bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP-575 Exhaled volatile organic compounds in the detection of colorectal cancer: A systematic seview and meta-analysis
Authors: Alsaadi Daniah , Clements Nicolle , Gabuniya Natiya , Chand Manish , Nader Francis 
Published: November 2022

Abstract

Aims
There is an apparent need for novel non-invasive colorectal cancer (CRC) screening tests that are more acceptable to patients and can reliably detect CRC or reduce the number of unnecessary colonoscopies performed in cancer-free patients. An emerging number of studies demonstrate the potential value of exhaled volatile organic compounds (VOCs) as a diagnostic and triaging test for CRC. A systematic appraisal and meta-analysis of the published evidence was done to determine whether exhaled VOCs can be used in the detection and screening of CRC.

Methods
Nine electronic databases were searched from inception of the databases until August 2020. Quantitative and descriptive data of CRC patients and healthy control (HC) participants who underwent VOCs breath analysis was extracted. In addition, where possible, sampling methods, analytical platforms, processors, and specific breath biomarkers found in each study were recorded.

Results
Fourteen articles were included in the systematic review with 491 colorectal patients and 754 HC participants (n=1245). Sub-group meta-analysis was conducted on nine of those articles and the pooled sensitivity was estimated to be 0.89 (95% CI = 0.80–0.99) whereas specificity was 0.83 (95% CI = 0.74–0.92). Heterogeneity of pooled sensitivity and specificity was estimated as I2=11.11%.

Conclusions
Although this study was limited by small sample size and different analytical platforms, the proposed future framework resolves such limitations and standardizes future research. It is reasonable to deduce that VOCs breath analysis is certainly a field of research that can progress to replace traditional methods within the framework of CRC screening and diagnosis.
EP-581 Prophylactic onlay mesh at emergency laparotomy: Promising early outcomes with long-acting synthetic resorbable mesh
Authors: Alsaadi Daniah , Stephens Ian , Simmons Lydia O , Bucholc Magda , Sugrue Michael 
Published: November 2022

Abstract

Background
Careful surgical strategy is paramount in balancing the prevention of fascial dehiscence, incisional hernia (IH) and fear of additional mesh-related wound complications post-laparotomy. This study aims to review early outcomes of patients undergoing an emergency laparotomy with prophylactic long-acting resorbable synthetic TIGR® mesh, used to reduce early fascial dehiscence and potential subsequent IH.

Methods
A retrospective, ethically approved review of 24 consecutive patients undergoing prophylactic TIGR® mesh placement during emergency laparotomies by a single surgeon between January 2017 and June 2021 at a University Hospital. A standardised approach included onlay positioning of the mesh, small-bite fascial closure, and a wound bundle. We recorded patient demographics, operative indications, findings, degree of peritonitis, postoperative complications, and mortality.

Results
The study included 24 patients; 16/24 (66.6%) were female and mean age was 66.5 (range 31–86); 14/24 patients were ASA grade III or greater; 4/24 patients (16.6%) developed six complications and 3/6 occurred in a single patient. Complications included subphrenic abscess, seroma, intrabdominal hematoma, enterocutaneous fistula leading to deep wound infection and small bowel perforation. Five (20.8%) patients died in hospital; central venous catheter sepsis (n=1), fungal septicaemia (n=1) and multiorgan failure (n=3). Surgical site infection and seroma rates were low, occurring in 2/24 patients (4% each).

Conclusions
This small study has identified that prophylactic onlay mesh in patients undergoing an emergency laparotomy is not associated with significant wound infection or seroma when used with an active wound bundle. The wider use of TIGR® to prevent fascial dehiscence and potential long-term IH prevention should be considered.
EP-582 Giant bilateral intrathoracic involvement from pseudomyxoma peritonei
Authors: Hunduma Gabriel , Kukreja Roy , Veres Lukacs , Tamburrini Alessandro 
Published: November 2022

