bluuebunny/crossref_metadata_2025_split huggingface dataset:
TU2.10 Clinicopathological Factors Affecting Lymph Node Yield and Positivity in Left-Sided Colon and Rectal Cancers
Authors: Ballanamada Appaiah Nikhil Nanjappa , Cai Wenyi , Khan Laeeq , Lovett Bryony 
Published: November 2022

Abstract

Background
The status of lymph node metastasis is a key factor for predicting the prognosis of colorectal cancers.

Aims
We aimed to find any significant difference in lymph node yield (LNY) between laparoscopic surgery (LS) and open surgery (OS). We aimed to identify any statistical correlation between LNY and lymph node positivity (LNP) with other patient, surgical and histopathological features.

Methodology
This is a retrospective, non-interventional review of consecutive patients who underwent left-sided colonic and rectal cancer resections over a three-year period between 01 April 2018 and 31 March 2021.

Results
A total of 102 patients were included in the study. LNY ranged between one and 43 nodes (median (interquartile range (IQR)) 17, 8). There was no statistically significant difference in LNY between laparoscopic surgery (LS) and open surgery (OS) (p=0.1449). Significant statistical correlation was identified between LNP and completeness of resection (CoR) (p=0.039), vascular invasion (VI) (p&lt;0.001), perineural invasion (PI) (p&lt;0.001), and circumferential resectional margin involvement (CRMI) (p=0.039).

Discussion
LNY and LNP are important prognostic indices in colorectal cancer. Patient age, tumor location, the urgency of surgery, and consultant experience did not significantly impact the LNY. Our study showed a positive correlation between LNP and CRMI, VI and PI comparable to literature. Contrary to other studies, we found no statistical significance between LS vs. OS and LNY. Whether 12 nodes per patient is an appropriate level remains controversial.
TU3.7 Increased incidence of gallbladder dysplasia and cancer during COVID19 pandemic
Authors: Muscara Francesca , Jebamani Jennifer , Ivanov Bogdan 
Published: November 2022

Abstract

Aims
Cholecystectomy is one of the most frequently performed operations in the United Kingdom. Following the spread of COVID19 infection, reduced operational capacity has led to lengthen the waiting time for cholecystectomy, which leads to significant readmission rate, growing financial burden and increased complexity of the surgical intervention. Our study aims to identify changes in gallbladder (GB) histopathological findings before and during COVID19 pandemic.

Methods
Data was collected retrospectively on 337 patients who underwent cholecystectomy between 01/2019–12/2019 (pre-COVID19) and 296 patients between 09/2020–10/2021 (during COVID19) at Princess Alexandra Hospital, including preoperative clinical-radiological, surgery waiting time, operation details, postoperative histology and complications. Statistical analysis performed using chi-square tests (p-value&lt;0.001).

Results
A total of 2 (0.6%) female cases (average age 75.6) had gallbladder dysplasia (GD) and 1 of them had GB adenocarcinoma found pre-COVID19 versus 8 (2.7%) (7F:1M, average age 46.6) with GD and 5 (1.7%) (3F:2M, average age 72.6) with adenocarcinoma during pandemic.
Other histopathological findings were 153 (45.4%) GB with chronic inflammation, 2 (0.5%) with necrosis or perforation pre-COVID19 versus 127 (42.9%) and 6 (2%) respectively during pandemic.
The average surgery waiting time for patients with GD or adenocarcinoma was 135 days before COVID19 versus 224.21 (33–676) during pandemic.

Conclusions
GD is associated with increased cancer risk at GB and other biliary tract sites. Our data demonstrated a statistically significant increase of incidence of GD and adenocarcinoma (p-value&lt;0.00089) in patients who underwent cholecystectomy during pandemic versus pre-COVID19. Further ongoing study is recommended to understand the correlation with prolonged surgery waiting time.
TU4.3 Caecal volvulus: A District General Hospital Experience and Review of the Literature
Authors: Chowdhury Ashim , Pangeni Anang , Rai Sujata , Colledge Jann Yee , Shrestha Ashish Kiran 
Published: November 2022

Abstract

Aim
Caecal volvulus (CV) is an uncommon cause of large bowel obstruction with potential for complications such as ischaemia, and perforation. Prompt diagnosis and treatment only will ensure better outcomes. We aim to describe our experience in the largest series of CV reported in the United Kingdom.

