bluuebunny/crossref_metadata_2025_split huggingface dataset:
TU8.7 An audit of the investigation and management of acute appendicitis at a tertiary referral centre in Ireland
Authors: Alanza Uchechukwu , Julius Barbara , Merrigan Anne , Baban Chanrow , Tormey Shona 
Published: November 2022

Abstract

Aim
Acute appendicitis (AA) is among the most common emergency surgical presentations to Irish hospitals. In 2020, the World Society of Emergency Surgery (WSES) updated its Jerusalem guidelines for the investigation, diagnosis, and management of AA. We aimed to evaluate our institutional compliance with these guidelines in the COVID era and outline potential areas for improvement.

Methods
We performed a retrospective chart review of all patients admitted to our institution with the diagnosis of AA in July 2021 and compared them against the standards outlined in the WSES Jerusalem guidelines.

Results
39 patients were identified. Average age was 25.4 years. 2.6% (n=1) had clinical scores documented. 33.3% (n=13) had computerised tomography scans performed, 33.3% (n=13) underwent ultrasound scans and 33.3% (n=13) had no diagnostic imaging. 100% proceeded with surgical management. Average time to theatre was 16.9 hours. 23.1% (n=9) were open appendectomies, 74.4% (n=29) were laparoscopic appendectomies and 2.6% (n=1) was a laparoscopic converted to open appendectomy. 100% had histopathological analyses. 69.2% (n=27) were true AAs, 15.4% (n=6) were negative appendectomies and 15.4% (n=6) were non-inflamed appendices with other pathology including lymphoid hyperplasia, fecolith or enterobius. Average length of stay (AvLOS) was 3.6 days.

Conclusions
As regards timely surgical intervention and routine histopathology, we are compliant with the guidelines. However increased utilisation of validated clinical scoring systems could potentially reduce negative appendectomy rates and AvLOS. We believe an educational intervention is required to improve our compliance with these standards.
TU8.8 Fundoplication or gastropexy in emergency giant hiatus hernia repair?
Authors: Alasmar Mohamed , Mckechnie Iona , Chaparala Ram 
Published: November 2022

Abstract

Aims
Operative management of emergency presentation with a hiatal hernia aims to reduce the herniated stomach, dissect the hernial sac and reapproximate the crura. This will often be followed by fundoplication or gastropexy to minimise the risk of recurrence. This study compares the recurrence rates between patients who underwent fundoplication and gastropexy.

Methods
From October 2012 to November 2020, 80 patients were admitted to a tertiary oesophagogastric centre requiring emergency surgery to repair a giant hiatal hernia. We conducted a retrospective review and analysis of their admission and follow-up. The primary outcome measure was acute and post-discharge symptomatic recurrence of hiatal hernia.

Results
Of the 80 patients requiring emergency hiatal hernia surgery, 38% had fundoplication procedures, 53% had gastropexy, and 3% had both (n 30, 42, 2 respectively). One patient had neither, and 6% (n 5) patients had a complete or partial stomach resection due to necrosis. Eight patients (10%) had a symptomatic recurrence of hiatal hernia requiring a repeat operation; three within the index admission, five postdischarge. 50% had undergone fundoplication, 38% underwent gastropexy and 13% underwent a resection (n 4, 3, 1)(p-value 0.5). 19% (n 15) patients were readmitted. Post-operative mortality was 6% (n 5).

Conclusions
There is no conclusive evidence in the literature favouring fundoplication versus gastropexy. The surgeon's experience and patient factors influence choice of technique. This review, which includes the largest cohort of patients available in the literature, demonstrates that surgical technique does not influence the symptomatic recurrence rate in our patient group.
TU8.11 Improving the efficiency of the EGS service in a University Teaching Hospital. Smarter application of standards and use of resources
Authors: Bose Sayantan , Baltatzis Minas , Carlson Gordon 
Published: November 2022

Abstract

Aim
Effective utilization of resources for emergency general surgery (EGS) is essential for operational efficiency. Many patients have pathology with a time-dependent outcome and clinical standards have been established regarding timing of surgical intervention. The aim of this study was to investigate barriers to the delivery of timely EGS.

