass and hiatal hernia repair for obesity
Authors: Al-ardah Mahmoud , Philip Ken , Cota Allwyn 
Published: November 2022

Abstract

Introduction and Background
Herniation of the remnant of the stomach post Roux-en-gastric bypass and hiatal hernia repair is a very rare complication that require high index of suspicion to diagnose and immediate surgical intervention. In the literature, there were reported cases of herniation of gastric pouch and Roux limb but not the remnant of the stomach hence we report this unusual case.

Case report
A 66-year-old lady was admitted with dysphagia, vomiting, epigastric and retrosternal chest pain. She has had laparoscopic Roux-en-y gastric bypass and hiatal hernia repair 8 years before this admission complicated with recurrence of the hiatal hernia which was repaired one year prior to this presentation.
CT scan of the chest and abdomen showed herniation of both the neo-stomach and the gastric remnant up in the posterior mediastinum through the hiatus. Patient consented for repair on the next day however her condition deteriorated over night and was taken to theatre and underwent emergency laparoscopic converted to open resection of strangulated ischemic remnant of stomach and preservation of the gastric pouch and the Roux limb.

Conclusion
This a very rare and uncommon event following a Roux-en-y gastric bypass and hiatal hernia repair, a prompt diagnosis and early surgical intervention is imperative to avoid catastrophic complications.
EP-674 Metastases to the breast from a primary lung adenocarcinoma: A case report and literature review
Authors: Westby Kealan , Mannion Evan , Davey Matt 
Published: November 2022

Abstract

Background
Primary breast cancer is the commonest malignancy in adult females. However, metastases to the breast is a rare occurrence with a frequency of approximately 0.2% - 1.3%. Lung adenocarcinoma is the most common type of lung cancer and distant metastases to other organs carry a poor prognosis. A wide variety of malignancies can metastasise to the breast, melanoma being most common. On review of the literature there is a paucity of published cases of primary lung adenocarcinoma metastasizing to the breast.

Case
A 77-year-old lady present to the emergency department (ED) with a 5-day history of presyncope. There were no other associated symptoms and the no findings on clinical exam. Computed tomography (CT) of the thorax, abdomen & pelvis reported diffuse opacities in both lungs and a solitary, 3×2cm mass in the upper inner quadrant of the left breast. A core biopsy of the lesion was carried out. Immunohistochemistry did not support a diagnosis of breast carcinoma but strongly suggested a primary lung adenocarcinoma. After a multidisciplinary meeting (MDM) discussion the plan was to commence a course of chemotherapy.

Conclusion
Given its atypical presentation it can be challenging to distinguish between a primary breast cancer and metastases. Metastatic disease, although rare, should be considered in the differential diagnosis as the treatment and prognosis differ greatly from primary breast cancer. Immunohistochemistry is essential for identifying the primary origin of the tumour.
EP-681 Adherence to VTE prophylaxis guidelines in general surgical patients: a single-centre study
Authors: Songra Lalana , Hussein Aliyah , Baker D 
Published: November 2022

Abstract

Introduction
Hospital acquired venous thromboembolism (VTE) is potentially preventable yet still accounts for 60% of all VTE seen. This study aimed to establish adherence to guidelines on VTE prevention including completion of VTE risk assessment within 24 hours of admission and appropriate prescription of mechanical and pharmacological VTE prophylaxis.

Methods
A database of all general surgical inpatients in our hospital at any point during the 48-hour period from 21/12/2021 to 22/12/2021 was obtained. Electronic records were examined to check for the presence of 11 established risk factors for VTE and to check for adherence to VTE guidelines. Every surgical patient was reviewed to check whether they were wearing anti-embolic stockings. Standard statistical analyses were undertaken.

Results
There were 107 general surgical patients in hospital during the study period. Of these, 33 (31%) had 3 or more risk factors on admission for VTE. 106 (99%) patients had VTE assessments completed within 24 hours of admission. Of these 107 patients, 93 (87%) had appropriate pharmacological VTE prophylaxis or had a documented reason why this was not prescribed. 14 (13%) patients had no pharmacological VTE prophylaxis prescribed. 84 patients were assessed as requiring anti-embolic stockings. Of these, 57 (68%) of patients were prescribed stockings, and 30 (36%) were physically wearing stockings.

