bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP-20 Postoperative music, a non-pharmacological pain relief: a randomized controlled trial
Authors: Aghakhani Nader , Ewalds-Kvist Béatrice Marianne , El Boghdady Michael 
Published: November 2022

Abstract

Aims
Postoperative moderate to severe pain disrupts patients’ sleep and affects their quality of life. Non-pharmacologic pain relief such as music therapy were considered beneficial. We therefore evaluated preferred type of music as pain relief in patients with abdominal surgery in a non-UK teaching hospital.

Methods
Patients undergoing open abdominal operations were included. Patients with laparoscopic or rectal surgery and/or spinal or epidural anesthesia were excluded. Routine postoperative analgesics were used. Demographic variables were recorded and VAS pain scale (0–10 most severe pain) was assessed in first day postoperative. Patients or their relatives gave informed consent.

Results
Sixty patients (Md age 39 years) were included; 30 patients allocated in experimental group who listened to preferred music using headphones (20 min) vs Control group used headphones without music.
Fisher's exact test and independent t-tests were computed. The pain intensity decreased from 6.94 (SD .13) to 6.21 (SD .21) in the control group (n.s,) and in the experimental group from 7.06 (SD .31) to 3.25 (SD .21), (p &lt;.0001, 2-tailed) with no significant difference between the two groups before intervention. Pain intensity in experimental group decreased due to the intervention. There was a significant difference in pain intensity between the experimental and control groups after music therapy (p &lt; .001, 2-tailed).

Conclusion
The patients who listened to preferred music after surgery, experienced less pain compared to their controls. A long-term follow-up with larger sample size may conform the efficacy of post-operative music as a pain-relief in UK settings.
EP-21 The adequacy of consent forms for post-operative inguinal hernia complications relative surgeon's grade of training
Authors: Quefferus Michael , El Boghdady Michael 
Published: November 2022

Abstract

Aims
Inguinal hernia repair is known to be one of the most commonly performed general surgery procedures in the UK. Pre-operative consenting is essential to be aware of potential complications and for patients to make fully informed decisions. We aimed to assess the adequacy of consent for elective inguinal hernia repair in a UK-teaching hospital.

Methods
A 4-months retrospective data analysis of consent forms was performed. Elective open and laparoscopic inguinal hernia repairs were reviewed for consent forms, including demographic data, date of surgery, grade of consenting surgeon, re-admissions and complications.

Results
A total of 132 operations were included, 108 open and 24 laparoscopic. The most commonly recorded risks were bleeding (97%) and recurrence (96%). Serious testicular complications such as testicular artery injury/orchidectomy were consented in 35% of patients. The consultants consented 63% of overall complications, specialist registrars (SpR) 66.9% and senior house officers (SHO) consented the most with 77.1%. Testicular complications were mostly consented by consultants 66.7% vs registrars 16.3% and 12% SHOs. Consultants consented for the fewest complications overall (63.7%). Six patients were readmitted with postoperative complications, 2 were readmitted for orchidectomies, 3 haematoma and 1 had recurrence.

Conclusion
There are significant shortcomings in consenting patients for serious testicular inguinal hernia complications. SHOs consented for the most complications, followed by SpRs then consultants with the least. To mitigate these shortcomings we would envisage having a standardised format for consenting, including patient information leaflets provided to the patients prior to their operations.
EP-33 Migrated Esophageal Stent Causing Imminent Perforation. A Case Report
Authors: Al Ain Atif Qurrat , Raza Mehdi , Essiet Edidiong , Ahmed Kazi 
Published: November 2022

Abstract

Introduction
Esophageal stents are being used more frequently for maintaining esophageal lumen patency in benign as well as malignant conditions. But the stents do not come without complications. The most common complication is stent migration. It can go unnoticed in asymptomatic individuals whereas timely exclusion of more urgent complications associated with migration is necessary to avoid morbidity and mortality.

Case Presentation
We present the case of a 58-year old patient with inoperable esophageal cancer. He underwent esophageal stenting twice, for palliation, and on both occasions, the stents did not maintain its position. He presented with abdominal pain, abdomen was peritonitic on examination and computerised tomography (CT) scan showed that the esophageal stent had migrated into his ileum. Upon laparoscopy, stent was found lodged in distal ileum causing ischemia and imminent perforation. We found the radiology and per-operative images interesting and are sharing herewith.

