bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP8.2.4 Mindfulness-based Cognitive Therapy (MBCT) reduces symptoms in patients with chronic visceral pain, and is associated with the alteration of pain-evoked neural activity and resting functional connectivity in the descending pain modulatory system
Authors: Waldman Sarah , Wanigasekera Vishvarani , Henrich Julia , Martin Maryanne , Gjelsvik Bergljot , Tracey Irene 
Published: November 2022

Abstract

Aims
Chronic visceral pain can cause repeated presentations to surgical services. Cognitive therapies show promise but are not often considered in the surgical setting. This study aims to assess the efficacy and mechanisms of MBCT-IBS, a mindfulness-based cognitive intervention for irritable bowel syndrome (IBS).

Methods
Fifteen women with IBS underwent a 6-week MBCT-IBS training course. Before and after this they completed validated questionnaires on symptoms, and functional MRI brain scans during thermal pain and at rest.

Results
MBCT-IBS led to improved symptoms (p&lt;0.05). Increased temperatures were required to achieve 5/10 pain ratings (mean 1.21°C, p&lt;0.001), indicating reduced pain sensitivity. Neuroimaging showed that MBCT-IBS led to altered pain responses in the anterior cingulate, the prefrontal cortex, the amygdala and the precuneus (Z&gt;2.3, p&lt;0.05). In the left dorsolateral prefrontal cortex (dlPFC) this correlated with reduced pain severity scores (rs(11)=-0.614, p=0.025). Altered functional connectivity was seen between the right dlPFC and multiple regions involved in emotional and sensory aspects of pain processing, including the amygdala. There was also altered connectivity between the amygdala and sensorimotor cortices (Z&gt;2.3, p&lt;0.05).

Conclusions
MBCT-IBS was an effective treatment for IBS. The fact that there was altered activity in and connectivity between key parts of the descending endogenous pain modulatory system suggests that MBCT-IBS may be an effective intervention for patients with dysfunctional pain pathways in whom the pathological cause for their pain is unclear. It is non-invasive and inexpensive, and has the potential to reduce the incidence of unnecessary surgical intervention in patients with chronic visceral pain.
SP8.2.5 Weekend Presentation to Emergency Surgical Units Results in Delayed Ultrasound Diagnosis and More Hospital Visits
Authors: Abdul-Hamid Sawsan , Sian Tanvir , Ning Lee Rachel Xue , Ng Oliver , Bharathan Balamurali 
Published: November 2022

Abstract

Aims
The principles of same day emergency care (SDEC) have been around early assessment, access to point of care testing and criteria led discharge. Supplementing clinical and biochemical assessment with ultrasound (USS) may not always achieve a diagnosis but still facilitates SDEC. Our 5-day SDEC USS service aims to achieve these objectives with only limited dedicated slots over the weekend and holidays. We present the results from our service, focusing on differences in outcomes in those who present on weekdays versus weekends.

Methods
Retrospective analysis of 558 patients who had USS between 2.2.21 and 12.4.21. Days from presentation to scan, number of re-presentations, and need for admission were compared.

Results
402 patients presented in the weekday and 156 at the weekend. The proportion of patients having same day USS was higher for the weekday group (65% vs 26%; χ2 p &lt; .001). The number of days to scanning was higher for weekend presenters (1.15 vs 0.38; Mann-Whitney p&lt;0.001). There was no difference in admission rate on index presentation (weekday = 36% vs weekend = 37%; χ2 p = 0.74), however, the average number of total attendances during the study period was higher in those with an index presentation on a weekend (1.74 vs 1.55; Mann-Whitney p=.007).

Conclusions
Patients presenting at weekends have longer waits for USS, delaying diagnosis and discharge. Whilst admission rates on index presentation are not affected, access to SDEC USS at the weekend would allow for same-day discharge and fewer visits to hospital for patients.
SP8.2.7 Is “Hot” Laparoscopic Cholecystectomy in patients with high BMI a safe option? - Outcomes of Emergency Laparoscopic Cholecystectomy in obese vs non-obese patients
Authors: Bezzaa Sabrina , Patel Reeya , Boven Carine , Gerogiannis Ioannis 
Published: November 2022

Abstract

Aim
NICE guidelines currently recommend offering patients presenting with acute cholecystitis a laparoscopic cholecystectomy within 1 week of diagnosis. We compared peri-operative outcomes for patients undergoing emergency laparoscopic cholecystectomy with a BMI of &lt;30 kg/m2 (Group 1) and ≥30 kg/m2 (Group 2).

Methods
A retrospective review of patients undergoing an emergency laparoscopic cholecystectomy at a District General Hospital between January 2018 and November 2020.