Conclusions
This study has shown that adherence to VTE guidelines among surgical patients in our hospital is substandard. We suggest having a VTE safeguard during the ward round responsible for identifying any deficits in VTE prophylaxis and ensuring recommendations are acted upon.
Sustainability Prize 4 Back to the future: Re-introducing Reusable gowns to achieve #NetZeroSurgery
Authors: Beatty Jasmine Winter , Gan Jonathan , Robb Henry , Dryden Simon , Ortega Patricia , Purkayastha Sanjay 
Published: November 2022

Abstract

Aims
In view of the planetary health emergency, we aimed to introduce an efficient and safe intervention to rapidly decrease the environmental impact of our surgical department whilst delivering financial and social benefits.

Methods
The project was registered with the Audit and Quality Improvement Department. Carbon hotspot identification and process mapping were performed.
A survey of theatre staff members was completed prior to the trial to ensure agreement.
Disposable surgical gowns were replaced with reusable gowns in two theatres. Where appropriate, reinforced gowns were substituted with standard gowns.
Staff were notified and posters made to remind them of correct removal procedures.
Environmental savings were estimated using published figures (Vozzola et al. 2018) and weights. Trust procurement data from 2019 was used to estimate financial and environmental savings. Staff evaluations were collected.
Preliminary results were shared with heads of surgical specialties, surgical managers, A&E, ITU and Anaesthesia across the trust.

Results
97.7% (74/77) of staff were favourable to trying the reusable gowns prior to the trial. 91.3% (42/46) gave positive feedback after testing them clinically and 97.8% (45/46) were happy to continue using them again.
3051 gowns were substituted over 6 months, leading to a saving of 3.292 tonnesCo2e. Savings were estimated at £366 from reductions in waste disposal and standard gown use.

Conclusions
Approval has been gained to extend the trial across the trust and a business proposal is being considered.
Scaled to the whole trust this intervention could save 234.7 tonnesCO2e/year, equivalent to driving a car around the equator 23.6 times.
SP1.1.2 The significant impact of using virtual cross match on achieving 100% within-18 hour target of cold ischaemia time in transplanting kidneys from donors following brain death in a single centre in UK
Authors: Tasleem Sadia , Austin Sharlene , Lennon Veronica , Mckane William , Pararajasingham Ravi , Marie Yazin 
Published: November 2022

Abstract

Aims
To evaluate the impact of virtual cross match in donation following brain death (DBD) kidney transplants on the cold ischaemia time (CIT) as one of the factors in achieving better renal graft outcomes.

Methods
Every patient on the deceased donor renal transplant waiting list in our centre was asked to give a blood sample to test for Human Leucocyte Antigen (HLA) antibodies. Our transplant coordinators ensured that this process is updated three monthly as part of the eligibility criteria to perform virtual cross match.
Other factors contributing to CIT were intentionally ignored given that there are no significant changes in the kidney allocation scheme or kidney acceptance criteria. Comparison was made between CIT in the financial years 2014/ 2015 and 2020 /2021.

Results
Since the introduction of this strategy, our centre was the only centre in all 23 UK kidney transplant centres to achieve 100% transplantation within 18 hour CIT for DBD kidneys transplants in the financial year 2020/2021. This represented a significant improvement compared to 58% in the financial year 2014/2015.

Conclusions
Virtual cross match was a key factor in achieving the 18 hours target for DBD kidney transplant regardless of other contributing factors. It is highly recommended that a three-monthly screening for HLA Antibodies is regularly performed to achieve this result.
SP1.2.7 Relative quality of UK post graduate School of Surgery web-site information
Authors: Luton Oliver , Mellor Katie , Eley Catherine , Egan Richard , Lewis Wyn 
Published: November 2022

Abstract

Introduction
Internet-derived health care information is increasingly accessed by patients, yet its quality is variable and equivalent educational and training information for medical professionals is less well understood. The aim of this study was to assess the quality of information available on the UK's Post-Graduate School of Surgery (SoS) websites with a validated 20-point tool (WebQual 4.0).

Method
Eight clinicians (Consultants 2, SpRs 2, Core Surgical Trainees 2, and Foundation Program doctors 2) evaluated SoS web-site quality in three domains: Usability, Information Quality, and Interaction (Likert scale: 1 - very much disagree, 5 - very much agree). Ranked scores were calculated as the sum of domain medians. A separate eight trainee focus group then appraised the top three websites related to COREQ recommendations.