Conclusion
With the growing use of esophageal stents, it is important to recognize the possible immediate and delayed complications to manage them effectively. Surgeons need to be aware of the possible complications and have a high index of suspicion to diagnose and treat these.
EP-34 A rare cause of upper abdominal pain – left gastric artery trapped in gastric band
Authors: Kam Cheuk Tung , Rait Jaideep 
Published: November 2022

Abstract

Introduction
Gastric banding has become one of the most commonly performed bariatric operations worldwide. Recognised complications are divided into; the laparoscopic approach, the band or the procedure itself. Gastric band misplacement is a rare but recognised early complication.

Case description
A 58-year-old patient presented to a district general hospital with a 6 day history of epigastric pain, incomplete dysphagia, vomiting, and constipation. Gastric band surgery had been performed 10 years prior in a UK tertiary centre. Diagnostic workup suggested the left gastric artery was trapped in the gastric band with no features of necrosis, perforation or obstruction. The patient was referred to the upper gastrointestinal surgical team and the band was removed laparoscopically and the patient had an uneventful recovery.

Discussion
Symptoms of gastric band misplacement may include nausea, vomiting, dysphagia, and upper abdominal pain. It is unusual that a malpositioned gastric band resulted in symptoms over 10 years after the procedure. Radiological evidence of gastric band misplacement in the literature is only reported in 0.07% of cases in plain radiograph. Surgical technique and experience are important to prevent band slippage, especially when considering the chosen placement and securing method.

Conclusion
This case describes an important late rare finding of complication following gastric band surgery. Consideration should be made in management for patients with gastric band presenting with gastrointestinal symptoms and a high level of clinical suspicion is needed to investigate and manage these patients.
EP-42 Adherence to Guidelines of Pre-operative Antibiotics Prophylaxis in Bahrain
Authors: Alanzi Ahmed , Almukhodher Sundus 
Published: November 2022

Abstract

Background/Introduction
Appendicitis is most an acute sickness that manifests within 24 hours, although it can also manifest as a chronic disorder.

Aims/Objectives
The current study was aimed to evaluate the adherence to the antibiotics prophylaxis guidelines in appendectomy in patients admitted to the surgical department of Salmanya medical Complex-Bahrain in 2020.

Method
The study included the patients admitted to the surgical department of Salmanya medical Complex-Bahrain in 2020.
Only adult patients, who underwent appendectomy, were included in the study while pediatric patients were excluded.
The records of the patients, who underwent surgical procedures, were evaluated.
From the records of these patients, information.

Results
Among 273 patients who were administered with the antibiotics, no one was administered with correct antibiotics as per guidelines of the hospital. 72 (26.37%) patients were administered with antibiotics within or equal to 60 minutes prior to surgical procedure remaining

Discussion/Conclusion
The current study revealed that the majority of the patients (72%, N=273) admitted to the Salmanya Medical Complex-Bahrain were not administered the antibiotics within the prescribed time as per guidelines from the hospital.
Also, the antibiotics administered for prophylaxis prior to the appendectomy procedure were not according to the guidelines i.e. Cefazolin 1g with Metronidazole 500mg.
Out of a total of 278 patients included in the study, no one was administered with the right choice as provided by the local guidelines.
Secondly, 1.8% of patients (N=278) were not administered with any of the antibiotics for prophylaxis prior to surgical procedure for appendicitis.
EP-43 Soup and sweet is not enough to eat: Postoperative nutritional intake is inadequate following open colorectal resection
Authors: Hardy Edward , Quinn Anna , Bergin Emma , Phillips Beth , Lund Jon 
Published: November 2022

Abstract

Aims
Adequate postoperative nutrition reduces complications and may modulate the metabolic stress response to surgery. In particular, protein intake may reduce loss of muscle mass and function thereby enhancing recovery to a normal functional level. This study aimed to assess the adequacy of nutritional intake in patients following an ERAS protocol after open colorectal resection.

