bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP-408 Colonic mucosal dehiscence in a patient with ischemic colitis- A case report
Authors: Rauf Fatima , Sial Fakhar Munir , Hanif Muhammad , Farooq Tashfeen , Sabir Alifa , Khan Huma Sabir 
Published: November 2022

Abstract

Introduction
Ischemic colitis (IC) is the condition that results when blood flow to the colon is reduced to a level insufficient to maintain cellular metabolic function.

Case summary
A 36 year old female; diabetic, hypertensive, with history of CVA and IHD, presented in ER with complaints of sudden onset, severe, colicky abdominal pain. Examination revealed a mildly tense, tender abdomen at left iliac fossa with a palpable ill-defined mass. Her TLC was 31.6/L and hemoglobin 9.3 g/dL. Serum amylase, lipase and lactate levels were normal. CECT abd/ pelvis showed thickened, edematous sigmoid and descending colon, with extensive mesenteric haze and stranding. Colonoscopy showed an illdefined, obstructing growth in rectosigmoid region at 25 cm from anal verge. There were multiple ischemic patches and underlying erythema and ulceration with bleed to touch mucosa at few sites. Scope could not be passed further. Biopsy showed active non-specific colitis with no evidence of malignancy. Patient improved on conservative management and was discharged. Patient presented in ER 2 weeks later with a long tubular structure that was expelled per-rectum. The histopathology of this structure revealed intestinal tissue with marked autolytic and ischemic changes. Patient again presented in ER with abdominal pain and vomiting with increased TLC. A diagnosis of severe ischemic colitis (ACG guidelines 2005)presenting as rectosigmoid mass was made and left hemi-colectomy was planned.

Discussion
This is a rare case of colonic mucosal shedding in ischemic colitis only described once in literature.

Conclusion
This case demonstrates the unusual way in which colonic ischemia can present.
EP-410 Improving data quality for emergency surgery: the effect of a dedicated NELA Fellow in a general surgical unit
Authors: Kronberga Madara , Saha Arin 
Published: November 2022

Abstract

Aims
The National Emergency Laparotomy Audit (NELA) has been running for over 8 years; despite this, there are still difficulties faced by some units and clinicians in having time and space to contemporaneously enter data and keep up to date. This study describes the improvements made to data quality after the introduction of a dedicated NELA Surgical Fellow in a single surgical centre. The role of the Fellow has been to liaise and engage with all members of the surgical team regularly to highlight the importance of accurate and timely data entry and, further, to produce monthly summaries of all emergency laparotomies and name surgeons who have not entered data.

Methods
The post of NELA Surgical Fellow was introduced at our DGH general surgical unit in August 2021. All patients who were entered onto the NELA database from our unit from January 2021 to July 2021 were compared to those entered onto the database after the introduction of the NELA Fellow.

Results
After the introduction of the NELA Surgical Fellow, contemporaneous data collection for patients has increased from 67% to 89% and the proportion of patients with complete data fields within a week after surgery has increased from 62% to 85%. The average time to complete data entry has fallen from 67 days after surgery to 52 days.

Conclusions
The introduction of a dedicated NELA Surgical Fellow, and the increased commitment to timely data collection, has led to improved accuracy of data and a faster completion time within just six months.
EP-415 The use of gastrografin in the management of adhesive small bowel obstruction
Authors: Vijayakumar Y , Kim S , Kumaran N , Habib H , Malik K 
Published: November 2022

Abstract

Background
Adhesive small bowel obstruction (aSBO) is a common surgical emergency causing high morbidity and even some mortality. The adhesions causing such small bowel obstructions (SBO) are typically the footprints of previous abdominal surgeries. The National Audit of Small bowel Obstruction (NASBO) recommended that in patients not needing emergency surgery for aSBO, gastrografin should be embedded in clinical management. An audit was undertaken to see our adherence to best practice in the management of aSBO.

Methods
Data of all patients who were admitted with SBO between April and October 2020 were obtained. This list was filtered carefully to extract patients who had aSBO. Data was collected on signs of intestinal ischaemia, administration of gastrografin and progression, need for surgery and length of stay.

