bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP3.1.3 Optimum treatment for sigmoid volvulus remains elusive but surgery may provide considerable benefit
Authors: Issa Mohamed , Guy Richard 
Published: November 2022

Abstract

Background
Sigmoid volvulus is a surgical emergency and patients are often elderly with significant comorbidities. Whilst endoscopic decompression is easy and effective in the short-term, recurrence and repeated admissions are common with surgery generally being reserved for non-resolution or complications. Consensus an optimum management is lacking.

Methods
A retrospective audit of all patients admitted with sigmoid volvulus to a DGH General Surgery service between 01/01/2015–20/10/2020 was undertaken. Patient demographics, comorbidities, clinical findings, investigations and treatment were recorded.

Results
Sixty-three patients were identified (median age 71.5 years; 58.7% male]. Some 50.8% had more than one previous presentation (range 1–6), 19% presented after 3 days of symptoms and 3.2% presented with perforation. Plain radiography and CT scanning was undertaken in 90.5% and 54%, respectively.
Endoscopic detorsion was performed in 77.77% and repeated in the same admission for 33.3% of cases. Flatus tubes and rigid sigmoidoscopy was used in 47.6% with a 59.6% success rate. Seventeen patients (27%) underwent sigmoid resection, 14 having open surgery and 3 laparoscopic. Primary anastomosis was undertaken in 64.7% (11 patients), with only one anastomotic leak; the remaining 6 patients had a colostomy. The re-admission rate was 30.1% (19% non-operated patients, 11.1% operated patients).

Conclusion
Most patients with sigmoid volvulus are managed non-operatively with endoscopic detorsion which may be associated with a considerable healthcare burden and high readmission rates. Selective resection can be associated with low morbidity and good outcomes. Clinicians could reasonably adopt a lower threshold for surgical intervention, particularly for recurrent volvulus.
SP3.1.4 Benign Lymph Node Ratio (LNR) and Lymph Node Yield (LNY) as predictors of survival in resected colorectal cancer (CRC)
Authors: Issa Mohamed , Ahmad Salma , Wilson Jeremy , Magee Conor 
Published: November 2022

Abstract

Background
Lymphadenectomy is central to tumor prognosis. 12 LNY during CRC resection is a standard of good oncological resection, but 30–50 percent of resections do not achieve this. LNR was suggested to be a more accurate predictive factor.

Aim
To examine the prognostic significance of LNY and LNR on survival in patients with non-metastatic CRC.

Methods
A retrospective study on patients with CRC treated at a DGH from January 2015 to February 2017. Outcome measures were Disease-Free (DFS) and Overall Survival (OS).

Results
265 cases were identified. The mean age was (71.4±11.3) years with a median follow-up of 56 (range 0–72) months. Median LNY was 18 (range 0–66) nodes. 74.9% of the cases have&gt; 12 LNY and only 25.1% of the cases have &lt; 12 LN yielded in the specimen; however, 76.4% have LNR of 0-&lt;0.25. Increasing LNR was associated with poorer OS and DFS (p-value 0.0001). An LNR of (0.75–1) was associated with a very poor prognosis (p-value 0.0001); it showed 30 and 33 months less in median OS and DFS retrospectively than LNR (0-&lt;0.25). LNY did not show any statistically significant predictive factor in survival. Multivariate analysis showed OS and DFS are affected (R2= 27.3% and 26.1% retrospectively) mainly by LNR. It did not show statistical significance with the other variables, including TNM, LNY, and Dukes' stages.

Conclusion
Increasing LNR was a marker of poor survival; however, LNY was not a statistically significant predictive factor. LNR is better in predicting survival than TNM and Dukes' staging.
SP4.2.2 Recovery after Emergency Laparotomy – what do patients want?
Authors: Silva L , Crole Rees C , Watts T , Bisson J , Cornish JA 
Published: November 2022

Abstract

Aim
Recent focus on Emergency Laparotomy outcomes has improved mortality, but little attention has been given to recovery. The aim of this qualitative study was to explore recovery after EmLap.

Method
A focus group was established of ten EmLap patients. Inclusion criteria: EmLap&lt;5 years ago, non-palliative. Patients were selected to provide balance of age, sex and pathology. Thematic qualitative analysis was performed by two researchers.