Results
159 patients were included. Group 1 had 97 patients (BMI range 18.8–29.9 kg/m2, age range 27–82 years, 56 females: 41 males). Group 2 had 62 patients (BMI range 30–56.3 kg/m2, age range 19–88 years, 38 females: 24 males).
ASA breakdown was 1(25.8%), 2(64.9%) and 3(9.3%) for Group 1 and 2(71%) and 3(29%) for Group 2. Indications for surgery included biliary colic, acute cholecystitis and gallstone pancreatitis. Operating surgeons had training in both Upper GI and Bariatric surgery.
There were no significant differences between Group 1 and Group 2 for anaesthetic time (minutes, 32.74 vs 32.50 p=0.91), operative time (minutes, 95.82 vs 93.67 p=0.75), total length of stay (days, 6.15 vs 5.17 p=0.30) or readmission rate within 30 days (22.68% vs 19.35% p=0.62). 4 patients in each group had acute complications during the index admission.

Conclusion
Emergency laparoscopic cholecystectomy for patients with a BMI ≥30 kg/m2 has similar peri-operative outcomes when compared to patients with a BMI &lt;30 kg/ m2 and is safe to be performed in a District General Hospital by operating surgeons with an interest in Upper GI and Bariatric surgery.
SP8.2.8 Resection and primary anastomosis is safe in selected patients with perforated diverticulitis; a cohort study
Authors: Dowdeswell Megan , Chang Jessica , Rajalingam Viswa , Wolos Maria , McCloud Joe , Cheetham Mark 
Published: November 2022

Abstract

Aims
Historically, the preferred procedure for perforated diverticular disease is Hartmann's procedure (HP). Although reliably achieving source control, it's associated with a high rate of post-operative complications and a stoma which often becomes permanent. We reviewed our experience of patients undergoing HP vs primary anastomosis (PA) for perforated diverticulitis.

Methods
All patients undergoing emergency resectional surgery for perforated diverticulitis between March 2015 and Jan 2021 were identified from the Hospital Episode Statistics (HES) data. Demographics were collected and the patient groups were case matched for age and Charleson Comorbidity Index (CCI), Computed Tomography (CT) appearance and intraoperative contamination data. Post-operative morbidity/mortality data was compared.

Results
105 patients were included. 15 patients had PA (without diversion) and 90 HP.
In the PA cohort were 10 males, median age 52 (range 27–76). There were no anastomotic leaks. 30-day morbidities were superficial wound dehiscence (1) and early incisional hernia (1). Median post-operative stay was 9 days (range 5–25).
HP control group (age below 76, Charlson score 10 and below, Hinchey 1–3 intraoperatively). Included 58 patients, 26 males, median age 60.5 (range 30–76). Median post-operative stay was 10.5 days (range 5–227). 2 patients required re-operation. 5 patients developed wound infections. At the time of the study 18 patients have undergone reversal, 6 are on active waiting-list for reversal.
There was a single 30-day mortality (post-discharge).

Conclusion
We have shown that PA is safe in selected cohort of patients and have identified that over 50% of patients undergoing HP could have been considered for PA.
SP9.1.2 Investigating the association between trust case volume and perioperative outcomes in colorectal cancer surgery
Authors: Al-Zubaidy Mustafa , Al-Hasani Aos , Hamakarim Tatiana 
Published: November 2022

Abstract

Background
Whilst current colorectal cancer care pathways operate by referral to local hospitals, there has been a recent drive to centralise cancer services to improve patient outcomes. Centralisation will inevitably increase trust case volume and the existing literature is inconclusive regarding a possible volume-outcome association. This study aims to investigate the association between case volume and unplanned readmission or unplanned return to theatre (URTT) rates in patients undergoing colorectal surgery across England and Wales.

Methods
A retrospective analysis was conducted of 14028 patients across 135 trusts using the 2020 NBOCA dataset. Primary outcome measures were 30-day unplanned readmission and 30-day URTT rates. Trusts were dichotomised into low or high-volume sites. Statistical analysis used Spearman's ρ correlation, Mann-Whitney U and Student T-test.

Results
11.2% (2.30–24.5) and 8.31% (0.00–23.3) of 14028 patients underwent an unplanned readmission and URTT respectively. There was no significant correlation between the number of cases and 30-day unplanned readmission (r=0.0628, 95%CI: -0.112–0.234, p=0.469), with no significant difference between low and high-volume trusts (p=0.432). Similarly, no significant correlation was found between the number of cases and 30-day URTT rate (r=-0.0848, 95%CI: -0.255–0.0904, p=0.328), with no significant difference between low and high-volume trusts (p=0.285).

