bluuebunny/crossref_metadata_2025_split huggingface dataset:
WE2.3 Comparative study of early versus delayed laparoscopic cholecystectomy following endoscopic sphincterotomy for mild to moderate acute biliary pancreatitis
Authors: Devkaran Bhavesh , Sharma Shivam , Sodhi Surinder , Chauhan Arun 
Published: November 2022

Abstract

Background
Acute pancreatitis is an inflammatory disease of the pancreas with acute biliary pancreatitis (ABP) accounting for 75% of cases. Current recommendations favour early laparoscopic cholecystectomy (LC) for mild acute gall stone pancreatitis during the same index admission to prevent recurrent attacks reported to be as high as 18–61% in various studies. Endoscopic sphincterotomy in cases who are unfit for cholecystectomy during the index admission or there is delay in cholecystectomy due to logistics may benefit from ES while waiting for elective cholecystectomy, in terms of reducing the number of recurrent attacks and decreasing morbidity.

Methods
A total of fifty-seven (57) patients of mild to moderate ABP were included in this study and were divided into three groups undergoing LC within 5 days of admission, ES within 7 days of onset of pain abdomen and LC within 4 weeks of initial illness and LC after 8 weeks of attack in the three respective groups and evaluated for level of difficulty of cholecystectomy, recurrent attacks and associated morbidity.

Results
Difficult LC in terms of adhesions, calots anatomy was seen in 17(n=57) patients. 13(n=38) patients had recurrent attack of pancreatitis during the waiting period for cholecystectomy, 2(n=19) in the ER group and 11(n=19) in the conservative management group, with all patients in the conservative group having more than 2 recurrent attacks.

Conclusion
LC in early period is a safe, effective, in patients of gallstone induced pancreatitis. ES is well tolerated and viable alternative to cholecystectomy to prevent recurrent pancreatitis until definitive treatment.
WE2.5 Laparoscopic Common Bile Duct Exploration using disposable Bronchoscope and Cystoscope: Case Series in a District General Hospital
Authors: Hackney Lauren , Eta Asim , Eltayeb Omar 
Published: November 2022

Abstract

Aims
Case Series performing Laparoscopic Common Bile Duct Exploration (LCBDE) using single use bronchoscope and cystoscope in a district general hospital. Aim is to explore the safety and efficacy of using single use instruments.

Methods
Retrospective study of all LCBDE from a single consultant using single use scopes from May 2019 to January 2022. Data collected from Electronic Care Record, notes and theatre management system. Both choledochotomy and transcystic approaches were used. Operations were recorded and outcomes of patients explored.

Results
Fifteen laparoscopic CBD explorations were carried out during the identified period. Indications included young patients (&lt;50yr) 33.3%, Failed ERCP 13.3%, Referral by gastroenterologist 13.3% and other reasons 40%.
The mean age (+/- SD) was 58 (+/-17) and 80% of patients were female. 66.6% of cases were emergencies, 40% had intraoperative cholangiograms, 100% underwent primary closure. The average length of stay (±SD) after the operation was 10 (±8). One patient developed a haemoserous collection that required a laparoscopic washout, one developed post-operative atrial fibrillation and one patient was readmitted with post-operative infection. There were no intraoperative complications or equipment failures.

Conclusions
The use of disposable bronchoscope and cystoscopes are safe and effective way of performing LCBDE. This approach is also cost effective compared to the more expensive reusable choledocoscope particularly when considering delays due to sterilisation as well as issues with availability in departments. Providing this service in district general hospitals will assist in extensive waiting lists and potentially avoid morbidity associated with ever lengthening waiting lists and reduce pressure on tertiary centres.
WE2.6 Procedural outcomes of laparoscopic caudate lobe resection: A systematic review and meta-analysis
Authors: Anwer Amal Azhar , Hajibandeh Shahab , Kotb Ahmed , Evans Louis , Sams Emily , Hajibandeh Shahin , Satyadas Thomas 
Published: November 2022

Abstract

Aims
to evaluate the procedural outcomes of laparoscopic caudate lobe resection.

