bluuebunny/crossref_metadata_2025_split huggingface dataset:
TH1.10 Antithyroid peroxidase antibodies and histopathological outcomes in Egyptian patients subjected to total thyroidectomy for nonmalignant nodular goiter. Retrospective study
Authors: Noureldin Khaled , Salman Mohamed , Issa Mohamed , Badawi Marwa , Bisheet Goerge , Maryosh Sally 
Published: November 2022

Abstract

Introduction
Thyroid is an endocrine gland. It produce T3 and T4 hormones through a series of enzymatic actions. These hormones regulate body metabolism and physiology. Immune disorders in this gland can cause hypo/hyperthyroidism.

Objective
The study aimed to assess antithyroid antibodies in patients with benign thyroid masses and the effect of total thyroidectomy on the antibodies titres.

Patients and Methods
This is a retrospective work of 112 cases managed with total thyroidectomy who have positive antithyroid peroxidase antibodies (TPO-Ab), antithyroglobulin antibodies (Tg-Ab), or both. All patients were euthyroid before surgery. Thyroid function tests and thyroid antibodies levels were measured before and 6 and 12 months after surgery.

Results
Histopathological evaluation revealed Hashimoto thyroiditis (47.3%), colloid nodules (22.3%), and lymphocytic thyroiditis (30.4%). All patients were TPO-Ab positive, while 96 patients (85.7%) were Tg-Ab positive before surgery. There was no considerable change in TPO-Ab and Tg-Ab after surgery (p = 0.817, and p=0.560, respectively). Also, there was no significant difference between the three histopathological diagnoses in the levels of TPO-Ab (p = 0.086) or Tg-Ab (p = 0.673).

Conclusions
Antithyroid antibodies are not valuable markers for diagnosis or prognosis of benign thyroid diseases subjected to total thyroidectomy. We do not recommend their use beyond being a supportive evidence of the possibility of autoimmune nature of the disease if other criteria are confirmed.
TH2.4 Systematic Review on Surgical Management of Difficult Common Bile Duct stones
Authors: Sam Zi Hao , Welsh Silje , Kong ChiaYew , Glen Paul 
Published: November 2022

Abstract

Aims
85–95% of common bile duct stones (CBDS) are successfully managed with endoscopic treatment, but a small proportion of CBDS are difficult to remove. These lead to high morbidity secondary to complications of biliary obstruction. This study aims to appraise existing management options for difficult to retrieve CBDS through systematic review of existing published data.

Methods
Systematic literature search was performed on search engines including MEDLINE, EMBASE, Cochrane library and ClinicalTrials.gov using pre-defined search strategy and pre-registered in International Prospective Register of Systematic Review (PROSPERO). All studies regarding management options, efficacies and/or complications of difficult CBDS managements were included. Definition of difficult to clear CBDS were outlined. Results were independently reviewed, assessed for bias, analysed and reported using Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results
59 studies were included through database search. Various difficult stone characteristics, surgical interventions and study designs were reported. Common bile duct exploration was shown to be the preferred management approach with good stone clearance. Stone clearance rate on CBD exploration and biliary enteric anastomoses were found to be overall above 83% among reviewed studies. Adjunctive strategies, particularly laser lithotripsy, were of additional beneficial value in clearing difficult stones. Overall complication rates were found to be low, and majority did not require significant intervention. However, included data were heterogenous and of high risk of biases.

Conclusion
Current evidence suggests good outcomes from surgical management of difficult choledocholithiasis, but evidence is of heterogenous quality. Further randomised controlled trials are warranted to explore preferable management options.
TH2.5 Evaluation of Radiological and Multimodal Prognostic Models in Discriminating Patients by Overall Survival in a Large Single Centre Cohort of Peri-Hilar Cholangiocarcinoma Patients
Authors: Bird Nicholas , Manu Nichola , Shehata Zak , Fenwick Stephen , Jones Robert , Malik Hassan 
Published: November 2022

Abstract

Aims
Several putative prognostic models have been developed to stratify patients with peri-hilar cholangiocarcinoma (PHC) by Overall Survival (OS). The objective of this study was to evaluate the utility of these models in determining prognosis for all patients presenting to a tertiary referral centre with PHC.

