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Abstracts from the Association of Surgeons
of Great Britain and Ireland, Annual
Congress, Liverpool, 2022
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Volume 109, Supplement 5

Talking Posters
Prize Abstracts
Short Papers
Contents

EPosters
v108
v40
v1
v6

Prize Abstracts
Moynihan Prize Abstracts
Abstract citation ID: znac246.005
Moynihan Prize 1
Antibiotic management of acute appendicitis avoids surgery in
over 70% of adults: one-year follow-up from a prospective,
multicentre, observational study
Hannah Javanmard-Emamghissi1, Brett Doleman1,
Marianne Hollyman2, Jon N. Lund1, Susan Moug3, Gillian M. Tierney4
1
University of Nottingham
2 Results: Of the total 69141 eligible patients who underwent a
Musgrove Park Hospital, Taunton
3 cholecystectomy, 511 (0.74%) had cirrhosis. In patients without
Royal Alexandra Hospital, Paisley
4 cirrhosis 86.55% underwent a laparoscopic procedure compared with
Royal Derby Hospital, Derby
Background: Surgeons are sometimes reluctant to manage
uncomplicated appendicitis non-operatively. Reasons cited are
unknown rates of recurrent appendicitis and the risk of missed
appendiceal malignancy. The aim of this study was to address these
uncertainties and determine the long-term efficacy of antibiotic
versus operative management of appendicitis.
Method: One-year follow-up of patients enrolled in the multicentre
observational COVID:HAREM cohort study during March-June 2020
was undertaken. Patients were diagnosed with appendicitis either
clinically or radiologically; initial operative or non-operative
management was determined on a case-by-case basis by the
responsible surgeon. Outcomes were the one-year appendicectomy
rate, resected appendix histology and predictors of antibiotic failure.
Results: A total of 625 patients who underwent non-operative
management were identified from 49 of the original 97 hospital sites.
The overall appendicectomy rate at one-year in the initial non-operative
group was 29% (180/625), with a median time to appendicectomy of 29
days [IQR 2-124]. Elective appendicectomy accounted for 17% (31/180) of
operations with normal histology found in 39% (12/31). The overall
normal histology rate was 11% (19/167). There were 7/167 malignancies
and 3/167 neuroendocrine tumours identified at delayed operation. The
presence of a faecolith (HR 1.72; 95% CI 1.18–2.51) and CRP>300 versus
<50 (HR 3.05; 95% CI 1.6–5.81) were independent risk factors for failure of
antibiotic-management (n=441).
Conclusion: The success rate of non-operative appendicitis
management was 71% at one-year. Appendicitis recurrence was
associated with the presence of a faecolith, malignancy and
significantly raised CRP. These factors should be considered when
counselling patients on non-operative management.
Abstract citation ID: znac246.006
Moynihan Prize 2
Cholecystectomy in patients with cirrhosis: a
population-based cohort study from England
Alfred Adiamah1, Colin Crooks1, John Hammond2, Peter Jepsen3,
Joe West4, David Humes1
1 waiting list with complications of gallstone disease. Of these, 51 had
National Institute for Health Research Nottingham Digestive Diseases
Biomedical Research Unit, E Floor West Block, QMC Campus, Nottingham
University Hospitals NHS Trust, Nottingham, UK, NG7 2UH
2 with only 79 same day discharges, and multiple investigations were
Division of Hepatobiliary and Transplant surgery, Freeman Hospital. Freeman
Rd, High Heaton, Newcastle upon Tyne, UK NE7 7DN
3 This was estimated to have cost a minimum of £364,917. Assuming an
Department of Hepatology and Gastroenterology, Aarhus University Hospital,
Aarhus, Denmark
4 £1,200 per hour, 202 additional cholecystectomies could have been
Population and Lifespan sciences, School of Medicine, University of Nottingham,
Clinical Sciences Building, City Hospital, Nottingham, UK, NG5 1PB
Introduction: There is an increased risk of cholelithiasis in patients with
liver cirrhosis irrespective of the underling aetiology. Cholecystectomy
© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved.
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BJS, 2022, 109(Supplement 5) v1–v5
https://doi.org/10.1093/bjs/znac246
Abstracts
is the recommended definitive treatment for symptomatic gallstones.
However, in patients with cirrhosis the postoperative outcomes after
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cholecystectomy are not fully defined. This population-based cohort
study aimed to determine postoperative outcomes after emergency
and elective cholecystectomy in patients with cirrhosis.
Methods: Linked electronic healthcare data from England were used to
identify all patients undergoing cholecystectomy between January 2000
and December 2017. Length of stay (LOS), 30-day re-admission, case
fatality and the odds ratio (OR) of 90-day mortality were calculated for
patients with and without cirrhosis, adjusting for age, sex and
co-morbidity using logistic regression.
57.53% in patients with cirrhosis (p<0.0001). LOS was longer in those
with cirrhosis (3 IQR 1–8days vs 1 IQR 1–3days, p<0.0001). The 30-day
re-admission rate was greater in patients with cirrhosis, 36.79%
compared with 14.95% in those without cirrhosis. The 90-day case
fatality after elective cholecystectomy in patients with and without
cirrhosis was 2.79% and 0.43%; and 12.82% and 2.39% following
emergency cholecystectomy. This equated to a 3-fold (OR 3.22 (95%-CI
1.72–6.02)) and a 4-fold (OR 4.52 (95%-CI 2.46–8.33)) increased odds of
death at 90-days following elective and emergency cholecystectomy
after adjusting for confounders.
Conclusion: Patients with cirrhosis undergoing cholecystectomy have
an increased 90-day risk of postoperative mortality, which is
significantly worse after emergency procedures.
Abstract citation ID: znac246.007
Moynihan Prize 3
Financial implications of gallstone-related complications
whilst awaiting elective cholecystectomy: a single institution
experience of 900 patients.
Charlotte Burford, Ellen Ainger, Tayyaba Syed, Astha Tanwar,
Antonia Efiannayi, Ankur Shah, Annabel Chan
East Kent Hospitals University NHS Foundation Trust
Aims: Over 65,000 cholecystectomies are performed each year in
the United Kingdom with increasing waiting-list times due to the
COVID-19 pandemic. This study set out to understand the cost to the
NHS of complications experienced whilst awaiting cholecystectomy.
Methods: A retrospective cohort study was carried out for all patients
who had been awaiting elective cholecystectomy for more than 20
weeks on the 17th September 2021 at a large NHS Foundation Trust.
Demographic data was collected at the time of listing. Re-admission
data was collected from patient notes. It included clinical history,
blood results and imaging investigations. Associated costs were
calculated.
Results: 900 patients included in the study (median age 56 years, 71.7%
female). 138 patients (15.3%) re-presented to hospital whilst on the
more than one presentation to hospital with 18 patients having more
than three presentations. This was equivalent to 625 days in hospital,
performed (ultrasound scan = 79; CT scan = 31, MRCP = 47, ERCP = 21).
average time for an elective cholecystectomy of 90 mins at a cost of
performed.
Conclusion: This study highlights the enormous potential to reduce
patient suffering by increasing the number of elective
cholecystectomy lists, and at no overall additional cost to the trust.
v2 | Abstracts
BJS Prize Abstracts
Abstract citation ID: znac246.001
BJS Prize 1
Postoperative electrical muscle stimulation attenuates loss of
muscle mass and function following major abdominal surgery:
A split body randomised control trial
Edward Hardy1,2, Jacob Hatt1,2, Brett Doleman2, Beth Phillips2,
Jon Lund1,2
1
Department of General Surgery, Royal Derby Hospital
2
Centre Of Metabolism, Ageing and Physiology, University of Nottingham
Aims: Significant loss of muscle mass and function occurs after major
abdominal surgery. Neuromuscular electrical stimulation (NMES) has
been shown to reduce muscle atrophy in some patient groups, but
evidence in postoperative patients is limited. This study assesses the
efficacy of NMES in attenuating muscle atrophy following major
abdominal surgery.
Methods: Fifteen patients undergoing open colorectal resection were
recruited to a split body randomised control trial and their lower
limbs randomised to control (CON) or NMES (STIM). The STIM
limb underwent 15 minutes of quadriceps NMES twice daily on
postoperative day (POD) 1 to 4. Ultrasound measurement of
Vastus Lateralis (VL) cross sectional area (CSA) and muscle thickness
(MT) was made preoperatively and on POD 5, as was
dynamometer measurement of knee extensor strength (KES). All
outcomes were analysed using linear mixed model techniques.