Methods
Dietary intake on postoperative day (POD) 1 to 4 was recorded. Energy (Kcal) and protein (g) intake was calculated using information from the hospital's food supplier. Values were compared to the European Society of Clinical Nutrition (ESPEN) guidelines for perioperative patients (25Kcal/kg and 1.5g/kg of protein per day, based on ideal body weights).

Results
Eleven patients were recruited. Mean daily energy intake was 490.0Kcal (± 470.7), 505Kcal (± 251.8), 541.0Kcal (± 488.1) and 610.5Kcal (± 900.5) on POD 1–4 respectively. Mean daily protein intake was 13.9g (± 14.1), 14.9g (± 10.2), 15.0g (± 15.6) and 18.5g (± 25.6) on POD 1–4 respectively. Excluding patients who developed ileus (n=4), total energy and protein intakes over POD1–4 were 42.6% (± 19.7) and 21.1% (± 11.4) of the ESPEN recommended daily amount respectively. In patients with ileus these values reduced to 12.8% (± 2.6) and 5.7% (± 0.9). Two thirds of meal choices were soup, jelly or ice cream.

Conclusions
Early postoperative nutrition after open colorectal resection in inadequate. Further strategies are required to counteract this. Examples may include protein fortification of popular postoperative meal choices and prehabilitation to improve patient's nutritional reserves.
EP-44 Improving Patient Education About Pre-Diabetes
Authors: Carey Charles , Natarajan Shanthi 
Published: November 2022

Abstract
Pre-diabetes is a common condition and although its development is heavily linked to lifestyle factors, many patients are unaware of interventions that can improve their condition. One-to-one consultations between patients and GPs focused on reducing carbohydrate consumption have been shown to be effective at improving pre-diabetes. This QIP aimed to improve patients’ understanding of pre-diabetes and reduce their carbohydrate intake.
Patients were included if they had 2 HbA1c measurements between 42 – 48mmol/mol and the ability to make dietary changes independently. A questionnaire based on the UK Diabetes and Diet Questionnaire was constructed and used to ask patients about their concern about pre-diabetes, knowledge of foods that contribute to the condition and the frequency at which they consumed various carbohydrates. Advice about reducing carbohydrate intake was given verbally and patients were provided with a diet sheet produced by Unwin et al. Patients were called again after 7–14 days to assess dietary changes and the impact of the advice.
31 patients responded to the initial telephone call of which 58.1% were concerned about pre-diabetes and 38.7% mentioned foods high in carbohydrate as a cause of pre-diabetes. 90.3% of patients consumed food high in carbohydrate on 4 or more days per week. 22 patients responded to the follow up telephone call of which 63.6% reported a reduction in carbohydrate intake, 95.5% knew more about pre-diabetes and 90.9% found the dietary advice helpful. These results suggest that pre-diabetic patients should be given verbal and written information about lowering carbohydrate intake at GP consultations.
EP-48 Laparoscopy in Emergency Colorectal Surgery: A 7-Year Retrospective Single Centre Cohort Study
Authors: Darbyshire Alexander , Smythe Rachel , Richardson John , Khan Jim , Mercer Stuart 
Published: November 2022

Abstract

Aim
Colonic diseases requiring urgent resection account for a third of emergency intestinal surgery. Laparoscopy is being increasingly used for emergency surgery, but its role is still being defined. This study describes our centre's experience of adopting a laparoscopic approach for emergency colorectal resection.

Method
A retrospective single centre cohort study was performed using local NELA data from January 2014-December 2020. All patients who had a colorectal resection were included, regardless of indication. Patient demographic, operative and in-hospital outcomes were compared for resection type and operative approach. Logistic and linear regression were performed for 30-day mortality and post-operative length of stay.

Results
A total 507 colorectal resections were performed. 48.1% were started laparoscopically and 27.6% successfully completed. Attempted laparoscopy rates increased over the study period to over 50% for the last 4 years. Colorectal specialists were more likely to start and complete cases laparoscopically (82.4% and 91.4% vs 60.3% for open). Cases started laparoscopically had significantly lower post-operative length of stay (10.5 vs 16.5 days, p&lt;0.001) and 30-day mortality (6.1% vs 17.9%, p&lt;0.001) than open surgery. Cases completed laparoscopically had a 30-day mortality comparable to elective surgery (2.1%, p&lt;0.001). Patients undergoing laparoscopy were statistically significantly younger, with lower ASA grade and P-POSSUM predicted mortality than open surgery.

