bluuebunny/crossref_metadata_2025_split huggingface dataset:
175 Comparative Evaluation of Efficacy of Ultrasound-Guided Erector Spinae Plane Block Versus Oblique Subcostal Transversus Abdominis Plane Block for Postoperative Analgesia of Adult Patients Undergoing Laparoscopic Cholecystectomy: A Retrospective Study
Authors: Harvitkar R.U. , Harishkumar P. , Gattupalli G.B. 
Published: February 2022

Abstract

Background
Laparoscopic cholecystectomy (LC) is a frequently applied minimally invasive surgery. Intraoperative access is provided with small keyhole entries on the abdominal wall. However, LC causes moderate to severe postoperative pain. To counteract this LC surgeries are always accompanied using nerve blocks.

Method
A retrospective study evaluating the outcome of two different post-operative analgesia techniques in patients undergoing LC surgeries. Eighty-two patients with the American Society of anaesthesiology grade I-II (ASA) who underwent LC records were analysed. Erector spinae plane block was performed in the erector spinae plane block (ESPB) group and oblique subcostal transversus abdominis block was performed in the oblique subcostal transversus abdominis plane block (OS-TAPB) group. Postoperative static and dynamic pain score as per the visual analogue scale (VAS), the intraoperative requirement of fentanyl, postoperative use of diclofenac, time to ambulation after surgery, and presence of any pain after surgery were noted. Separate t-test and Mann–Whitney U-test were used for quantitative data, while Chi-square test was used for comparing qualitative data.

Results
Static and dynamic VAS scores were significantly lower in the ESPBgroup (P&lt; 0.05). Intraoperative fentanyl requirement (165 ±30.72–ESPB,180.95±29.12–TAPB,P = 0.020) and number of patients requiring diclofenac(28/42–ESPB,37/42–TAPB,P = 0.019)were lower, while number of patients ambulating by 4 hours(20/42–ESPB,9/42–TAPB,P = 0.012)were higher in ESPB group. Patients suffering from pain at 1 week (22/42– ESPB and 34/42–TAPB, P = 0.005) and 1 month (9/42–ESPB and 13/42–TAPB,P = 0.207) were lower in the ESPBgroup.

Conclusions
Ultrasound-guided ESP block reduced postoperative pain score, analgesics consumption more effectively than OS-TAPB after laparoscopic cholecystectomy surgery.
179 Using QIP to Create a Structured Teaching Programme to Improve Confidence in Basic Surgical Topics in Foundation Year 1 Doctors
Authors: Harris M. , Alfred J. , Tempany J. 
Published: February 2022

Abstract

Aim
We aim to create a new, structured teaching programme to help fill in knowledge gaps in newly qualified doctors, who have rotated into General Surgery.

Method
We ran the programme over three four-month periods.
Prior to each rotation, we used a survey to assess multiple aspects: prior experience of surgical teaching, overall feeling of preparedness and confidence. We also asked for a self-evaluation on the doctor's confidence for specific basic surgical topics, on a 5-point scale. We asked for suggestion topics that doctors found difficult or lacked confidence in. We used this information to create a curriculum for the programme.
We then reassessed these variables at the end of the cycle, using the information to plan and implement the next cycle.

Results
During the first cycle, we made no significant difference in any area. Experiencing significant barriers to attendance, organisation, and interaction with the survey. We used this first cycle to identify these barriers and address them for the second cycle.
These changes led to a significant improvement in attendance, feedback from sessions and interaction with the questionnaires. We saw a 3-fold increase in attendance to sessions on average.
After the second cycle, there was an overall improvement of confidence in all basic surgical topics. There was an increase in the number of doctors considering a career in surgery.

Conclusions
This teaching programme has led to an improvement in junior doctors’ confidence in basic surgical topics. Repeated PDSA cycles are allowing continuous improvement and change to maximise exposure to surgical teaching and training.
194 The Effect of the Disruption Caused by the COVID-19 Pandemic on the Rates of Post-Tonsillectomy Complications After the Recovery of Services
Authors: Amin M. , Abdeen B. , Hassaan A. 
Published: February 2022

Abstract

Aim
In June 2020, and after the first wave of the COVID outbreak has settled, we resumed operating in our trust for elective surgery in three different hospitals. However, it was thought that the number of post-tonsillectomy complications had increased. We performed an audit to evaluate the rate of post-tonsillectomy complications in our trust and investigate possible causes.