Conclusions
No association was discovered between volume and unplanned readmission or URTT in this cohort. Increasing volume among trusts who demonstrate favourable outcomes, rather than indiscriminately increasing volume may be beneficial. This study increases our understanding of volume-outcome relationships, however further prospective studies at a national level into other outcomes should be conducted to rule out centralisation.
SP9.1.4 Performance and Cost-Effectiveness of a Virtual Consultation Clinic for 2-Week-Wait Colorectal Cancer Referrals – A Response to the Covid-19 Pandemic
Authors: Davidson Christopher , Conlon Sinead , Al-Fagih Othman , Khan Nauwab , Cheetham Drostan , Patel Vanash 
Published: November 2022

Abstract

Aims
Measure performance and cost effectiveness of a Virtual Consultation (VC) clinic, compared to face-to-face (FF) clinic, for 2-week-wait (2WW) colorectal cancer (CRC) referrals, which did not meet the criteria for nurse-led Telephone Assessment Service.

Methods
2WW CRC referrals were triaged by a colorectal surgeon to either a doctor-led VC or FF clinic. Demographics, referral indications, and primary outcome measures (time to clinic/results; investigation type; cancer detection rate) were compared pre-pandemic (November 2019–January 2020) and during the pandemic (May–June 2021).

Results
158 (pre-pandemic) and 160 (pandemic) consecutive patients were analysed, with no difference in age (74 vs. 75 years, p=0.936). During the pandemic, patients were referred with an increased number of positive FIT tests (29 vs. 13%, p&lt;0.001), were more likely to have computerised tomography (65 vs. 45%, p=0.003), had a longer time from referral to clinic assessment (10 vs. 8 days, p=0.002), but were informed of results more promptly (59 vs. 138 days, p&lt;0.001) than pre-pandemic patients. During the pandemic patients were assessed earlier via VC than FF clinics (9 vs. 11 days, p=0.049). There were no significant differences in cancer detection rate pre or during the pandemic (12 vs. 8%, p=0.187), or between VC and FF clinic during the pandemic (6 vs. 12%, p=0.294). Cost effective analysis showed £15,000 per annum saving with doctor-led VC clinic.

Conclusion
Virtual consultation for 2WW CRC referrals may improve efficiency without compromising the cancer detection rate, as well as reducing risk of Covid-19 transmission and being more cost effective.
SP9.1.5 Occult appendix pathology in patients undergoing colorectal cancer resection suggests a role for appendectomy at left colon or rectal cancer resection
Authors: Ravi Prabhu , Di Fabio Francesco , Khan Kashuf , Abduelraheim Abu , Arnold Steve , Moran Brendan 
Published: November 2022

Abstract

Aims
There is epidemiological evidence suggesting that the incidence of appendicular neoplasms is increasing. The purpose of this study is to assess the incidence of appendix neoplasms in patients undergoing colorectal cancer resection in a unit where standard of care is appendectomy, with consent, when left colon or rectal cancer resection is performed.

Methods
This is a retrospective single-centre study on a prospectively collected data base of 718 consecutive patients undergoing colorectal cancer resection between January 2015 and June 2021. The primary outcome was the proportion of histologically abnormal appendix specimens at incidental appendectomy. Secondary outcome was complications from incidental appendectomy.

Results
Overall, 222/718(31%) patients had previous appendectomy. The remaining 496 comprised 169/496 (34%) who had a right-/extended-right hemicolectomy or sub-total colectomy which incorporates appendectomy, and 327/496(66%) who had left-sided resection (left-hemicolectomy, anterior resection or abdomino-perineal excision) with incidental appendectomy.
At definitive histology, 454(92%) had a normal appendix, 13(2.6%) had inflammatory appendix pathology, 17(3.4%) had a hyperplastic/serrated polyp and 12(2.4%) had an appendix neoplasm, which included 5 carcinoids and 7 low-grade appendiceal mucinous neoplasms (LAMN).
In the 327 patients who had incidental appendectomy, 7(2.1%) had a neoplasm (4 carcinoid and 3 LAMN). There were no complications attributable to appendectomy.