The study was approved by NHS research ethics committee (ref 20/
EM/069).
Results: NMES significantly reduced the loss of CSA (-2.52% vs -9.16%,
p<0.001), MT (-2.76% vs -8.145, p=0.001) and KES (-10.35% vs -19.69%,
p=0.03). No adverse events occurred, and patients reported that NMES
caused minimal or no discomfort.
Conclusions: NMES reduces loss of muscle mass and function following
major abdominal surgery and may be an important tool in aiding
recovery to normal activity levels. This will be especially important in
preventing postoperative loss of independence in the increasingly
physiologically frail patients undergoing major abdominal surgery.
Further studies should establish the efficacy of bilateral whole-leg
NMES for improving patient-centred outcomes.
Abstract citation ID: znac246.002
BJS Prize 2
Exploring variation in surgical practice: the colorectal
surgeon’s personality influences anastomotic
decision-making in rectal cancer
Carly Bisset1,2, Eamonn Ferguson3, Raymond Oliphant4,
Ewan Macdermid5, Susan Moug6,2, Plato Project Steering Group
1
University of Aberdeen, UK
2
Dept of General Surgery, Royal Alexandra Hospital, UK
3
Dept of Psychology, University of Nottingham, UK
4
Dept of General Surgery, Raigmore Hospital, Inverness, UK
5
Dept of Colorectal Surgery, Bankstown-Lidcombe Hospital, NSW, Australia
6
University of Glasgow, UK
Background: The influence of internal surgeon-specific factors, such as
personality, on cognitive bias and decision-making in surgery is not well
understood. These factors may be particularly influential in clinical cases
where there is a high degree of equipoise. This study aimed to explore
personality traits that may influence anastomotic decision-making in
rectal cancer.
Methods: Colorectal surgeons were invited via social media to
participate in a 2-part online survey (Snap11). The survey included: 1)
44-item Big Five Inventory (personality), 2) 30-item DOSPERT
(risk-taking), 3) 3-item Cognitive Reflection Test (thinking style), and
twenty hypothetical patient scenarios involving rectal anastomotic
decisions.
Results: 186 certified colorectal surgeons participated with 127
completing both parts (68.3%). 143 participants in this cohort were
aged 30–49 years (79.6%) and 131 participants were male (70.4%).
Surgeons scored higher than average population levels for emotional
stability (degree of even-temperedness; 3.25 vs 2.97), with lower levels
of agreeableness (ability to cooperate with others; 3.03 vs 3.74) and
openness (creativity; 3.19 vs 3.67). Personality influenced anastomotic
decision-making in specific circumstances e.g., high levels of
openness predicted stoma formation when providing a second
opinion, whereas high levels of extraversion predicted stoma
formation when the patient was a staff member. Early career surgeons
were highly influenced by colleague criticism following recent
anastomotic leakage.
Conclusions: Surgeon personality influences anastomotic decision-
making in difficult circumstances. Colleague support is vital following
anastomotic leakage and is influential upon early career surgeons’
subsequent decision-making. Personality is modifiable through
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experiences, therefore targeted educational interventions (e.g.
reflexivity) may enable surgeons to recognize their own cognitive biases.
Abstract citation ID: znac246.003
BJS Prize 3
PPE-induced systemic hypercapnic-hypoxaemia: translational
implications for impaired cognitive-clinical-functional
performance
Oliver Luton1, Benjamin Stacey2, Katie Mellor3, Richard Egan1,4,
Damian Bailey2, Wyn Lewis1
1
Health Education and Improvement Wales’ School of Surgery, Tŷ Dysgu, Cefn
Coed, Nantgarw, UK, CF15 7QQ
2
Neurovascular Research Laboratory, Faculty of Life Sciences and Education,
University of South Wales, Treforest, UK, CF37 4AT
3
Health Education and Improvement Wales’ School of Surgery, Tŷ Dysgu, Cefn
Coed, Nantgarw, UK, CF15 7QQ
4
Department of Surgery, Morriston Hospital, Swansea, UK, SA6 6NL
Background: Personal Protective Equipment (PPE) has been reported to
adversely influence pulmonary gas exchange, resulting in systemic
hypercapnic-hypoxaemia and cerebral hyperperfusion-induced
cephalalgia. This study aimed to determine to what extent these
changes impact functional cognition and manual dexterity given their
relevance to surgical performance.
Method: Thirty-one surgical trainees (20 male, 11 female, aged 29 yr.
(29.2 ± 2) participated in a randomised single-blind repeated measures
crossover trial, completing one-hour of standardised laparoscopic
simulation tasks, on two separate occasions (same day), once in
Standard Operating Attire (SOA), and once in full PPE (including FFP3
mask). Global Cerebral Blood Flow (gCBF) was determined using
duplex arterial ultrasound. Cognition and manual dexterity were
assessed by timed Grooved Pegboard and a novel measure of
laparoscopic bead placement.
Results: Following one-hour of simulation, PPE (compared with SOA)
increased heart rate (93 ± 13 b/min vs. 79 ± 13 b/min, p=0.001),
decreased peripheral O2 saturation (96.9% ±1% vs. 97.9% ±1%,
p=0.001), increased gCBF (Δ+7 ± 8 mL/min/100g vs. + 1 ± 11 mL/min/
100g, p=0.016; reflecting hypercapnic-hypoxic cerebral vasodilatation)
and skin temperature increased by 0.6°C (p=0.001). Cephalalgia was
reported by 21 (67.7%) participants wearing PPE vs. 13 (41.9%) wearing
SOA (p=0.001). Dominant hand pegboard and laparoscopic bead
performance were both impaired by PPE: 71.1s (±12) vs. 61.4s (±12),
p=0.001; 270.7s (±135) vs. 192.5s (±67), p=0.001 respectively.
Conclusion: Collectively, these findings are the first to demonstrate that
PPE-induced systemic hypercapnic-hypoxaemia is associated with
important impaired cognitive-clinical-functional performance that
may have a cerebrovascular basis.
Abstract citation ID: znac246.004
BJS Prize 4
PANC Study (Pancreatitis: A National Cohort Study)
Angeliki Kosti1 On behalf of PANCStudy2
1
Southmead Hospital, North Bristol NHS Trust
2
Somerset NHS Foundation Trust
Aims: Acute pancreatitis (AP) is a common, yet complex, emergency
surgical presentation. Multiple guidelines exist and management can
vary significantly. This first UK, multicentre, prospective audit aims to
assess variation in management of AP to guide resource planning and
optimise treatment.

Method: All patients ≥18 years presenting with AP, as per the Atlanta
criteria, from March-April 2021 were included and followed up for 30
days prospectively. Anonymised data was uploaded to a secure
electronic database in line with local governance approvals.
Results: 113 hospitals contributed data on 2580 patients, with 1287
(49.8%) female and a mean age of 57 years. The aetiology of AP was
gallstones in 50.6% (n=1306), alcohol in 17.5% (n=452) and idiopathic
in 22.4% (n=579). 34.7% (n=893) received antibiotics within 48 hours of
which 4.7% (n=121) had confirmed infection. CT was performed in
54.5% (n=1406), most commonly within 24 hours of admission (41%).
MRCP was performed in 39.9% (n=1029); gallstones were diagnosed in
18.3% (48/262) who had not been seen on ultrasound. EUS was
performed in 1.1% (n=29). 34.1% (n=441) of patients with gallstone
disease underwent cholecystectomy by 30 days.
Conclusion: Management of AP in the UK deviates from national and
international guidelines. Recommendations include improving
antibiotic stewardship, further investigation to be performed
in idiopathic cases of AP, consideration of further biliary
imaging when looking for gallstones and improving appropriate
timing of CT. Further work will look at guidance for diagnostic
pathways and development of protocols for ambulatory management
in mild AP.
Sustainability Session Abstracts
Abstract citation ID: znac246.008
Sustainability Prize 1
Green Endoscopy to reduce CO2e generated by endoscopic
waste – the GECO2e interventional study
João A. Cunha Neves1,2, Joana Roseira1,2, Patrícia Queirós1,2,
Helena Tavares de Sousa1,2, Gianluca Pellino3,4, Miguel Cunha5,2
1 could contribute to the current Greener NHS trajectories: a Net Zero
Department of Gastroenterology, Algarve University Hospital Centre, Portimão,
Portugal
2 Reference: 1. WHO Guidelines on Hand Hygiene in Health Care: First
Department of Biomedical Sciences and Medicine, University of Algarve, Faro,
Portugal
3 Health Organization; 2009. 13, Surgical hand preparation:
Department of Advanced Medical and Surgical Sciences, Universitá degli Studi
della Campania “Luigi Vanvitelli, Naples, Italy
4
Colorectal Surgery, Vall d’Hebron University Hospital, Barcelona, Spain
5
Colorectal Disease Group - Department of General Surgery, Algarve University
Hospital Centre, Portimão, Portugal
Aims: Endoscopy is healthcare’s third-largest waste-generating
procedure. This study aimed to measure a single unit’s waste carbon
footprint and to perform a pioneer evaluation applying the principles
of green endoscopy towards a more sustainable unit.
