bluuebunny/crossref_metadata_2025_split huggingface dataset:
WE4.1 A Prospective Observational Study on Quality of Life Pre and Post Gastrojejunostomy for Benign Disease
Authors: Black Rebecca , McCance Angus , Ainger Ellen , Fernandes Mr 
Published: November 2022

Abstract

Background
Benign disease leading to gastric outlet obstruction is a major cause for morbidity and malnutrition. Surgery in the form of a gastrojejunostomy is aimed at improving quality of life by bypassing the obstructing lesion and restoring adequate oral nutrition.

Methods
Patients undergoing an open gastrojejunostomy for benign disease at a district general hospital operated by the same surgeon over a 3 year period were recruited. Based on the HRQoL SF-12 questionnaire, the pre-operative physical component summary (PCS) score were recorded together with pre-operative albumin levels and weight. The post operative PCS score, post-operative albumin and post-operative weight were recorded at 90 days. Differences were investigated using univariate comparisons.

Results
The mean ± SD pre-operative PCS score were 33.9 ± 8.1, postoperative score were 42.7 ± 7.8 9 (p= 0.003) in 6 patients. Mean ± SD pre-operative serum albumin levels were 27 ± 4 and postoperative levels were 32 ± 3 (p=0.04). There was a 3.7 ± 1.2 kg increase in weight over the 90 day period (p=0.03). There were no complications nor returns to theatre. The mean length of stay was 6 ± 3 days.

Conclusions
Gastrojejunostomy for benign disease causing gastric outlet obstruction has been shown to improve quality of life, serum albumin and weight over a 90 day period. It can therefore be concluded that beneficial patient outcomes can be achieved in a relatively short time span post-surgery.
WE4.3 Complete versus partial excision of an infected mesh following abdominal wall hernia repair: A systematic review and meta-analysis
Authors: Bodkhe Komal , Qayum Mohammed Kaif , Kar Irfan , Hajibandeh Shahab , Hajibandeh Shahin 
Published: November 2022

Abstract

Aims
We aimed to evaluate comparative outcomes of complete and partial excision of infected mesh following abdominal wall hernia repair.

Methods
A systematic search of electronic databases 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. Surgical site infection (SSI), chronic sinus formation, recurrent hernia and need for reoperation were the evaluated outcome measures.

Results
Six comparative observational studies were identified, reporting a total of 317 patients of whom 193 underwent complete mesh excision and the remaining 123 patients underwent partial mesh excision for an infected mesh following abdominal wall hernia repair. The complete mesh excision was associated with significantly lower rates of SSIs (OR: 0.36; 95% CI, 0.16–0.81, p=0.01), chronic sinus formation (OR: 0.11; 95% CI, 0.02–0.71, p=0.02), and reoperation (OR: 0.10; 95% CI, 0.03–0.33, p=0.0001) compared to the partial mesh excision. There was no significant difference in hernia recurrence rate (OR: 3.96.16, 95% CI 0.62–25.44, p=0.15) between two groups.

Conclusions
Our meta-analysis demonstrated that complete mesh excision may be associated with lower SSI, chronic sinus formation and need for reoperation when compared to the partial mesh excision in an infected mesh event. However, the available evidence has failed to report the outcomes with respect to the main confounding factors which, together with other important outcomes such as fistula formation, should be considered by future high quality research.
WE4.4 Robotic versus laparoscopic splenectomy in management of non-traumatic splenic pathologies: a systematic review and meta-analysis
Authors: Hajibandeh Shahin , Hajibandeh Shahab , Bhattacharya Pratik , Phelan Liam , Patel Ishaan 
Published: November 2022

Abstract

Aims
We aimed to evaluate comparative outcomes of robotic and laparoscopic splenectomy in patients with non-traumatic splenic pathologies.

Methods
A systematic search of electronic databases and bibliographic reference lists were conducted and a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in electronic databases were applied. Intra-operative and post-operative complications, wound infection, haematoma, conversion to open procedure, return to theatre, volume of blood loss, procedure time, and length of hospital stay were the evaluated outcome parameters.