Abstract
A 46 year old male never smoker was referred to the unit for investigation of progressively worsening shortness of breath, 9 months after being treated for pseudomyxoma peritoneum. He had completed 3 cycles of CAPOX chemotherapy followed by total colectomy and hyper-thermic intraperitoneal chemotherapy (HIPEC).
Computed tomography showed very extensive and bulky bilateral intrathoracic disease with large infiltrations in the parietal and visceral pleura, pericardium and diaphragm, suggesting significant intrathoracic extension of pseudomyxoma peritoneum.
Following MDT discussion, pleurectomy and decortication with cytoreductive intent was performed. A pleural mass measuring 5cm was resected, along with drainage of copious amounts of yellow gelatinous material. Extra-pleural dissection was continued up to the apex from the mediastinum and diaphragm. Pericardial tissue was also resected and reconstructed with a vycril mesh. He was discharged home on postoperative day 6 and found to have significant improvement in his symptoms 3 months after surgery.
EP-583 Review of lower limb orthoplastic flap monitoring protocol
Authors: Dastidar Anannya Ghosh , Gardner Earl , Abdelrahman Mohamed 
Published: November 2022

Abstract

Aim
To improve upon the existing muscle and fascio-cutaneous flap monitoring protocol. The objective is to follow the patient's journey from the time of admission up to discharge and then follow up, in a tertiary care hospital in the Northern region of England, United Kingdom.

Method
The patients were selected from the online plastic surgery audit tool regularly used for documentation, handover and maintaining continuity of care. We looked at the patients requiring free muscle flaps, pedicled muscle flaps and fascio-cutaneous flaps, following fractures sustained to the lower limb, from April 2016 to April 2021. The exclusion criteria were elective free flaps or pedicled flaps and open fracture with no wound management concerns.
The parameters being evaluated were patient observations, flap observations, urine output, bloods, intravenous fluids, patient-controlled analgesia, oxygen, dressing, nutrition, mobility and follow up. Following analysis of the results, a more standardised protocol was distributed across the wards. The response to the new monitoring protocol was measured based on continuity of care, staff satisfaction and outcomes.

Results
There was an initial need for standardisation of monitoring protocols and elimination of multiple charts. This included the nutrition status, use of blood products, dressings and physiotherapy, in addition to the previously mentioned parameters.

Conclusion
The staff feedback was positive and felt better equipped. It removed the ambiguity and patients were aware of their follow up dates prior discharge. The collaboration with the physiotherapy team was well coordinated. This led to an organised recovery period.
EP-592 Hepatic abscess secondary to intrahepatic migration of ingested foreign body: A Case Report
Authors: White Annabelle , Badawi Marwa , Cruikshank Naomi , Rakhimov Iskandar 
Published: November 2022

Abstract

Introduction
Cryptogenic liver abscesses present a unique diagnostic and therapeutic challenge, especially in patients with delayed presentation. Presence of a foreign body, not always immediately apparent on imaging, can explain treatment failure of presumed cryptogenic liver abscesses, often requiring surgical or endoscopic removal for abscess resolution.

Case
We described the case of a 20-year-old female patient, previously fit and well with no surgical or medical history of note. She initially presented to a DGH A&E department following ingestion of a pen, and was discharged clinically stable following review of an inconclusive chest x-ray. She represented 5 months later with ongoing epigastric pain and nausea, and underwent a CT scan showing the foreign body perforating her duodenum and continuing up to the right lobe of the liver where it lay within an abscess. She was immediately started on intravenous antibiotics, and referred to a local hepato-pancreato-biliary unit where she underwent a laparotomy and removal of the object.

Conclusion
This was an unusual case due to the duration of foreign body being in situ, and the patient remaining haemodynamically stable throughout and systemically well. Upon review of the literature, we found 60 cases reported of liver abscesses secondary to foreign body ingestion, and key areas for right lobe abscesses originate from perforation of either first or second part of the duodenum, pylorus or antrum of stomach. Due to the diagnostic challenge presented by these patients, diagnostic algorithms including indirect evidence of FB migration including of fistula tracts or adhesions have been suggested.
EP-593 Blind loop mucocele of a side-to-end colorectal anastomosis as a rare cause of large bowel obstruction
Authors: Peacock Luke , Pangeni Anang , Prakash Samip , Sontenam Venkata , Shrestha Ashish , Allu Veera 
Published: November 2022

Abstract

Background
Large bowel obstruction (LBO) after colorectal surgery draws wide differentials. Very few reports of LBO secondary to closed loop mucocele have been published. To our knowledge, LBO due to mucocele of the blind colonic limb of a side-to-end colorectal anastomosis has not been described.