Method
We measured the rates of patients who developed complications post-operatively during the period from June to November 2020 and compared it to the rates in the pre-COVID year and the national rate. Moreover, we scrutinized retrospectively the operative notes of each patient presenting with a post-tonsillectomy complication and identified risk factors.

Results
In the study period, we performed 129 tonsillectomies. Of these patients, 14 presented with complications; 11of which had bleeding, while 3 had post-operative pain. Two patients needed to return to the theatre to control the bleeding. During the same period in 2019, 28 patients had complications out of a total of 199 patients. The rate of complications in 2020 was 10% which compared favourably with the previous year (14%). The highest number of patients (9/14) was in a hospital which posed a new environment to our surgeons. Dissection by Bipolar diathermy was the most contribute factor for bleeding in most patients (11/14).

Conclusions
The disruption caused by the pandemic situation did not influence overall rates of complications. However, the hospital which presented a new operating environment had the highest rate.
195 Surgical Education Runs A-MOOC!
Authors: Mellor C. , Musbahi A. , Rangarajan S. , Eagles E. , Immanuel A. 
Published: February 2022

Abstract

Aim
This study aims to review the available surgical Massive Open Online Course (MOOCs), to assess their scope, users, function and to use a quality assurance score to assess whether they are of sufficient quality. Understanding gaps will aid development of future surgical MOOCs.

Introduction
MOOCs have been changing the fabric of medical education over the last ten years1. They are perceived to be disruptive in their dismantling of the traditional methods of content delivery. Their offer of remote but flexible access and visually appealing content has been an integral part of their success.

Method
We scrutinised publicly accessible websites offering MOOCs using the search terms “surgery” and “surgical”. Thirty-eight of the 234 MOOCs found were deemed relevant and analysed further. Each MOOC was ranked into categories (not achieved, partially achieved, largely achieved, fully achieved) for standards set out by a validated OpenUp education tool.

Results
Only 34.2% of MOOCs were suitable for patients or relatives. The average cost of accessing a course (and certificate if available) is £50.39. Only 5.26% courses met the minimum recommended 25-hour study time. Only 5.26% MOOCs provided different learning pathways with different activities with a range of difficulties. An astounding 34.2% of MOOCs did not achieve providing reliable and fair assessments and providing regular feedback to students.

Conclusions
Not many high-quality surgical MOOCs exist. There is scope to produce more MOOCs aimed at patients and medical students, to reduce the cost of accessing the course and to improve how the courses are designed and assessed.
203 Clinical Significance of Haemorrhagic Cholecystitis: Retrospective Case Series
Authors: Khan Hotak M. , Gananadha S. 
Published: February 2022

Abstract

Aim
Hemorrhagic cholecystitis (HC) is a rare entity of acute cholecystitis. HC is hard to detect clinically as its symptoms are easily confused with acute calculus or acalculus cholecystitis. Although it is rare the purpose of this study is that early recognition may prevent possible life-threatening complications.

Method
A retrospective review of HC patients diagnosed by histopathology from 2010 to 2021 at the Australian Capital Territory health hospitals. A search of the histopathology database, patients’ medical records, laboratory results and imaging were conducted.

Results
Thirty-five patients (1%) were diagnosed on the histopathology report from approximately 3500 patients with cholecystectomies. Thirty-one Patients (88.6%) were presented to emergency, four patients (11.4%) had elective surgery. Twenty-one patients (60%) were female, fifteen patients (40%) were male. The median age was 51 years. All patients had laparoscopic cholecystectomy, four patients (11.4%) were converted to open, and five patients (14.2%) required ERCP. Two patients (5.7%) were on anti-coagulation. Twenty-three (65.7%) had ultrasound, twelve patients (34.2 %) had CT just one was reported as HC. Three patients (8.5%) had MRCP. Intraoperative findings were 8 patients with mucocele (22.8%), 6 patients had gangrenous gall bladder (17.1%),4 patients had empyema of gall bladder (11.4%) and 2 patients had perforated gall bladder (5.7%).