Methods: This was a 3-stage, prospective study. Stage 1: 4-week
observational audit, during which daily endoscopic waste (landfill,
biohazard) was weighed. Stage 2: 1-week intervention with
presentation of retrieved data and education of the team towards
waste handling. Recycling bins were placed in endoscopy rooms, and
landfill and biohazard bins were relocated. Stage 3: 4-week
post-interventional period, during which daily endoscopic waste was
weighed. An engineer-calibrated scale was used. Equivalence of 1kg of
landfill waste to 1kg carbon dioxide equivalent (CO2e) and 1kg of
biohazard waste to 3kgCO2e was applied. Paired samples T-tests were
used for comparisons before and after the intervention. The opinion
of the staff was collected.
Results: Total waste and biohazard waste were diminished by 12.2%
(p=0.166) and 41.4% (p=0.010), respectively, whereas landfill waste
(p=0.059) and recycling waste increased (paper: p=0.001; plastic:
p=0.007). In terms of CO2e, a total decrease of 31.6% (138.8kgCO2e) was
found (mean kgCO2e 109.7 vs 74.9, pre- vs post-intervention, p=0.018).
Mean endoscopy load was similar (46.2 vs 44.5, p=0.275). The
endoscopy unit may achieve an estimated annual reduction of
1665.6kgCO2e. The personnel agreed “the project did not disturb daily
work”.
Conclusions: In this interventional study applying green endoscopy
principles to a real-world scenario, biohazard waste reduction and
daily recycling were achieved, without compromising endoscopy
productivity.
Abstract citation ID: znac246.009
Sustainability Prize 2
Calculating the Carbon Footprint of Surgical Scrubbing
Abstracts | v3
Ella Cannings1, Cleo Kenington2, Kofi Cox1
1
St George’s University of London
2
St George’s Hospital
Aims: This study aims to measure the estimated carbon emissions that
could be saved if alcohol-based hand rubs (ABHRs), which have been
shown to be as effective at antisepsis as antimicrobial soap and hot
water (1), are used to scrub for all operations at a UK teaching hospital
over 1 year.
Methods: The number of operations performed during October 2021 was
obtained via hospital database.
Across 25 cases, the volume of water per case was estimated by
multiplying the time using water by the volume calculated per second
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flow. This data was used to calculate an estimate of the total volume
of hot water used per year and therefore the carbon, cost, and water
savings that could be made.
Results:
Parameter Value
Number of cases in 1 month 1910
Mean number scrubbing per case 3.43 (+/- 1.32)
Mean time per scrub 148.65 seconds
Mean flow rate 8.32 L/min
Mean volume water per case 70.1 litres, SD 36.482
Estimated volume of water per year 1,606,692 litres
CO2 emissions were calculated from the energy production of heating this
water.
Conclusion: This study shows that 2.2 tonnes of carbon could be saved
in a year if a single teaching hospital converted to ABHR. The outcome
NHS by 2050.
Global Patient Safety Challenge Clean Care Is Safer Care. Geneva: World
state-of-the-art.
Abstract citation ID: znac246.010
Sustainability Prize 3
Surgeons’ awareness and opinions on sustainability in
surgery: the ECOS-Surgery global survey
ESCP ECOS-Surgery Collaborators, Miguel Cunha
European Society of Coloproctology ESCP
Aims: Healthcare is one of the largest waste-generating activities
contributing to climate change, with surgery the most energy-intense
sector. This international survey aimed to evaluate current
understanding and perspectives of colorectal surgeons on
sustainability, with a specific focus on surgical practice.
Methods: The European Society of Coloproctology (ESCP) designed an
online survey - ECOS-Surgery (ESCP Collecting Opinions on
Sustainable Surgery). Questions were divided into three sections to
capture demographic characteristics of participants, their awareness
on global sustainability with its application to surgical practice, and
their perspectives on future directions in sustainability.
Results: 370 participants from 57 countries answered the survey
(median age 39; 75% men; 73% consultant surgeons). Around 60% of
them were unaware that the health sector contributed to global
greenhouse gas emissions. Delivering sustainable surgery was
perceived as a matter of great importance for most (92%), and 97% of
participants were willing to change their practice to improve
sustainability. However, 78% of them had no local or national
guidance on this subject. Lack of understanding by the surgical
community was recognised as the primary key barrier in improving
sustainable pathways (63%). Research in sustainability was perceived
to play a role in improving sustainability in surgery by the majority
(97.5%). Promoting healthy lifestyle among patients (38%) and use of
low-carbon alternatives in surgery (29%) were the solutions most
commonly suggested.
Conclusion: Our survey shows the surgical community’s interest in
supporting a sustainable surgery pathway, although underlining the
lack of contemporary guidance/support to achieve this goal.
v4 | Abstracts
Abstract citation ID: znac246.011
Sustainability Prize 4
Back to the future: Re-introducing Reusable gowns to achieve
#NetZeroSurgery
Jasmine Winter Beatty1,2, Jonathan Gan1, Henry Robb1, Simon Dryden1,
Patricia Ortega2, Sanjay Purkayastha1,2
1
Department of Surgery & Cancer, Imperial College London, London, UK
2 entire cohort was 9.74% and 13.96% for the over 70’s. Mean NELA-RPT
Imperial College Healthcare NHS Trust, London, UK
Aims: In view of the planetary health emergency, we aimed to introduce
an efficient and safe intervention to rapidly decrease the environmental
impact of our surgical department whilst delivering financial and social
benefits.
Methods: The project was registered with the Audit and Quality
Improvement Department. Carbon hotspot identification and process
mapping were performed.
A survey of theatre staff members was completed prior to the trial to
ensure agreement.
Disposable surgical gowns were replaced with reusable gowns in two
theatres. Where appropriate, reinforced gowns were substituted with
standard gowns.
Staff were notified and posters made to remind them of correct removal
procedures.
Environmental savings were estimated using published figures (Vozzola
et al. 2018) and weights. Trust procurement data from 2019 was used to
estimate financial and environmental savings. Staff evaluations were
collected.
Preliminary results were shared with heads of surgical specialties,
surgical managers, A&E, ITU and Anaesthesia across the trust.
Results: 97.7% (74/77) of staff were favourable to trying the reusable
gowns prior to the trial. 91.3% (42/46) gave positive feedback after
testing them clinically and 97.8% (45/46) were happy to continue using
them again.
3051 gowns were substituted over 6 months, leading to a saving of 3.292
tonnesCo2e. Savings were estimated at £366 from reductions in waste
disposal and standard gown use.
Conclusions: Approval has been gained to extend the trial across the
trust and a business proposal is being considered.
Scaled to the whole trust this intervention could save 234.7 tonnesCO2e/
year, equivalent to driving a car around the equator 23.6 times.
NELA Prize Abstract
Abstract citation ID: znac246.012
NELA Prize
The correlation between actual and predicted 30-day mortality
for emergency laparotomies in adults, using National
Emergency Laparotomy Audit (NELA) risk predicting tool – a
multi-center, retrospective, observational, cohort study.
Andrei Moscalu1,2, Balakrishnan Saravanan3, Aryal Kamal3,
Martin Sinclair2
1
Brigham and Women’s Hospital/Harvard Medical School, Boston, USA
2
Ipswich Hospital, UK
3
James Paget University Hospital, UK
Background: Emergency laparotomy (EL) is associated with a high
30-day-mortality (30-dm) risk. More than 22,000 EL are performed
annually in the UK, half of patients being ≥70 years. To improve
patient outcomes, reliable preoperative risk assessment is of
paramount importance. 30-dm can be assessed by a multitude of
tools, including the National-Emergency-Laparotomy-Audit risk
prediction tool (NELA-RPT). No one tool is perfect in preoperative risk
prediction, with over or underprediction requiring special
consideration.
