bluuebunny/crossref_metadata_2025_split huggingface dataset:
WE8.2 Has the change in emphasis to conservative management of appendicitis during the first wave of COVID- 19 had a longer lasting affect on assessment and management of patients
Authors: Thakkar Rudrik , Badnenoch Tom , Kosti Angeliki , Rakin Asef , Hollyman Marianne 
Published: November 2022

Abstract

Aims
During the first wave of the COVID-19 pandemic (March-June 2020), surgeons were advised where possible to avoid operating on appendicitis due to the perioperative risk for patients and theatre staff. This resulted in an increase in conservative management and a decreased negative appendicectomy rate (NAR) (COVID:HAREM). We sought to assess if the experience in 2020 had changed practice a year on.

Methods
Data collection was undertaken of patients presenting acutely with appendicitis or clinical appendicitis requiring diagnostic laparoscopy, using the electronic records. Data was collected over the same three-month period in 2019, 2020 and 2021. Patient's electronic records were reviewed.

Results
In total 174 patients were identified over the three-year period (59, 46 and 69). Mean age was 42 and 55% were female. The number of patients undergoing US scans dropped during the pandemic (36%, 26% and 41%) whereas CT use increased (37%, 63% and 46%). In 2021, conservative management of patients had not returned to pre-pandemic levels (5%, 46% and 19%). NAR were 12%, 0% and 5%. Mean length of stay was unchanged (3.3, 3.9 and 3.5days).

Conclusions
This study demonstrates the change of practice during and following the first wave of pandemic. In 2020, more patients were undergoing a diagnostic imaging and fewer patients were undergoing an operation compared to 2019, demonstrated improvement in the NAR in 2020. Although these changes have dampened in 2021, the trend is still present; there is an improved NAR in 2021 compared to 2019, possibly due to more patients undergoing CT.
TH1.6 Management of Phyllodes Tumour - a 10 years experience
Authors: Narayanasamy Sangara , Muntean Brenda , Goyal Amit 
Published: November 2022

Abstract

Introduction
Phyllodes tumors are rare fibroepithelial neoplasm of the breast (phyllodes -leaf like pattern). The three main types of phyllodes tumour are benign, intermediate and malignant.

Current Guidelines: Follow up

Results of Audit

Conclusions

Recommendations
TH2.3 Elective versus emergency management of gallstone disease at a tertiary referral centre amidst the COVID-19 pandemic - should the protocol be altered?
Authors: Renna Maxwell , Sinha Aaditya , Pinto Kevin , Roe Caitlin , Koh Chloe , Cheung Katie 
Published: November 2022

Abstract

Background
Gallstones are a common pathology affecting approximately 15% of the population in UK, 20% of which are symptomatic. It is suggested symptomatic patients undergo cholecystectomies. Guidelines recommend this is performed within one week of initial emergency presentation or 52 weeks for elective case. Surgical capacity to manage emergency cholecystectomies was limited due to the COVID pandemic. We assessed wait time discrepancy between elective and emergency cholecystectomies.

Methods
A retrospective review of all patients undergoing cholecystectomies between January and November 2021 in a major tertiary referral centre in London was undertaken. Initial pathology at the time of presentation, elective vs emergency presentation, pre-surgical biliary complications along and wait times were reviewed.

Results
219 (74 elective, 145 emergency) patients underwent surgery, mean age 48 years (23% Male and 77% Female). Average wait times for elective cholecystectomies were 69.7 days (min 0, max 246) in comparison to 68.9 days (min 1, max 253) for emergency surgery. 22 (15%) of the patients of initial emergency presentation re-attended hospital and 6 (4%) had adverse events such as gallbladder perforation or pancreatitis due to delayed treatment. Comparatively, 9 (12%) elective patients attended A&E due to pain, with no adverse outcomes.