Conclusions
Our results revealed that all patients with HC were treated with surgical removal of gall bladder and had no post-operative complications. This shows diagnosing HC not effecting the overall clinical outcome for patients.
206 Longevity of Deep Brain Stimulation Batteries at a Tertiary Neurosurgical Centre
Authors: Saad M. , Morris R. , Rudwick C. 
Published: February 2022

Abstract

Introduction
Deep brain stimulation (DBS) is a surgery used in the treatment of movement disorders. It involves surgical placement of electrodes in the brain that are connected to a battery-powered stimulator to regulate brain activity. DBS has been used successfully in the management of Parkinson's disease (PD). It has improved patients' movement and quality of life. However, one inconvenience is the limited battery life and the need for battery change to prevent deterioration in function. In this audit, we measured the longevity of DBS batteries in PD at a tertiary neurosurgical centre.

Method
A retrospective audit on the longevity of DBS batteries in 86 Patients with PD. We collected data on; date and position of device implant, type of battery used (rechargeable vs non-rechargeable), and the two most recent battery changes. We excluded battery changes that were due to infection.

Results
86 patients had DBS batteries. 21 patients had rechargeable batteries (Abbot Brio, Medtronic Activa RC and Boston Gevia), and 65 had non-rechargeable batteries (Abbot Infinity, Abbot Libra XP, Medtronic Activa PC). 53 patients have undergone a battery change, 49 of those were non-rechargeable batteries. Average battery life of non-rechargeable batteries was 3.06 ± .55 years in Infinity (n = 16), 4.0 ± 1.7 years in Libra XP(n = 22), and 4.6± .9 years in Activa PC (n = 11).

Conclusions
All three types of non-rechargeable batteries are lasting less than five years. Activa PC batteries had the lengthiest battery life of 4.6± .9 years, while infinity had the shortest battery life of 3.06± .55 years.
213 Utility of Botox Injection in Early Laparostomy Closure for Abdominal Compartment Syndrome in Acute Severe Pancreatitis – a Case Report
Authors: Ain Q. , Chouari T. , Awonaya K. , Thomas R. 
Published: February 2022

Abstract
Acute pancreatitis can cause significant visceral oedema due to fluid resuscitation, paralytic ileus and ascites with raised intra-abdominal pressure(IAP) and abdominal compartment syndrome (ACS &gt;20mmHg). Failure of conservative management is an indication for decompressive laparostomy. Early fascial closure is the priority following laparostomy to reduce morbidity, mortality, and the risk of enteric fistulation. Chemical component separation with Botulinum toxin injection is proven to be of benefit prior to elective complex ventral hernia repairs and has been reported in laparostomy closure. We report our use of Botox to assist with vacuum and mesh-assisted early closure of laparostomy in a patient with acute severe pancreatitis.
A 29-year-old male was admitted with severe alcohol induced pancreatitis. He developed acute respiratory distress and was intubated and ventilated. On day 14 of admission, he developed raised IAP of &gt;40mmHg with multiorgan dysfunction and underwent laparostomy and application of Abthera© vacuum assisted negative pressure dressing. 3 days later, the dressing was replaced and a prolene mesh was sutured to the fascial margins to allow approximation of the wound to prevent retraction of the rectus sheath. He underwent further dressing change with trimming of mesh on day 6 and received 300U of Botulinum toxin injection into the abdominal musculature bilaterally. On day 7 following botox injection, the mesh was excised, and the midline wound was closed without tension. He remained stable with normal IAP and no wound related complications. Chemical component separation with Botulinum toxin may be a valuable adjunct in early closure of laparostomy.
216 Open Versus Minimally Invasive Surgery (MIS) Transforaminal Lumbar Interbody Fusion (TLIF): A Single-Centre Experience
Authors: Eldoadoa M. , Aldarragi A. , Rao P. , Sian P. , Kapoor V. , Mazarakis N.K. 
Published: February 2022

Abstract

Introduction
Transforaminal Lumbar Interbody Fusion (TLIF) is a technique used for the management of various pathologies such as degenerative disc disease, recurrent disc herniations and spondylolisthesis, to mention the most common indications. There is an ongoing debate regarding the use of open versus minimally invasive techniques for TLIF. Each has its own advantages and disadvantages. In the present study, we aim to present our experience regarding the use of open vs MIS TLIF at Stepping Hill Hospital in Manchester.