Methods
Three hundred and two patients diagnosed with PHC referred to a regional tertiary referral centre between 2008 and 2019 had their demographic and survival data retrospectively analysed from a prospectively held database linked to Hospital Episode Statistics and Somerset Cancer Registry data. Univariate and multivariate modelling was utilised to determine significant prognostic variables. Concordance indices were constructed for the prognostic models to determine internal validity within the cohort.

Results
Multivariate analysis demonstrated that: pre-interventional ECOG status (p 0.02); bilirubin levels (p 0.001); resectional status (p 0.001) and Mayo Clinic (MC) model (p 0.003) were significant predictors of OS. MC staging system demonstrated utility in stratifying patients by OS in pre-interventional patients with peri-hilar cholangiocarcinoma in all comers (p 0.001) and patients who did not progress to resection (p=0.021). There was strongly significant concordance between pre-intervention MC staging and OS in all comers in this cohort (C-index 0.59).

Conclusions
This study has validated the use of the MC model in a pre-interventional clinic setting. Bilirubin, a standardised easily obtainable serological biomarker, should be considered for incorporation into the MC model to refine patient stratification by OS.
TH2.11 The influence of sarcopenia and systemic inflammation on survival in resected pancreatic cancer
Authors: Bryce Adam , Dreyer Stephan , Chang David 
Published: November 2022

Abstract

Aims
Sarcopenia, cachexia and systemic inflammation are early hallmarks of pancreatic cancer. The impact of these processes on survival has been demonstrated in other cancer types using image-based body composition analysis. We sought to determine the impact of sarcopenia and systemic inflammation on survival in pancreatic cancer.

Methods
A database of patients with pancreatic cancer undergoing resection with curative intent was maintained. Single-slice (L3) skeletal muscle index from pre-operative CT was used to define sarcopenia. Pre-operative systemic inflammation measures were curated (modified Glasgow Prognostic Score and neutrophil-lymphocyte ratio).

Results
176 patients underwent resection. Median post-operative survival was 26.3 months and 95 were sarcopenic (54%). Sarcopenia was not associated with worse survival versus non-sarcopenia (median 24.2 months vs 27.4 months, p = 0.558). mGPS was raised in 52 patients (30%) however this was not associated with worse survival versus normal mGPS (median 26.2 months vs 26.6 months, p = 0.193). Raised NLR did not significantly influence survival.

Conclusions
Pancreatic cancer represents a complex biological process with survival likely influenced by tumour biology and the relationship between tumour epithelium and tumour microenvironment. Survival has previously been shown to be influenced by sarcopenia in all patients with pancreatic cancer, suggesting selection of “fitter” patients for resection in our cohort. Further understanding of tumour biology is needed to determine the relationship between tumour epithelium, tumour microenvironment, cachexia and systemic inflammation. Analysis of this relationship is ongoing and we envisage presenting results of this research in conjunction with this abstract if selected for presentation.
TH5.11 Quality Improvement Project-NELA Assessment of factors influencing the mortality of emergency laparotomy patients
Authors: Narayanasamy Sangara , Naing Zwe , Husain Najam , Eccersley James , Thomas Pradeep 
Published: November 2022

Abstract

Aim
NELA aims to enable the improvement of the quality of care for patients undergoing emergency laparotomy, through the provision of high quality comparative data from all providers of emergency laparotomy

Methods

Conclusions
Factors analyzed are

Recommendations
TH5.12 Impact of Nurse Specialist to Clinical Outcomes after Emergency Laparotomy
Authors: Ng Hwei Jene , Clark Maggie , Moug Susan 
Published: November 2022

Abstract

Aims
The role of the Emergency Laparotomy nurse specialist (EmLapNS) is under-researched. In addition to data collection for ELLSA (Emergency Laparoscopic and Laparotomy Scottish Audit), the EmLapNS may provide: education; ERAS principles (daily chest exercises and early mobilisation); advocacy; multidisciplinary meetings; emotional support. We report on clinical outcomes before and after the appointment of an EmLapNS.

Methods
Retrospective analysis was performed on data collected from one site as part of ELLSA. The data were compared between 6 months of 2017 (pre-EmLapNS) and 6 months of 2021 (post-EmLapNS). The role of ELLSA nurse was explored using key ELLSA clinical outcome markers.