Conclusion
Laparoscopy can be used effectively and sustainably for emergency colorectal resections in a centre experienced with minimally invasive surgery. This study adds to the body of evidence supporting the safety and efficacy of laparoscopy in the emergency setting.
EP-49 First reported case of preperitoneal herniation of small bowel causing intestinal obstruction after total extraperitoneal hernia [TEP] repair- case report and review of the literature
Authors: Samarakoon Lasitha Bhagya , Chandraprakash Samip , Fernandes Roland , Basnyat Pradeep 
Published: November 2022

Abstract

Introduction
A pre-peritoneal hernia is a very rare complication following laparoscopic inguinal hernia repair. We report a patient who developed a preperitoneal hernia following an accidental breach of peritoneum following Total extraperitoneal repair [TEP]. Even though it has been described following total abdominal pre peritoneal repair [TAPP], to the best of our knowledge this is the first reported case following TEP repair.

Case presentation
A 57-year-old male underwent right inguinal hernia TEP repair on 20/10/2021. Initial recovery was uncomplicated but on POD 10 he developed sudden onset of vomiting and abdominal pain. Initial imaging showed small bowel obstruction without a definite transition point. We maintained a high index of suspicion for internal hernia and he was offered urgent diagnostic laparoscopy after careful counseling. A preperitoneal defect was noted with distended proximal ileum and collapsed distal ileum and colon. Small bowel run through which did not reveal any pathological abnormalities. A presumptive diagnosis of preperitoneal hernia was made, and the defect was closed with a running V lock suture. The patient made an uneventful recovery post-operatively.

Conclusion
An inadvertent breach in peritoneum during TEP repair can lead to preperitoneal of small bowel and intestinal obstruction postoperatively. This is the first-ever reported case of this very rare complication following TEP that hernia and general surgeons should be aware of. A high degree of suspicion is needed and early diagnostic laparoscopy is indicated if suspected to avoid morbidity and mortality from bowel ischemia.
EP-51 Acute presentations of Jejejunal diverticulosis – a literature review of the uncommon entity
Authors: Samarakoon Lasitha Bhagya , Pangeni Annang , Florance Charlotte , Sontenam Venkat Satya , Shrestha Ashish K 
Published: November 2022

Abstract

Introduction
Jejunal diverticula are distinctly less common than their colonic counterparts, 60% of patients with small intestinal diverticula have concomitant colonic diverticula. Although Jejunal diverticula are relatively asymptomatic, they can present with life-threatening complications such as perforation, bleeding, obstruction.
Due to their rarity, reporting radiologists, as well as emergency surgeons, may be unfamiliar with the imaging findings of complicated Jejunal diverticular disease.

Methods
A retrospective review of medical records was carried out for a period of 6 years from 2015–2021, in a large district general hospital in Kent, UK. We included all patients who had complications of Jejunal diverticulosis and were treated by the surgical teams during this period, regardless of whether they were managed operatively or conservatively. Following a retrospective review of the medical records epidemiological data, comorbidities of patients, we reviewed the images of CT scans obtained during the emergency admissions retrospectively with a consultant radiologist with more than 20 years of gastrointestinal radiology.

Conclusion
Although Jejunal diverticula are very rare and mostly asymptomatic, their complications can be lethal. Therefore emergency surgeons should suspect their presence, especially in elderly patients presenting with nonspecific abdominal pain and acute abdomen with no clear etiology identified for complications seen on cross-sectional imaging. A high index of suspicion and Surgical exploration [minimally invasive if the expertise is available] can be both diagnostic and therapeutic.
EP-53 The ambulatory care of unusual presentation of Boerhaave's syndrome
Authors: Loganathan Santhosh , Gul Rahman , Whittaker Laura 
Published: November 2022