Results
Eight comparative studies reporting a total of 560 patients comparing outcomes of robotic (n=202) and laparoscopic (n=258) splenectomies were included. The robotic approach was associated with significantly lower volume of blood loss (MD:-82.53 mls, 95% CI-161.91–-3.16, p=0.04) compared to the laparoscopic approach. There was no significant difference in intra-operative complications (OR:0.68, 95% CI 0.21–2.01, p=0.51), post-operative complications (OR:0.91, 95% CI 0.40–2.06, p=0.82), wound infection (RD:-0.01, 95% CI -0.04–0.03, p=0.78), haematoma (OR:0.40, 95% CI 0.04–4.03, p=0.44), conversion to open (OR:0.63; 95% CI, 0.24–1.70, P=0.36), return to theatre (RD:-0.04, 95% CI -0.09–0.02, p=0.16), procedure time (MD: 3.63; 95% CI, -16.99–24.25, P=0.73) and length of hospital stay (MD:-0.21; 95% CI, -1.17–0.75, P=0.67) between two groups.

Conclusions
Robotic and laparoscopic splenectomy seem to have comparable perioperative outcomes with similar rate of conversion to an open procedure, procedure time and length of hospital stay. The former may potentially reduce the volume of intra-operative blood loss. Future higher level research is required to evaluate the cost-effectiveness and clinical outcomes
WE4.9 Complete versus partial excision of an infected mesh following abdominal wall hernia repair: A systematic review and meta-analysis
Authors: Bodkhe Komal , Qayum Mohammed Kaif , Kar Irfan , Hajibandeh Shahab , Hajibandeh Shahin 
Published: November 2022

Abstract

Aims
We aimed to evaluate comparative outcomes of complete and partial excision of infected mesh following abdominal wall hernia repair.

Method
A systematic search of electronic databases 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. Surgical site infection (SSI), chronic sinus formation, recurrent hernia and need for reoperation were the evaluated outcome measures.

Results
Six comparative observational studies were identified, reporting a total of 317 patients of whom 193 underwent complete mesh excision and the remaining 123 patients underwent partial mesh excision for an infected mesh following abdominal wall hernia repair. The complete mesh excision was associated with significantly lower rates of SSIs (OR: 0.36; 95% CI, 0.16–0.81, p=0.01), chronic sinus formation (OR: 0.11; 95% CI, 0.02–0.71, p=0.02), and reoperation (OR: 0.10; 95% CI, 0.03–0.33, p=0.0001) compared to the partial mesh excision. There was no significant difference in hernia recurrence rate (OR: 3.96.16, 95% CI 0.62–25.44, p=0.15) between two groups.

Conclusions
Our meta-analysis demonstrated that complete mesh excision may be associated with lower SSI, chronic sinus formation and need for reoperation when compared to the partial mesh excision in an infected mesh event. However, the available evidence has failed to report the outcomes with respect to the main confounding factors which, together with other important outcomes such as fistula formation, should be considered by future high quality research.
WE5.1 Review of acute referrals to Surgical SDEC at a DGH
Authors: Chidambranath Rajesh , Thomas Pradeep , Flatt Janette 
Published: November 2022

Abstract

Aim
We intend to interpret the pathway that patients attending Surgical SDEC followed in this journey, at first contact point, their experience at each stage of contact with emergency services and reasons for taking the final pathway.

Method
We formed an anonymised questionnaire for patient pathway to SDEC, filled on arrival at SDEC. First 53 patients were included from 1 week data. This included the reason for their visit, duration of their presenting problem and whom they called before attending or being directed to SDEC and patient experience with each provider such as 111, 999 and GP in brief. Finally, we observed who they contacted and how urgent they thought their problem was.

Result
There were 53 patients, 50 responding for themselves. 51 of 53, agreed that they would contact GP or 111 for non-urgent queries. 41/53 77.35% approached their GP initially and we found that 58.5% were referred to SDEC. Of the 32 (37.7%) patients seen by GP, 24 (58.5%) were referred to SDEC. 20% thought they were too urgent for GP. We found that GPs were managing most urgent referrals (38%) and the majority of these were referred to SDEC as in the case of 111 responders.

