bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP-67 An Audit of extended Venous Thromboembolic Prophylaxis for major Laparotomy in a District General Hospital, Are We Compliance With NICE guidelines?
Authors: Elshafey Tarek , Azam Muhammad , Satchidanand Rajish 
Published: November 2022

Abstract

Aim
Development of Thrombo-embolic episode is a well-recognised complication after major abdominal surgery in high risk patients. studies have shown the extended VTE prophylaxis is beneficial for the patients after a major abdominal surgery.
Aim of this study was to evaluate the administration of extended VTE prophylaxis after being discharged home.
We prescribed LMWH for prophylaxis postoperatively for 28 days and patients or carers were trained to self-administer before discharge.

Method
This is a retrospective review of prospectively collected and maintained data on major abdominal surgery (Laparotomy) in a district general hospital for the length of VTE prophylaxis after discharge home. and compare the result with the standard set out by NICE. we collected the patients’ data from electronic database from January 2019 to January 2021.

Results
A total of 310 patients records were retrieved from the database system.
Our record result showed that 189(61%) patients went home with extended VTE prophylaxis. 121(39%) patients did not receive VTE prophylaxis after discharged.
Out of 121 patients 2 patients developed VTE
1 patient developed DVT and PE and one patient developed DVT only. Patient with DVT and PE was admitted for medical management.

Conclusion
Post operative DVT and PE are worrisome preventable complications for the patients after major surgery especially the elderly and patients with medical co morbidities. the morbid patients with malignancy are more challenging to mobilise after the surgery. There has been studies on extended VTE prophylaxis for such patients after discharge and benefits are documented for those patients with extended VTE prophylaxis.
EP-69 The use of IFAbond© tissue adhesive to reduce seroma rates and improve breast reconstruction outcomes
Authors: Lefroy Rebecca , Mylvaganam Senthurun 
Published: November 2022

Abstract

Introduction
Tissue adhesives have had uses in surgery for over 45 years. Evidence for use in haemostasis and cavity closure is growing. Seromas are a common (up to 85% incidence) but potentially serious complication in implant-based breast reconstruction (IBBR). If infected can cause implant loss and reconstruction failure. Tissue adhesives may reduce seroma rates.

Aims and Methods
Our study considered whether IFAbond© significantly reduces seroma formation following IBBR and as a pilot to evaluate the optimum use and application of IFAbond©. 7 consecutive patients undergoing pre-pectoral IBBR were recruited to the control arm (standard closure) and a further 7 patients undergoing pre-pectoral IBBR were recruited to the intervention arm (standard closure including IFAbond©). Qualitative assessment of seroma formation and IBBR objective early outcomes were assessed at 1 week, 2 weeks and 30 days.

Results
Cohorts were comparable for demographics, mastectomy weight and implant size. No wound infection, healing concerns or implant loss at thirty days in either cohort. No patients developed clinically significant seroma (requiring drainage) in either arm. 4 of 7 control arm patients developed clinically noticeable seroma at 30 days compared to none in the intervention arm.

Conclusions
IFAbond© is safe and easily applied during IBBR adding little time to closure. This study suggests that IFAbond© can reduce clinically evident seroma formation in IBBR compared to standard closure. This pilot will inform a larger study to explore the statistical significance of this intervention and with longer term follow-up whether this correlates to lower rates of implant loss/failure.
EP-82 The First International Delphi Consensus Statement on Laparoscopic Gastrointestinal Surgery
Authors: Omar Islam , Madhok Brijesh , Amr Bassem , Pouwels Sjaak , Graham Yitka , Mahawar Kamal 
Published: November 2022

Abstract

Introduction
Laparoscopic surgery is now firmly established in the field of gastrointestinal (GI) surgery and has replaced open surgery in many areas. The purpose of this exercise was to prepare a consensus statement highlighting the important principles of laparoscopic GI surgery.

Methods
A committee of 38 experts in laparoscopic GI surgery proposed and voted on 149 statements in two rounds following a modified Delphi protocol.