Abstract
Boerhaave's syndrome is a rare but well established clinical condition with spontaneous longitudinal rupture of the oesophagus. It is a life-threatening condition with a mortality rate of up to 40%. The symptoms are variable or classical Mackler triad of Vomiting, chest pain and subcutaneous emphysema are noted. However, it is challenging or missed to diagnose this condition in patients with chronic symptoms.
We present an unusual presentation of Boerhaave syndrome in a 27-year-old female with no comorbidity presented to the emergency department with acute onset of shortness of breath and chest pain. Blood tests showed elevated D-Dimer on initial evaluation, and the rest of them were unremarkable. A CT pulmonary angiogram was done, which showed thickened lower oesophagus. She was reassured and sent home from the emergency department. Further discussion of the CT images in the upper GI MDT revealed that she had a small sealed off perforation of the oesophagus. The repeat scan after a few days as Outpatient demonstrated a sealed oesophageal perforation and a small collection. The water-soluble contrast swallow did not reveal any leak or stricture in the oesophagus. The patient had a gastroscopy after two months which was reported to be normal. Retrospectively, the patient mentioned that she had an episode of vomiting a few weeks earlier to this acute presentation to the hospital.
The knowledge about this condition and high suspicion in patients with chronic presentation is vital to diagnosing this potentially lethal condition which could be critical in preventing mortality and morbidity from this condition.
EP-55 Subclinical Spigelian hernia: sailing with the hidden iceberg
Authors: Goswami Aakansha Giri , Basu Somprakas , Shukla Vijay Kumar 
Published: November 2022

Abstract

Background
Spigelian hernia quaintly designated as occult anatomical distortion is no less than a conjurer. Its diagnosis is extremely exigent and is complicated by a lack of physical findings and the surgeon's supposition. Therefore, a thorough physical examination along with high-level clinical suspicion remains crucial in diagnosing Spigelian hernia.

Methods
A retrospective data of all subclinical Spigelian hernia cases was scrutinized for clinical presentation, physical examination, radiological investigation, surgical treatment and outcome.

Results
Of 72 patients treated for subclinical Spigelian hernia, we found that females were affected twice more. The mean duration of symptoms was 10.69 months and was more on the right side (59.72%). The most common presenting symptom was intermittent, sharp, localised pain. On examination, tender point in linea semilunaris better elicited on leg raising test was found in 70.83% cases. Fascial rupture at the lateral border of rectus was found in all patients using real-time ultrasound. All patients underwent open surgical repair with 5 patients treated with anatomical repair and 67 patients with mesh preperitoneal hernioplasty. Recurrence was seen in only 1 patient who underwent anatomical repair and 13 patients developed postoperative complications, the most common being seroma (61.53%).

Conclusion
Spigelian hernias are rare and are believed to represent the tip of a prodigious yet unperceived iceberg. Their diagnosis requires a high index of clinical suspicion given the lack of prototypical signs and symptoms. Usually, the patient presents with abdominal pain syndrome and an astute clinician couple a proper history and physical examination with preoperative imaging to secure the diagnosis.
EP-66 Omental infarct – A rare cause of Right iliac fossa pain in a child
Authors: Samarakoon Lasitha Bhagya , Chandraprakash Samip , Allu Veera 
Published: November 2022

Abstract

Introduction
Idiopathic omental infarction is a very rare cause of abdominal pain in the pediatric age group. We report a case of suspected acute appendicitis in an 8-year-old child, noted to have omental infarct on diagnostic laparoscopy.

Case presentation
An 8-year-old male child with no other medical issues presented to the acute surgical take with a 2-day history of right iliac fossa pain. The pain was of sudden onset and there were no other associated urinary or bowel symptoms. On clinical examination, there was right iliac fossa tenderness. There were mildly raised inflammatory markers. An ultrasound scan performed showed a possible blind-ending tubular structure measuring 7mm in the right iliac fossa with a small amount of free fluids. A presumptive diagnosis of acute appendicitis was made and the patient was taken to theatre.
Upon diagnostic laparoscopy, we noted blood in the RIF with a normal-looking appendix and area of omental infarction adjacent to the appendix. We proceeded to excise the area of mesenteric infarction using an energy device. The appendix was removed to avoid future diagnostic confusion.

Conclusion
Idiopathic omental infarction is an extremely rare cause of abdominal pain in children and may mimic acute appendicitis. Ultrasound imaging may be misleading. Laparoscopic exploration allows for accurate diagnosis as well as treatment.