Conclusion
Changes introduced by the Long Term Plan were well received by patients with majority of patients being seen in SDEC. The first patient contacts also resulted in SDEC referrals from the community and it would be appropriate for such referrals to be sent directly to SDEC by GPs and 111.
WE5.2 Safety of in-hospital delay to appendicectomy in acute appendicitis: a retrospective study
Authors: Claydon Oliver , Down Billy , Kumar Sidharth 
Published: November 2022

Abstract

Aims
In many hospitals the availability of operating theatres and access to senior surgical and anaesthetic support diminishes during night hours. Therefore urgent surgery is sometimes postponed until the following morning rather than performed overnight, if judged to be safe. We aim to determine if a delay to laparoscopic appendicectomy in cases of acute appendicitis of over 12 hours, analogous to an overnight delay, is correlated to worse patient outcomes. Our primary outcome was delayed discharge from hospital. Our secondary outcomes were appendicitis severity, conversion, and post-operative complications.

Methods
We undertook a retrospective review of the medical records of patients who underwent laparoscopic appendicectomy at a UK district general hospital between 01/01/2018 and 30/08/2019. For each patient clinical and demographic information; and times of hospital admission, surgery, and discharge; were collected. Delayed discharged was defined as ‘time to discharge’ &gt;24 hours.

Results
506 patients were included. In 144 patients (28.5%) ‘time to surgery’ was under 12 hours; in 362 patients (71.5%) ’time to surgery’ was over 12 hours. 362 patients (71.5%) had a delayed discharge. 303 patients (59.9%) had simple appendicitis; 143 patients had severe appendicitis (28.3%); 60 patients had a macroscopically normal appendix (11.9%). No statistically significant association between ‘time to surgery’ and delayed discharge, appendicitis severity, conversion or 30 day re-presentations was observed.

Conclusions
Time from admission to start of appendicectomy did not affect patient outcomes. Short in-hospital delays to appendicectomy, for example an overnight delay, may be safe in certain patients, taking account of clinical judgement.
WE5.3 Emergency laparoscopic “hybrid” IPOM+ repair of incarcerated umbilical hernia in patient with BMI 62 and small bowel obstruction; a case study
Authors: Clyde Danielle , Healey Andrew , Damaskos Dimitris 
Published: November 2022

Abstract

Background
Large abdominal incisions in obese patients are associated with considerable rates of systemic and wound complications. Recently published European Hernia Society guidelines recommend laparoscopic intraperitoneal on-lay mesh (IPOM) repair for large hernia defects and patients at higher risk of wound morbidity, ideally with closure of the defect and a 5 cm overlap.
Case Presentation: We report on a 69-year-old, morbidly obese (BMI 62), comorbid woman who presented as an emergency with a 5-day history of vomiting and abdominal pain. A pre-operative computed tomography (CT) scan confirmed small bowel obstruction secondary to a ventral abdominal wall hernia. Operative findings confirmed an obstructed paraumbilical hernia containing small bowel and omentum. A laparoscopic “hybrid” IPOM+ repair was performed, with a generous overlap. She recovered uneventfully with no surgical complications.
Discussion: Minimally-invasive surgical techniques are preferred for obese patients with evidence suggesting lower perioperative complications and recurrence rates compared with open repair. However, additional challenges must be taken into consideration including; surgeon expertise, timing of operation, surgeon ergonomics, distortion of surface anatomical landmarks, need for higher pneumoperitoneum pressures and the physiological effects of this on the patient.

Conclusion
With preoperative planning, our case study demonstrates that IPOM ventral hernia repair remains a viable option for severely obese patients even in emergency presentations. The closure of the defect is recommended whenever feasible. Addition of the hybrid approach (excision of the sac with a limited incision after the laparoscopic closure) reduces the risk of postoperative seromas.
WE5.4 The Successful Resurrection of NELA in a District General Hospital
Authors: Gohil Bhavesh , Sarodaya Varun , White Alastair , Garg Arti 
Published: November 2022

Abstract

Introduction
The NELA requirements of data collection is known to be mandatory. Our DGH had three years of non compliance. We present an executed plan in the collection of retrospective and prospective process to achieve national standard.