Methods: This is a multi-center, retrospective, observational, cohort
study investigating the correlation between predicted 30-dm using
NELA-RPT and actual 30-dm in patients aged ≥18, following EL, in two
UK District General Hospitals, over a 2-year period. The correlation
between actual 30-dm and the: day of the week the laparotomy
took place, subspecialty of the main surgeon, grade of surgeon
or primary-procedure performed were also analyzed. Sample size
was calculated at 385. Statistical analysis was done using Stata
Version 14.2.
Results: 626 cases were analyzed. Male/female ratio was 1.17 and mean
age 66.03. 50.65% cases were ≥70 years of age. Actual 30-dm for the
30-dm was 9.8% and 14.01% for over 70’s. There was no statistically
significant association between actual or NELA-RPT 30-dm and
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the day of the week the laparotomy took place, the subspecialty of the
main operating surgeon, the grade of the main surgeon or the
primary-procedure performed.
Conclusion: NELA-RPT is a tool that can reliably estimate the 30-dm risk
following EL.
Short Paper of Distinction
Abstract citation ID: znac246.013
SPOD1
Effect of BMI on Safety of Bariatric Surgery during
the COVID-19 pandemic, Procedure Choice, and Safety
Protocols – an analysis from the GENEVA Study
Rishi Singhal1, Islam Omar2, Brijesh Madhok3, Christian Ludwig4,
Abd A Tahrani5, Kamal Mahawar6,7
1
Upper GI unit, University Hospital Birmingham NHS Foundation Trust, UK
2
General Surgery Department, Wirral University Teaching Hospital NHS
Foundation Trust, UK
3
Upper GI unit, University Hospital of Derby and Burton NHS Foundation Trust,
UK
4
Institute of Metabolism and Systems Research, College of Medical and Dental
Sciences, University of Birmingham, Birmingham, UK
5
Institute of Metabolism and Systems Research, College of Medical and Dental
Sciences, University of Birmingham, Birmingham, UK; Centre for Endocrinology,
Diabetes, and Metabolism, Birmingham Health Partners, Birmingham, UK;
Department of Diabetes and Endocrinology, University Hospitals Birmingham
NHS Foundation Trust, Birmingham, UK
6
Bariatric Unit, South Tyneside and Sunderland NHS Foundation Trust,
Sunderland, UK
7
University of Sunderland, UK
Background: It has been suggested that patients with a Body Mass Index
(BMI) of >60 kg/m2 should be offered expedited Bariatric Surgery (BS)
during the Coronavirus Disease-2019 (COVID-19) pandemic. The main
objective of this study was to assess the safety of this approach.
Methods: We conducted a global study of patients who underwent BS
between 1/05/2020 and 31/10/2020. Patients were divided into three
groups according to their preoperative BMI - Group I (BMI<50 kg/m2),
Group II (BMI 50–60 kg/m2), and Group III (BMI>60 kg/m2). The effect of
preoperative BMI on 30-day morbidity and mortality, procedure choice,
COVID-19 specific safety protocols, and comorbidities was assessed.
Results: This study included 7084 patients (5197;73.4% females). The
mean preoperative weight and BMI were 119.49±24.4 Kgs and 43.03
±6.9 Kg/m2, respectively. Group I included 6024 (85%) patients,
whereas Groups II and III included 905 (13%) and 155 (2%) patients,
respectively.
The 30-day mortality rate was higher in Group III (p=0.001). The
complication rate and COVID-19 infection were not different.
Comorbidities were significantly more likely in Group III (p=<0.001).
A significantly higher proportion of patients in group III received
Sleeve Gastrectomy or One Anastomosis Gastric Bypass compared to
other groups. Patients with a BMI of >70 kg/m2 had a 30-day
mortality of 7.7% (2/26). None of these patients underwent a
Roux-en-Y Gastric Bypass.
Conclusion: The 30-day mortality rate was significantly higher in
patients with BMI >60 kg/m2. There was, however, no significant

difference in complications rates in different BMI groups, probably due
to differences in procedure selection.
Abstract citation ID: znac246.014
SPOD2
Microvesicles as biomarkers for the screening of colorectal
neoplasm
Mohammad Eddama1,2, Rijan Gurung1, Konstantinos Fragkos3,
Richard Cohen4, Marilena Loizidou1, Lucie Clapp5
1 Arun Krishna, Giovanni Ferrara, Joshua Edwards, Baber Chaudhary,
Research Department of Surgical Biotechnology, University College London,
London, UK
2 Ysbyty Gwynedd, Betsi Cadwaladr University Health Board
Department of General Surgery, University College Hospital, London, UK
3
Department of Gastroenterology, University College London, London, UK
4 Aim: NICE recommends that a FIT <10µgHb/g may not warrant an
Division of Surgery and Interventional Science, University College London,
London, UK
5 assess outcomes at a local level for FIT <10µgHb/g. Secondary aims
Institute of Cardiovascular Sciences, University College London, London, UK
Background: Colorectal cancer (CRC) is the second cause of cancer death
worldwide. Screening for CRC by Faecal Immunochemical Test (FIT)
aims to detect early cases before symptoms occur. Yet, the FIT has
poor predictive value and low compliance rate. To address this, the
role of circulating microvesicles as potential screening tool is a novel
approach that warrants prioritised research.
Methods: In a two-gate diagnostic accuracy study, 35 patients with
benign colorectal polyps (BCRP) (n=16) and colorectal cancer (CRC)
(n=19) were compared to 17 age-matched healthy controls. Total
annexin-V positive microvesicles and sub-populations positive for
selected biomarkers relevant to bowel neoplasm were evaluated in
patients’ plasma using flow cytometry.
Results: Total plasma microvesicles, and sub-populations positive for
CD31, CD42a, CD31+/CD42a-, EPHB2, ICAM and LGR5 (component
factor-1) were able to identify patients with BCRP and CRC with a
receiver operator curve (AUC) accuracy of a 100% (95% CI: 100% to
100%) and 95% (95% CI: 88% to 100%) respectively. To identify patients
with BCRP, a cut-off point value of component factor-1 ≥761
microvesicles/µL demonstrated a 100% sensitivity, specificity and
negative predictive value (NPV) and a 93% positive predictive value
(PPV). To identify patients with CRC, a cut-off value of component
factor-1 ≥439 microvesicles/µL demonstrated a 100% sensitivity,
specificity and NPV and a 65% PPV. CEA+ microvesicles sub-population
were significantly (p<0.02) higher in CRC in comparison to BCRP.
Abstracts | v5
Conclusion: Microvesicles as biomarkers for the early detection of CRC
is a simple and effective tool that yields a potential breakthrough in
clinical management.
Abstract citation ID: znac246.015
SPOD3
F.I.T for Discharge? Role of Faecal Immunochemical Testing
(FIT) in ruling out Primary Bowel Cancer: A review of current
outcomes.
Anil Lala
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Urgent Suspected Cancer (USC) Referral. Our primary aim was to
included whether a high FIT(>100µgHb/g) determines increased
cancer risk and whether a moderate FIT(10–100µgHb/g) warrants USC
inv: estigations.
Methods: A retrospective review of all symptomatic patients who
received a FIT in a District General Hospital in North Wales between
June-December 2020. These were divided into 3 groups: negative
FIT(<10µgHb/g), moderate FIT(10–100µgHb/g) and high FIT(>100µgHb/
g). The results of any subsequent investigations such as Endoscopies,
CT Colons or CTs were recorded along with the histology results from
polyps/biopsies/specimens from Endoscopy/Surgery. Simple
sensitivity and negative predictive value(NPV) analyses were
performed.
Results: A total of 722 patients returned a FIT result. 544 were negative,
106 moderate and 72 high. 2/544(0.37%) in the negative FIT group had
cancer, however histology of both showed Squamous Cell Carcinoma
from Anal Cancer. 3/106(2.83%) in the moderate FIT and 15/72(20.83%)
in the high FIT group had cancer. Polyp histology demonstrated
high-grade dysplasia in 2(2.78%) in the high, 2(1.89%) in the moderate
and 0 in the negative group. FIT sensitivity of 90% and NPV of 99.62%
was demonstrated.
Conclusions: A negative FIT can adequately exclude primary bowel
cancer in symptomatic patients. Patients with high FIT could proceed
“straight-to-test”, while moderate FIT may need further outpatient
assessment. Inappropriate investigations and delayed diagnosis have
drastic clinical and financial implications.