Method
A retrospective observational cohort study involving 60 patients was conducted at Stepping Hill Hospital in the UK. Patients who had TLIF surgery between 2019 and 2020 were included. Patients were consecutively allocated to either the open TLIF or the MIS TLIF group. Data were collected from hospital records including pre- and post-operative follow up notes. We also assessed pain score using the visual analogue scale.

Results
26 patients underwent MIS TLIF whereas 34 patients underwent an open procedure. The MIS group showed better outcomes compared to the open group in terms of post-operative complications, improvement of symptoms and the average hospital stay: 7.6% vs 8.8%, 73.7% vs 58.8% and 1.82 vs 2.76 days, however, the open group had a lower rate of metalwork failure 8.8% vs 11.5% in the MIS.

Conclusions
Our study showed that MIS TLIF at our unit seems to result in better outcomes related to symptoms alleviation, post-operative complications and less hospital stay despite having a slightly higher rate of metalwork failure.
226 Management of Closed Fractures of the Hand; Single Centre Audit
Authors: Saleki M. , Abdelaty M. , Kandil M. , Ashfaq F. 
Published: February 2022

Abstract

Aim
To compare current practice at the local Plastic Surgery Department to national Standard
British Society for Surgery of the Hand BSSH guidelines recommend for closed hand fractures.

Method
Retrospective data collection
All procedures done within one month June 2021, compare it to previous audit done in Feb 2021 and close the audit loop
Electronic data records

Results
June 2021 (90.5 %) meet the standard of time to presentation compared to 76% in Feb 2021
June 2021 62% meeting the standard for time to surgery compared to 46% in Feb 2021
Main reasons for delay unavailable dedicated Plastic Surgery theatre lists, busy emergency theatre lists.

Conclusions
Documentation of delays in presentation/Management has improved.
More theatre capacity is required to avoid cancelation and delayed management.
229 A Systematic Review Protocol Examining the Role of Immobilisation in Hand Infections
Authors: Banhidy N. , Ramjeeawon A. , Nolan G. , Jain A. 
Published: February 2022

Abstract

Aim
Hand infections are common and varied, leading to long-term complications when managed poorly. Splinting of the hand in a position of safe immobilisation (POSI) is frequently used to avoid complications including pain and stiffness, however it is not a universally accepted technique because the effects of splinting in hand infections remain unestablished.
This systematic review will compare outcomes in adult hand infections between those treated using hand immobilisation and those not immobilised. The primary aim is to compare patient reported outcomes, for example pain, and the secondary aim is to compare functional active range of motion, complications, and resource use.

Method
A systematic review protocol has been developed. The search strategy was developed following background reading, expert opinion, and review by an academic librarian, and will be used to search MEDLINE, Embase, CINAHL, Web of Science and the Cochrane Central Register of Controlled Trials, to identify publications on management of hand infections including use of hand immobilisation. Title, and full-text screening will be carried out by two independent investigators to identify studies for inclusion. Editorials, letters, and literature reviews will be excluded.

Results
This systematic review has been successfully registered on the PROSPERO International prospective register of systematic reviews (CRD42021232880)

Conclusions
This systematic review will summarise the available evidence to establish the effect of hand immobilisation in hand infections, including whether hand immobilisation leads to improved outcomes in hand infections, which could guide health care professionals in their practice and influence future clinical guidelines.
241 Is There a Role for Empirical Treatment of Orthopaedic Patients with Suspected, but Not Confirmed, VTE in the Post-Operative Period?
Authors: Menon D. , Abcha O. , Kallel S. , Pandit H. 
Published: February 2022

Abstract

Introduction
Major surgery, including major orthopaedic surgery, is a key risk factor for developing venous thromboembolism (VTE). This poses a challenge in the post-operative phase when considering initiation of therapeutic-dose anticoagulation for suspected VTE due to the risk of major bleeding.

Method
A search strategy was developed with inclusion criteria involving all studies relating to the treatment of suspected VTE in the post-operative orthopaedic patient. Journal articles predating 3rd June 2021 were searched for in Medline, Embase and PubMed. Titles and s were reviewed based on clinical relevance.