Conclusion
Patients undergoing left sided colorectal cancer surgery with an appendix in situ should be counselled on the benefits of co-incidental appendectomy to treat the small proportion with synchronous neoplasms and inflammation and eradicate the risk of metachronous appendicitis or a subsequent appendix tumour.
SP9.1.6 Save the scope - a 3-year analysis of follow-up methods for acute diverticulitis and the incidence of colorectal malignancy
Authors: Gurowich Louise , Hollyman Marianne 
Published: November 2022

Abstract

Aims
Previously, guidelines for the management of diverticular disease have recommended endoscopic evaluation following acute diverticulitis to exclude colorectal cancer (CRC). However, 2021 ACPGBI consensus guidelines recognised the sensitivity of modern CT scanning and low incidence of CRC, and suggested no routine re-imaging in CT-proven uncomplicated disease.

Methods
Patient were identified presenting between 2017–2019 at a single centre. Records were retrospectively reviewed to evaluate the incidence of CRC at a minimum of 18-month follow up in this patient group. Secondary outcomes included the imaging method requested, operative management, and complications following endoscopy.

Results
Of 486 admissions in 461 patients, 168 (35%) had CT-proven complicated disease, 225 (46%) had uncomplicated, and 93 (19%) had no imaging. 281 (59%) had follow-up investigations requested; 126 CT colonoscopy (CTC) and 150 endoscopic. 133 investigations were performed in patients with uncomplicated diverticulitis.
Only 6 patients (1%) were diagnosed with CRC; 2 at endoscopy, and 4 by histology from colorectal resections during emergency admission; all had CT-proven complicated diverticulitis. No malignancy was identified in patients with uncomplicated diverticulitis.
Secondary outcomes identified that 26 (24%) flexible sigmoidoscopies were poorly tolerated, necessitating further imaging.

Conclusions
At our centre, there was little consensus on whether patients had follow-up imaging following acute diverticulitis, and what modality was used. We identified no CRC in patients with CT-proven uncomplicated disease, with 133 potentially unnecessary investigations performed in this group. We recommend use of CTC or endoscopy following acute CT-proven complicated diverticulitis in line with ACPGBI guidelines, avoiding follow-up in uncomplicated disease.
SP9.2.1 Postoperative outcomes in patients undergoing Total Pelvic Clearance for locally advanced Primary and Recurrent Rectal Cancer: A Systematic Review to assess Perioperative Mortality, Rate of R0 Resection and 5Year Overall Mortality
Authors: Khan Rehan , Selvasekar Chelliah , Jamshed Nayer , Sahu Ankit 
Published: November 2022

Abstract

Introduction
The outcomes of complex surgical procedures such as Total pelvic clearance (TPC) have improved due to advances in technology, improvements in surgical technique and experience. Majority of Reviews include older studies diluting the benefits and outcomes. Secondly, very few studies mention all important outcomes in one leading to non-uniformity in reporting of data. Lastly, there was further need of updating the previous reviews, the last one published a decade earlier, hence, the review of Perioperative Mortality, rates of R0 resection and 5-year overall survival were carried out in patients undergoing TPC for primary or recurrent rectal cancer in a systematic manner.

Methods
Literature searches were performed in three databases: MEDLINE, PUBMED and Cochrane Library. Each study was evaluated with regards to its design and statistical methodology. The quality assessment of studies was carried out in this review as per the SIGN grading system. Publication bias was assessed by drawing funnel plots for each outcome. Each outcome was further analysed by creating Forrest plot using fixed effect model.

Results
A total of 1632 articles were identified through electronic databases. A total of 21 articles were finally included which met the inclusion and exclusion criteria. Out of 963 resections carried out, perioperative mortality was 3.4%. Overall R0 rection rates were 72.4%. Out of total 374 patients, overall, 5-year survival rate was 42%.

Conclusion
TPC is safe in experienced hands at specialist centres experienced in dealing with such cases with acceptable outcomes outlined above.
SP10.1.3 Can We Justify Routine Group & Screen Testing Prior to Appendicectomies? - A Single Centre Analysis
Authors: Deb Rita , Deb Gita , Pore Naresh , Sheth Hemant , Raje Durgesh 
Published: November 2022

Abstract

Aim
Numerous sources have suggested that routine preoperative Group & Screen (G&S) testing prior to cholecystectomies 1–4, breast surgery 5 and gynaecological procedures including Caesarean sections 6 may be unnecessary because perioperative blood transfusion incidence remains low.
This project aimed to understand whether routine pre-appendicectomy G&S testing can be justified by analysing blood transfusion incidence for appendicectomies completed at our hospital. To further comment on their relevance to clinical practice, we also aimed to investigate any potential delay to surgery that G&S tests may pose, and their cost implications.

Method
For all appendicectomies undertaken at our hospital from 2018 to 2021 (n = 257), we noted if the patient received a blood transfusion anytime during their admission. The date and time of G&S sample collection and of the surgery were recorded, including any documentation of delays to surgery.