Results
A consensus was achieved on 133 statements after two rounds. There was 100% consensus on informing the team of unusual complex operations, asking for a second opinion when needed and following the ergonomics principles.
Additionally, 94.7% advised to have multiple options for abdominal entry, 100% agreed on tailoring the first port site to the patient, and 84.2% advised to use Veress needles with caution.
Moreover, 97.4% consensus was reached on keeping the intra-abdominal pressure at the minimum required, and 92.1% agreed that a pressure of 12 mm Hg is adequate for most intra-abdominal surgery.
There was a complete (100%) consensus on using cartridges of appropriate height, checking the doughnuts after using circular staplers, adding any foreign body inserted into the abdomen to the operating count, ensuring the integrity of instruments on removal from the abdomen, and avoiding handing over an operation in the middle.
There was a 100% consensus on focusing on precision, not the speed, and learning to use the non-dominant hand effectively.

Conclusion
A 38 experts achieved a consensus on 133 statements. Increased awareness of these should enhance the safety of patients undergoing laparoscopic surgery.
EP-85 Abdominal hernia mesh repair in patients with inflammatory bowel disease: A systematic review
Authors: El Boghdady Michael , Ewalds-Kvist Béatrice , Laliotis Aggelos 
Published: November 2022

Abstract

Aims
Postoperative hernia-repair complications are frequent in patients with inflammatory bowel disease (IBD). This fact challenges surgeons’ decision about hernia mesh management in these patients. Therefore, we systematically reviewed the hernia mesh repair in IBD patients with emphasis on risk factors for postoperative complications.

Method
A systematic review was done in compliance with the PRISMA guidelines. A search was carried out on PubMed and ScienceDirect databases. English language articles published from inception to October 2021 were included in this study. By MERSQI scores quality and evidence classifying were performed in agreement with GRADE's recommendations. The research protocol was registered with PROSPERO (CRD42021247185).

Results
The present systematic search resulted in 11243 citations with a final inclusion of 10 citations. One paper reached high and 4 moderate quality. Patients with IBD exhibit about 27% recurrence after hernia repair. Risk factors for overall abdominal septic morbidity in Crohn's disease comprised enteroprosthetic fistula, mesh withdrawals, surgery duration, malnutrition, midline incision site of hernia, biological mesh and digestive concomitant procedure.

Conclusion
Patients with IBD were subject, more so than controls, to postoperative complications and hernia recurrence. The use of a diversity of mesh types, a variety of position techniques and several surgical choices in the citations left room for less explicit and more implicit inferences as regards best surgical option for hernia repair in patients with IBD.
EP-94 To see or not to see: A case of complex multidisciplinary surgical reconstruction
Authors: Afify Sarah Jane , Leon-Villapalos Jorge , Scawn Richard , Sobti Manvi , Joshi Naresh 
Published: November 2022

Abstract
A 4 year-old child suffered catastrophic 60% total body surface area burn injuries affecting head and neck, trunk and limbs following sulphuric acid burns. He underwent limited treatment in his country consisting of first aid and debridement and grafting in upper and lower limbs and trunk, but no treatment to the facial and ocular areas.
He was referred for assessment and reconstruction in the United Kingdom. Even though there were widespread burn scar contractures, his most severe injuries involved both eyes and adnexal structures with evidence of severe bilateral cicatricial ectropion and threat to vision.
He required multidisciplinary plastic surgery and ophthalmic complex bilateral eyelid reconstruction in two separate procedures to restore anatomical and cosmetic integrity to both eyes.
The initial procedure involved examination under anaesthesia of both eyes, release of the left upper and lower eyelids burns scar ectropion and resurfacing of the resulting defect with full thickness grafts from the left clavicular area. The grafts had full take with no evidence of infection and excellent cosmesis.
A similar procedure was performed to reconstruct the right eyelids 6 weeks later. The vision of this eye was beyond salvage but the need for cosmetic eyelid symmetry was considered as an appropriate indication to proceed to reconstruction. This was found to be successful with excellent graft take and parental satisfaction.
This case required coordination, expert holistic approach, complex surgery and extra efforts from the team to ensure compliance, communication and positive outcomes and highlights the importance of multidisciplinary team effort.
EP-100 Skin Graft Versus Local Flaps in Management of Post-Burn Elbow Contracture
Authors: Noureldin Khaled , Issa Mohamed , Badawi Marwa , Darwish Mariam , Makram Mahmoud , Abdelazizi Ayyat 
Published: November 2022

Abstract

Introduction
Contracture is a pathological scar tissue resulting from local skin tissue damage, secondary to different local factors. It can restrict joint mobility, resulting in deformity and disability. This study aimed to investigate the outcomes of skin grafts compared to local flaps to reconstruct post-burn elbow contractures. These parameters included regaining function, range of movement, recurrence, and local complications.