Results
95 patients underwent EmLap in 2017 and 68 in 2021. Comparing pre-EmLapNS vs post-EmLapNS, the median age was 66 vs 61 years, 52.6% vs 45.6% were females and 63.2% vs 60.3% were ASA ≥3. Post-operative chest physiotherapy post op day 1–3 was performed in 8.8% pre-EmLapNS versus 48.4% post-EmLapNS (p&lt;0.05); 30-day morbidity was 52.6% vs 33.8% (p&lt;0.05) and length of stay was 11 days vs 8 days. 30-day mortality and rates of readmission were unchanged (11.6% vs 8.8% and 10.5% vs 11.8% respectively).

Conclusions
The introduction of EmLapNS has significantly improved morbidity and perioperative care. These clinical improvements are likely to be complemented by other aspects of this patient-centred role which require further analysis.
TH6.5 Perioperative group and save testing are not routinely indicated for emergency laparoscopic appendicectomy and laparoscopic hernia repairs
Authors: Reece Ieuan , Shakweh Ealaff , Britton Clemency , Chen Jun Yu , Zafar Norman , Al-Musawi Jasim 
Published: November 2022

Abstract

Introduction
Major haemorrhage is a rare complication of laparoscopic hernia repair and laparoscopic appendicectomy. It is common practice for patients undergoing these procedures to have 2 valid group and saves preoperatively, however perioperative blood transfusions for these patients is seldom required. Obtaining valid samples is not only financially burdensome but frequently leads to delays in theatre lists and patient care. Our unit therefore performed a retrospective cohort analysis to investigate blood transfusions performed perioperatively and within 28 days of laparoscopic appendicectomy and laparoscopic hernia repairs.

Method
We used our electronic records system to collect data of all laparoscopic appendectomies and laparoscopic hernia repairs between March 2017-March 2021. Patients of any age undergoing laparoscopic appendicectomy or laparoscopic hernia repair were included. Patients requiring concomitant intra-abdominal surgery or had incomplete medical records were excluded.

Results
1893 patients were included in the study of which 1464(77.3%) had a laparoscopic appendicectomy vs 429(22.7%) laparoscopic hernia repair. In total 3511 group and saves were taken costing £47,398.50. Only 1 patient (0.068%) required an emergency blood transfusion (4 units of red cells) secondary to major haemorrhage and 2 patients (0.11%) required pre-operative transfusions for anaemia.

Conclusion
Our findings demonstrate that the incidence of perioperative blood transfusions for laparoscopic appendicectomy and laparoscopic hernia repairs is low, challenging the indication for routine preoperative group and saves. Considering our findings, the burden of cost, patient discomfort and theatre delays; we advocate a more nuanced approach to preoperative group and saves, reserving these for patients stratified as high risk.
TH6.10 Rare case of concurrent caecal volvulus and internal herniation through the mesenteric defect following a Roux en Y gastric bypass - Case report and review of the literature
Authors: Samarakoon Lasitha Bhagya , Hopkisson Lucy , Pangeni Annang , Fernandes Roland 
Published: November 2022

Abstract

Introduction
Roux En Y gastric bypass [RYGB] remains the most effective bariatric surgical option to date. Unfortunately, the anatomic alterations caused by the surgery can predispose towards the very rare occurrence of internal herniation through the mesocolic defect created if a retro colic approach is used.

Case presentation
We report a patient who underwent laparoscopic roux en y gastric bypass 3 years ago who presented to our surgical unit with acute abdominal pain and obstipation. On exploratory laparotomy, we noted internal herniation of the entire small bowel and caecum through the mesenteric defect with concomitant volvulus of the caecum around its axis. Fortunately, the bowel was viable after detorsion and after reduction, the mesenteric defect was repaired.