Short Papers
Abstract citation ID: znac247.001
SP1.1.1 Barriers for cadaveric kidney organ utilisation: Results
of a National Transplant Access to Theatre (NTACT) pilot study
Mariyam Mujeeb1, Balint Borbas1, Andrei Tanase2, Somaiah Aroori3
1
University of Plymouth
2
University Hospitals Plymouth NHS Trust
3
Univerity Hospitals Plymouth NHS Trust
Aims: There are various barriers to cadaveric organ utilisation across
the UK. However, there is a paucity of data on these barriers after the
arrival of organ/s at the implanting centre. We set up the national
“NTACT” study to identify barriers after arrival of organs at
implanting centre.
Methods: Prospective pilot study collecting data on adult kidney/
pancreas cadaveric organs across five UK centres in July 2021. Data
collected includes time intervals between significant checkpoints prior
to transplantation and perceived reasons for delays after arrival at
implanting centre. Data was recorded on RedCap and analysed for
delays using descriptive statistics.
Results: Between five transplant centres, data was entered on 27
transplants. Five patients were excluded from the study (live
transplant-2, incomplete data-3). There were six donation after
circulatory death (DCD) and 16 donation after brainstem death (DBD)
organs. Fifty percent (n=3/6) of DCD and 12.5% (n=2/16) of DBD
allografts surpassed the national recommendations for cold ischaemia
time (CIT). Majority of cross-matches were virtual (15-virtual and
seven-full). Delays included cross-match results (median=03:37:30),
time between arrival of the kidney and patient into theatre
(median=03:13:00), time between anaesthetic induction and knife to
skin (median=00:52:00). The median warm ischaemia time was
00:41:30 (IQR-00:33:00–00:49:30). Qualitative answers highlight themes
including “surgical team occupied in another case”, “emergency
theatre occupied”, and “porter availability for transporting patients”.
Conclusion: Our pilot study identified various barriers to implantation,
and a significant proportion of kidneys are implanted beyond nationally
accepted CIT. Further work is required to get a national picture over an
extended period.
Abstract citation ID: znac247.002
SP1.1.2 The significant impact of using virtual cross match on
achieving 100% within-18 hour target of cold ischaemia time in
transplanting kidneys from donors following brain death in a
single centre in UK
Sadia Tasleem, Sharlene Austin, Veronica Lennon, William Mckane,
Ravi Pararajasingham, Yazin Marie
Sheffield Kidney Institute, Northern General Hospital
Aims: To evaluate the impact of virtual cross match in donation
following brain death (DBD) kidney transplants on the cold ischaemia
time (CIT) as one of the factors in achieving better renal graft outcomes.
Methods: Every patient on the deceased donor renal transplant waiting
list in our centre was asked to give a blood sample to test for Human
Leucocyte Antigen (HLA) antibodies. Our transplant coordinators
ensured that this process is updated three monthly as part of the
eligibility criteria to perform virtual cross match.
Other factors contributing to CIT were intentionally ignored given that
there are no significant changes in the kidney allocation scheme or
kidney acceptance criteria. Comparison was made between CIT in the
financial years 2014/ 2015 and 2020 /2021.
Results: Since the introduction of this strategy, our centre was the only
centre in all 23 UK kidney transplant centres to achieve 100%
transplantation within 18 hour CIT for DBD kidneys transplants in the
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BJS, 2022, 109(Supplement 5) v6–v39
https://doi.org/10.1093/bjs/znac247
Abstracts
financial year 2020/2021. This represented a significant improvement
compared to 58% in the financial year 2014/2015.
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Conclusions: Virtual cross match was a key factor in achieving the 18
hours target for DBD kidney transplant regardless of other
contributing factors. It is highly recommended that a three-monthly
screening for HLA Antibodies is regularly performed to achieve this
result.
Keywords: virtual cross match, cold ischaemia time, kidney
transplant, donation following brain death
Abstract citation ID: znac247.003
SP1.1.3 Feasibility, safety and cost effectiveness of outpatient
removal of ureteric stent following kidney transplantation
Sadia Tasleem1, Kartik Shetty1, Nadia Gulnaz2, Nathan Chidambaram1
1
Sheffiled kidney institute, Northern General Hospital
2
Hull Royal Infirmary, Hull
Aims: The aim of this study was to evaluate the feasibility, safety, and
costs associated with a dedicated flexible cystoscope for the removal of
ureteric stents from transplant recipients in the outpatient setting.
Methods: In our centre, we routinely performed post renal transplant
ureteric stent removal in theatres. Recently we have switched this practice
to outpatient settings. We performed retrospective analysis of prospectively
collected data from two settings between Aug 2018-Dec 2021 to compare
the impact on the timing of post renal transplant ureteric stent removal,
associated complications, cost effectiveness and patient satisfaction.
Results: In total 99 ureteric stents were removed from 100 transplant
recipients in theatre and 100 stents in outpatient department. 2
patients in clinic cohort did not tolerate procedure under LA. 5
patients in theatre cohort and 6 patients in clinic cohort underwent
PD catheter removal in theatres along with stent removal.
Earlier stent removal was achieved in clinic compared with theatre with
(36 versus 55 days after transplant; p=0.001)
There was no statistically significant difference in infection rates
following stent removal in either groups.
Outpatient stent removal proved to be very cost effective to the trust
with savings of over £250 per procedure in comparison to the theatre
setting.
Patient satisfaction was measured by numerical rating score for pain and
discomfort which showed that the patients tolerated the outpatient
procedure under local anaesthesia very well,(mean score 4/10).
Conclusions: A dedicated outpatient ureteric stent removal service
for kidney transplant recipients seems to be feasible, cost effective,
and safe.
Abstract citation ID: znac247.004
SP1.1.4 Caveat Chirurgicus - Opioid use following surgery
Kesav Aditya Vijayagopal, Talal Majeed, Jeremy Wilson, Conor Magee
Wirral University Teaching Hospital
Introduction: Over the last 20-years there has been increasing opioid
related deaths, in the context of a worldwide epidemic of misuse
including addiction and overdose. Startlingly, opioid commencement
is usually iatrogenic. Most published data is from the USA with little
evidence from UK surgical practice.
Methods: Retrospective analysis of surgical unit opioid prescriptions.
Data included opioids prescribed on discharge, 1, 3- and 6-months
post-discharge usage and milligrams-of-morphine equivalence(mgEq)
used to compare regimes.
Results: One hundred cases reviewed. 35% of patients were opioid naïve
on admission and of these 20%, 5.71% and 8.57% remained on opioids at
1, 3- and 6-months post discharge respectively.

Females more likely to remain on long-term opioids at 6 months at
lower doses (42% v 30%).
Only 6% of discharge summaries recommended GP follow-up and
assessment of opioid requirements. Furthermore, none were
prescribed a tapering dosage regime on-discharge.
Patients receiving Acute Pain Team reviews, more likely to remain on
long-term opioids, at lower doses (30.67mgEq, 29.25mgEq and
32.63mgEq at 1-, 3- and 6-months post-discharge) compared to those
without (69.16mgEq, 74.25mgEq and 65.13mgEq).
Only 11% of patients with pre-existing opioid prescriptions were
reviewed by the acute pain team.
Worryingly, no documented assessment of opioid misuse risk in
patients.
Conclusion: Standardised assessments i.e., opioid Risk Assessment
Tools and mgEq need to be documented and monitored in primary
and tertiary care. Acute pain team services should be offered to more
patients. Our study hopes to raise awareness of the need for effective
opioid stewardship in surgical patients.
Abstract citation ID: znac247.005
SP1.2.1 The Theatre Training Checklist (TTC): A toolkit to
improve training within the operating theatre
Joanna Aldoori1, Mark Peter2, David O’Regan1, Andrew Robson1
1
Leeds Teaching Hospitals NHS Trust
2
Calderdale and Huddersfield NHS Foundation Trust
Aims: The operating theatre is a crucial learning environment for
different trainees (nurses, anaesthetists, surgeons etc.) Equity of
access is essential to achieve their individual training requirements.
Traditionally, opportunities within a theatre list are informally
discussed between trainers and trainees at some point during the list.
Furthermore, there is currently limited discussion between different
members of the full team. The Theatre Training Checklist (TTC) is a
simple framework that aims to facilitate coordination of training for
all team members.
Methods: The TTC was devised as an extension of the WHO checklist. It
consists of four stages: Trainer/Trainee discussion before theatre brief
regarding training goals for the list, formal identification of all trainees
within the theatre brief, explanation to the team of what each trainee
will undertake, followed by use of theatre debrief to reprise whether
training goals were met. The TTC was piloted and outcomes measured
using an anonymised structured questionnaire from across the entire
team.