Results
Inter-rater agreement and correlation was good (rho &gt;0.800, p&lt;0.001). Median (range) overall website score was 3 (2–5) and individual domain scores were: Usability 3.75 (2–5, p=0.001); Information Quality 3 (2–5, p=0.001); Interaction 3 (2–5, p=0.001). The three highest ranked Deaneries were HENW, HEEE, and HEKSS with scores of 14, 13.5 and 12 (out of 15) respectively. Focus group priorities included: minimising text, embedding educational and extracurricular content, and clear hospital placement mapping.

Conclusion
UK SoS website information was in general poor, with greater than two-fold variance in overall quality. Improved web-site standardisation should help and enhance trainee application and career progression.
SP1.2.10 The First Delphi Consensus on Surgical Ward Round
Authors: Amr Bassem , Omar Islam , Abdelrahman Mohamed , Abdulkuddos Muhamed , El Ella Yasmin Abou , Mahawar Kamal 
Published: November 2022

Abstract

Background
The ward round is an integral part of everyday surgical practice. It is a complex clinical activity that requires clinical management and communication skills. It has an impact on patient safety, mortality and quality of the healthcare services delivered. This study reports the results of a consensus-building exercise on the common aspects of the general surgical ward rounds.

Methods
The consensus-building committee involving a range of stakeholders from 16 NHS trusts took part in this consensus exercise. The members discussed and suggested a series of statements concerning surgical ward round. An agreement of ≥ 70% amongst members was regarded as a consensus.

Results
Thirty-two members voted on 60 statements. There was a consensus on fifty-nine statements after the first round of voting, and one statement was modified before it reached consensus in the second round. The statements covered nine sections: a preparation phase, team allocation, multidisciplinary approach to the ward round, structure of the round, teaching considerations, confidentiality and privacy, documentation, post-round arrangements, and weekend round.
There was a consensus on spending time to prepare for the round, consultant-led round, involving the nursing staff, an MDT round at the beginning and end of the week, a minimum of 5 minutes allocated to each patient, utilisation of round checklist, afternoon virtual round, and a clear handover and plan for the weekend.

Conclusion
The consensus committee achieved agreement on several aspects concerning the surgical ward round. This should help improve the care of general surgical practice on wards.
SP2.1.2 Increasing Burden of Complications of Gastric bands on NHS Bariatric Services
Authors: Desai Chaitya , Panesar Harrypal , Kumar Nakulan Nantha , Xiang Jinpo , Idialu-Ikato Kelvin , Cheruvu Chandra 
Published: November 2022

Abstract

Background
Approximately 40% of patients that undergo laparoscopic adjustable gastric band (LAGB) insertion for obesity experience long-term complications and a lack of weight loss. This has caused a surge in LAGB removal procedures under the NHS. We review patient outcomes for these procedures at our tertiary bariatric centre.

Methods
All LAGB removals performed between October 2012 and August 2021 were reviewed. Data was collected prospectively & analysed retrospectively for demographics, body mass index (BMI), surgical indications and postoperative complications.

Results
During the study period, a total of 178 patients underwent LAGB removal (93.8% female). Most bands were inserted out of province, done privately and patients’ mean BMI pre-operatively was 41.6. Indications for band removal included dysphagia (41.1%), band slippage or tubing damage (25.8%), pain (15.2%), obesity-related health condition (11.2%), infected/ leaking band (3.9%), and band erosion (2.8%). At LAGB removal, patients’ mean BMI was 37.0 – thus there was a mean decrease of 4.6 in BMI between index and removal operations. One LAGB removal case was converted to open. The mean length of stay for LAGB removal patients was 2.9 days. 12 patients had post-operative complications: wound infection (58.3%), peritonitis (25.0%), pneumonia (8.3%) and food ball in stomach (8.3%). 38 out of 178 (21.3%) patients then underwent revision bariatric surgery in the form of laparoscopic Roux-en-Y gastric bypass procedures.

Conclusion
Although most primary gastric banding procedures are performed privately, the number of removals under NHS services is increasing. LAGB removal can be successfully performed to ease debilitating symptoms with excellent symptom resolution and minimal peri-operative complications.
SP2.1.5 A Systematic Review of Bariatric Surgery in Patients with Obesity and Type 1 Diabetes Mellitus
Authors: Appel Simone , Lee Lyndcie , Parmar Chetan 
Published: November 2022

Abstract

Background
The prevalence of obesity in the T1DM population has been increasing at a worrying rate. Bariatric surgery has proven to be effective in treating patients with T2DM, as weight changes had a direct effect on insulin resistance and requirements, and thus glycaemic control. However, evidence for the benefit of the procedure for patients with T1DM is still limited, demonstrating the need for a systematic review investigating this.