Results
Several key themes were highlighted;
Lack of communication on diagnosis/expectations after surgery. Little continuity of care. Long delays in seeing doctors after surgery and no way to contact them and GPs unable to help.
Financial consequences are significant, with no guidance. Took longer to recover than expected, difficult to explain to employer. Led to early retirement or change of hours/role.
Hernias; Some patients aware of hernia risk but given conflicting advice, e.g avoid lifting and rest for 6 weeks, others told to exercise regularly. Difficult to access support garments.
Diet – Conflicting advice on what they could/couldn't eat, especially fibre. Felt more by patients who had stoma or bowel resection. Poor quality food in hospital and lack of options for diet (e.g. vegan, coeliac).
Poor mental health after surgery with anxiety, depression and loss of confidence all having large impact, especially on relationships and intimacy. Key issues lack of access to services and waiting times. Too ‘complex’ for primary care.

Conclusions
The impact of emergency surgery on patients is significant, particularly mental health and financial impact. Recommend standardised information (leaflets/website/signposting) and key support worker.
SP5.2.3 Protocolised MRI as an Adjunct to CT in the Diagnosis of Femoral Neck Fracture in High Energy Ipsilateral Femoral Shaft Fractures – a Breakeven Analysis
Authors: MacKinnon Thomas , Selmi Hussein , Reilly Peter , Sarraf Khaled , Sabharwal Sanjeeve 
Published: November 2022

Abstract

Background
In high-energy femoral shaft fractures, ipsilateral femoral neck fractures can be missed by conventional trauma computed-topography (CT) imaging, resulting in increased treatment costs and patient complications. Evidence suggests that a rapid, limited-sequence pelvis and hip magnetic resonance imaging (MRI) protocol can identify these occult fractures and be feasibly implemented in the trauma setting. This study aims to analyse the economic viability of implementing a such an MRI protocol for all high-energy femoral shaft fractures.

Methods
We used an adapted break-even economic tool to determine whether the costs of an MRI protocol can be offset by cost-savings achieved through prevention of missed fractures (thus avoiding prolonged inpatient admission, re-operation and implant costs). Sensitivity analyses were performed to demonstrate the reliability of the economic modelling across a range of assumptions.

Results
Assuming a baseline of hip fractures missed on CT of 12%, an MRI cost of £129 and cost of treating each missed hip fracture of £2633.5, the equation yielded a breakeven rate of 7% and absolute risk reduction (ARR) of 5%, indicating that for every 100 femoral shaft fractures, MRI would need to diagnose 5 of the 12 missed hip fractures to be economically viable (NNT=20). Economic viability was maintained even at double the cost of MRI, while increasing the cost of treating each complication served to reduce the ARR further, increasing cost effectiveness.

Conclusion
A rapid, limited-sequence MRI protocol to exclude occult ipsilateral hip fractures in all femoral shaft fractures would be an economically justified measure.
SP5.2.9 Perioperative immunonutrition in reducing the infectious complications in patients undergoing colorectal cancer resections: a meta-analysis of randomized controlled trials
Authors: Mohamed Mazin , Nour Hussameldin M , Sajid Muhammad , Sains Parv , Baig Mirza K 
Published: November 2022

Abstract

Objective
Perioperative nutritional interventions have been reported to improve colorectal rectal cancer surgery outcomes. The objective of this article is to assess the influences of immunonutrition intervention during perioperative period in patients undergoing colorectal cancer resections.

Method
Meta-analysis was conducted according to the PRISMA guidelines. Systematic search of medical databases like MEBASE, MEDLINE and pubmed was performed to find studies exclusively reporting the perioperative use of immunonutrition in patients undergoing colorectal cancer resections and relevant published randomized, controlled trials (RCT) were shortlisted according to the inclusion criteria. The analysis of the pooled data was done using the RevMan statistical software.

Result
Ten RCTs on 1218 patients with colorectal cancer fulfilled the inclusion criteria. In the random effects model analysis, the use of perioperative immunonutrition in patients undergoing colorectal cancer resections statistically reduced the risk [odds ratio 0.59, 95% CI (0.35–1.0), z= 1.96, p=0.05] of infectious complications. However, there was significant heterogeneity [Tau2 = 0.35; Chi2= 19.11, df = 9 (P &lt; 0.02; I2 = 53%)] among included studies. The variables of postoperative mortality [odds ratio 2.1, 95% CI (0.33–12.36), z= 0.75, p=0.45] and length of hospitalization [standardized mean difference 0.16, 95% CI (-0.08–0.39), z= 1.31, p=0.19] were statistically similar in patients using immunonutrition or standard conventional perioperative nutrition.