Results: 27 staff participated, including 7 trainees. Individuals’
understanding of trainees’ objectives improved as a result of the TTC
(25/27, 92.6%) along with perceived improved theatre list efficiency
(18/27, 66.6%). All trainees agreed that the checklist improved
achievement of their training objectives. Qualitative feedback
included: “This is a great way to identify what students and trainees want
to achieve in theatre and how we can work together to overcome any difficulties”
Conclusion: Initial data suggests the checklist qualitatively improves
training. The TTC Toolkit is available for use and consists of the
checklist tool and an instructional video.
Abstract citation ID: znac247.006
SP1.2.2 Core Surgical Training Bootcamp- a five year review
Oliver Brewster, Louise Merker, Richard Bamford
Severn School of Surgery
Aims: Surgical bootcamps may improve abilities across cognitive,
affective and psychomotor domains. This deanery bootcamp is an
intensive program involving induction, focussed teaching of core
content, technical and non-technical skills. We aim to describe the
successes and areas for development for this course through five
years of feedback.
Method: A free three-day programme is delivered with lectures,
workshops, skills teaching and simulation. Trainees are loaned
equipment for self-taught surgical skills practice and laparoscopic
simulation. Trainees must meet simulator proficiency targets which
may improve early laparoscopic skills. Five years of feedback was
analysed and previous attendees were contacted for retrospective
focussed feedback.
Results: Across five years, 96–100% of trainees reported that they
enjoyed the experience and would recommend attendance to others.
Abstracts | v7
88–100% felt more confident to assess a surgical patient and 100% of
responding attendees felt more prepared to begin core training. In the
retrospective survey, 75% felt that Bootcamp helped them to get the
best out of training and 70% felt that Bootcamp had improved their
chances of passing annual progression meetings. There is evidence
that attendance at induction core surgical bootcamps correlates with
appointment to a national training number. In our study 50% of
attendees regarded Bootcamp as helpful towards gaining their
specialty training post.
Conclusion: This annual deanery bootcamp has benefited from five
years of feedback and improvement. The program has evolved to
reflect changes in the surgical curriculum and to tackle new
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challenges in education. We believe that each deanery should offer
this and our format is applicable nationally and internationally.
Abstract citation ID: znac247.007
SP1.2.3 The SIMple Things: Using Simulation Models to
Improve Junior and Undergraduate Surgical Teaching in a DGH
Nikki Bruce
NHS Borders
Aims: Many clinical activities remain cancelled or uncertain in the
COVID world. We established a Surgical Skills Club in our DGH, where
students and juniors are rotated far from their home institution. We
also aimed to improve our undergraduate teaching by incorporating
new surgical Sim sessions.
Methods: We established a weekly Surgical Skills Club by trainees, and
promoted this through MedEd to all juniors, students and ANPs. We
used a combination of higher-fidelity models owned by the hospital
and low fidelity models designed by ourselves such as lap-appendix
and hernia. We utilised social media to share ideas. We recorded
attendance and sought written feedback. We also set up dedicated
simulation sessions as part of ongoing undergraduate teaching.
Results: Anonymous feedback was documented weekly via app/online.
For skills club, 100% of attendees documented experience as “great” or
“good” (options great, good, average, fair, poor). Attendance varied
from 2–15 each week. The best attendance was a formalised session
with consultant input. For undergraduate Sim, 100% of attendees
rated experience as “great” or “good”. All attendees agreed Sim
teaching improved their experience of surgery. 20% stated it made
them consider a career in surgery.
Conclusions: Surgical simulation is an excellent tool for improving
experience of general surgery especially in a COVID environment, and
can widen access to surgical training by allowing juniors to explore their
skills in a controlled, informal environment. Lap Skills gave students
real-world confidence. A combination of low fidelity models provided the
best experience showing that the barrier of cost can be broken.
Abstract citation ID: znac247.008
SP1.2.4 A pilot study: Developing bespoke high volume low
complexity (HVLC) theatre lists with a focus on training,
in order to address the impact of COVID-19 on training
and elective waiting lists
Tarak Agrebi Moumni Chouari, Sarah Zhao, Georges Rizkallah,
Narisu Yang, Stella Vig, Nikheel Patel, Akriti Nanda
Croydon University Hospital, NHS Trust
Introduction: We are faced with long waiting lists coupled with a loss of
training opportunities for surgical trainees as a result of COVID-19. It is
imperative to ensure training opportunities are optimised and trainees
are encouraged to contribute to the service recovery efforts we are faced
with.
Methods: A pilot ‘the hernia fest’ was undertaken with the aim of
training core trainees, supporting senior trainees as independent
practitioners coupled with supporting the delivery of high volume,
low complexity (HVLC) care. Parallel bespoke theatre lists with the
grouping of specific cases (hernias), have been run with a consultant
surgeon overseeing 2–3 lists. Each list includes a selected senior
trainee who is suitable to train colleagues. Cases were screened prior
to booking. All theatre staff were briefed on the purpose of the lists.
All patients, trainees and theatre staff completed a questionnaire.
Results: 50 hernia training cases were carried out over 15 sessions. 100%
of patients were confident with their treatment and would recommend
v8 | Abstracts
the service. 100% of trainees felt they had progressed in their operative
competence and skill acquisition. 100% of trainees were satisfied. Senior
trainees enjoyed the responsibility of running an independent list. 100%
of theatre staff felt they would participate in future lists.
Conclusion: This model cultivates a learning environment whilst
addressing waiting lists. The grouping of operations together allows
for repetitive practice and may encourage rapid skill acquisition. We
discuss lessons learnt and a proposed framework & checklist which
can be applied to the future planning of such lists.
Abstract citation ID: znac247.009
SP1.2.5 A Prospective Evaluation of Out of Hours Operations:
Informing ENT Training Bootcamps
Henry Dunne1, Tony McGilligan2
1
Cambridge University Hospital
2
Brighton and Sussex University Hospital
Introduction: All trainees are invited to attend national trainee
bootcamps upon commencing ENT speciality training. This induction
course uses simulations to teach technical and non-technical skills
and includes teaching on various emergency procedures. We aimed to
prospectively record which procedures are being performed out of
hours by ENT trainees to inform training programmes.
Methods: We recorded all operations out of hours performed by ENT
speciality trainees in Kent Surrey and Sussex over 6 months. In
January - February 2020 and August - November 2021 trainees
completed data sheets detailing operations they were involved in that
took place between 18:00 and 08:00 on weekdays or on weekends.
Responses were analysed using Excel.
Results: Trainee response rate was 92%. In total 89 operations were
performed out of hours. The speciality trainee was the most senior
surgeon present in 58% of these cases (n=52). 27 different operations
were performed. 5 procedures made up 53% of all operations
performed: Oesophagoscopy and removal of foreign body (n=23);
Tracheostomy (n=10); Removal of foreign body from nose (n=8);
Drainage of neck abscess (n=6); and SPA ligation (n=5).
Discussion and Conclusions: To our knowledge, this is the first study to
investigate the frequency of ENT procedures performed out of hours by
trainees. Our findings can be used to plan and prioritise teaching of
procedural skills in national trainee bootcamps. Oesophagoscopy and
removal of foreign body was the most commonly performed out of
hours procedure and along with other emergency procedures it should
be prioritised in training camps.
Abstract citation ID: znac247.010
SP1.2.6 Expanding the General Surgery Extended Surgical
Team improves service delivery and provides increased
training opportunities for surgical trainees
William Luffman, Sarah Duff, Patrizia Capozzi, Gail Sharpe,
Rachael Hine
Manchester University NHS Foundation Trust (South)
Aim: The Extended Surgical Team (EST) provides an additional surgical
workforce with transferable skills. By expanding our EST and developing
our Surgical Ambulatory Care service, we aimed to improve the delivery
of acute surgical care to our patients. This also allowed us to improve
CST training experience by supporting the CST on-call, providing an
admissions base, helping decision making and maximising trainee
educational opportunities.
Method: As part of an HEE EST Project, we used funding to expand the
ambulatory care unit and employ/train further surgical ACPs. We
surveyed the core trainee group regarding their on-call working
pattern, training opportunities when on-call and where most time
was spent. We implemented a change of working to utilise the new
expanded EST, reducing the CST (and patient) time in ED. We
re-surveyed the group after intervention.
Results: Results showed a reduction in the amount of time CSTs were
spending with patients in the emergency department, easing the
pressure on ED. Results showed support for the decision making
on-call was greatly improved and the workload eased, allowing for
improved educational opportunities for the trainee.