Methods
We performed a systematic review in accordance with PRISMA statement standards to identify all studies reporting the outcomes of laparoscopic resection of caudate lobe of liver. The population of interest included adult patients with benign or malignant lesions located in caudate lobe of liver. The intervention of interest included laparoscopic resection of caudate lobe of liver. Random-effects models were applied to calculate pooled outcome data.

Results
196 patients from 12 studies were included. The mean operative time, volume of intraoperative blood loss, and length of hospital stay were 225 mins (181–269), 134 ml (85–184), and 7 days (5–9), respectively. The pooled risks of need for intraoperative transfusion was 2% (0–5%), conversion to open surgery was 3% (1–6%), need for intra-abdominal drain was 6% (0–19%), postoperative mortality was 1% (0–3%), biliary leakage was 2% (0–4%), intra-abdominal abscess was 2% (0–4%), biliary stenosis was 1% (0–4%), postoperative bleeding was 1% (0–3%), pancreatic fistula was 1% (0–4%), pulmonary complications was 2% (1–5%), paralytic ileus was 1% (0–4%), and need for reoperation was 1% (0–4%).

Conclusions
Evidence from case series suggests that laparoscopic approach may be safe, feasible and promising for resection of lesions located in caudate lobe of liver. The findings of current study can be used for hypothesis synthesis in future studies and can be used to inform surgeons and patients about the estimated risks of perioperative complications until a higher level of evidence is available.
WE2.7 Meta-analysis of interrupted versus continuous suturing for Roux-en-Y hepaticojejunostomy and duct-to-duct choledochocholedochostomy
Authors: Hajibandeh Shahin , Hajibandeh Shahab , Patel Ishaan 
Published: November 2022

Abstract

Aims
To compare outcomes of interrupted (IS) and continuous (CS) suturing techniques for Roux-en-Y hepaticojejunostomy and duct-to-duct choledochocholedochostomy.

Method
s. A systematic search of electronic information sources and bibliographic reference lists were conducted. A combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases was applied. Overall biliary complications, bile leak, biliary stricture, cholangitis, liver abscess, and anastomosis time were the evaluated outcome parameters.

Results
Nine comparative studies were included which reported 1061 patients of whom 630 patients underwent Roux-en-Y hepaticojejunostomy (IS:281, CS:309) and the remaining 431 patients underwent duct-to-duct choledochocholedochostomy (IS:168, CS:263). Although use of IS for hepaticojejunostomy was associated with significantly longer anastomosis time (MD:9.82 minutes, p&lt;0.00001) compared to CS, there was no significant difference in overall biliary complications (OR:1.34, p=0.19), bile leak (OR:1.73, p=0.26), biliary stricture (OR:0.77, p=0.64), cholangitis (OR:1.54, p=0.35), or liver abscess (OR:0.58, p=0.40) between two groups. Similarly, use of IS for choledochocholedochostomy was associated with no significant difference in risk of overall biliary complications (OR:0.92, p=0.90), bile leak (OR:1.70, p=0.28) or biliary stricture (OR:1.07, p=0.92) compared to CS.

Conclusions
Interrupted and continuous suturing techniques for Roux-en-Y hepaticojejunostomy or duct-to-duct choledochocholedochostomy seem to have comparable outcomes although the former may be associated with a longer anastomosis time. The available evidence may be subject to confounding by indication with respect to diameter of bile duct. Future high quality research is encouraged to report the outcomes with respect to duct diameter and suture material.
WE2.9 Quality of ultrasound report in patients with biliary symptoms in the context of surgical diseases
Authors: Mateescu Daniela Ioana , Hakeem Abdul , Chedid Youssef , Chattopadhyay Dipankar 
Published: November 2022

Abstract

Aim
The diagnosis of surgical pathology in patients presenting with biliary symptoms is highly reliant on a good quality ultrasound report, our aim was to identify if there are any deficiencies in reports of ultrasound which are important diagnostic parameters of upper GI abnormalities.

Methods
Patients presenting to our hospital with biliary symptoms who require an ultrasound of biliary diseases were included, 8 parameters from the guidelines of Society and College of Radiographers were taken and analysed, means of missing data was calculated, CBD diameter was considered as a significant parameter. Quality of report for CBD was further scrutinized with patients who required 2nd investigations like MRCP and CTAP using crosstabs.