Methods
The delivery of EGS between 31/01/21 and 30/08/21 was studied. All cases were reviewed to determine clinical urgency, appropriateness of “urgency” within the clinical context (diagnosis, NEWS-2 score) and timing of EGS. Discrepancies between theatre booking and clinical need and delay in undertaking EGS compared with the relevant clinical standards were identified.

Results
EGS was undertaken in 520 patients (262M:258 F), mean age 49 (16–101) years. 34(6%) were booked as needing “immediate”, 130 (25%) “urgent 2–6hr”, 242 (47%) “urgent 6–18 hr” and 114 (22%) “expedited” EGS. In 373 (71.7%), EGS was undertaken in a time frame which met (or exceeded) relevant standards. In 235 (45%) cases, the urgency of booking exaggerated clinical need. EGS was “delayed” in 147 (28.3%) cases when compared with urgency as booked, but when actual clinical need was reviewed EGS was delayed in only 66 cases (12.7%). Delay was due to unavailability of facilities in 25 (38%) of cases, whereas in 24 (36%) treatment was delayed purely “overnight”.

Conclusion
Inappropriate allocation of clinical urgency resulted in the majority of “delayed” EGS. The routine application of RCS18 standards would prevent this. Avoiding delay overnight and an increase in theatre resource would improve efficiency.
TU8.12 Group and Screen for Laparoscopic Appendicectomies: Is It Necessary?
Authors: Bradley Rebecca , Linder Cortland , Marsden Max , Abraham Adjit 
Published: November 2022

Abstract

Background
Blood transfusion is rarely required in laparoscopic appendicectomies. The incidence of major vessel injury is 0.04%, yet many trusts require two valid G+S samples prior to the operation. A retrospective review was conducted to assess the incidence of peri-operative blood transfusion in laparoscopic appendicectomies in a large tertiary centre, to challenge the requirement for these G+S samples in the hope to reduce clinical and financial burden.

Methods
A retrospective case note review of patients undergoing emergency laparoscopic appendicectomies in the Royal London Hospital was conducted from 01/06/21 – 01/12/21. Patients under 18 years and those who received an appendicectomy as a concurrent procedure during other operations were excluded. The monetary value of each G+S sample was investigated through discussion with laboratory staff, and a total saving was calculated.

Results
95 patients were included. 93 patients had two valid G+S samples prior to their appendicectomy. No patients required perioperative blood transfusion (within two days pre and post op). One patient required a blood transfusion in the 5th postoperative day. An estimated total of £10,500 could be saved per year in this hospital alone, should G+S samples not be required for laparoscopic appendicectomies based on this data.

Conclusions
We concluded that two G+S samples are not necessary for every patient undergoing a laparoscopic appendicectomy. The incidence of transfusion is scarce throughout literature, and it appears that the financial and clinical burden of these blood samples far outweighs the population transfusion requirement in this particular surgery
TU8.13 How can we help things move along? – A review of the management of the acute bowel obstruction
Authors: Tijani Muzammil , Anjum Nabeel , Byrne Hannah , Musse Umeyma , Abdulkadir Munirashirwa , Ahmed Jamil 
Published: November 2022

Abstract

Background
Acute bowel obstruction (ABO) is a common surgical emergency and is associated with significant morbidity and mortality. Currently there is no national guidance for the management of ABO and an NCEPOD study highlighted the resulting variance in care nationwide. This study recommended several standards of care for the management of ABO and we aimed to review our practice against this guidance.

Method
A retrospective review identified all adult patients admitted with a radiologically confirmed diagnosis of ABO, over an 8 month period. 8 key performance indicators (KPIs) were adapted from the NCEPOD recommendations and data was collected from patient notes, drug charts and computer records. A total of 22 patients are included in this study to date.

Results
The median length of time from referral to surgical review and from surgical review to CT scan was 112 mins and 134 mins respectively. 31.8% of patients underwent emergency surgery. Pain documentation was the only KPI that met 100% target compliance. A MUST score was completed in 72.7% of cases, a treatment escalation plan in 36.4% of cases, hydration status was documented in 4.5% of cases and no patients had a frailty score documented.