Conclusion
Although internal herniation of the small bowel through the trans mesenteric defect following RYGB has been reported, we believe ours is the first report of caecal and ascending colonic herniation. Secondly, we believe our case is unique in that there was concomitant caecal volvulus in addition to herniation through the trans mesenteric defect. A careful search of the literature did not reveal any similar cases with concurrent internal herniation and volvulus of the right colon following RYGB.
Internal herniation and volvulus of the right colon may rarely occur following RYGB. Symptoms may be nonspecific and classic features of small bowel obstruction such as vomiting and abdominal distension may not be seen. Imaging may be nonspecific. A high index of suspicion and early intervention is essential to prevent morbidity and mortality.
TH7.6 Recurrent Gallstone Ileus: A Case Report
Authors: White Annabelle , Shepherd Joanna , Al-Robaie Basim 
Published: November 2022

Abstract

Introduction
Gallstone Ileus (GSI) is a rare cause of mechanical bowel obstruction secondary to impaction of an ectopic gallstone within the bowel lumen. Recurrent GSI is rare, accounting for less than 3% of SBO. The main risk factors for recurrence include a large choleduodenal fistula, an active fistula or faceted gallstones.
There is currently no mainstay approach to managing GSI, with “single-stage” and “two-stage” options advocated.

Case
A 73-year-old lady presented with epigastric pain and vomiting, and was shown to have an obstructing gallstone in the distal ileum. She underwent a laparotomy and enterolithotomy and initially made a good recovery. However, she represented three months later with similar symptoms and was found to have a jejunal gallstone causing proximal small bowel obstruction. She underwent a second enterolithotomy, and is planned for an interval cholecystectomy.

Discussion
The management of recurrent GSI include one of three options: enterolithotomy alone, “single-stage” (enterolithotomy, cholecystectomy and fistula repair) or “two-stage” approach (enterolithotomy and interval cholecystectomy). The optimal approach in management is still debated. The traditionally taught two-stage approach demonstrates a lower mortality and recurrence rate and shorter index procedure in the unstable patient, requiring a skillset common to most general surgeons. However, with increasing reports of recurrent GSI, a single-stage approach during the index procedure has been advocated, citing decreased risk of cholecystitis, cholangitis and repeat laparotomy in the event of recurrence. Our patient underwent emergency enterolithotomy on both presentations, however there may support for a “single-step” approach in certain patient cohorts.
TH7.7 Pre-operative Coagulation Screening in General Surgery
Authors: Yomi-Orungbe Esther , Fazili Noureen 
Published: November 2022

Abstract

Aim
Routine preoperative coagulation screening is considered standard practice to predict peri-operative bleeding. However, according to British Society of Haematology, indiscriminate coagulation screening is not recommended as it may to inappropriate delay of surgery, lead to further unnecessary tests and is also associated with significant costs. Instead, they recommend detailed bleeding history, including family history and use of medications.

Methodology
A retrospective audit of 148 post-operative patients in Northwick Park Hospital admitted under the General Surgical who presented to Surgical Assessment Unit between 01.04.2021 to 14.05.2021 at the initial audit and between 20.09.2021 to 07.10.2021 at the re-audit.

Results
The initial audit was done over a 6 week period with 98 cases selected. 19% of them had appropriate requests with 81% of the tests done being inappropriate. There was significant improvement by the re-audit with appropriate requests increasing to 56% and inappropriate tests dropping at 44%. The criteria for appropriate were: a) Not requested as no significant medical history. b) Requested as clinically indicated. With each coagulation screening costing an average of £29.42, an overall estimate of £2971.42 was expended in inappropriate requests

Conclusion
All patients had relevant blood requests and PMH were documented but many inappropriate requests were made. It was recommended that instead of indiscriminate coagulation testing, a thorough history was advised to determine appropriate testing. There was a marked improvement at the re-audit with more appropriate requests being made.

Recommendations
TH8.4 The potential for day case total parathyroidectomy in patients with secondary hyperparathyroidism
Authors: McDonald Sophie , Al-Saadi Nina , Chang Jessica , Neophytou Christodolous , Houghton Andrew 
Published: November 2022

Abstract

Aims
Hypocalcaemia is a common complication after parathyroidectomy for secondary hyperparathyroidism (SHPT) and is often the cause of a prolonged hospital stay post operatively. Although there is no current guidance on targets for total parathyroidectomy for SHPT, current guidance recommends a day-case rate of 90% for patients undergoing surgery for primary hyperparathyroidism.
Our centre has developed a safe protocol which allows us to perform total parathyroidectomies as a day-case procedure in patients with SHPT. This protocol, developed in conjunction with the renal physicians, involves giving the patients alpha calcidol pre-operatively for 5 days, to minimise the incidence of hypocalcaemia, and close monitoring of the calcium levels post operatively, to permit safe discharge.