Conclusions
Overall wait time of emergency vs elective cholecystectomies were similar. This review indicates emergency cases require prioritisation over elective cholecystectomies due to the higher number of re-attendance and adverse events. Emergency cases need to be prioritised to meet guidelines, which could also reduce complication rates whilst awaiting surgery and lead to fewer adverse outcomes.
TH2.6 Evaulation of the prognostic utility for hENT 1 transmembranous protein in resected hilar cholangiocarcinoma patients
Authors: Bird Nicholas , Manu Nichola , Shehata Zak , Fenwick Stephen , Jones Robert , Malik Hassan 
Published: November 2022

Abstract

Aims
Human equilibriative nucleoside transporter protein 1 (hENT1) facilitates nucleoside transport into the cell. Immunohistochemically-detected hENT1 is increased in cholangiocarcinoma tumour cells and in highly metabolising cells. The Mackey 10D7G2 hybridoma has demonstrated prognostic utility in Pancreatic Ductal Adenocarcinoma. The Proteintech Polyclonal hENT1 antibody's prognostic utility has not been assessed. Cellular Ki67 expression is linked to tumour proliferation. This study aims to assess the antibodies’ prognostic utility for resectable hilar cholangiocarcinoma.

Methods
Between 2009–2016, 54 patients underwent resection for peri-hilar cholangiocarcinoma. Formalin-Fixed Paraffin Embedded blocks from 44 specimens were retrieved. A Tissue-Matched Array was constructed and stained for each antibody. H-scores were utilised to determine expression intensity. Correlation of expression was determined by Pearson correlation co-efficient and Chi-squared. Silencing RNA for transfected HepG2 cell-lines was used to determine accurate hENT1 staining by the Proteintech antibody. Demographic and survival characteristics were acquired from a prospectively held database, and were calculated with global log-rank calculations.

Results
There was significant correlation between the Mackey and Proteintech antibodies (p&lt;0.001), and between the Proteintech antibody and Ki67 expression (p= 0.02). Knockdown of hENT1 with silencing RNA transfected HepG2 cells was confirmed by Western blot. The antibodies (Mackey; Proteintech; Ki67) showed no significance for predicting OS (p= 0.75; 0.63; 0.22 respectively). Nodal stage (p= 0.03) and tumour differentiation (p= 0.02) showed prognostic utility.

Conclusion
While the Proteintech antibody demonstrates concordance with the 10D7G2 antibody in determining hENT1 expression, they didn't demonstrate significant prognostic ability. Standard histopathological co-variates retain prognostic utility within the cohort.
TH2.8 Continuing fast-track (Expedited) pancreaticoduodenectomy service during the Covid-19 pandemic: Experience from an established pancreatic surgical centre
Authors: Trivedi Dharmadev , Lee Sheah Lin , Takhar Arjun , Armstrong Thomas , Primrose John , Arshad Ali 
Published: November 2022

Abstract

Aim
Avoiding preoperative biliary drainage (PBD) can facilitate early curative surgery for patients with periampullary tumours. However, the evidence over PBD is conflicting. This prospective re-audit aimed to assess compliance to NICE guidelines (NG85) and surgical outcomes at a well-established HPB surgery unit after achieving additional theatre sessions following prior audit.

Methods
Prospective data collection and analysis for all patients undergoing pancreaticoduodenectomy with curative intent was performed as re-audit at a tertiary pancreatic centre between September 2020 to August 2021.

Results
64 or 71 patients received curative pancreaticoduodenectomy (43 Kausch-Whipple & 23 pylorus-preserving pancreaticoduodenectomy, 7 inoperable). Of 29 patients without PBD, 10 were jaundiced with median bilirubin levels of 138 Micromole/L (range 27–357 Mmol/L). Median time (range) from diagnostic imaging to surgery with curative intent was 21 days (3–42) for patients without PBD compared to 62 days (22–305) for those with PBD (p=0.00028). No statistically significant difference in median HDU/ITU stay (4 Vs 3 days, p=0.849), postoperative complications (C-D&gt;2) (30% Vs 27.8%, p=0.755), R0 resection rates (42.8% Vs 75%, p=0.364), and median hospital stay (17 Vs 10 days, p=0.076) was observed for patients without or with PBD respectively. Interestingly, inoperable patients had shorter time delay from diagnostic imaging to surgery (29 Vs 49 days, p=0.010)

Conclusion
Fast-track (expedited) pancreaticoduodenectomy is feasible and safe for selected group of jaundiced patients without PBD. The constraints and challenges posed by Covid-19 pandemic are likely reflected in higher number of patients receiving PBD (42/ 71) despite clear referral pathway established following prior work at our institute.
TH2.12 Difficulties in managing acute gallstone disease at a Tertiary Referral Centre admist COVID-19
Authors: Pinto Kevin , Roe Caitlin , Koh Chloe , Cheung Katie , Sinha Aaditya , Ebied Husam , Renna Maxwell 
Published: November 2022

Abstract

Background
Acute biliary disease, a surgical emergency, is predominantly treated conservatively initially. Specialist units aim to follow guidelines set by the Royal College of Surgeons and NICE to provide a cholecystectomy within a set time. Clinical practice at St Thomas’ Hospital was reviewed along with the difficulties during the COVID-19 pandemic.