Conclusion
Our results demonstrate that significant improvements can be made in the management of ABO and the recognition of aspects known to impact patient morbidity and mortality. In keeping with NCEPOD recommendations we suggest the implementation of an ABO pathway. We hope this will assist clinicians in caring for patients with ABO, promote MDT collaboration and highlight clinical concerns early.
WE1.1 Bilateral Gracilis Reconstruction following Extra-Levator Abdominoperineal Excision: an updated case-series
Authors: Jenkins Evan , Humphrey Hannah , Watts Andrew , Rogers Patrick , Rogers Patrick , Daniels Ian 
Published: November 2022

Abstract

Introduction
Circumfrential resection of low rectal or anal cancers poses a challenge to the reconstructive surgeon. Resective procedures including the extralevator abdomino-perineal excision or pelvic exenteration utilise a wide margin of excision, creating a significant tissue deficit. The aim of this case series is to demonstrate that use of bilateral pedicled gracilis muscle flaps (BPGMF) may offer several advantages to other methods of perineal reconstruction. This technique avoids any disruption to the abdominal wall; a benefit in laparoscopic surgery. Fashioning both muscles into a ‘weave’ creates a muscular sling across the perineum. This offers support to pelvic contents following the excision of the pelvic floor muscle groups.

Methods
This is a retrospective, single centre study, of patients undergoing reconstruction of perineal defects using BPGMF. All cases took place between January 2008 to July 2021.

Outcomes
There were 56 patients who underwent perineal reconstruction using BPGMF. The indications for surgery were cancer (52 patients) and perineal hernia repair (4 patients). There were 24 female patients and 27 male patients in the patient. The average age of patients was 60 years. The 30 day mortality was 2% (1 patient).
A healed perineal wound was seen at 30 days following surgery in 82% (46/56) of patients. The complication rate for the donor site and reconstructed site was 14% and 23% respectively. Complications included infection, hematoma, dehiscence and seroma formation.

Conclusion
BPGMF offers a reliable and technically simple muscle flap to reconstruct large perineal defects. It is associated with low morbidity and recreates support to the pelvic floor.
WE1.5 Management of Anorectal trauma - A UK trauma centre based experience
Authors: Keshishian Karekin , Bradley Rebecca , Forsyth Katrina , Knowles Charles , Hancorn Kate 
Published: November 2022

Abstract

Introduction and Aim
The evidence base supporting the management of traumatic anorectal injuries is poor. Previous case series provide some general observations on management decisions. The aim of the current study was to describe the largest UK experience of anorectal trauma management from a national major trauma centre.

Methods
Retrospective review of prospective data, collected systematically as part of routine trauma practice locally, was performed. Data were extracted on mechanism of trauma, immediate hospital care, diagnostics and operative management. Outcome data were extracted, where available, from follow up. Data are presented descriptively in a case series format.

Results
37 patients (35 male vs 2 female) presented with traumatic anorectal injury between March 2012 and December 2021. The median age was 34 (6–93), 20 (54%) were penetrating injuries (11 stabs, 5 GSW, 5 other) vs 17 (46%) blunt (13 RTA, 4 other). Median Injury severity score was 16. Of the 37 cases treated, there were 18 intra peritoneal (8 both intra and extra) vs 16 extra peritoneal injuries. 30 patients had defunctioning stoma (DS), 8 cases had primary repair (PR) (with or without DS). Mean length of stay was 27 days. 15 out of 37 have had GI continuity restored, out of which 13 had a water-soluble contrast study and 5 anorectal physiology preoperatively.

Conclusions
Traumatic anorectal injuries are uncommon within UK practice, affect predominantly young men and have high morbidity. In the majority of cases defunctioning stomas are still the mainstay of treatment. Primary repair of extraperitoneal injuries is a viable procedure.
WE1.6 Effects of prehabilitation programme on outcomes after colorectal cancer surgery
Authors: Kumaran N , Al-Eryani Y , Ihedioha U 
Published: November 2022

Abstract

Aims
Surgery for colorectal cancer is associated with risks of complications and death. These are associated with higher mortality and morbidity rates, lower quality of life and increased expenditure in healthcare. We aimed to determine the impact of prehabilitation on patient outcomes with regards to length of hospital stay and postoperative complications.