Results
A total of 278 patients were included in the study, 97.9% were due to gallstone diseases and 2.1% were for post-cholecystectomy. 89.7% had mentioned the normality of CBD while only 21.1% mentioned the actual value of CBD. 93% reports mentioned flow of portal vein, 7% did not mention portal vein flow. Interestingly 2.1% of ultrasounds were for post cholecystectomy but during scans, 4.6% of patients had absent gallbladder. 98 (34.5%) patients had one or more secondary investigations. 22.9% of normally reported CBD on ultrasound had positive CBD findings on MRCP.

Conclusions
This audit demonstrates the importance of a good quality ultrasound report. A good quality ultrasound can aid in clinical diagnosis and guidance of further investigations. Important factors to consider are the value of CBD Diameter, portal vein flow and quality of biliary stone/sludge.
WE3.3 Discharge delay-A pitfall for NHS; Can we improve?
Authors: Nessa Ashrafun , Ghazanfar Mudassar , Pawlay Karola , Purewal Ramandeep , Ganeshmoorthy Kajenthiny , Tayo Oluwasegun 
Published: November 2022

Abstract

Aim
Identify reasons for discharge delays from hospital and areas of improvement and any scope for trainees to make a difference – Trainee lead intervention.

Method
All inpatients including Elective and Emergency admissions were included from all 3 teams over 1 week. Data were collected on Microsoft Excel and analysis done with SPSS.

Result
Total 102 patients were included (Purple 44, Yellow 40, Red 18). Mean age was 60.5 years. 54 (52.9%) patients were Female. 57.4% data were missed for clinical frailty score (CSF). 46.5%patients had polypharmacy. 61 patients did not have any Expected date of Discharge (EDD). Mean Length of Hospital stay (LOS) is 18.01 days and median 10 (1–161) days. Total 27 patients were delayed. 1 stayed for 161 days awaiting rehab bed. Mean Duration of delay was 4.93 days and Median 1 day (1–42).4 patients were waiting beds outside of hospital for 3, 6,10, &gt;30 days;6 patients were delayed for Stoma nurse review for average 1 day. Delayed discharges do not seem to be affected by polypharmacy (p=0.067), DNACPR (p=0.926), frailty score (p=0.761) or gender (p=0.518), or which team they were on (p=0.801). Discharges are however affected by age(p=0.037).

Conclusions
Our recommendations were to Identify patient at risk of discharge delay by trainees on admission by CSF, early identification of care requirements with OT/PT, regular EDD review, pre-emptive discharge letter preparation. We also recommended increased resources like training of senior nurses to assess stoma training, phlebotomists/ new clinical support worker to collect early morning bloods, increased Surgical bed capacity.
WE3.4 Nutrition in the Surgical Patient: Evaluation of the Current Knowledge and Practice in a Tertiary Centre
Authors: Procter Alice , Murdoch Jodie , Shah Shaneel , Curran Finlay 
Published: November 2022

Abstract

Aims

Methods
We performed a multi-cycle assessment using the PDSA format. To establish current knowledge a quiz was designed in consultation with local dietitians.
The following domains were evaluated against NICE guidelines:
A pass mark of 80% was established to aid data collection.
Cohort 1 consisted of 47 foundation year 1 doctors undertaking surgical rotations.
With the analysis of results from the first cohort a teaching session was designed. Following delivery of the teaching session, the cohort re-attempted the quiz.

Results
Cohort 1

Conclusions
WE3.6 The effect of the Covid pandemic on operative experience of laparoscopic appendicectomy
Authors: Kenber Melisa , Cheetham Stephanie , Doughty Alice , Smellie Eloise , Saha Arin 
Published: November 2022

Abstract

Aims
The Covid-19 pandemic has led to many changes in the delivery of surgical services; perhaps the greatest of these, for the long-term sustainability of surgery at least, is that on training. This study aimed to describe the effect of these changes on operative experience of laparoscopic appendicectomy

Methods
All patients who had surgery for suspected appendicitis from 2016 to 2021 were identified from a prospectively maintained database of surgeries. Data for 2020 and 2021 were compared with preceding years.