Case Details
A 57-year-old man presented with pain, gradual abdominal distension and one week history of constipation. He had extensive surgical history – colo-vesical fistula takedown, sigmoid resection and Hartmann type end colostomy followed by reversal, and mesh repair of incisional ventral hernia among others. Notably, a side-to-end configuration was fashioned as a descending colo-rectal anastomosis. CT, followed by MRI scans, of the abdomen and pelvis respectively suggested a mucus-filled short blind colonic bowel segment compressing the anastomotic site as the cause of large bowel obstruction proximal to the site. On flexible sigmoidoscopy under general anaesthesia, external compression of the rectum with narrowing of the lumen was noted. Transrectal needle aspiration of the blind colonic segment yielded 145 mL of mucoid fluid and allowed proximal examination. Anastomotic site was of normal calibre.
The patient's symptoms improved and he was discharged with scheduled outpatient follow-up. Gastrografin enema post-discharge demonstrated an end-to-side rectosigmoid anastomosis with local rectal stenosis and showed the blind loop had emptied.

Conclusion
This case highlights that blind colonic loop mucoceles in colorectal anastomosis can rarely cause obstruction and endoscopic management is feasible when accurate diagnosis is confirmed on imaging.
EP-595 The Use of Scrotal Compression Following Large Open Inguinoscrotal Hernia Repairs
Authors: Jesuyajolu Damilola , Jesuyajolu Paul 
Published: November 2022

Abstract

Aims
Large inguinoscrotal hernias are endemic in Sub-Saharan Africa, and scrotal edema is a common complication following surgery. The use of scrotal compression has been advised, especially in tropical regions, to reduce its incidence. We aimed to determine the rate of usage of scrotal compression following large inguinoscrotal hernia repairs as recommended.

Method
A review of all herniorrhaphies done for large inguinoscrotal hernias over one year in the hospital was carried out to evaluate the application of scrotal compression post-op.

Results
Out of the 22 large inguinoscrotal hernia repairs done, 12 of them did not have a scrotal compression post-surgery.

Discussion/ Conclusion
Due to the deep dissection needed during open hernia repairs, as well as the potential space left after surgery, there is a tendency for fluid to collect in the space, leading to an edematous scrotum. Although not mandatory, the use of scrotal compression confers some benefits in preventing the occurrence of scrotal edema. Following the presentation of the findings to the department and a re-audit, there was increased usage of scrotal compression and a reduced incidence of post-operative scrotal edema. The use of scrotal compression is a useful tool in reducing the incidence of scrotal edema.
EP-602 The impact of COVD-19 on the surgical management of acute cholecystitis
Authors: Leiberman Christopher , Kizis Georgis , Leipner Anna-Marie , Hendry Julianne 
Published: November 2022

Abstract

Aim
The Association of Upper Gastrointestinal Surgeons (AUGIS) recommends performing a laparoscopic cholecystectomy within 72 hours of admission for acute cholecystitis. COVID-19 has drastically affected the way healthcare is able to be delivered worldwide. This project was designed to audit the impact of COVID-19 on the surgical management of acute cholecystitis against AUGIS guidelines.

Methods
All general surgical admission from November 2020 were retrospectively analysed. Admission records were screened for those presenting with acute cholecystitis. Those identified had their records analysed for laparoscopic cholecystectomy. Patients who died before surgery, had an alternative procedure performed, or who were unfit for surgery, were excluded.