Methods
The prehabilitation programme was introduced to our unit in March 2021. We compared outcomes of all patients undergoing elective colorectal cancer surgery before and after introduction of the programme from a prospectively maintained database. Records of patients in the non prehabilitation group (NP) between January to June 2019 and those in the prehabiltation group (PhP) between April to October 2021 were analysed. Our primary aim was to compare the length of stay between the groups with a secondary aim to compare postoperative complications.

Results
A total of 151 elective colorectal cancer patients were included. There were 64 patients in the NP group and 87 patients in the PhP group. The median length of stay in the NP group was 7 days and in the PhP group was 5 days. 30% of patients in the NP group developed post-operative complications while only 19% of patients in the PhP group developed post-operative complications.

Conclusion
Prehabilitation is a vital component in a patient's treatment journey. Results from our study have shown an improvement in postoperative outcomes. It should therefore be an element of all enhanced recovery programmes. Further research in this domain could include individualised programs to obtain more benefits
WE1.7 Comparing the white cell count (WCC) and C-reactive protein (CRP) in robotic and laparoscopic colorectal resections within the immediate post-operative period
Authors: Liu Mamie , Gami Mayur , Hopson Bradley , Saju Christy 
Published: November 2022

Abstract

Aims
Determining factors affecting the WCC and CRP in laparoscopic and robotic colorectal cancer resections within the immediate 48-hour period.

Methods
Single centre data was collected retrospectively.100 robotic and 193 laparoscopic cases were included.
Cut offs for WCC and CRP were set at &gt;11 and &gt;50. Fisher's Exact test was used for analysis.

Results
Robotic group had 67% left sided operations vs 43% laparoscopically. Stoma formation was higher in the robotic group (61% Vs 15%). Other patient demographics including male to female ratio, BMI, ASA and tumour size were comparable.
Average length of stays (LOS) and operation times were longer for robotic than laparoscopic approaches of the same operation. Average lymph node yield was higher for robotic right hemicolectomy 26.6 (vs 23.5 laparoscopic) (P=0.05).
Median WCC within 48-hours was higher in the laparoscopic group 10.9 (vs 11.3 robotic). More laparoscopic cases 53% (vs 35% robotic) had WCC &gt;11 (P=0.006). Median 48h CRP was higher in robotic 51.6 (vs 45.6 laparoscopic).
CRP was consistently higher in operations involving stoma formation (P= 0.008) and operative time &gt;4 hours (P=0.001) both laparoscopically and robotically.

Conclusions
Absolute median immediate WCC and CRP were similar between laparoscopic and robotic colorectal resections although operative times were longer and stoma formation higher in the robotic group. Stoma formation and longer operations correlated with higher CRPs. No firm conclusions can be drawn about differences in the immediate serum WCC and CRP between laparoscopic and robotic cases in this study due to confounding factors.
WE1.10 Acute Diverticulitis: Are We Following National & International Guidance On Antimicrobial Strategy For Uncomplicated Cases?
Authors: Patel Nikheel , Oladeji Emmanuel , Bains Parisha , Day Nigel , Gupta Ashish 
Published: November 2022

Abstract

Aims
Uncomplicated acute diverticulitis is conventionally treated with antibiotics. Emerging evidence has suggested a non-antimicrobial approach in systemically well patients is a safe alternative strategy. Our aim was to assess adherence to national (NICE) & international (WJES) guidelines for uncomplicated cases.

Methodology
Data was gathered from PACS imaging & discharge summaries retrospectively (1st October 2020–1st March 2021).The inclusion criteria was: CT confirmed cases of modified Hinchey stage 0 or 1a. The cohort was stratified into systemically well or unwell based on: admission CRP &lt;150, observation score &lt;2 (NICE sepsis stratification), immunocompetance status & Charlson score &lt;3, as evidenced in the literature.