Methodology
A retrospective study reviewed twenty-one patients for elbow reconstruction over 12 months. Only patients with post-burn elbow contracture were included. Other causes, including previous corrective surgery, any resultant elbow stiffness, and patients who opted out of postoperative physiotherapy, were excluded. Subdivision was according to the method of coverage into three groups: graft alone(G1), local flap(G2), or combined approach(G3).

Results
Females were three times at higher risk to suffer a burn injury, while almost half of the cases were children. Scald injury represented 81% of burn causes. G1,2,3 were used in 47.6%, 42.9% and 9.5% of cases retrospectively. Overall rate of infection was 28.5%. 100% graft taken was recorded in 81.8% of cases; however, flap take was in 90%. After 12 months of follow-up,re-contracture was 60% and 22.8% in G1 and G2; however, the satisfaction rate was 70% and 100% in both groups retrospectively. The overall satisfaction was 85.7% in all groups.

Conclusion
Grafts and local flaps are reasonable options for post contracture release; however, flaps are superior. Coverage selection depends on the lost tissue area and exposure of underlying deep structures. Physiotherapy and patient satisfaction are crucial in the outcomes.
EP-116 Family and Next of Kin (NOK) Communication - Time for a new NELA standard?
Authors: Ahmed Salma , Hassan Karim , Abubaker Malaz , Wilson Jeremy , Magee Conor 
Published: November 2022

Abstract

Introduction
The Covid-19 pandemic highlighted the importance of communication between patients, families, and the surgical team. Covid left many patients bereft of personal contact with loved ones and NOK were often left without information due to overwhelming, challenging situations for surgical teams. These challenges may not be unique to Covid- e.g team shift-working, late-night operating are ongoing barriers to NOK communication following emergency laparotomy (EmLap).

Methods
Twenty random EmLap patients during the pandemic were identified. Qualitative data on NOK discussion were obtained including telephone follow-up to confirm whether discussions took place.

Results
Only 50% of patients had documented NOK discussion- of these seven were held prior to surgery, 4 post-operatively and 5 during admission. Communication with families was mainly carried out by nurses while consultant/registrar discussions were documented on 7 occasions only.

Conclusion
Communication with the NOK of patients undergoing emergency laparotomy needs improving. Patient-centred care must involve the NOK. We would suggest that NOK should be informed of surgical outcomes and prognosis by a senior surgical team member. Notwithstanding the usual caveats of confidentiality and patient wishes- the importance of this facet of surgical care to many patients and their relatives cannot be understated and could be considered as a potential NELA standard of care.
EP-125 A rare case of abdominal wall necrotizing fasciitis caused by Actinomyces europaeus—a novel pathogen
Authors: Allen Neill , James Georgina , Jain Yogesh 
Published: November 2022

Abstract
Actinomyces europaeus is a sub-species of actinomyces first isolated in humans in 1997. It is commensal bacteria found within the genitourinary and gastrointestinal tract. Although it is known to cause soft tissue infection and has been known to cause abscesses, it has never been identified as the primary pathogen in a case of necrotizing fasciitis. We present the case of a 59-year-old man with recurrent groin infections, poorly controlled Type 2 diabetes and obesity who developed necrotizing fasciitis of his lower abdominal wall secondary to Actinomyces europaeus. We discuss the clinical course and the value of early identification of the pathogen and specialist microbiologist advice.
EP-148 Acute appendicitis complicated by COVID-19: an unexpected postsurgical sequela, Case Presentation
Authors: Ahmed Salma , Zaver Vasudev , Shafi Adil , Al-Hamid Zaid 
Published: November 2022

Abstract

Background
This is a case in which we explore the presentation and management of a 62-year-old gentleman, who attended a UK based surgical unit with appendicitis and a positive COVID-19 on admission. Following an urgent appendicectomy, he suffered a morbid and protracted postoperative period, complicated by an upper gastrointestinal bleed and prolonged ileus. The virus has been recognised to increase the risk of micro-thromboembolic events and gastrointestinal complications. We discuss the possibility of COVID-19 causing the patient's presentation and his post-surgical recovery. We aim to demonstrate our experience of the relationship between acute appendicitis and the morbidity associated with COVID-19.