Results
0% of appendicectomies between 2018–2021 required a blood transfusion during the admission. On average, 3.9% of appendicectomies per year were delayed due to preoperative G&S testing with an average delay to surgery of 78.71 minutes.
The total cost of G&S tests undertaken for appendicectomy patients between 2018–2021 was £5768.03.

Conclusion
It is difficult to justify routine pre-appendicectomy G&S testing when our data suggests such a low risk of blood loss necessitating transfusion, and that these tests delay treatment. This may warrant pre-appendicectomy risk stratification to streamline G&S testing. Additionally, should an emergency occur, uncrossmatched blood is readily accessible and poses minimal risk to patients7.
SP10.1.6 Effect of hyaluronate-based bioresorbable membrane (Seprafilm) on outcomes of abdominal surgery: a meta-analysis and trial sequential analysis of randomised controlled trials
Authors: Hajibandeh Shahin , Hajibandeh Shahab 
Published: November 2022

Abstract

Background
We aimed to evaluate comparative outcomes of abdominal surgery with and without hyaluronate-based bioresorbable membrane (Seprafilm).

Methods
We conducted a systematic search of electronic databases and bibliographic reference lists with application of a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits. Small bowel obstruction, anastomotic leak, surgical site infections, ileus, and severity of adhesions were the evaluated outcome measures.

Results
Thirteen randomised controlled trials reporting a total of 3,665 patients evaluating outcomes of abdominal surgeries with (n=1,800) or without (n=1,865) use of Seprafilm were identifed. Use of Seprafilm was associated with significantly lower risk of small bowel obstruction (RR:0.53, 95% CI 0.38–0.73, P=0.0001) but significantly higher rate of anastomotic leak (RR: 1.85, 95% CI 1.15–3.00 P=0.01). Moreover, while Seprafilm resulted in significantly more adhesions-free patients (RR:5.57, 95% CI 3.37–9.19, P&lt;0.0001) compared to no Seprafilm, its use was associated with significantly lower grade 2 (RR:0.57, 95% CI 0.35–0.95, P=0.003) or 3 (RR:0.31, 95% CI 0.17–0.55, P&lt;0.0001) adhesions. There was no significant difference in surgical site infection (RR:1.21, 95 CI 0.86–1.70, P=0.28), intra-abdominal abscess (RR: 1.46, 95 CI 0.92–2.32, P=0.11) or paralytic ileus (RR:0.97, 95 CI 0.68–1.38, P=0.87) between two groups. The trial sequential analysis demonstrated that the meta-analysis findings are conclusive.

Conclusions
Seprafilm reduces the risk of small bowel obstruction and severity of adhesions after abdominal surgery. However, it may increase the risk of anastomotic leak. We recommend use of Seprafilm in any abdominal surgery which does not involve an anastomosis.
SP10.1.8 Acute uncomplicated diverticulitis: to scope or not to scope?
Authors: Howie Emma , Almafreji Ibrahim , Cole Charlotte , Watt David 
Published: November 2022

Abstract

Aims
To investigate whether endoscopic follow up after a CT proven diagnosis of acute uncomplicated diverticulitis detected additional pathology, specifically colorectal cancer, and if our findings support the European Society of Coloproctology's consensus statement that “a single episode of CT verified uncomplicated diverticulitis endoscopic follow-up remains controversial and may not be necessary”.

Methods
A retrospective study evaluated every General Surgical emergency admission with acute uncomplicated diverticulitis to our unit in a 5 year period (2015–2020) to assess for radiological diagnosis and endoscopic follow up.

Results
Over the 5 years there were 685 admissions with acute uncomplicated diverticulitis affecting 547 individuals. 74.3% of admissions and 80.3% of individuals underwent a Computerised Tomography (CT) during admission. 244 admissions (48%) went on to have an endoscopic examination, with 12.3% of these being inpatient investigations. 50% (122) of patients undergoing endoscopy had confirmed uncomplicated diverticulitis. Of the remaining patients undergoing endoscopy, 79.5% had no pathology detected. Only 1 malignant polyp was discovered on endoscopy with no tumours detected.

Conclusions
CT has a high sensitivity and specificity in the diagnosis of acute uncomplicated diverticulitis. We suggest that it is reasonable not to utilise endoscopy as a screening tool after uncomplicated diverticulitis and the risks versus benefits must be carefully considered, especially in the era of Covid-19 where resources are tight and waiting lists ever growing. An endoscopic procedure is a costly, uncomfortable procedure that puts the patient at risk of morbidity and mortality.
Our findings support the European Society of Coloproctology's statement regarding endoscopic follow-up.