Results
There were 48 patients included (female 29 vs male 19). The number of systemically well patients was 32 (67%) & unwell 16 (33%). Compliance to guidance 1 (NICE) - ‘systemically well & therefore no antibiotics’, was low with only 2/32 (6%) patients. Of the remaining, 14/30 (47%) were given intravenous antibiotics. Compliance to guidance 2 (NICE) - ‘systemically unwell & therefore oral antibiotics’, was 4/16 (25%) with the remaining majority of 12/16 (75%) treated with intravenous form. The median number of inpatient nights was 1.48 (well: 1.28 vs unwell: 1.88).

Conclusions
The majority of patients with uncomplicated diverticulitis were systemically well. Compliance with guidelines on antimicrobial strategy was low. The incorporation of a risk stratification tool as demonstrated, allows for identification of patients that be discharged (with ambulatory follow up) after assessment. CT scans should be reviewed by radiologists with a multidisciplinary discussion on the most appropriate antimicrobial strategy.
WE2.1 An Audit of MRCP usage in patients with suspected biliary disease in a major teaching hospital in Dublin
Authors: Aketch Martin Safari , Qaoud Yazan , Hill ADK 
Published: November 2022

Abstract

Aim
To assess MRCP usage in patients with suspected biliary disease in a major teaching hospital in Dublin

Background
Our surgical team in this hospital regularly admits patients with complications arising from gallstones e.g. acute pancreatitis. This audit is aimed at looking at the appropriateness of using MRCP in this cohort of patients.

Methods
We accessed Beaumont's electronic patient records and its radiology system to gather the data. Data was collected over 3-months between September and December 2021 which included 91 patients.

Results
There were 82 inpatient and 9 outpatient requests performed over the 3-month period. The average inpatient wait for MRCP was 3.2 days. The commonest clinical indication was CBD stones. There were 55 females and 36 males with suspected biliary disease with an average age of 58 years. Majority of our patient cohort had deranged LFTs and had symptoms suggestive of a biliary disease. Ultrasound abdomen was performed in 41 patients (45%) prior to MRCP. CBD stones were only found in 15 patients (16%). 20 patients (22%) had surgical decompression of their biliary system.

Conclusion
Our clinicians use BSG guidelines on gallstones as an adjunct whether a patient needs an urgent MRCP. We still place a strong emphasis on the patient's clinical presentation and background history prior to ordering this scan.

Recommendation
Work with our radiology and gastroenterology colleagues, come up with a tailored approach and hospital guideline, to diagnose and treat our cohort of patients with biliary disease.
WE2.2 Video Presentation of performing a Laparoscopic Cholecystectomy on a patient diagnosed with Situs Inversus Totalis
Authors: Asnani Kusum , Ikechi Chijioke , Shah Ankur , Fernandes Roland 
Published: November 2022

Abstract

Background
Situs inversus totalis (SIT) is a condition in which the arrangement of the internal organs is a mirror image of normal anatomy, occurring in 0.0001% of patients. A thorough understanding of the human anatomy and anatomical variances is crucial in everyday clinical practise and emergency surgical care. We present a video on a patient with SIT who underwent a Laparoscopic Cholecystectomy (LC).

Case
Our patient is a 40-year-old lady with a known diagnosis of SIT. She presented with jaundice and left upper quadrant pain (LUQ). An ultrasound and CT scan confirmed the diagnosis of gall stones, CBD stones and SIT. She underwent an ERCP to clear CBD stones.
LC is one of the commonest general surgical procedures, however, this case proved challenging due to reversed anatomy. Intraoperatively, operating positioning was reversed with mirror imaging of ports used normally. Standard 10mm ports were placed in the infraumbilical and epigastric regions and the remaining ports placed in the LUQ. Abdominal organs were inspected and SIT was confirmed. It was ensured that a slow, meticulous delineation of Calot's triangle and window of safety was performed. The cystic duct and artery were clipped. The rest of the procedure was uneventful.

Results
The patient was discharged on the same day as the procedure. There were no immediate or short-term complications. Gallbladder histology showed chronic cholecystitis, cholelithiasis and cholesterolosis.

Conclusion
This case demonstrates that with appropriate planning and an advanced skill set, a LC can be performed in a patient with SIT, with little or no complications.