Methods
A systematic review was performed in accordance with the PRISMA guidelines. Articles not in relation to T1DM or lacking specific quantitative data were deemed unsuitable and excluded.

Results
26 studies were included with a total of 262 patients (F=167, M=73, N/A=22). The mean age was 37.08 years (n=207). The mean weight and BMI were 112.4kg (n=157) and 31.88 kg/m2 (24–58.9, n=261) respectively.
Most common procedures performed were SG with 120 patients (46%) followed by RYGB with 104 patients (39.3%). Insulin requirements changed from 90.77 IU/day (36.2–174) pre-operatively to a mean of 36.5 IU/day (5–75) post-operatively. No significant trend was found for changes of HbA1c levels. Main side effects were episodes of hypoglycaemia and DKA; mortality was not reported in any article. The mean %EWL was 72.3% (60–90.5%) at ≥6 follow up months. Reductions in co-morbidities such as hypertension and CVD were recorded in multiple studies.

Conclusion
Obese patients with T1DM can expect significant weight loss, potential resolution of co-morbidities, and reduction of insulin requirements, but it does not usually result in improved glycaemic control.
SP3.1.9 Implementation of colon capsule endoscopy (CCE) into the clinical setting – an early analysis
Authors: Pollock Alasdair , Pollock William , Moug Susan , Winter Jack , Boulton-Jones Rob , Witherspoon Paul 
Published: November 2022

Abstract

Aim
Analysis of the collaborative implementation of colon capsule endoscopy (CCE) within NHS Greater Glasgow and Clyde

Methods
Database collected prospectively from first 175 patients referred. Demographic data collected for those undergoing CCE.
Primary outcomes: negative, positive and incomplete/complications.
Secondary outcomes: those requiring further investigation and outcomes (normal, abnormal and not performed). Abnormal findings: benign disease, dysplastic changes, malignancy and unresulted.

Results
Of the first 175 patients put forward for CCE, 128 (73%) underwent CCE: n=47 deemed unsuitable due to patient preference (n=21) and consultant decision (n=15).
Mean age 57.8 (+/-13.9 SD), 56% female, 32% had ≥2 co-morbidities, and 6% having colorectal cancer family history.
CCE findings: negative 16% (n= 21), positive 71% (n=91), incomplete/complications 12.5% (n= 16).
Time from referral to CCE (Mean 130 days, Median 86 days). Time from CCE to reporting (Mean 9.4 day, Median 8 days). Time from referral (CCE report) to colonoscopy (Mean 127 days, Median 106 days). Colonoscopies still awaited (Mean 271 days, Median 269 days).
80% required further tests: 77% (n=98) colonoscopy or sigmoidoscopy and 4% (n=5) imaging. Results: 20% normal, 48% abnormal, 30% not yet performed and 2% inadequate/no longer required. Pathology: benign disease 38%, dysplastic changes 45%, invasive malignancy 9%, 9% unreported.

Conclusions
CCE has received significant investment to attempt to reduce the workload of endoscopy departments. However, 77% of the patients who underwent CCE require further investigation by scope. With an excellent safety profile, defining patient selection is key to optimising the clinical applicability of this evolving technology.
SP4.1.1 An Audit of Negative Appendicectomy Rates at the Borders General Hospital
Authors: Brown Jasmine , Lennon Kirsty , Rae Richenda , Young Jamie 
Published: November 2022

Abstract

Aims
Appendicitis is the most common abdominal surgery emergency globally with 50,000 acute appendicectomies in the UK annually. Despite improvements in diagnostic techniques, negative appendicectomies still occur.
We aimed to audit local results of negative appendicectomy rates (NAR) against the 2012 National Appendicectomy Audit which recommends an NAR &lt;20%.

Methods
Retrospective data of patients who underwent appendicectomy from January 2016-October 2021 was collected using electronic records. Patients who underwent elective appendicectomies, were not suspected appendicitis or did not have pathology results were excluded. Data was collected on patient demographics, surgical approach, pathology and radiological investigations prior to surgery.