Method
A new structural setup with anaesthetic and surgical teams was formalised.
A recruitment of 13 foundation doctors was made and each were induced to NELA with a teaching session. Allocation of 15–20 hospital numbers with a primary deadline of seven days to achieve full entry was expected. A formal NELA certificate and recognition for taking part from the divisional director was issued.
A prospective strategy was initiated with patient ownership from the joint anaesthetic and surgical team involved. A NELA login with local access was setup, plus paper format readily available for rare access situations. A two email reminder system with further escalation process was introduced if entry was incomplete. The escalation being contact from the clinical lead / divisional director. This information was highlighted at a local meeting plus a familiarity of the NELA database was ensured.

Results
A large proportion of the retrospective data has been collected over a short time period due to a clear incentivised scheme. Prospectively there has not been any escalation emails needed since the new setup.

Conclusion
Areas of problems were identified with a wide range of solutions being put forward.
A multi collaborative approach was needed plus positive cooperation from the clinical lead, clinical director and the divisional director to ensure the successful new era.
WE5.6 Hajibandeh index is more accurate than NELA score in predicting mortality following emergency laparotomy in patients aged over 80
Authors: Anwer Amal Azhar , Hajibandeh Shahab , Hajibandeh Shahin , Waterman Jennifer , Miller Bethany , Evans Louis , Maw Andrew 
Published: November 2022

Abstract

Aims
To compare performance of the Hajibandeh Index (HI) and National Emergency Laparotomy Audit (NELA) score in predicting mortality following emergency laparotomy (EL).

Methods
In compliance with STROCSS guidelines for observational studies a cohort study was conducted. All patients who underwent EL between January 2014 and January 2021 in our centre were included. The performance of HI and NELA score in predicting 30-day and 90-day postoperative mortality were compared. The discrimination of each test was evaluated using ROC curve analysis, classification using classification table and calibration using a plotted diagram of the expected versus observed mortality rates.

Results
Analysis of 700 patients showed that the predictive performance of the HI and NELA models were comparable (AUC: 0.86 vs 0.87, P=0.557). HI was significantly better than the NELA model in predicting postoperative mortality in patients aged over 80 (AUC: 0.85 vs 0.72, P=0.0174). The performances of both tools were comparable in patients with ASA status above 3 (AUC: 0.82 vs 0.82, P=0.9775), patients with intraperitoneal contamination (AUC: 0.77 vs 0.85, P=0.0728) and patients who needed a bowel resection (AUC: 0.85 vs 0.88, P=0.2749). Both tools were comparable in terms of classification and calibration.

Conclusions
Hajibandeh index is better than the NELA score in predicting mortality following EL in patients aged over 80. Its performance is comparable to NELA for all patients, patients with ASA status above 3, patients with intraperitoneal contamination or patients who need a bowel resection. We encourage other researchers to validate HI in predicting mortality following EL.
WE5.7 A Comparison of Small and Large Bites Closure of Fascia in Midline Laparotomy Wounds: Experience in a District General Hospital
Authors: Heard Rachel , Darbi Elmahdi , Soh Coreen , Barker Jonathan 
Published: November 2022

Abstract

Aims
Small bites (SBC) laparotomy closure (5mm fascial bites, 5mm apart) is thought to decrease incisional hernia rates compared to large bites (LBC) closure (1cm bites, 1cm apart). A colorectal surgeon in our centre changed practice following the STITCH trial. We aimed to assess whether this change affected outcomes.

Methods
All midline laparotomy patients immediately before and after the change in practice in 2017 were considered for inclusion. Data on demographics, co-morbidities, operation details, length of stay (LoS), complications and outcome were gathered from operation notes and electronic patient records. Follow up was censored at 12 months to make groups comparable.

Results
80 patients were included (38 SBC; 42 LBC), undergoing laparotomy from August 2014-December 2020. Age, gender and ASA grade were comparable between groups. 58% SBC; 71% LBC were emergency cases. LoS was 7 days (range 3–166) for SBC; 11 (5–369) LBC. Overall wound complication rates were similar (23.7% SBC; 19% LBC, p=0.61). There were 4 (10.5%) burst abdomens following SBC and 2 (4.8%) following LBC (p=0.21). 1 (2.6%) SBC and 3 (7.1%) LBC developed incisional hernia at 12 months.