Results

Conclusions
In 2020, there were fewer operations performed for appendicitis and markedly reduced opportunities for trainees. This may reflect a fall in acute admissions, greater reliance on pre-operative imaging and reployment of surgical juniors. With a focus on returning to ‘normal’ in 2021 and a commitment to preserving surgical services, training opportunities have returned for laparoscopic appendicectomy despite the impact of Covid.
WE3.7 Cognitive computing in minimally invasive surgical training
Authors: Schaffer Sierra , Lo Justine JS 
Published: November 2022

Abstract

Aims
Research on Cognitive Computing (CC) in surgery is exponentially developing, however is only just starting to be investigated in minimally invasive surgical skills training. The technology is being underutilized, especially when compared with technical skills training in other industries. This review aimed to establish how CC is currently being used in minimally invasive surgical training and evaluate how this is projected to evolve.

Methods
A literature review was done of Pubmed, MedlineOvid, and PapersWithCode using the MeSH search terms CC (including machine learning, artificial intelligence, and neural networks), and minimally invasive surgical training and education.

Results
AI and NN were the most common CC technologies applied to minimally invasive surgical training. Basic laparoscopic training followed by general surgery robotics procedures were the most common skill sets studied.
The majority of studies focused on the assessment of skills and rating of participants after the training was complete. Overall CC was found to be effective and accurate at this task.
Few studies evaluated CC use for real-time feedback in order to improve participants’ training. Those that did found the technology capable of image tracking within 1–5 seconds. They were only used to provide feedback on one quality within the skill, most commonly economy of movement.

Conclusions
The application of CC to minimally invasive surgical training has only just started to be explored. Further interdisciplinary research with a focus on database development is needed in order to accelerate the wider utilization of CC within minimally invasive surgical training.
WE3.9 Operative competence should be assessed on a procedure-specific basis: analysis of submitted Supervised Structured Assessments of Operative Performance (SSAOPs) by Core Surgical Trainees in Ireland using Generalisability Theory
Authors: Toale Conor , Morris Marie , O'Keeffe Dara , Ryan Donncha M , Boland Fiona , Kavanagh Dara O 
Published: November 2022

Abstract

Introduction
Competency-based training programmes require reliable summative assessment methods. The aim of this study is to assess the reliability of the Supervised Structured Assessment of Operative Performance (SSAOP) tool in determining the operative competence of core surgical trainees in Ireland.

Methods
SSAOP scores from April 2016 - February 2021 were analysed. Reliability analyses for assessment of laparoscopic appendicectomy were compared to those across all submitted procedural assessments. Generalizability and decision studies determined the number of assessments and observers needed to achieve a reliability coefficient (G) of ≥0.7 and ≥0.8 (appropriate for low- and high-stakes assessment respectively).

Results
2,294 SSAOPs were analysed; 85 were completed for laparoscopic appendicectomy. G ≥0.70 is achieved using a single assessor observing a minimum of 3 laparoscopic appendicectomy cases, though G ≥0.70 cannot be achieved for assessments across a wider group of procedures without large numbers of assessors and cases. G ≥0.80 can be achieved with a minimum of two random assessors each observing 3 cases using the Overall Performance rating, or by two assessors and 6 assessments using the ‘Total Checklist’ score. Reliable assessment of a trainee's skill across all procedures, regardless of sub-specialty, could only be achieved using 89 cases and 7 assessors using the Overall Performance rater, or 67 cases and 9 assessors using the Total Checklist.

Conclusion
Operative competence should be assessed on a procedure-specific basis. Assessing overall competence across procedures is not feasible in practice. Trainers and trainees should focus on repeated assessments observing index procedures suitable for a given trainee's stage of training.
WE3.10 The Impact of Simulation Training on Junior Doctors Managing Surgical Emergencies
Authors: Wang Liyang , Morton Jonathan , Powar Michael , Davies Justin , Fearnhead Nicola , Wheeler James , Panagiotopoulou Ioanna 
Published: November 2022

Abstract

Aim
The use of simulation for the training of junior doctors in surgery usually involves either practicing technical skills or exercising communication skills. We have identified a gap in crisis resource management training of junior surgical trainees with scenario-based simulation. We have developed a one-day simulation course on general surgical emergencies and evaluated its impact.