Results
During this time, 28 patients were admitted with acute cholecystitis. In total, 3 patients were excluded: 1 died before any possible intervention, 1 was unfit for surgery, and 1 received a cholecystostomy. Of the 25 included patients, only 11% (n=3) patients received a laparoscopic cholecystectomy within seven days from their hospital admission. The remaining 89% (n=22) of patients were managed conservatively with fluids, analgesia, and antibiotics.

Conclusion
It can be concluded that COVID-19 has severely impacted the surgical management of acute cholecystitis as only 11% of those patients presenting were managed in accordance with AUGIS guidelines. Whether conservative management is an alternative long-term option for management remains to be seen as further long-term studies are needed.
EP-603 What a difference a year makes: Long-term follow-up of non-operative management in acute cholecystitis
Authors: Leiberman Christopher , Kizis Georgis , Leipner Anna-Marie , Hendry Julianne 
Published: November 2022

Abstract

Aim
Surgery is currently the recommended treatment for acute cholecystitis and the Association of Upper Gastrointestinal Surgeons (AUGIS) recommends that laparoscopic cholecystectomy be performed within 72 hours of admission. However, given the impact of the COVID-19 pandemic on healthcare delivery, this is not always possible. So, what happens to those who are managed conservatively?
We observed the long-term impact of conservative management of patients admitted with acute cholecystitis over the course of one year.

Methods
Twenty-eight patients were admitted with acute cholecystitis to a large tertiary hospital in November 2020; twenty-three were discharged without having had a cholecystectomy. These patients were followed up for one year and observed for the development of any gallstone-related admissions and surgical procedures.

Results
Of the 23 patients observed, 30% (n=7) were admitted for gallstone-related complications. Biliary colic was responsible for 43% of these admissions with pancreatitis (14%), cholangitis (14%), choledocholithiasis (14%), and cholecystitis (14%) causing the rest. Only 9% (n=2) received a laparoscopic cholecystectomy. In both cases, it was in an emergency setting during admission for biliary colic.

Conclusion
Long-term observation of conservatively managed acute cholecystitis was possible in around two-thirds of patients as no gallstone-related hospital admissions were observed. Biliary colic was the most common cause of gallstone-related admissions. Longer observation is required to assess the feasibility of long-term non-operative management in acute cholecystitis.
EP-604 The Golden Patient Pathway - Improving Efficiency of Emergency General Surgery Theatres and Bed Management
Authors: Rizkallah Nayer , Smith Katherine 
Published: November 2022

Abstract

Aim
This closed loop audit aimed at improving efficiency of time management with good utilisation of the first hour of the day in emergency theatres. This was reflected on bed management and patient service.

Methods
Patients who required simple emergency operations were the target population. Retrospective data of patients’ demographics, time of attendance to surgical admission unit, time waiting for an operation, anaesthetic start times, surgical start times and postoperative inpatient stay were collected. Then the Golden patient pathway was implemented via a list of agreed criteria for the Golden patient (simple procedure, non-septic, non-diabetic, etc.). The chosen patient was labelled as Golden on the booking form. A precise time scale for anaesthetic review and theatre sending time was agreed. This pathway was tried for a month followed by data collection to compare outcomes.

Results
After starting the Golden patient pathway in our emergency surgery service, the mean anaesthetic start time (+/- standard deviation) improved from 09:12 +/- 0.11 to 08:32 +/- 0.01. Consequently, the mean operation start time improved from 09:45 +/- 0.10 to 08:53 +/- 0.01. The percentage of patients with same day discharge after simple procedures increased from 57% to 100% thus providing better use of hospital beds.

Conclusion
The Golden patient pathway provides a good utilisation of the first hour of the day in emergency theatres. It has a positive impact on patient service and bed management via reducing the waiting times. The Golden patient pathway is an asset to the emergency general surgery service.
EP-605 Perineal Partial Myocutaneous Gluteal (PMG) Flap Reconstruction after Extra Levator Abminoperineal Excision (ELAPE): Recent Experience and Outcome
Authors: Patil Sangram , Bowers Ciara , Chandrashekhar Bhargavi , Mohammed Paul , Sivakumar Rangasamy , Bashir Abdul Mohamed 
Published: November 2022

Abstract

Background
Extra Levator Abminoperineal Excision (ELAPE) is widely performed surgery for low rectal cancers. A large defect in the perineum adds significant post-operative morbidity. There is no clear unanimity about the closure of the defect. The aim of the study is to evaluate our experience and outcome of the perineal wound management after ELAPE with partial myocutaneous gluteal (PMG) flap reconstruction in a large series of 81 patients at a single centre in the United Kingdom (UK).