Conclusion: We have shown that the expansion of the EST and
ambulatory service, when properly utilised by the surgical team,
improves the training opportunities available to junior trainees, whilst
also improving the delivery of General Surgery acute services by
reducing the surgical patient pressure on our already stretched
emergency department. We plan to continue the expansion of our EST
and new model of delivery of CST on-call services.
Abstract citation ID: znac247.011
SP1.2.7 Relative quality of UK post graduate School of Surgery
web-site information
Oliver Luton, Katie Mellor, Catherine Eley, Richard Egan, Wyn Lewis
Health Education and Improvement Wales’ School of Surgery, Tŷ Dysgu, Cefn
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Coed, Nantgarw, UK, CF15 7QQ
Introduction: Internet-derived health care information is increasingly
accessed by patients, yet its quality is variable and equivalent
educational and training information for medical professionals is less
well understood. The aim of this study was to assess the quality of
information available on the UK’s Post-Graduate School of Surgery
(SoS) websites with a validated 20-point tool (WebQual 4.0).
Method: Eight clinicians (Consultants 2, SpRs 2, Core Surgical Trainees 2,
and Foundation Program doctors 2) evaluated SoS web-site quality in
three domains: Usability, Information Quality, and Interaction (Likert
scale: 1 - very much disagree, 5 - very much agree). Ranked scores
were calculated as the sum of domain medians. A separate eight
trainee focus group then appraised the top three websites related to
COREQ recommendations.
Results: Inter-rater agreement and correlation was good (rho >0.800,
p<0.001). Median (range) overall website score was 3 (2–5) and
individual domain scores were: Usability 3.75 (2–5, p=0.001);
Information Quality 3 (2–5, p=0.001); Interaction 3 (2–5, p=0.001). The
three highest ranked Deaneries were HENW, HEEE, and HEKSS with
scores of 14, 13.5 and 12 (out of 15) respectively. Focus group priorities
included: minimising text, embedding educational and extracurricular
content, and clear hospital placement mapping.
Conclusion: UK SoS website information was in general poor, with
greater than two-fold variance in overall quality. Improved web-site
standardisation should help and enhance trainee application and
career progression.
Abstract citation ID: znac247.012
SP1.2.8 Applying Kolb’s Experiential Learning Theory
Improves Medical Student Confidence in Reviewing
Post-Operative Patients
Neale J Marlow
Oxford University Hospitals NHS Foundation Trust, Nuffield Department of
Surgical Sciences, University of Oxford
Aims: To see if a structured teaching programme designed according to
Kolb’s Experiential Learning Theory could be applied to improve medical
student confidence in reviewing post-operative general surgery
patients.
Methods: Post-final examination medical students at a UK university
agreed to participate in the educational pilot in 2019 (n=18). The
cohort were interviewed to evaluate any anxieties around undertaking
FY1 surgical posts and responses were grouped thematically;
reviewing the post-operative patient emerged as a dominant concern.
Subsequently, a four-part teaching session was designed to move the
learner through ‘Abstract Conceptualisation’ (Before the Bedside),
‘Active Experimentation’ (At the Bedside), ‘Concrete Experience’ (After
the Bedside) and ‘Reflective Observation’ (Expert Example). Pre- and
post-intervention interviews and Likert scale-based surveys were
employed to evaluate impact (Kirkpatrick Level One).
Results: 18/18 (100%) participants reported feeling more confident
reviewing the post-operative patient after the intervention. Learner
feedback included “very little of the subject covered previously so
helpful to get a structured approach”, “useful to discuss the history
and examination before reviewing the patient” and “observing a
consultant post-op review at the end really cemented what we were
learning”.
Conclusions: A graded approach to developing confidence in assessing
the post-operative patient, as proposed by Kolb’s Experiential Learning
Theory, seems to offer a useful teaching method and is valued by the
learner. Ongoing expansion of this educational pilot will further
evaluate its impact.

Abstract citation ID: znac247.013
SP1.2.9 Stylish surgical writing: the state of the art surveyed
Katie Mellor, Oliver Luton, Jerome Ling, Ismay Fabre, Arfon Powell,
Wyn Lewis
HEIW
Introduction: Glaring gaps exist between what most readers consider
proficient writing and what academics typically publish. This study
aimed to assess the writing styles of the 13 journals held in the
highest esteem by 11 surgical specialties.
Methods: The first 1,000 words of the initial 10 articles published in
January 2018 from the 11 journals affiliated with surgical specialty
associations were assessed as well as the BMJ and Lancet. The primary
effect measures were Flesch-Kincaid Readability Ease (FRES, range zero
(difficult) to 100 (easy)) and Flesch-Kincaid Grade Level (FGL, range -3.40
to infinity), related to journal Impact Factor and article citations.
Results: FRES median was 18.2 (1.4–38.2) and FGL 16.3 (12–26.2). FRES
was directly related to the use of be verbs (p=0.004), but inversely
proportional to numbers of common abstract nouns, words per
sentence, characters per word, authors, references, level of evidence,
and Journal Impact Factor (all p<0.04). Citations were inversely related
to FRES (rho -0.292, p<0.001; critical value 14.5 (OR 0.20 p<0.001)) and
directly proportional to FGL (rho 0.279, p=0.001; critical value of 15.5
(OR 5.04 p=0.05)). The journal with the highest FRES (most readable)
was the British Journal of Oral & Maxillo-Facial Surgery (median 30.4;
total citations 5).
Conclusion: Big differences in writing style and readability were plain
with FRES varying 28- and FGL two-fold. No journals had a FGL of <12
(reading age of >17 yr.). Superior Journal prestige, Impact Factor, and
citations were not associated with better Flesch-Kincaid reading ease.
Abstract citation ID: znac247.014
SP1.2.10 The First Delphi Consensus on Surgical Ward Round
Bassem Amr1, Islam Omar2, Mohamed Abdelrahman1,
Muhamed Abdulkuddos1, Yasmin Abou El Ella3, Kamal Mahawar4
1 different between the two groups.
University Hospitals Plymouth NHS Trust, UK
2
Wirral University Teaching Hospital NHS Foundation Trust, UK
3
Royal Devon& Exeter NHS Trust, UK
4
South Tyneside and Sunderland NHS Foundation Trust, UK
Background: The ward round is an integral part of everyday surgical
practice. It is a complex clinical activity that requires clinical
management and communication skills. It has an impact on patient
safety, mortality and quality of the healthcare services delivered. This
study reports the results of a consensus-building exercise on the
common aspects of the general surgical ward rounds.
Methods: The consensus-building committee involving a range of
stakeholders from 16 NHS trusts took part in this consensus exercise.
The members discussed and suggested a series of statements
concerning surgical ward round. An agreement of ≥ 70% amongst
members was regarded as a consensus.
Results: Thirty-two members voted on 60 statements. There was a
consensus on fifty-nine statements after the first round of voting, and
one statement was modified before it reached consensus in the second
round. The statements covered nine sections: a preparation phase,
team allocation, multidisciplinary approach to the ward round,
structure of the round, teaching considerations, confidentiality and
privacy, documentation, post-round arrangements, and weekend round.
There was a consensus on spending time to prepare for the round,
consultant-led round, involving the nursing staff, an MDT round at the
beginning and end of the week, a minimum of 5 minutes allocated to
each patient, utilisation of round checklist, afternoon virtual round,
and a clear handover and plan for the weekend.
Conclusion: The consensus committee achieved agreement on several
aspects concerning the surgical ward round. This should help improve
the care of general surgical practice on wards.
Abstract citation ID: znac247.015
SP2.1.1 Safety of Bariatric Surgery in The Older Patients During
the COVID-19 Pandemic
Rishi Singhal1, Islam Omar2, Brijesh Madhok3, Yashasvi Rajeev4,
Yitka Graham5,6, Kamal Mahawar7,8
Abstracts | v9
1
Upper GI unit, University Hospital Birmingham NHS Foundation Trust,
Birmingham, West Midlands, UK
2
General Surgery Department, Wirral University Teaching Hospital NHS
Foundation Trust, Wirral, North West, UK
3
Upper GI unit, University Hospital of Derby and Burton NHS Foundation Trust,
Derby, East Midlands, UK
4
Pediatric Accidents and Emergencies Department, London Northwest University
Healthcare NHS Trust, London, UK
5
Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland,
North East, UK
6
Faculdad de Pyscologia, Universidad Anahuac, Anahuac, Mexico
7
Bariatric Unit, South Tyneside and Sunderland NHS Foundation Trust,
Sunderland, North East, UK
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8
University of Sunderland, Sunderland, UK
Background: The progressive growth of the older patients with obesity
represents a challenge to the weight management teams. Although
initially, old age was a relative contraindication to the surgical option,
current advances in laparoscopic techniques and perioperative
optimization protocols have changed the old notion. However, the
performance of bariatric procedures in the older patients during the
ongoing COVID-19 pandemic carries a potential risk. This study aimed
to assess the safety of bariatric surgery (BS) in older patients during
the pandemic.