Conclusions
SBC did not result in decreased wound complications: although incisional hernia rate and LoS were reduced, there was a (non-significant) higher rate of burst abdomens in SBC. The latter may reflect a learning curve effect of a new technique. This study suggests SBC is feasible in a DGH, but long-term outcomes of SBC are yet to become apparent, which may have affected results in this cohort.
WE5.8 Length of stay in Emergency General Surgery – Time for a Comprehensive Look at Our Elderly Population
Authors: Howie Emma , Helley Michael , Box Emma , Watt David 
Published: November 2022

Abstract

Aims
Patients’ Length of stay (LoS) has increased due to increasing age and co-morbidities. The British Geriatric Society 2020 Position statement states patients &gt;65 being considered for laparotomy should have a documented Clinical Frailty Scale (CFS) within 72hrs of admission and, if &gt;5, should receive Geriatrician lead Comprehensive Geriatric Assessment (CGA) which improves patient outcomes.
We sought to quantify CFS documentation in Emergency General Surgery (EGS) patients in a District General Hospital before implementing a new CGA to improve elderly EGS patient care.

Methods

Planning
Business intelligence records of all adult EGS admissions over 1-year were retrospectively interrogated – comparing LoS between age groups, comorbidity number, discharge destination and whether a procedure was undertaken.
EGS admissions were prospectively reviewed over 1-month, noting patients &gt;65 and CFS documentation.

Results
Retrospective: 3962 patients &gt;16 were admitted January-December 2019. 1317 patients (33%) were &gt;65. Average LoS was 3.9 days, overall highest LoS was ages 75–84 (8.5 days). Highest average LoS were &gt;75yr olds requiring supported care at home (15.5 days). LoS varied directly with number of diagnosis codes and increased if undergoing a procedure.
Prospective: There were 130 EGS admissions in 1 month, 53 (40%) patients were &gt;65. No patients &gt;65 had a CFS documented.

Conclusions
Increased LoS in EGS is associated with increasing age and comorbidities - particularly patients &gt; 75 awaiting home-care. BGS statement concordance to establish prompt frailty assessment is imperative to improve patient outcomes. Staff education and surgery-specific CGA note-stickers may improve concordance. Subsequent analysis to evaluate effectiveness in patient and economic outcomes is paramount.
WE5.9 Management of acute abdominal pain in children at District General Hospital (DGH)
Authors: Jalali Uzma , Alam Imran , Fani Mazyar 
Published: November 2022

Abstract

Introduction
Children with acute abdominal pain are frequently seen in paediatric A&E at DGH. Acute appendicitis is the most common surgical cause of acute abdominal pain in children. Diagnosis and management can be a problem in the absence of paediatric surgical unit

Methods
A retrospective study was conducted at a busy DGH where general surgical department is routinely involved in the management of acute abdominal pain in children. 6 months data was collected from 01/06/21 to 30/11/21.

Results
381 patients (5–16 years) attended paediatric emergency with complaint of abdominal pain. 24% referred to surgeons (females 53%, mean age 10.9 years). All Presented with pain in RIF, migratory pain was in 42%. Nausea and vomiting were reported in 38%, loose stools in 10.8% and loss of appetite in 21.7%. Duration of pain vary between 24 hours to 3 weeks. WCC was raised in 32% patients, US was performed in 21.7%, CT scan in 5.4%, MRI 1%, and 1% had both Ultrasound and MRI. 46.7% did not have any radiological investigations. Appendectomy was performed in 21% (19) patients including laparoscopic in two. Duration of stay range from less than 24 hours to 5 days. 46.7% were discharged within 24 hrs of review, 21.7% stayed for one and only 2% stayed for five days. 1 patient was readmitted following a post operative collection that was managed conservatively. 2 referred to tertiary paediatric unit for complicated appendicitis.

Conclusion
This data proves that paediatric patients with suspected appendicitis can be safely managed in a surgical unit at DGH.