Results
A total of 518 patients were included. 54.1% (280) were male and 45.9% (238) were female. The age range was 5–87 years with an average of 36.4 years.
48.9% (253) had CTs with 98.4% reporting appendicitis, 16.2% (84) had ultrasounds with 50% reporting appendicitis, 34.9% (181) had no imaging prior to surgery. Of those imaged the NAR was 12.8% (6.3% CT, 32.1% ultrasound) and no scan was 17.1% (p=0.188).
26.2% (135) of appendicectomies were open, 69.5% (358) laparoscopic and 4.3% (22) converted.
Pathology showed that 14.3% (74) appendixes were negative and 85.7% (444) positive. Males had a lower NAR of 11.1% vs females with 18.1% (p=&lt;0.05).

Conclusions
Our result of a 14.3% NAR shows that we are working within the recommended national guidelines of a &lt;20% NAR. The NAR was higher in females than males. The use of imaging in addition to clinical evaluation helps reduce the NAR, with CT being more effective than ultrasound.
SP5.2.1 Intra-muscular interposition of nerve endings to minimise neuropathic and residual pain in lower limb amputations
Authors: Lu Victor , Zhou Andrew , Krkovic Matija 
Published: November 2022

Abstract

Introduction
A major cause of morbidity in lower limb amputees is phantom limb pain (PLP) and residual limb pain (RLP). This study aimed to determine if surgical interposition of nerve endings into adjacent muscle bellies at the time of major lower limb amputation can decrease the incidence and severity of PLP and RLP.

Methods
Data was retrospectively collected from January 2015 to January 2021, including eight patients that underwent nerve interposition (NI) and 36 that received standard treatment. Primary outcomes included the 11-point Numerical Rating Scale (NRS) for pain severity, and Patient-Reported Outcomes Measurement Information System (PROMIS) pain intensity, behaviour, and interference. Secondary outcome included Neuro-QoL Lower Extremity Function assessing mobility. Cumulative scores were transformed to standardised t scores.

Results
Across all primary and secondary outcomes, NI patients had lower PLP and RLP. Mean ‘worst pain’ was 2 out of 10 for RLP in the NI group, compared to 3.58 in the control group (p=0.045). Mean PROMIS t scores were lower for NI cohort for both RLP (pain intensity [41.2 vs 48.1;p=0.035]; pain interference [44.9 vs 46.3;p=0.260]; pain behaviour [44.4 vs 50.8;p=0.039], and PLP (pain intensity [50.8 vs 58.5;p=0.029]; pain interference [49.1 vs 54.0;p=0.009]; pain behaviour [53.4 vs 55.6;p=0.061]). Mean Neuro-QoL t score was lower in NI cohort (45.4 vs 41.9;p=0.03).

Conclusion
Surgical interposition of nerve endings during lower limb amputation is a simple yet effective way of minimising PLP and RLP, improving patients’ subsequent quality of life. Additional comparisons with targeted muscle reinnervation should be performed to determine the optimal treatment option.
SP5.2.5 Optimising Communication during Damage Control Surgery- a survey of adult Major Trauma Centres in England
Authors: Patton Ethlinn , Lisagors Ilans , Smith Stella 
Published: November 2022

Abstract

Aims
Snap briefs (truncated WHO checklists) and Sit Reps (situational reporting), are long established practices within the military, developed from their vast experience in treating patients requiring Damage Control Surgery (DCS)[1,2].
Our aim was to establish if formal systems like these are in place in Major Trauma Centres (MTCs) in England, and gather staff's experiences of using these systems.

Methods
An online survey was devised and distributed to MTCs in England via the Major Trauma Network. It consisted of 14 questions, relating to use of modified WHO checklists and Sit Reps during DCS.

Results
Results were received from all 23 adult MTCs in England. Eight centres (34.8%) reported using a modified WHO checklist for DCS. Most commonly these were modified to include reference to blood products used and available, other specialties needed, and presence of surgical equipment prior to start (eg. thoracotomy.)
12 centres (52.2%) are using Sit Reps during DCS. Many respondents from centres without a formal policy in place stated that they personally endeavor to maintain communication when they are involved in DCS cases, and recognised that a formal system would be greatly beneficial.

Conclusion
Many MTCs are not using truncated WHO checklists and Sit Reps for DCS. From the centres who have adopted these methods, staff have reported they improve shared decision making. Wider implementation of these techniques could therefore lead to both improved patient care and staff experiences.