Conclusion
Perioperative immunonutrition in patients undergoing colorectal resections seems to reduce infectious complications but this study failed to demonstrate its role in reducing the postoperative mortality and length of hospitalization.
SP6.1.7 Radio-frequency ablation using the STRETTA© is a feasible treatment option for GORD and reduces need for primary fundoplication
Authors: Joel Abraham , Konjengbam Alakh , Hammond Emily , Franks Helen , Viswanath YKS , Cowie Stuart 
Published: November 2022

Abstract

Introduction
The STRETTA© system of using radiofrequency (RF) energy to the gastro-oesophageal junction (GOJ) for management of refractory gastro-oesophageal reflux disease (GORD) has shown to improve baseline symptoms, PPI dependence and reduce the need for anti-reflux operations in select group of patients. We aimed to review our outcomes of STRETTA© for patients with medically refractory GORD.

Methods
A retrospective review of a prospectively maintained database was carried out in a tertiary British centre. All patients who underwent STRETTA© procedure from 2015 were reviewed. General practises and individual patients were followed up to obtain the proton pump inhibitor (PPI) free time after undergoing STRETTA© procedure.

Results
A total of 200 patients underwent STRETTA© procedure from 2015. All patients were reviewed once in clinic between 4–6 weeks with an overall median follow-up of 34.5 months. Preliminary analysis suggest over half of the patients (54%, n=108) remaining without PPI usage. Data for median time before restarting proton pump inhibitors (PPI) after STRETTA© is being collected. No patients needed further STRETTA© treatment and 2 patients (1%) has gone onto have anti-reflux procedure for non-resolution of symptoms.

Conclusion
Our preliminary findings suggest STRETTA© as a valuable and feasible option for treating refractory GERD. It may help reduce the need for fundoplication procedures and our data suggests that it increases the time before which surgery is required.
SP6.2.3 Boerhaave's Syndrome vs Iatrogenic Oesophageal Perforation - A Comparison Between Aetiology
Authors: Alasmar Mohamed , Shehata Zak , Altarawni Mohammad , Casey Patrick , Melhado Rachel , Sultan Javed 
Published: November 2022

Abstract

Aim
Oesophageal perforation is a rare surgical condition with high mortality. Boerhaave's syndrome (BS) may be associated with worse outcomes due to the degree of mediastinal contamination when compared to ‘clean’ iatrogenic perforations. This study aims to assess the differences in treatment and outcome between these two groups.

Methods
Data was collected from a tertiary centre from 2009–2021 (n=73, 42 BS, 31 Iatrogenic). Data was collected retrospectively using the electronic patient record. Complications were quantified using the comprehensive complication index (CCI). Univariate analysis was used to determine statistical significance.

Results
BS had a higher 30-day mortality compared to iatrogenic perforations (21.4% vs 3.2% p=0.025), however this was no longer significant at 90 days and 1 year (21.4% vs 16.1% p=0.57, 21.4% vs 19.4% p=0.83). Iatrogenic perforations were more likely to be managed non-operatively (73.8% vs 25.8% p&lt;0.001). All of the iatrogenic deaths that occurred between 30 days-1 year had been managed non-operatively. Median length of intensive care stay was higher in BS (15 days vs 6 days p=0.047), with no significant difference in median overall length of stay (48 days BS vs 38 days iatrogenic p=0.88). Median CCI was greater in BS (53.9 vs 29.6 p=0.002).

Conclusion
Whilst CCI and 30-day mortality was higher in Boerhaave's there was no difference in 90-day and 1 year mortality suggesting that long-term survival is not dictated by aetiology of the perforation. Most of the iatrogenic perforation were managed non-operatively which raises the question whether iatrogenic perforation should be managed more aggressively.
SP7.3 Behind Every Stereotype is a Grain of Truth: Perceptions of a Career in General Surgery Amongst Doctors
Authors: Sheridan Kelda , Quinton Naomi 
Published: November 2022

Abstract

Introduction
General Surgery (GS) educational community of practice faces crisis. Recruitment challenged by cultural norms of postponing post-foundation training; and retention with perceptions of elitism, discrimination and inflexibility. Surgical pedagogy has been examined through skill acquisition but what of the hidden curriculum. Three research aims were posed: who is a General Surgeon, what are the enablers or barriers to pursuing this career and is our current UK training system fit for purpose.