Discussion
The case demonstrates a unique sequela following an otherwise routine emergency appendicectomy. In concurrence with a radiologically and microbiologically evident COVID-19 infection, it raises the question of whether the appendicitis was caused or at least complicated by the virus. This hypothesis is supported by a similar discovery in a case series carried out in Wuhan, in which a paediatric patient acutely presented with a perforated appendix in parallel with a SARSCoV-2 infection, which required urgent surgery. Contrastingly, a case which involved a COVID-19 positive adult male with a non-perforated and non-suppurative appendix demonstrated no complications post-operatively.

Conclusion
It is possible to postulate that the severe presentation outlined in our case could also have been caused by a delayed COVID-19 presentation. However, there is currently no formal research to support this and the approach has not been exemplified in a complex case such as ours.
EP-157 Pyocystis: A silent complication of a supravesical urinary diversion
Authors: Anwar Baseerat , Khalil Waqas , Rao Praveen , Ghiblawi Salaheddin , Ul Islam Jawad 
Published: November 2022

Abstract

Aim
Pyocystis is an important yet overlooked rare complication of a non-functioning urinary bladder. It is due to collection, liquefaction and decomposition of shed bladder epithelium, resulting in accumulation of pus in the bladder causing sepsis. We describe a case of Pyocystis in a patient with bilateral nephrostomies who presented with urosepsis multiple times due to this complication.

Case Report
A 78-year-old man, known case of Ca Prostate wit bilateral nephrostomies warranted multiple subsequent hospital admissions in one month due to urosepsis presenting with fever, urethral discharge, suprapubic pain and very high inflammatory markers. He underwent a CT Abdomen & Pelvis which revealed markedly distended bladder despite nephrostomies in place. Upon catheterization, no urine output was observed which raised concerns. An attempt at bladder washout displayed a large amount of thick foul-smelling pus which was aspirated. This was sent for culture and patient was commenced on appropriate IV antibiotics. After a thorough bladder wash out under flexible cystoscopy, patient was eventually discharged on a long-term catheter with regular bladder washouts in community as required. Patient was successfully managed on conservative treatment.

Conclusion
Pyocystis can sometimes be a missed complication of urinary diversion or a non-functioning bladder that can present silently under sepsis and should therefore be considered as a differential diagnosis of sepsis in patient with supravesical urinary diversion.
We wanted to highlight this condition which if left undiagnosed will progress to severe sepsis and possible death. Hence prompt intervention and aggressive management is vital.
Treatment for this complication requires catheterization, bladder irrigation and antibiotics.
EP-168 A rare encounter of “Forgotten disease”
Authors: Sengupta Shreya , Bose Sayantan 
Published: November 2022

Abstract
With the advent and prompt use of antibiotics after throat infections, the rare entity of Necrobacillosis has almost disappeared in clinical practice. Here we present a case of a fit and well 27 year old lady who was brought into A&E with septic shock, DIC and MODS after initial diagnosis of a sore throat 4 days ago which was treated by oral antibiotics. She was found to have bilateral patchy consolidations which later became necrotic cavities, empyema thoracis, peritonitis and abscess cavities in abdomen with evolving splenic abscess, prolonged QT and ectopics and type 2 respiratory failure. She was resuscitated, intubated and transferred to the ICU. With an isolate of Fusobacterium necrophorum from blood culture Meropenem, clindamycin and metronidazole were started. However, over the next few days of treatment, lack of clinical response prompted antibiotics changing, and surgical drainage of abscesses in chest and abdomen. Eventually after a considerable period of abdominal abscess drainage and about 3 weeks of metronidazole and other antibiotics followed by Piperacillin and tazobactam for another 3 weeks the patient recovered from sepsis and was stepped down to ward. This case though rare is a good example of the benefits of surgical drainage and prolonged antibiotics for septic patients with collections. A rapid weaning only results in re-collection and clinical deterioration or recurrent collection as happened to this patient. This is a rare case of Lemierre's syndrome which depicts the surgical difficulties faced due to recurrent abscess cavities formed in this condition.
EP-180 Analysis of two-week wait referrals to a colorectal surgery department for iron deficiency anaemia in a rural DGH
Authors: Anderson Catherine , Chituku Tsitsi , Rao Milind 
Published: November 2022