Results
26 patients were admitted with aSBO in the above period. Half of all patients needed an emergency operation. Only 30% (8) received gastrografin. Conservative management was successful in 62% (5/8) of patients who received gastrografin. 38% (3/8) needed surgery as they either had signs of intestinal ischaemia or gastrografin failed to pass through. More than half of all patients (55%) who did not receive gastrografin (10/18) required surgery. The average length of stay was significantly higher in patients who did not receive gastrografin.

Conclusion
From the limited data it is evident that the use of gastrografin in patients with aSBO reduces the duration of stay and need for surgery. We have now developed and implemented a local protocol for managing such patients and we aim to re-audit in 6 months.
EP-420 Delayed primary repair of zone 2 flexor tendon injury after 4 weeks: Does it work?
Authors: Labib Amir , Lingamanaicker Vidhya , Fay Emily , Blakeway Megan , Fleming Andrew 
Published: November 2022

Abstract

Aims
To report the outcomes of delayed primary repair of zone 2 flexor tendon injuries after 4 weeks.

Methods
Retrospective evaluation of all adult patients presented with more than 4 weeks of flexor tendon injuries and underwent primary surgical repair between 2016 and 2019.

Results
271 patients’ notes have been reviewed. Only 12 patients met the criteria. 70% of patients were male with a mean age of 25 years and 40% of them were manual workers. Knife laceration was by far the most common mechanism of injury. The little finger was the most affected finger followed by the ring and middle fingers. The mean time interval between initial injury and repair was 40 days. Only one infection was reported that was treated with oral antibiotics. Two cases were in need of tenolysis due to flexed contracture. The mean total active range of motion was 167. Patients reported a good functional outcome with a mean DASH score of 10. The number of hospital visits was 40% less compared with their counterparts who underwent two-stage reconstruction.

Conclusions
In our experience, immediate reconstruction of delayed flexor tendon injuries is a better option for these cases. It is associated with a reasonable range of motion with fewer hospital visits. This facilitates early return to work, especially in the manual workers’ population.
EP-434 Is Cholecystostomy the correct temporising strategy for complicated cholecystitis and how should it be utilised to meet the NICE criteria for ‘early cholecystectomy’
Authors: Ismail Adam , Patel Pranav H , Parmar Chetan 
Published: November 2022

Abstract

Aims
The incidence of undiagnosed gallstones is reported in up to 22% of females, with acute cholecystitis (AC) being a common emergency presentation. NICE guidance recommends index cholecystectomy for patients with proven gallstones. Emergency Laparoscopic Cholecystectomy (LC) in co-morbid patients carries a risk, with percutaneous cholecystostomy tube (PTC) insertion utilised as a temporising measure to relieve sepsis. Whilst effective at decompression, the long-term outcomes are unclear.

Methods
We retrospectively reviewed all patients undergoing emergency PTC between 2019 and 2021 in our hospital. Data collection included: demographics, ASA classification, Clavien-Dindo grades, cholecystostomy complications.

Results
A total 24 patients (12:12 male:female) underwent emergency PTC. Median age was 73 years (range 31–89) and median ASA grade of 3 (ASA 1 n=3, ASA 2 n=8, ASA 3 n=7, ASA 4 n=6). Median time from PTC insertion to LC was 20 weeks (range 6–73 weeks). Morbidity post PTC according to Clavien-Dindo grades were: 4 with grade 3 (16.7%), 5 with grade 4 (8.3%) and 5 with grade 5 (20.8%). 8 patients (33.3%) re-presented with further cholecystitis. 4 (16.7%) patients had completion LC, without complication.

Conclusions
Our findings highlight significant morbidity and mortality in this high-risk cohort secondary to complicated AC. 20 patients (83.3%) did not undergo a completion cholecystectomy, despite 18 being ASA 1–3. We suggest a judicious use of PTC and a greater focus on index multi-disciplinary surgical fitness assessment in order to optimise a patient for acute LC. This strategy is key to enable full adoption of AUGIS guidance for performing LC within 72 hours.
EP-440 A novel approach to extraction of a bezoar
Authors: Abdelsaid Kirolos , Jayasankar Balaji , Aal Yasser Abdul , Bailey Charles 
Published: November 2022

Abstract

Introduction
A young girl presented with a confounding clinical picture of abdominal pain, not tolerating oral feeds on a background of being hypoalbuminemic and anemic. She had been evaluated at multiple instances in the past for similar complaints.