Methodology
This was a retrospective study of 16 consecutive patients diagnosed with CV between March 2017 and March 2020.

Results
Out of 16 patients, 11 were female, with a median age of 64 (range 33–80) years. All patients presented with abdominal pain and vomiting. An initial diagnosis of bowel obstruction was made only in 8 patients (50%). Computed tomography (CT) scan of the abdomen and pelvis correctly diagnosed CV in fourteen (87.5%). Fifteen patients (94%) underwent surgical intervention. All but one (n=14,93.4%) underwent laparotomy, and one patient (6.6%) underwent successful laparoscopic intervention. Right hemicolectomy was performed in all operated patients, and fourteen patients (93.4%) had primary anastomosis. Twelve patients (80%) had one or other form of morbidity. Seven patients (47%) and three patients (20%) had grade II and III (Clavien-Dindo Classification) complications respectively with a median hospital stay of 10 (range 1–49) days. One patient (6.7%) managed conservatively was deemed to be futile. There was no postoperative mortality.

Conclusion
CV can present with non-specific symptoms, and a definite preoperative diagnosis is only possible with the aid of CT. Open resectional procedures with primary anastomosis is the most favoured approach in management, though laparoscopic access is also feasible in fit patients.
TU4.7 Audit of pilonidal sinus surgery – our experience in a district general hospital
Authors: Hajiesmaeili Hamed , Clack Aidan , Thomas Pradeep 
Published: November 2022

Abstract

Aim
Pilonidal disease is a common condition affecting the subcutaneous tissue of the natal cleft. There are a number of different types of operations with varied success rate. The purpose of this audit is to analyse our cohort of patients who underwent pilonidal sinus surgery and look at certain risk factors such as smoking and obesity in predicting 30-day post-operative infection rates.

Method
A cohort of 63 patients who underwent all pilonidal sinus surgery between 2017 to 2021 were analysed. Data was gathered using our electronic patient record (Meditech V6).

Result
Total of 63 patients were analysed with a mean age of 27.9. 86% Male Vs 14% Female. Mean BMI of 30.1. More than half of our cohort underwent Karydakis Procedure (52%), 27% modified Bascom technique, 13% Rhomboid flap and the other 8% of patients were not primarily closed. 37% of our cohort developed post-operative wound infection. Furthermore; more than half (52%) of these patients with wound infections were smokers and also 52% were obese with a BMI of more than 30. Interestingly 83% of these patients were either smokers or obese with a BMI&gt;30.

Conclusion
Post-operative wound complications are common following pilonidal sinus surgery specially in patients who are smokers and/or have obesity. Patients who undergo flap surgery should be encouraged to stop smoking and to lose weight when necessary otherwise they may face long and complicated post-operative recovery phase leading to significant financial burden on the NHS.
TU5.1 Challenges Faced by Female IMGs practicing medicine in the U.K
Authors: Elbakri Sabreen , Noaman Islam Mohammed , Dhahri Adeel Abbas , Abohatab Esraa Moustafa 
Published: November 2022

Abstract

Aim
Disparities in medicine may be caused by many variables including sex, ethnic background, specialty choice and practice location. International Medical Graduates (IMGs) in particular face challenges that could impact their learning and career progression. In this study we aim to investigate challenges faced by Female IMGs that could impact their learning and career progression.

Materials and Methods
An electronic survey composed of 36 questions was distributed via different social media platforms to groups including IMGs. Analysis of responses was done via Google forms.

Results
We received a total of 148 responses. The majority of the survey participants (59.5%) perceived their gender and IMG status to be a barrier to their career progression. 94 (63.5%) of the participants reported they did not receive adequate support from their organisations. 65.5% felt they did not receive adequate support from seniors and 43.2% felt they did not receive adequate peer support to facilitate their integration into the U.K. medical system. More than 80% of the participants required more support with access to research/higher degrees and opportunities for leadership roles whilst more than 50% required support with accessing study budgets and less than full time training to progress in their careers.