Methods
Qualitative methodology within a constructivist research paradigm was utilised. Recruitment via the snowballing technique included representative sampling of junior doctors, including men, women and those from diverse ethnic backgrounds. 1:1 Semi-structured interviews explored participant perspectives of training, recruitment and work-life balance. Data was transcribed, familiarised, de-constructed and generated. Latent data analysis, coding and development, maintained reflexivity. ‘Data sets’ were transformed to a thematic map and key themes identified.

Results and Discussion
Foundation, specialty doctors, core and higher surgical trainees were included (60% men, 40% women). Fundamental themes of support, attitudes and sacrifice were identified, interacting to influence educational narrative. Support comprised personal, institutional, academic and cultural forms. Attitudes of elitism, implicit and explicit gender bias, microaggressions and overt discrimination concealed as surgical tradition. An overarching concept of sacrifice was noted: personal, professional, fiscal and emotional, the so-called surgical currency.

Conclusions
The study explored phenotype, motivation, intellect and philosophy within GS. Highlighting issues in the system surrounding negative attitudes, cultures and behaviours, education is a powerful tool which can be used to challenge perceptions and improve training.
SP7.10 Improving Our Preop Fasting Practice
Authors: Khalid Ayesha , Iqbal Faisal , Keen Muhammad Irfan , Tiwari Mr , Waqar Hamza 
Published: November 2022

Abstract

Aims
Preoperative fasting has always been a tussle between patient and surgery staff. Keeping patient nil by mouth unnecessarily not only increases the anxiety, thirst, hunger, postoperative insulin resistance but can also lead to serious hypoglycemic events in diabetic patients. The objective of our study to standardize the habits of pre-operative fasting according to AABGI guidelines and make sure to curtail the fasting period to the required minimum to 2 hours for liquids.

Method
This retrospective study included all inpatients who had any vascular surgery done under general anaesthesia from Sep 2020 to Nov 2020 in Birmingham Heartland Hospital. As per departmental practices every patient is fasted from 0300. Anaesthesia induction time was noted for every patient from theatre logbook to calculate the fasting interval. After data analysis meetings were done with the ward sister, anaesthetic & vascular surgery consultants to draw an action plan.

Results
Data collected from a total of 50 patients showed that average fasting period was 11 hrs 2 mins with longest fasting interval was 14 hrs 55 mins. Blanket allowance of clear fluids till 7 am, late dinner and communication of theatre list priority to the ward resulted in achieving an average fasting period of 2 hrs 53 minutes.

Conclusions
Identification of this simple but crucial problem is the first step towards compliance with the standard. These unassuming butchallenging implementations can significantly affect patient satisfaction and help achieve recommended fasting intervals. Pre-op fasting can easily be optimized by good communication between staff. As further evidence arises, structured peri-operative care can progress.
SP7.11 Preliminary results from the TACKoMesh RCT; comparing the patient experience of pain following elective laparoscopic incisional hernia repair with ‘Protack™ versus Reliatack™’, IPOM and sutured fascial closure
Authors: Pilkington James , Wilkinson Fiona , Pritchett Jim , Shah Shaneel , Fullwood Catherine , Sheen Aali 
Published: November 2022

Abstract

Aims
Provide a report on all patients who underwent laparoscopic incisional hernia repair as part of the TACKoMesh RCT prior to unblinding of treatment arms.

Methods
Trial recruitment was for primary incisional hernia with a defect diameter of 3–10cm. 63 patients (target 74–136) were operated on prior to the outbreak of COVID-19. Post-operative pain is the primary trial outcome.
Surgery was performed with spiral-tack mesh-fixation devices (Protack™ (permanent) or Reliatack™ (absorbable)), Symbotex™ IPOM mesh, and sutured fascial closure using extracorporeal knot ties.
Data was collected on trial forms and lifestyle questionnaires (SF-36 and CCS). All data were explored and described in RStudio v1.4.1106.