Methods
On further evaluation this turned out to be secondary to a bezoar lodged in her stomach and small bowel. This had been causing her severe distress over a period of 6 months with significant weight loss. Extraction of the bezoar by gastroscopy was not possible and she was taken up for surgery.

Results
Intra-operatively, we describe a novel method of extraction of the bezoar by using laparoscopic instruments through the incision over the gastric wall and extraction of the bezoar.

Conclusion
A novel method describing extraction of foreign body from the intestine
EP-458 Robotic surgery improves outcomes for patients with benign and malignant colorectal conditions
Authors: Karategos Athanasios , Farquharson Ja'quay , Liu Ben , Yassin Nuha 
Published: November 2022

Abstract

Aims
Robotic surgery represents the newest minimally invasive technology available to reduce the impact of surgery and provides unique benefits in pelvic access of the technically challenging colorectal resections. The purpose of this study was to assess the feasibility and clinical outcomes of robotic resections at our trust.

Methods
A series of 106 consecutive patients who underwent robotic surgery between October 2020 and January 2021 was analyzed retrospectively in terms of demographics, perioperative and 30-day postoperative outcomes. Patients divided in three groups: colorectal cancer (CRC), IBD and diverticular disease.

Results
Seventy-four patients underwent robotic resection due to CRC. Fifty-two per cent (n=39/74) had sigmoid cancer followed by right sided colon cancer in 22%(n=16/74) and rectal cancer in 26%(n=19/74). Pathologically complete resection (R0) was achieved in all patients with a median lymph node ratio of 0.14. Twenty-two patients were included in the IBD group (77% Crohn's disease). Four patients underwent robotic resection due to fistulating diverticular disease. For all the groups there were no conversions to open surgery. Return of gut function was noted within 48 hours in 91% of the patients. All patients were discharged on their baseline Hb with no need for iron replacement therapy or blood transfusion. The median length of hospital stay was 5 days. There was no reported 30-day mortality.

Conclusion
Robotic surgery is feasible, safe and improves clinical and surgical outcomes. This novel approach ensures that surgery remains minimally invasive, leading to a significant reduction in length of hospital stay, and rapid postoperative recovery.
EP-468 Impact of COVID19 on surgical training
Authors: Fox Katherine , Parkin Benjamin 
Published: November 2022

Abstract

Aims

Methods
An online survey consisting of 10 questions was sent to general surgical trainees, at different stages of training.

Results
All respondents felt that training has been adversely affected by COVID19. Aside from reduced operating, 96% of respondents felt that training has been adversely affected in other ways including more ward cover, less exposure to clinic and elective work and less availability of teaching. All trainees reported that teaching had moved online; 56% felt that this was less effective. Half of respondents felt that they are likely to require more time in training as a result of the pandemic. When asked what can be done moving forwards to help catch up, responses included increasing access to wet labs and waiting list initiatives. Pre pandemic, 48% of respondents felt that was a lack of cadaver teaching and 20% reported issues accessing mandatory courses.

Conclusion
Surgical training has been adversely affected by COVID19, not only due to less elective operating but also lack of teaching, courses, simulation and increased stress. With half of respondents feeling that they will need additional time, finding ways to address lost training opportunities is of paramount importance to surgical trainees and should be done not only in theatre, but also through wet labs, simulation and teaching.
EP-473 Laparoscopy versus Laparotomy for Abdominal Trauma: a Case of Iatrogenic Haemoperitoneum in a Haemodynamically Unstable patient
Authors: Stavropoulou - Tatla Stavroula , Imad Dora , Fardanesh Armin , Volteas Spiridon 
Published: November 2022

Abstract

Introduction
Laparoscopy is the gold-standard approach to elective abdominal surgery. Nevertheless, its application to abdominal trauma, including the treatment of haemoperitoneum, has been historically challenged by links to missed injuries. The European Association for Endoscopic Surgery does not clearly recommend therapeutic laparoscopy in trauma, despite the recognised potential benefits, in light of the scarcity and poor standardisation of available evidence.