Conclusion
Disparities caused by gender and ethnic background leave female IMGs vulnerable to additional challenges that could hinder their career progression. Additional support measures addressing these issues should be installed in order to facilitate a smooth career pathway for this subgroup of medical professionals.
TU5.5 Examining the Benefits of One-To-One African Caribbean Mentoring for Prospective Medical Students
Authors: Carey Charles , Jordan Chloe , Wheatle Monique , Edward Shikila 
Published: November 2022

Abstract

Introduction and aims
African Caribbean people are underrepresented in UK medical schools. African Caribbean Medical Mentors (ACMM) is a UK registered charity that provides one-to-one mentoring to prospective African Caribbean medical students. Mentors consist of current African Caribbean medical students and doctors. This study aimed to investigate the specific benefits provided by ACMM and the attributes of successful mentoring relationships.

Methods
Participants were identified using ACMM's database of mentees and mentors enrolled within the last 3 years and an online questionnaire was distributed via Qualtrics. Questions were scored on a scale between 1 and 10 and participants were asked to explain their rankings.

Results
11 mentees and 7 mentors responded to the surveys. 63.6% and 72.7% of mentees gave a score between 8 – 10 regarding the importance of having a mentor and having a mentor that was African Caribbean respectively. All mentees reported satisfaction with their mentor, with 45.5% citing individualised interview practice and 63.6% reporting mentor support and availability as positive aspects of their mentoring relationship.
All mentors reported being satisfied with the program, with 57.1% and 71.4% giving a score between 8 – 10 regarding the importance of having a mentor and having a mentor that was African Caribbean respectively. 42.9% of mentors reported that improved methods and proactivity with communication could have improved their mentoring relationship.

Conclusions
This study suggests that one-to-one mentoring between African Caribbean mentors and mentees was helpful during medical school applications. Interview practice proved particularly useful, whilst methods and timescales of communication represent areas for improvement.
TU5.11 Do surgical discharge summaries meet national standards? A closed loop clinical audit
Authors: Ferriter Bridgid , Lynch Amie , Tormey Shona 
Published: November 2022

Abstract

Background
High quality health care is information reliant. Access to high quality information in a timely manner is imperative in provision of quality patient care. A national standard for discharge summaries has been developed by the Health Information and Quality Authority (HIQA). A standard for surgical discharge letters is needed to avoid patient readmission, unnecessary presentation to primary care and to ensure continuity of care in the community. The aim is to assess the quality of surgical discharge summaries using the HIQA national Standard. To implement quality improvement strategies recommended by current research. To reassess the quality and close the audit loop.

Methods
For cycle one of audit, one month of discharge summaries in 2020 were generated across four consultant surgeons at the University Hospital Limerick. 33% of those were sampled evenly across consultants. 60 patient discharge summaries were audited. Training was implemented virtually. For cycle two of audit the same methodology was used, 43 discharge summaries were audited.

Results
Overall performance was 49%, improved to 69% following training. The worst performing category was future management, 20%, improved to 45%. The best performing categories were auto-populated, patient details 97% and primary care details, 100%. Patient medications were compliant in 25%, improving to 59%. Admission and discharge details were complete in 36% improving to 59%. Clinical narrative was present in 37% improving to 64%. Consultants had not signed off on any letters.

Conclusions
Surgical discharge summaries audited remain non-compliant with the national standard however, as research shows, NCHD training has improved performance across categories.
TU6.4 Inspiring future surgeons: comparing open vs laparoscopic simulated surgical skills
Authors: Lingam Gita , Shakir Taner , Karim Seiver 
Published: November 2022

Abstract

Background
Applications to surgical training are declining. Whilst early introduction to surgical specialities may develop interest, medical schools do not place enough emphasis on the growing trend towards performing laparoscopic procedures. We hypothesised that exposing medical students to laparoscopy would stimulate an interest in pursuing a surgical career.

Methods
Clinical medical students were randomised into two groups: Laparoscopic skills with box trainer and open surgical skills. Each session lasted one hour and was organised and conducted by the same tutors. Prior to participation in the teaching session, each student completed a pre and post event questionnaires regarding their speciality interest.