Results
Patients were aged 36–80 and 57.1% male. Mean preoperative BMI was 30.91.
Mean operating time was 81minutes. In 20.6% patients multiple hernia defects were identified. A good degree of fascial closure was achieved in all patients using a median 3 knots.
Median mesh-fixation time was 286seconds and a mean of 25 tacks/patient were used. Median length of hospital stay was 3.5days.
Patients were asked “Please indicate on this scale [VAS 0–10] the pain that you currently experience from your incisional hernia during activity?”. Median responses for Day0/pre-op, Day1, Day6, Day30 and Day365 were 4.5, 8.0, 6.0, 3.0 and 1.5 respectively.
At one year, 11% patients had experienced hernia recurrence and 52% a post-operative seroma.

Conclusions
Target recruitment was not possible owing to COVID-19. This technique has comparable recurrence rates. Reported pain increases post-operatively but is reduced at post-operative day30 and day365.
SP8.2.1 Robotic versus laparoscopic left lateral hepatic sectionectomy: a systematic review and meta-analysis
Authors: Hajibandeh Shahin , Hajibandeh Shahab , Qayum Mohammed Kaif , Dosis Alexios 
Published: November 2022

Abstract

Aims
To evaluate comparative outcomes of robotic and laparoscopic left lateral hepatic sectionectomy (LLS).

Methods
A systematic search of PubMed, Web of Science, EMBASE and bibliographic reference lists with application of a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits was conducted. Overall, minor (Clavien–Dindo grade&lt;III) and major (Clavien–Dindo grade&gt;III) postoperative complications, mortality, volume of blood loss, conversion to an open procedure, procedure time, length of hospital stay, cost-effectiveness, and R1 resection were the evaluated outcome measures.

Results
Seven comparative observational studies reporting a total of 319 patients of whom 150 underwent robotic LLS and the remaining 169 patients underwent laparoscopic LLS were included. The robotic approach was associated with significantly longer procedure time (MD: 29.40 minutes, p=0.01) and higher cost (MD: $4170, p&lt;0.00001) compared to the laparoscopic approach. There was no significant difference in overall postoperative morbidity (OR: 1.29, p=0.62), Clavien-Dindo grade &lt;III (OR: 1.65, p=0.49), Clavien-Dindo grade &gt; III (OR: 1.18, p=0.85), perioperative mortality (RD: 0.00, p=1.00), volume of blood loss (MD: 1.96 mls, p=0.91), conversion to an open procedure (RD: -0.02, p=0.46), length of hospital stay (MD: 0.22 day, p=0.52) or R1 resection (RD:0.00, p=1.00) between two groups.

Conclusions
Meta-analysis of the best available evidence (level 2) demonstrated that robotic LLS is associated with significantly longer procedure time and higher cost and similar perioperative outcomes compared to the laparoscopic approach. Future randomised studies are required to evaluate short-term perioperative, long-term oncological and surgeon-centred outcomes.
SP9.1.3 Colorectal Cancer Referrals During COVID-19: The Use of CT and qFIT in Triaging Patients in NHS Grampian
Authors: Ashad Fabbiha , Ramsay George , Morrisey Brian 
Published: November 2022

Abstract

Introduction
The COVID-19 outbreak resulted in fundamental changes to clinical practice for patients referred to secondary care with lower gastrointestinal symptoms. The use of colonoscopy services was reduced due to a perceived risk of viral transmission. Resultantly, computed tomography abdomen pelvis (CTAP) scans were utilised to triage patients. This study aimed to assess the accuracy of CTAP and qFIT in triaging patients at risk of colorectal cancer.

Methods
This study retrospectively gathered data on patients referred via the urgent suspected cancer (USC) pathway from the start of lockdown over a 6-month period in a single Scottish Health Board. Data were collected on presenting symptoms, qFIT levels, vetting decision, investigations, and subsequent diagnosis. Patients were vetted into one of five pathways: CTAP, direct to colonoscopy, downgraded from assessment, flexible sigmoidoscopy, or CT colonography.

Results
The overall cancer detection rate was 6.4%. Of the patients with cancer on the CTAP pathway, 22.9% had cancer undetected on CTAP which was later identified on colonoscopy. In the cohort of patients with colorectal malignancy, 7.5% had a negative qFIT value (&lt;10 ug/g).

Conclusion
CTAP alone may not be accurate in detecting colorectal cancers. One should consider the whole clinical picture and decide whether further imaging is warranted following a negative CTAP scan. Additionally, qFIT remains the leading laboratory investigation within screening programmes, however, it should not be used in isolation to rule out colorectal malignancy.