Aims
Reassess practice at a specialist unit failing to meet guidelines during the start of COVID-19. Prospective data collection, on patients booked for a laparoscopic cholecystectomy (LC) after emergency attendances.

Method
Initial retrospective data analysis, reviewing pre-COVID (PC19) practice (03/19–02/20), initial COVID-19 (IC19) management (03/20–12/20). Prospective data (01/21–11/21) after implementing changes (AC19).
Identifying demographics, pathology, length of stay during acute admission, average wait for surgery and readmission rate prior to surgery. Patients receiving surgery within 6 weeks, which has been set by our trust as an acceptable standard.

Results
Patients with acute presentation (acute cholecystitis, gallstone pancreatitis, cholangitis) 162 (PC19), 80 (IC19), 145 (AC19). Gender Ratio M:F 1:2 for all groups. Average wait to surgery 93 (PC19), 44 (IC19), 69 (AC19) days. Patients receiving surgery within 6 weeks 24.7% (PC19), 32.5% (IC19), 51.7% (AC19). Patients who were still awaiting surgery at the end of each time frame 49% (PC19), 51% (IC19), 48% (AC19). Mean length of surgical stay 1.75 (AC19) days.

Conclusions
Further changes are required, as guidelines are still not being met, with average wait times significantly above the recommended wait to undergo laparoscopic cholecystectomy.
TH3.4 Perineal reconstruction following standard and extralevator abdominoperineal excision: results of a national practice questionnaire
Authors: Shah Rushabh , Kamble Rituja , Herieka Mohammad , Dalal Milind 
Published: November 2022

Abstract

Aims
Challenging perineal defects resulting from extralevator (ELAPE) and standard abdominoperineal excision (APE) have resulted in a growing multidisciplinary approach between colorectal and plastic surgery colleagues. Currently there is a paucity of evidence on best practice in this emerging field. This study aims to define and describe current national practice within the United Kingdom (UK) in perineal reconstruction following APE/ELAPE.

Methods
A national practice questionnaire was designed using ‘Google Forms' and circulated via email to 41 units across the UK performing perineal reconstruction following APE/ELAPE.

Results
Complete responses were received from 23 units (response rate 56%), representing 12 regions across the UK. All units had a dedicated APE/ELAPE service. 70% had a standardised approach to reconstruction, with the Inferior Gluteal Artery Perforator (IGAP) flap being the most common approach (n = 11). Significant variation was observed in the reconstructive approach with regards to flap choice and routine use of pelvic acellular dermal matrix or mesh. Similar differences were observed in the perceived importance of various surgical factors that guide the reconstructive decision making process.

Conclusions
Our national practice questionnaire responses report nationally well established local networks between colorectal and plastic surgeons. However, the variation in results reflects a lack of national consensus on the optimal reconstructive method after APE/ELAPE. Our study highlight the need for the development of collaborative evidence based national guidance on best practice.
TH3.10 An audit assessing factors contributing to the 5-year disease recurrence rate after curative resection of rectal cancer
Authors: Youssef Nadia , Sinha Ishani , Williams Gethin 
Published: November 2022

Abstract

Aim
To study the 5-year recurrence rate of rectal adenocarcinomas following curative surgery in a cohort of patients from a single Health Board, and to identify statistically significant risk factors of disease recurrence.

Method
This audit included a total of 95 patients who underwent elective resections of primary rectal cancer between January 2014 and January 2016 at a single health board. The 5-year disease recurrence rate was documented. Medical records were accessed via the Clinical Workstation system and a number of factors were recorded and statistically analysed on Microsoft Excel using z-score for two populations portions. A p-value of &lt;0.025 was considered statistically significant.

Results
Of the 92 patients included in this audit, 23 suffered disease recurrence. Younger age at diagnosis, tumour perforation, positive lymph nodes, tumour involvement of circumferential resection margin, and extramural vascular invasion were all associated with significantly increased risk of disease recurrence and poorer prognosis. Postoperative complications were observed in 26% of the cohort and it was significantly (p=0.009) associated with disease recurrence. Although more patients who developed disease recurrence received chemoradiation as part of their initial disease management, the number was not statistically significant.