Methods
The course included a human factors presentation and several scenarios of acute surgical emergencies. It was aimed at core surgical trainees, but other junior doctors were invited. High fidelity human simulator (SimMan®) was used and controlled by faculty. Surgical scenarios were selected in order to provide insight for the appropriate resuscitation for acute surgical patients. The impact of the course was evaluated with a post course questionnaire.

Results
Ten courses were completed between 2015 and 2021. A total of 58 doctors attended, 45 were core surgical trainees. All 51 participants who responded to the questionnaire rated the course “Good (4/5)” or “Excellent (5/5)”. Following the course, of 51 participants, 50 felt better prepared and 51 were confident in recognising unwell surgical patients; 42 felt better prepared and 50 confident in providing resuscitation; 46 felt better prepared and 51 confident in escalating care. During debriefs and on free text feedback, participants frequently reported the course helped develop their non-technical skills.

Conclusion
The General Surgical Emergencies simulation courses were rated useful by the learners. The course has positively impacted on the preparedness and confidence of junior surgical trainees in recognising unwell surgical patients, providing initial resuscitation and escalating care.
WE3.11 Inguinal hernia repair operation; review of the consent and the supported decision-making in the out-patient department
Authors: Abbakar Malaz , Ahmed Salma , Stojkovic Stevan 
Published: November 2022

Abstract

Introduction
In 2015, the ruling of the UK Supreme Court in Scotland in the case of Montgomery v Lanarkshire fundamentally changed the practice of consent. According to the Judges, doctors are no longer the sole arbiter of determining what risks are material to their patients. In this study, the RCS CONSENT: SUPPORTED DECISION-MAKING guide was used to evaluate our practice in regards to consent taking for inguinal hernia repair.

Methods
OPD letters to GPs were reviewed between 01/01/2019 to 30/12/2019. For risks with its percentages, alternative management exploration with the patient and whether information leaflets supplied to the patients.

Results
There were 63 patients. 19/63 letters had different options of treatment documented. 37/63 letters showed risks and complications documented and only 4/63 letters had percentages of the risks written. 25/63 patients signed consents in OPD. 0/63 letters indicated a signed consent copy was given to patients. Only 10 patients had been given an information leaflet.

Conclusion
Overall quality of letters was: 36/63 were poor, 21/63 were average and 5/63 were good. Therefore, to improve our practice leaflets shall be made easily accessible in all clinics. A prompt notification, if consent has been signed when booking a patient. workshops with feedback for middle grades.
WE3.12 A Closed Loop Clinical Audit on The Implementation of WHO Surgical Safety Checklist at a Tertiary Level Hospital in India: Where do we stand?
Authors: Sinha Akatya Vidushi , Kadam Sameer 
Published: November 2022

Abstract

Aim
To complete an audit on the level of compliance to the WHO surgical safety checklist in surgical operating theatres at a Tertiary level hospital in India.

Method
A total of 40 general surgeries were observed at the operating theatres at a tertiary level hospital in India to confirm the practice of the WHO surgical safety checklist. The study was conducted for a period of 2 months starting from July to August 2021. The results were compared with standard guidelines and further analyzed. Interventions were carried out by a series of rigorous departmental meetings and discussions with the medical and nursing staff. A re-audit was conducted after 2 weeks.

Results
Of all the operations audited, 45% Sign-In and only 1% Sign-Out were performed in the first cycle. After the re-audit, a significant change was reported as the Sign-In improved to 80% and a 55% Sign-Out was conducted. The Time-Out was observed to increase from 15% to 65%.

Conclusion
Though in the first cycle of our audit the compliance to the SSCL was found to be suboptimal, significant improvement was demonstrated in the second cycle after rigorous awareness programs and training sessions. Compliance was seen to be greater in major surgeries than in minor surgeries. Compliance with all items in the checklist and active participation by all medical and nursing staff is mandatory for successful implementation of the Surgical safety checklist.