Case description
A 68-year old male, presented with worsening shortness of breath and ascites. He was in type-2 respiratory and renal failure on a background of decompensated heart failure. He was admitted to the ITU for circulatory and ventilatory support and underwent ascitic drainage, removed on day 2. On day 3, the patient became peritonitic, exhibited a haemoglobin drop and went into class 2 haemorrhagic shock. A CT-abdomen showed moderate haemorrhagic ascites. An emergency laparoscopy was undertaken, which revealed active bleeding from the left lower abdominal wall. Haemostasis was achieved with ligation and electrocautery of the deep inferior epigastric perforators. Post-operatively, the patient showed a sustained clinical improvement. On day 4 he was stepped down to the ward and on day 10 discharged without further complications.

Discussion
Therapeutic laparoscopy is efficacious and safe in selected cases of intra-abdominal trauma, as revealed by emerging literature. The haemodynamic stability of the patient is not always a pre-requisite, and the patient's preoperative comorbidities can be key in deciding in favour of laparoscopy. We underline the following important conditions for success: an experienced surgeon, a systematic approach, suitable equipment and short time to surgery.
EP-474 An audit of cardiovascular risk modification in patients undergoing major limb amputation for the complications of peripheral atherosclerotic arterial disease and diabetes mellitus
Authors: Rodger Chloe , Fatima Kinza , Trinder Thomas , McGivney Feldheim , Hussey Keith 
Published: November 2022

Abstract

Introduction
The 5-year mortality for patients with peripheral atherosclerotic arterial disease is significant. Major adverse cardiovascular events are common – 16% of patients will have an event within 1-year of the diagnosis. Patients who present requiring major limb amputation represent a group where cardiovascular complications are significant – we have audited how risk is modified for this group at the point of discharge from hospital following treatment.

Methods
This was a retrospective review of patients admitted for major limb amputation. Specific variables of interest were the prescription of an antiplatelet agent (or oral anticoagulant) and a statin at the time of discharge from hospital. This was defined from immediate discharge letters.

Results
During the period of interest there were 282 major limb amputations performed and 235 patients were discharged from hospital. Most patients had peripheral atherosclerotic arterial disease (68%). A diagnosis of diabetes was mellitus was also common (52%). In this group of patients many had previous major adverse cardiovascular events – myocardial infarct 21%, angina 16% and previous stroke 18%. At the time of discharge on 80% of patients were prescribed an antiplatelet agent (or anticoagulant) and only 82% of patients had been prescribed a statin.

Discussion
Pharmacological management of cardiovascular risk in this high-risk group should be improved. At the point of admission a comprehensive assessment of cardiovascular risk should be made and modifiable risk factors addressed.
EP-482 What is the evidence from in vivo studies that mesenchymal stem cell derived extracellular vesicles can facilitate tendon and ligament repair?
Authors: Lu Victor , Tennyson Maria , Zhang James , Khan Wasim 
Published: November 2022

Abstract

Aim
Tendon and ligament injury pose an increasingly large burden to society. With surgical repair and grafting susceptible to failure, tissue engineering provides novel avenues for treatment. This systematic review explores evidence whether mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) can facilitate tendon and ligament repair in animal models.

Method
A systematic search was performed on PubMed, Web of Science, Cochrane Library, Embase. Risk of bias was assessed using SYstematic Review Center for Laboratory animal Experimentation (SYRCLE). Studies administering EVs isolated from human or animal-derived MSCs into in vivo models of tendon/ligament injury were included. In vitro, ex vivo, in silico studies were excluded. Data on isolation and characterisation of MSCs and EVs, and in vivo findings in animal models were extracted.