Results
A total of 45 students participated. 18 (33%) expressed an interest in a surgical career prior to the event. After the session, 15/23 (65%) of students who participated in the laparoscopic skills session expressed an interest in a career in surgery. The open surgical skills group had a positive response from 9/22 (41%) with respect to a career in surgery.

Conclusions
Participation in our surgical skills course increased interest in pursuing a surgical career amongst clinical medical students. Of note, our laparoscopic skills session increased interest more in comparison to an open surgical skills session. Our study highlights the importance of introducing laparoscopy simulation to the medical school curriculum in order to maintain interest towards the surgical specialities.
TU6.7 How to solve the problem of endoscopy training for General Surgery trainees
Authors: Massie Eleanor , Hughes Rebecca , Vella Mark , Moug Susan , Renwick Andrew 
Published: November 2022

Abstract

Introduction
COVID-19 has negatively impacted on all aspects of surgical training, compounding longstanding issues with surgical trainees achieving required endoscopy training standards. Innovative approaches are required to ensure trainees progress appropriately.

Aims
We aim to present an ideal immersive training pathway for endoscopy training for general surgery trainees.

Results
JAG certification has strict criteria which are achievable during a six month “immersive” training period with six, half day, sessions per week. JAG basic skills courses should be booked in advance and ideally complete in the 2nd to 3rd month of training.
Weeks 1–2: Supervised simulator training to introduce basic scope handling and manipulation. Observation of “upper” and “lower” lists to grasp understanding of patient journey.
Weeks 3–4: Attend at least 3 dedicated training sessions per week with DOPS discussion and completion. Ongoing simulator practice (1–2 sessions per week). Attendance at service lists with recognised trainers (1–2 sessions per week); likely to be opportunities for trainees to participate on ad Hoc basis.
Weeks 4–20: As per weeks 3–4 with an increased attendance of ad Hoc lists and reduction of simulation to one session per week.
Weeks 20–24: Consolidation of learning, endoscopies undertaken with minimal assistance from trainer.
Weeks 24–26: Reduced capacity lists with trainer in the department but out-with scope room in preparation of independent lists after JAG certification.

Conclusions
We have described the ideal immersive endoscopy training pathway. Consideration should be given to incorporating this into the general surgical curriculum around on-call commitments, elective operating and clinics.
TU7.1 “When Can I Go Home?”- Unplanned Admissions following day case elective surgery
Authors: Armstrong Lara , Hughes Paul , McLoughlin Peter 
Published: November 2022

Abstract

Aim
Day case surgery is an effective and economical method to manage patients while maintaining quality of care. During the COVID-19 pandemic and the reinstatement of non-cancerous elective surgery, efficient use of bed space capacity has been crucial. Strategies were implemented to reduce unplanned admission rates, including careful patient selection and preoperative assessment. We aimed to review rates of unplanned admissions (UA) following intended day case procedures and to identify methods of future prevention of UA.

Methods
A retrospective review was carried out of patients undergoing day case hernia repairs or laparoscopic cholecystectomy in a single district general hospital, between May 2021 and September 2021. Data was collated from an institutional data base with follow up data obtained from an electronic care record.

Results
53 patients included, with a median age of 76 years (range 23–79), 56.6% male, 23 inguinal hernia repairs and 30 cholecystectomies. 30.2% were unexpectedly admitted post operatively (9 Cholecystectomies and 7 inguinal hernias). Of those admitted, median length of stay was 3.1 days (range2–10). Reason for admission included pain (43.8%), post-operative complications (18.8%) and urinary retention (18.8%). Patients requiring admission were significantly older (mean age 62 vs 49 years old), were more likely to be male (62.5% vs 37.5%) and had a significantly longer theatre time (1.46 vs 1.08 hours, p=0.0001).

Conclusions
Our short review has identified older and male patient are more likely to require an overnight admission. Improvement in pain management, theatre planning and streamlining along with optimal discharge planning may reduce the volume of patient requiring UA.
TU8.9 Emergency Giant Hiatus hernia repair, Single Centre Experience
Authors: Alasmar Mohamed , Mckechnie Iona , Chaparala Ram 
Published: November 2022

Abstract

Aim
Patients with giant hiatus hernias can present acutely with volvulus or strangulation. Early emergency surgical intervention with reduction of the hernia and hiatal repair reduces the mortality rate. However, surgery is not without risk or complications. This study assessed the rate of complications and length of hospital stay in patients requiring emergency surgery.