Abstract
Iron deficiency anaemia (IDA), defined as low haemoglobin and ferritin levels, affects 2–5% of adults in the developed world. Asymptomatic malignant gastrointestinal pathology must be excluded in all patients.
Patients referred on a two-week wait Colorectal pathway with IDA between 4/1/2018–28/2/2021 were recruited (n=566). 92.4% of patients were investigated, only 45.2% had true IDA. Although screening for coeliac disease was a prerequisite in the referral pro forma, 63.2% were referred without.
NICE guidance recommends upper and lower gastrointestinal investigations in all patients with confirmed IDA. 61.6% of patients had both investigations performed. 65.1% patients were diagnosed with benign conditions- diverticular disease (37.6%), polyp (31%) and hiatus hernia (28.5%). Age was the strongest predictor for pathology in patients with IDA (p=0.001), not specifically for cancer (p=0.111).
4.4% (n=23) patients were diagnosed with colorectal cancer. Low haemoglobin was significantly correlated with cancer (p=0.002), however only 60.9% had low ferritin.
Guidelines suggest that only post-menopausal women should be investigated for IDA unless symptomatic or risk factors. Although only 80% had symptoms; the entire cohort had investigations and only 60% returned a positive test.
This study highlighted variability in investigations in addition to lack of adherence by primary care physicians to referral guidelines resulting in avoidable referrals and potentially inappropriate investigations in pre-menopausal women by secondary care physicians, thus overwhelming an exceedingly burdened two- week wait pathway.
EP-182 The predictive significance of neutrophil-to-lymphocyte ratio in cholecystitis: a systematic review and meta-analysis
Authors: Millward Alex , Kler Aaron , Taib Adnan , Hajibandeh Shahab , Hajibandeh Shahin , Asaad Peter 
Published: November 2022

Abstract

Aims
The aim of this review was to examine whether neutrophil-to-lymphocyte ratio (NLR) can predict the presence of cholecystitis and distinguish between simple and severe cholecystitis.

Methods
A systematic literature search was performed. Risk of bias was assessed using the Newcastle-Ottawa Scale. Random effects model was used to calculate mean difference (MD) in two situations: (a) no cholecystitis versus cholecystitis and (b) simple versus severe cholecystitis. Receiver operating characteristic (ROC) curve analysis was performed to determine cut-off values of NLR for the above situations.

Results
Ten retrospective studies comprising of 2827 patients were included. 327 had no cholecystitis, 2100 had simple cholecystitis and the remaining 400 had severe cholecystitis. NLR was significantly higher in acute cholecystitis compared to “no cholecystitis” (MD = 8.05 (95% CI 7.71–8.38), p &lt; 0.01) and severe cholecystitis when compared with simple cholecystitis (MD = 3.14 (95% CI 1.26–5.02), p &lt; 0.01). For patients with cholecystitis compared to those without cholecystitis, an NLR cut-off value of 2.98 was identified (AUC = 0.90). Logistic regression analysis confirmed NLR &gt; 2.9 was an independent predictor of cholecystitis (OR 36.0, p = 0.006). In simple versus severe cholecystitis, an NLR cut-off value of 8.5 was identified (AUC = 0.73). Binary logistic regression analysis suggested an NLR &gt; 8.5 was not an independent predictor of severe cholecystitis (OR 6.5 p = 0.090).

Conclusion
NLR is significantly higher in patients with cholecystitis of any severity compared to patients without cholecystitis. Moreover, NLR can predict acute cholecystitis. However, NLR cannot predict the severity of disease due to inadequately powered studies.