Methods
We carried out a single centre retrospective study on all patients who underwent a total parathyroidectomy for SHPT between February 2005 and May 2021. All the patients received the alpha calcidol regimen pre-operatively. Data on patient baseline characteristics, peri-operative calcium, potassium and PTH levels, length of hospital stay, operative procedure details, hospital readmission and 30-day morbidity were collected.

Results
49 patients underwent a total parathyroidectomy during the study period. 67% of patients were discharged on day 0 or on day 1 post-operatively. Reasons for prolonged hospital stay in the remaining patients included refractory hyperkalaemia requiring dialysis, complications secondary to anaesthesia, as well as hypocalcaemia in a few cases. No patients required readmission during the 30-day post-operative period.

Conclusion
Day-case surgery for SHPT can be achieved safely with a pre-operative regimen of alpha calcidol and close monitoring of calcium levels post-operatively.
257 Ethics of International Medical Student Electives and Their Impact on Local Students’ Learning Opportunities
Authors: Chmura Magdalena 
Published: November 2022

Abstract

Aim
International electives are often considered a valuable learning opportunity for medical students. Yet, as travelling to low- and middle-income countries (LMICs) becomes more common, ethical considerations of such practices emerge. We conducted a literature review to assess the extent to which five ethical themes are addressed in existing literature about electives.

Method
We searched PubMed database and identified 35 papers which discussed international electives to LMICs, undertaken by medical students, and included discussion of ethics. On reading these, we noted whether or not there was discussion of any of the five chosen themes. A further focus area was explored in more detail: the impact of electives on host students’ access to learning opportunities.

Results
The most commonly addressed ethical theme was exceeding clinical competence (discussed in 26 papers), second was one-sided benefits in partnerships (in 20 papers). Respect for patients and local culture was addressed in 12 papers, local resource use in 10, and working with local community/colleagues in 10. Interestingly, 6 papers identified a negative impact of visiting students on local students’ learning opportunities. Reasons for this were: visiting students requiring local clinicians’ supervision, interference with teaching programmes, and being prioritised over local students.

Conclusions
It appears that while there is awareness of some ethical shortcomings of electives, the negative impacts on local students’ access to medical education are addressed infrequently. We recommend that this notion should be further explored in pre-departure elective teaching courses, to increase travelling students’ awareness of the impact of their presence on the host community.
129 Development of a Post-Op Analgesic Regimen for Patients Undergoing Local Anaesthetic Hand Trauma Surgery
Authors: Shah Savan , Bedford James D 
Published: November 2022

Abstract

Aim
Post-operative pain was a recurrent issue reported at the dressing clinic following local anaesthetic (LA) hand surgery at our regional centre. In the absence of a local protocol, we aimed to standardise advice and analgesic prescriptions following LA hand surgery to observe whether pain could be more optimally managed.

Method
In cycle 1, day 1 and 7 pain scores were recorded for ∼30 patients using a validated visual analogue scale (VAS).
In cycle 2, an analgesia advice leaflet and standardised prescription were provided, and the same data points were collected, with the addition of day 0 (evening of surgery).

Results
Cycle 1 revealed generally high day 1 pain scores (M = 5.91/10). Day 7 scores were considered acceptable (M = 2.16). There was no significant difference in pain scores when we compared fracture fixation to soft tissue surgery (p= 0.64), and patients prescribed codeine versus those with paracetamol alone (p = 0.53). Most patients provided with codeine did not co-administer paracetamol and ibuprofen (n = 14, 70%). A large proportion of patients were only taking analgesia PRN rather than regularly for prophylaxis (n=12, 43.75%).
In cycle 2, all patients were provided with codeine 30–60mg PRN QDS and the advice leaflet. Day 1 pain scores (3.43) were significantly lower for cycle 2 than cycle 1 (p &lt; .00001).

Conclusions
Codeine, paracetamol and ibuprofen taken regularly and correctly can be effective in managing pain post-operatively for LA hand surgery patients. Information sheets can be an effective means of facilitating this.