Results
Eleven case-control studies were included for analysis. Six studies utilised bone marrow-derived MSCs. All studies characterised MSCs via flow cytometry, which expressed CD44 and CD90, and isolated EVs via ultracentrifugation (average diameter 125nm). Five studies utilised histological scoring systems, all of which reported a lower score with EV treatment, suggesting improved healing ability. Four studies reported increased anti-inflammatory cytokine expression (IL-10, TGF-β1); three studies reported decreased endogenous M1/M2 macrophage ratio with EV treatment. Eight studies reported increased maximum stiffness, breaking load, tensile strength in EV-treated tendons.

Conclusions
MSC-EVs are effective therapeutic agents for tendon/ligament pathologies, attenuating the initial inflammatory response, accelerating tendon matrix regeneration, however evidence linking biomechanical alterations to functional improvement was weak. Future randomised controlled trials are needed to definitely demonstrate MSC-EVs superiority in tendon/ligament injury management.
EP-483 Adipose Tissue-Derived Mesenchymal Stem Cells as a potential restorative treatment for Cartilage Defects: A PRISMA review and Meta-analysis
Authors: Meng Henry , Lu Victor , Khan Wasim 
Published: November 2022

Abstract

Aim
Joint damage through trauma or degeneration causes cartilage defects, leading to osteoarthritis (OA). Current therapies relieve symptoms or replaces damaged joint, which is costly and fraught with complications. Mesenchymal stem cells (MSCs) have immunomodulatory properties and low immunogenicity, making them a novel avenue for research for OA treatment. This systematic review investigates whether adipose derived MSC (AMSCs) can treat cartilage defects.

Method
A systematic search was performed on MEDLINE, EMBASE, Cochrane Library, Web of Science. Clinical, imaging, functional outcomes were extracted from nineteen included studies. Inclusion criteria was studies conducted on human populations that compared effects of AMSCs on cartilage regeneration to non-exposed controls. Studies conducted on animals, ex vivo studies, in vitro studies were excluded.

Results
Nine studies reported improved Visual Analogue Scale (VAS) scores (mean difference -3.30; 95% CI:-3.72,-2.89; p&lt;0.001). Eight studies reported improved Knee injury and Osteoarthritis Outcome Score (KOOS) in five subscales. Pooled analysis of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores in seven studies revealed an improvement (mean difference -25.52; 95% CI:-30.93,-20.10; p&lt;0.001). Cartilage regeneration was assessed using Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score. All studies reported improved regeneration, with a pooled end-point score of 68.12 (95% CI:62.18–74.05; p&lt;0.001).

Conclusions
AMSCs are effective therapeutic agents for cartilage defects. We recommend researchers to determine roles of biochemical components that facilitate AMSC-mediated cartilage repair. Establishing the most efficient methods for MSC extraction, culture, delivery, and performing studies with long follow-up times enable future research to provide evidence needed to bring AMSC-based therapies into the market.
EP-488 Pre-operative electronic checklists as a systematic method to improve patient care
Authors: Bhat Srushti , Al Yasen Nada , Perikleous Periklis , Lau Kelvin 
Published: November 2022

Abstract

Aims
The COVID-19 pandemic has resulted in major changes in pre-operative assessment, as consultations became conducted over the telephone, and pre-operative tests carried out a few days before surgery to coincide with the COVID testing visit. This increased the chances for preoperative tests to be missed. A recent audit in our unit revealed missed investigations just before surgery. A checklist was introduced to identify issues early and help reduce avoidable delays.

Methods
An audit was performed for completeness of preoperative preparations. A pre-operative checklist was created to include pre-operative investigation reports, routine laboratory results, proof of COVID-19 swabs and vaccination records, correct details on the theatre lists, signed consent forms with clearly visible patient marking. The checklist was launched and the team, including doctors and nurses, were educated on its value in improving patient care.

Results
The implementation of electronic pre-operative checklists resulted in an immediate improvement of care, with preliminary results showing issues with a potential of causing delays being promptly identified and addressed. Late identification of issues could not be entirely avoided; however, this was discussed with team members, further education was provided, and data collection continues, to ensure good practice is sustained.

Conclusion
COVID-19 has reduced the time for hospital visit and face to face interactions, but this created the opportunity for missed tests and processes leading to delays and cancellation of surgery. The checklist in our case has proven useful in identifying issues early and promptly managing potential delays in patient care.