Conclusion
The audit supports lowering the age of bowel cancer screening. Strategies are required to minimise the risk of postoperative complications in patients undergoing elective rectal cancer resections. Reasons must be identified as to why patients with a higher risk of recurrence, undergoing curative surgical resection of tumours, do not have higher uptake of adjuvant and neoadjuvant chemoradiation.
TH4.2 To do or not to do, Branch ligation of a non-maturing arterio-venous fistula for haemodialysis
Authors: Abdelwahed Abdallah , de Figueiredo Fatima , Gambhir Raghvinder Pal Singh 
Published: November 2022

Abstract

Aim
Up to 20% of arterio-venous fistulas (AVFs) may fail to mature to become usable for renal access in patients on Haemodialysis (HD). There is no consensus on benefit of branch ligation. This study aimed to assess the outcomes of branch ligation on maturation of these AVFs.

Methods
Electronic patient records and Renalware were accessed to obtain data of branch ligation procedures done at secondary care centre from 2016 till 2021.

Results
With a prevalent dialysis population of over 771 patients and incident dialysis population of 147 in 2021, we as a centre perform 250–300 access procedures annually.
A total of 23 ligation procedure were done in the above-mentioned period. Less than 50% of patients had a large branch documented on Duplex scan report to be draining a significant and measurable flow away from the AVF. The other procedures were done based on clinical judgement. All procedures were done under Duplex guidance and under Local or Regional anaesthesia. About two thirds of the fistulas that required branch ligation were Radio-Cephalic AVFs, the rest Brachio-Cephalic AVFs. No complications were reported though one patient needed a fistuloplasty due to vein pinch.
In 16 out of the 23(69.5%) patients there was clinical and sonological improvement in flow, and or vein diameter after the branch ligation making them usable for HD.

Conclusion
Branch ligation of non- maturing fistula in selected cases can help maturation and make these arteriovenous fistulas usable.
TH5.2 Gender differences in patients undergoing emergency appendicectomy
Authors: Khan Khurram , Gall Lewis , Miller Gillian , Al-Azzawi Yassir , Macdonald Andrew 
Published: November 2022

Abstract

Aims
Although appendicectomy is common, there exists minimal published literature exploring whether there are differences between adult males and females undergoing appendicectomy. This study aimed to investigate the demographics, pre-operative investigation, intra-operative findings and clinical outcomes between both genders having an emergency appendicectomy (EA).

Methods
A multicentre retrospective observational study was carried out across four hospitals who had an EA between August 2018 and November 2020. Patients were identified through pathology records. Data was extracted from electronic records for demographics, pre-operative (peak) blood results, pre and post-operative imaging, operative details, and the clinical outcomes. Patients were dichotomised by gender and results compared. Data was analysed using unpaired Student t test or Chi-squared test as appropriate with p &lt; 0.05 considered statistically significant.

Results
1,128 emergency appendicectomies (57.5% male) were included. Males undergoing EA were younger (median age: 34 vs 40 years, p&lt;0.001). There was no difference in peak pre-operative white cell or neutrophil count; however, C-reactive protein was lower in male patients (median 72 vs 97, p&lt;0.001). Pre-operative imaging was performed more often in females: ultrasound (20.7 vs 1.5%, p&lt;0.001) and CT scan (61.8 vs 54.9%, p=0.020). Male patients underwent more open surgery (14.0 vs 6.5%, p&lt;0.001). There was no difference in the severity of appendicitis, rate of negative appendicectomy, median total hospital stay, post-operative complication or 30-day readmission rates.

Conclusions
This study demonstrates that differences exist between males and females who have EA in terms of age, use of pre-operative imaging and operative approach, however, clinical outcomes are similar.
TH5.3 Improving the Quality of Surgical Discharge Summaries Using a Discharge Summary Checklist- A Prospective Closed Loop Audit
Authors: Lee Melody , Lim Ju Lyn , Khun Ng James Chean , Chowdury Abeed 
Published: November 2022

Abstract

Aim
Discharge summaries (DS) form the mainstay of communication between primary and secondary care following inpatient episodes. Poor quality DS often leads to poor continuity of care. We aim to audit the quality of DS following admission under general surgery and improve DS by implementing a DS checklist.