Method
Retrospective review of all patients undergoing ELAPE and primary PMG flap reconstruction between January 2012 and December 2021 in a large district general hospital. Patient demographics, 30 days morbidity and mortality were studied.

Results
Total 81 patients (male 52, female 29) had ELAPE (laparoscopic 65, open 11, converted to open 5) and PMG flap closure for low rectal cancer. Mean age of patients was 67.2 years (SD+- 10.7). Length of stay was average 19 days (range: 6 to 168 days). Half of the total patients had neoadjuvant chemoradiation. 18.5% patients developed minor perineal wound complications, whereas only 2.5% patients needed to return to theatre for major wound complications. None of patients had perineal hernia or mortality in 30 days. All flaps were viable during the follow-up.

Conclusion
PMG flap provides safe and reliable method for perineal closure after ELAPE perineal defect without any additional morbidity compared to conventional closure offering overall good patient outcome and experience.
EP-606 An audit to assess the requests for plain abdominal radiographs for surgical conditions for the patients admitted in SAU are appropriate
Authors: Ravindran Sharanya , Sarveshwaran Janahan 
Published: November 2022

Abstract

Aim
To ensure that requests for plain AXR for surgical conditions for the patients admitted in SAU are performed appropriately as advised by Royal College of Radiologists guidelines.
We intend to reduce the radiation dose and early access to more appropriate investigations.
RCR iRefer guidelines for AXR

Methods
Patients admitted in SAU with abdominal pain in the month of October 2020 were taken. Total number of patients audited 50.
22 patients had AXR whereas 28 didn't have any.
In this 28 patients (56%); 16(58%) of them directly underwent higher imaging CT scan as they were quite unwell on arrival. Remaining 12 (42%) did not have abdominal x ray in line with the guidelines.
Out of 22 patients who had abdominal Xray, we noted that 15 were not indicated which are shown in the table below.
Group 1. – 28(56%) did not have an x-ray, in that 12 (42%) met the guidelines
Group 2. – 22(44%) patients had an x-ray 15(68%) of these were not indicated

Conclusion
EP-608 Robotic surgery in Inflammatory Bowel Disease: single centre experience
Authors: Banaskiewicz Karolina , Madurska Marta J , Randhawa Neena 
Published: November 2022

Abstract

Aims
Minimally invasive surgical approach has been shown to be beneficial especially with its utilization in the rectal dissection for the management of malignant disease. There has been growing interest in robotic approach in the surgical management of diverticular disease and inflammatory bowel disease (IBD). The aim of this study is to present our local institutional experience following implementation of a robotic service for surgical management of benign colorectal disease.

Methods
Data on patient demographics, intraoperative details, length of hospital stay (LOS), and postoperative complications were collected prospectively with a 30 day follow up. Patients included those who underwent robotic ileocaecal resection, subtotal colectomy, anterior resection, panproctocolectomy or proctectomy between April and December 2021, for benign disease including diverticular disease, IBD, or chronic constipation.

Results
Seventeen patients were included. 35% were male, median (IQR) age was 38 (22) years and BMI was 23 (2). Procedure duration was 181 (125) minutes, and one patient underwent conversion to open surgery. LOS was 9 (6) days and one patient required admission to HDU for one day. N=3 (18%) had ileus, and n=1 (6%) had an anastomotic leak, acute renal failure, or a chest infection. Two patients had collection requiring percutaneous drainage. No return to theatre or deaths were recorded.

Conclusions
Our early experience demonstrates encouraging outcomes as well as feasibility and safety of robotic approach in managing benign colorectal disease. Future studies with larger samples will allow to draw more definitive conclusions.