Method
A retrospective study looked at all patients who underwent emergency hiatal hernia surgery at a tertiary oesophagogastric centre. Over an eight-year period, 80 patients were identified. Their clinical course was evaluated from medical records, collecting data on their length of stay, complications and mortality.

Results
Of the 80 patients, 30 patients (37.5%) had no documented complications from the surgery. 62.5% did have complications, of which respiratory complications were the most frequent (43%). 10% of patients had a symptomatic recurrence of the hiatus hernia that required operative correction during index admission or subsequent admission. The median length of hospital stay was eight days (IQR 5–16). There was a positive correlation between the number of complications and length of stay. Post-operative mortality was 9%.

Conclusion
Emergency surgery for hiatus hernias has a high morbidity rate, as expected for an emergency procedure in acutely unwell patients. Despite the high rate of post-operative complications, the length of hospital stay was relatively short with low mortality, showing emergency surgery to be an effective lifesaving treatment.
WE1.3 Surgical Multi-disciplinary Team's engagement with the Implementation of the New “Safe Anastomosis” Checklist
Authors: Alamin Nadeen , Jeyarajah Maathusha , Vigneswaran Natali , Collins Jen , Shrestha Ashish 
Published: November 2022

Abstract

Aims
Introducing a surgical intervention can only be effective if it is deemed user-friendly by the participants involved in the study. Hence, it is crucial to gather the consensus amongst the users to maximise engagement with the intervention. A questionnaire was created with the aim of gathering data regarding the ease, practicality, and any area for improvement of the ‘safe anastomosis checklist’ at a district general hospital.

Methods
An anonymous questionnaire, with qualitative and quantitative questions, regarding the ‘Safe Anastomosis checklist’ was created. The aim of this study was explained to the surgical department and the questionnaire was given to members of the surgical multi-disciplinary team to complete. The results were gathered and analysed to yield results regarding this intervention.

Results
Of the 22 responses obtained, 77.2% rated the ease of the questionnaire as being 9+ out of 10 while 59% found this intervention very useful especially when it was done during the “team brief”. Although in 68% of cases, it did not lead to any changes with the intra-operative method, it was used an opportunity for the team to re-evaluate the procedure itself and the technique to be used.

Conclusion
The questionnaire was well received amongst the participants, with most of the participants considering the intervention to be a quick, easy, and practical tool to re-enforce the purpose of the procedure and further eliminates any risks that could lead to an anastomotic leak.
WE1.11 Auditing the quality of operation notes in colorectal surgery at University Hospitals of North Midlands
Authors: Poolovadoo Yanish , Malik Aizad , Aziz Haseeb , Nair Nandu , Varghese Gigi , Varghese Philip , Kumar Nakulan Nantha 
Published: November 2022

Abstract

Introduction
Constructing an accurate and comprehensive operation note is an important process in a patients’ journey as it should provide sufficient information to allow continuity of care by other healthcare professionals. We performed an audit of operation notes in colorectal surgery to assess whether they meet the standards as described by the Royal College of Surgeons.

Method
Retrospective data was collected over a period of 10 months to include all major elective colorectal operations. Operation notes were scrutinised for all 17 relevant data points as described in Good Surgical Practice. The electronic patient system at our trust populates the operation note with date/time, surgeons and anaesthetist.

Results
There were a total of 232 major colorectal procedures performed between May 2020 and March 2021. 12 data points were adhered to 100%. Estimated blood loss was only documented in 18.1% (n=42) of operation notes. Pre-operative DVT prophylaxis was documented in 6% (n=14) of operation notes. Details of tissue removed were not documented in 3% (n=7) of operation notes. Antibiotic prophylaxis was not documented in 1.7% (n=4). Theatre anaesthetist was not documented in 1.3% (n=3) of operation notes.

Conclusions
Operation notes in electively colorectal surgery are not meeting the standard as set out in Good Surgical Practice. There is a potential for change by adding drop down sections on the electronic operation note to ensure all operation notes meet the standards and are uniform. These changes will be trialled and the data re-audited in the near future.