Results
56 articles were generated using this search strategy. 22 results were excluded as conference papers and/or case reports. Title and review of the remaining 34 studies did not identify any relevant articles reporting outcomes.

Conclusions
No evidence is available to guide recommendations for the empirical treatment of suspected VTE in the post-operative orthopaedic patient prior to a confirmed VTE diagnosis. This is therefore a risk-benefit clinical decision to be undertaken based on individual patient factors. Current American College of Chest Physicians guidelines advise initiation of anticoagulation for suspected acute VTE in cases with a high clinical suspicion, or intermediate clinical suspicion with expected delay in diagnostic imaging for at least 4 hours. However, this does not apply to patients following recent surgery who are at increased risk of bleeding post-operatively. Empirical systemic treatment dose anticoagulation for VTE in the post-operative period should therefore only be initiated when timely image-based diagnosis cannot be achieved.
284 Pneumomediastinum in the COVID-19 Era: To Drain or Not to Drain
Authors: Loufopoulos I. , Geropoulos G. , Kapriniotis K. , Kakos C. , Bhakhri K. , Panagiotopoulos N. 
Published: February 2022

Abstract

Introduction
Although quite uncommon in the pre-COVID-19 era, pneumomediastinum has been increasingly reported in COVID-19 cases complicating the management and prognosis of these patients. The aim of this study is to present the current experience on COVID-19 associated pneumomediastinum and to propose a management algorithm based on the existing literature.

Method
A search strategy focused on electronic databases (Medline, Embase, Google Scholar) was performed. Main search keywords were pneumomediastinum and COVID-19-related keywords. Eligible studies were included without strict limitations on type of study, type of publication, language, or date.

Results
Several reports of pneumomediastinum management in the context of COVID-19 infection have been reported. An initial diagnostic approach with computed tomography scan is recommended for all patients with increased oxygen requirements and suspicious chest X ray. In stable, non-intubated patients, pneumomediastinum can be initially monitored, whereas in the event of progressing air accumulation and cardiorespiratory compromise, a subxiphoid drain alone may preserve the cardiopulmonary reserve. In cases with coexisting pneumothorax and pneumomediastinum, a pleural drain should be prioritised and a subxiphoid drain should be reserved for cases not responding to initial treatment. In surgical emphysema cases, conservative management, especially in non-intubated patients, is suggested, while coexisting pneumothorax as described above. For refractory surgical emphysema cases, subcutaneous drain or subxiphoid drain- in presence of pneumomediastinum- might be required.

Conclusions
In air space complications such as pneumomediastinum, surgical emphysema and pneumothorax, a proposed treatment algorithm can be applied aiming to improve the outcomes of these complicated COVID-19 patients.
292 Patient Centred Care in the Outpatient Department
Authors: Moore E. , Dholoo F. , Dinneen A. , Solan M. 
Published: February 2022

Abstract

Aim
The NHS long term care plan recognises the need for a personalised approach to healthcare. Patient initiated follow up (PIFU) is one way in which the NHS can support patients with becoming more autonomous in decisions about their own health.

Method
Our trust implements PIFU in 2 ways. Firstly, patients considering an elective operation were provided with a clinic letter detailing the treatment options and a PIFU card. They were discharged and asked to return the card if they wished to proceed to surgery, at which point they were added to the waiting list. Secondly, patients discharged from clinic were provided with a card which they returned if they needed to be seen again for the same complaint.

Results
95 patients were recruited for the operative pathway. 38 (40%) requested surgical treatment within 6 months. 149 patients were recruited for the clinic pathway, of which 17% returned for the same condition within 6 months.

Conclusions
This study has shown that 60% of patients choose, after meaningful dialogue and time to reflect, to avoid surgical treatment. In all cases the surgeon would have “added to the waiting list” had a joint decision been made at the end of the consultation. Furthermore, 83% of patients who would ordinarily have had a routine follow-up appointment did not return to clinic.
This PIFU system empowers patients to make decisions about treatment. Offering direct access to the operative waiting lists and clinics has multiple benefits: fewer primary care and hospital appointments; reduced waiting times and reduced costs.