Methodology
A prospective audit was conducted for 100 DS across 4 surgical wards (emergency and elective) between 1/1/2021 to 1/3/2021. Data collection included the clinical summary, operation details, significant investigation results and follow up plans. A DS checklist was created and introduced at junior doctor induction. A re-audit was conducted prospectively on 100 DS produced from 1/8/2021 to 1/10/2021.

Results
A general improvement in quality of DS is seen across different domains. In particular, operation date (76.1% vs 90.1%, p=0.019), abnormal blood test results (89% vs 97%, p=0.323), outpatient investigations (72% vs 85%, p=0.025) and their urgency (39.6% vs 43.3%, p=0.741), GP plans and actions (73% vs 81%, p=0.178) and outpatient appointments (85% vs 93%, p=0.037). Interestingly, details of clinical summary (98% vs 94%, p=0.149) and duration of venous thromboembolism (VTE) prophylaxis (99% vs 90%, p=0.005) were worse on reauditing.

Conclusion
The introduction of DS checklist has significantly improved the quality of documentation and instructions for primary care for most domains. This was not seen for the domain of duration of VTE prophylaxis.
TH5.13 Stoma reversal post emergency laparotomy
Authors: Ng Hwei Jene , Clark Maggie , Alhoweris Ala Eldin , Teo Serene , McGuigan Mark , Moug Susan 
Published: November 2022

Abstract

Aims
Approximately a fifth of stomas have to be sited in emergency setting and the National Bowel Cancer Audit found almost one third of patients undergoing anterior resection do not have reversal of their stoma within 18 months following surgery. We aim to explore the reversal rate of stoma post emergency laparotomy (EmLap).

Methods
Retrospective analysis was performed on all patients undergoing EmLap over 12 months (2018) from one site using the local ELLSA (Emergency Laparoscopic and Laparotomy Scottish Audit) database. Demographic, indication for surgery, stoma formation/ type, 30-days morbidity and mortality were collected. Follow-up and stoma reversal data were evaluated at 12 months postoperative.

Results
205 patients underwent EmLap (52.5% female, median age 66 years). 42% (n=85) had emergency stoma formation: 58% ileostomy, 42% colostomy.
Of those who had stoma formed (51% female, median age 67 years), 45% presented with bowel obstruction and 24% had new colorectal cancer diagnosis. Of those alive at follow-up (89%), 19% had stoma reversed (1:1 ileostomy:colostomy; mean reversal time 11 months). Of the 81% not reversed: 28% declined, 12% were unfit, 4% technically not feasible, 4% on waiting list, 11% had 30-day mortality. The remaining 22% had no documented stoma reversal discussion (5%) or no follow-up (17%).

Conclusions
Compared to the elective setting, the stoma reversal rate post-EmLap is significantly lower (reversal of ileostomy 9.5% in this study vs 85% in Close-IT study). Although this may reflect a higher risk surgical population, post-EmLap pathways should consider routine follow up to ensure shared decision making.
TH5.14 Surgical Telephone Virtual Clinic: A Safe and Effective Alternative to Hot Clinics for Semi-Urgent, Ambulatory Patients
Authors: Osunlusi Oluwafemi , Patel Sima , Ashok Apurva , Stonelake Stephen 
Published: November 2022

Abstract

Introduction
Many ‘Hot Clinics' deal with ambulatory patients only requiring semi-urgent investigation and treatment, potentially avoiding hospital admission. These clinics often use the same staff and resources being utilised for acute surgical admission and treatment. We present data showing that “Virtual Clinics” (VC) are safe alternatives to this system, improving patient service and relieving a significant burden on the acute surgical units.

Method
78 patients who came through the established VC between 23/12/2020 and 19/01/2021 (4 weeks), were assessed for delays in scan date, call-backs, diagnosis, referral patterns, readmission rates and eventual outcomes for those who needed surgical interventions.

Results
83% of patients had their scans within the set-out time of 72 hours. 89.7% of scans were reported on the same day. Only 18% of the patients had a surgical diagnosis. 51% had no diagnosis at all and were discharged safely from the clinic. 16.7% were still symptomatic at the time of the VC with 3.8% of these having a surgical pathology. 22% were referred to other specialities. 2 patients were referred to MDT.
In total, 6 patients were re-admitted to the hospital (7.6%). 4 patients were listed for surgery following the VC.

Conclusion
The VC proves to be a safe and effective system for semi-urgent, ambulatory patients. Re-admission rates are low, justifying the discharge of these patients from the acute surgical assessment unit to a virtual follow up environment.