Methods: We conducted a prospective international study of patients
who underwent BS between 1/05/2020 and 31/10/2020. Patients were
divided into two groups - older patients ≥65-year-old (Group I) and
young < 65-year-old (Group II). Two groups were compared for 30-day
morbidity and mortality.
Results: We included 7084 patients, the mean age was 40.35±11.9 years,
and 5197 (73.4%) were females. The mean preoperative weight and BMI
were 119.49±24.4 Kgs and 43.03±6.9 Kg/m2, respectively.
The overall comorbidities were significantly higher in Group I,
p= <0.001. In Group II, 14.8% were current smokers, compared to 7.4%
of Group I. The complications in Group I were significantly higher
(11.4%) compared to Group II (6.6%), p= 0.022. However, the mortality
rate and COVID-19 infection within 30 days were not significantly
Conclusions: Bariatric surgery during the COVID-19 pandemic in the
older patients (≥65 years old) is associated with a higher complication
rate than the younger age group. However, the mortality and
postoperative COVID-19 infection rates are comparable to the younger
age group.
Abstract citation ID: znac247.016
SP2.1.2 Increasing Burden of Complications of Gastric bands
on NHS Bariatric Services
Chaitya Desai, Harrypal Panesar, Nakulan Nantha Kumar, Jinpo Xiang,
Kelvin Idialu-Ikato, Chandra Cheruvu
University Hospitals of North Midlands NHS Trust
Background: Approximately 40% of patients that undergo laparoscopic
adjustable gastric band (LAGB) insertion for obesity experience
long-term complications and a lack of weight loss. This has caused a
surge in LAGB removal procedures under the NHS. We review patient
outcomes for these procedures at our tertiary bariatric centre.
Methods: All LAGB removals performed between October 2012 and
August 2021 were reviewed. Data was collected prospectively &
analysed retrospectively for demographics, body mass index (BMI),
surgical indications and postoperative complications.
Results: During the study period, a total of 178 patients underwent LAGB
removal (93.8% female). Most bands were inserted out of province, done
privately and patients’ mean BMI pre-operatively was 41.6. Indications
for band removal included dysphagia (41.1%), band slippage or tubing
damage (25.8%), pain (15.2%), obesity-related health condition (11.2%),
infected/ leaking band (3.9%), and band erosion (2.8%). At LAGB
removal, patients’ mean BMI was 37.0 – thus there was a mean
decrease of 4.6 in BMI between index and removal operations. One
LAGB removal case was converted to open. The mean length of stay
for LAGB removal patients was 2.9 days. 12 patients had
post-operative complications: wound infection (58.3%), peritonitis
(25.0%), pneumonia (8.3%) and food ball in stomach (8.3%). 38 out of
178 (21.3%) patients then underwent revision bariatric surgery in the
form of laparoscopic Roux-en-Y gastric bypass procedures.
v10 | Abstracts
Conclusion: Although most primary gastric banding procedures are
performed privately, the number of removals under NHS services is
increasing. LAGB removal can be successfully performed to ease
debilitating symptoms with excellent symptom resolution and
minimal peri-operative complications.
Abstract citation ID: znac247.017
SP2.1.3 Effect of laparoscopic sleeve gastrectomy on
vasoactivemediators in obese hypertensive patients: A
prospective study
Mohamed Salman1, Khaled Noureldin1, Mohamed Issa2,
Marwa Badawi3, Mohamed Tourky4
1 2
Cairo University Hospital
2
Prince Charles Hospital
3 3
Conquest Hospital, Hastings
4
Great Western Hospital, NHS Foundation Trust
Introduction: The relationship between obesity and high blood pressure
is established; however, detailed pathways for such association are still
under research. This work aims to assess the changes in neprilysin,
vasoconstrictor and vasodilatory molecules in obese hypertensive
patients undergoing laparoscopic sleeve gastrectomy (LSG).
Patients: Prospective study was done on 59 hypertensive obese patients
in whom LGS was performed. Blood pressure, as well as blood samples
for neprilysin, angiotensinogen, angiotensin II, renin, endothelin-1
“ET-1”, aldosterone, atrial natriuretic peptide “ANP” and B-type
natriuretic peptide “BNP”, were assessed before and 15 months after
surgery. Patients were divided into two groups according to the
remission of hypertension (HTN).
Results: After 15 months, remission of hypertension was seen in 42
patients (71%). The declines in the following measurements were
higher in patients with remission than those with persistent HTN:
aldosterone (p = .029567), angiotensin II (p < .000001), angiotensinogen
(p = .000021), n eprilysin (p = .000601), renin(p = .000454) and
endothelin-1(p = .000030). There was a significantly higher
incrementin ANP (p = .000002) a nd a n on-significant increment i n B
NP (p = .081740).Angiotensin II 15 months after LSG and Δ ANP % were
significant independent predictors of persistent HTN.
Conclusion: In setting of LSG, aldosterone, angiotensinogen,
angiotensin II, renin and neprilysin were significantly lower in
patients with remission of HTN after 15 months than those with
persistent HTN, and natriuretic peptides were significantly higher.
lower postoperative level of angiotensin II and a larger percentage
increment of ANP are independently associated with hypertension
remission after LSG.
Abstract citation ID: znac247.018
SP2.1.4 Predictors of Type-2 Diabetes Remission Following
Bariatric Surgery After a Two-Year Follow Up
Khaled Noureldin1, Mohamed Salman1, Marwa Badawi2,
Ahmed Shalaby2, Mohamed Tourky3, Sally Maryosh4
1
Cairo University Hospitals, Cairo, Egypt
2
Conquest Hospital, Hasting, UK
3
Great Western Hospital, NHS Foundation, Swindon
4
Prince Charles Hospital, Merthyr Tydfil
Purpose: Bariatric surgery is evolving as a successful tool for managing
morbid obesity and T2DM. This study aimed to identify predictors of
diabetes remission after two types of bariatric procedures.
Methods: This prospective study enrolled 172 patients with morbid
obesity associated with T2DM scheduled for bariatric surgery. Two
laparoscopic bariatric procedures were done; single anastomosis
gastric bypass (SAGB, n=83) and sleeve gastrectomy (LSG, n=68). Lipid
accumulation product index (LAP) and quantitative insulin sensitivity
check index (QUICKI) were used to evaluate lipid profile and insulin
sensitivity. Two years after surgery condition of DM was evaluated as
complete remission (CR), partial remission (PR), or improvement. The
primary outcome measure was predictors of diabetes remission.
Results: Two years after surgery, 151 patients were available for
evaluation, where 75 patients (49.7%) achieved CR, while PR was found
in 36 (23.8%). CR was significantly associated with younger age,
shorter duration of DM (p < 0.001, for both), higher C-peptide and
GLP-1 levels (p < 0.001 and p = 0.002, respectively), and bypass surgery
(p = 0.027). On multivariate analysis, shorter duration of DM, lower
BMI, and higher C-peptide levels were the independent factors
predicting CR.
Conclusion: Complete remission of T2DM can be achieved in nearly half
of the patients two years after SG or SAGB. The duration of diabetes and
preoperative BMI and C-peptide levels are the independent factors
predicting complete remissions.
Abstract citation ID: znac247.019
SP2.1.5 A Systematic Review of Bariatric Surgery in Patients
with Obesity and Type 1 Diabetes Mellitus
Simone Appel1, Lyndcie Lee2, Chetan Parmar3
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1
Medical School, University College London, London, UK
Department of Obstetrics and Gynaecology, Peterborough City Hospital,
Peterborough, UK
Department of Surgery, The Whittington Hospital NHS Trust, London, UK
Background: The prevalence of obesity in the T1DM population has
been increasing at a worrying rate. Bariatric surgery has proven to be
effective in treating patients with T2DM, as weight changes had a
direct effect on insulin resistance and requirements, and thus
glycaemic control. However, evidence for the benefit of the procedure
for patients with T1DM is still limited, demonstrating the need for a
systematic review investigating this.
Methods: A systematic review was performed in accordance with the
PRISMA guidelines. Articles not in relation to T1DM or lacking specific
quantitative data were deemed unsuitable and excluded.
Results: 26 studies were included with a total of 262 patients (F=167,
M=73, N/A=22). The mean age was 37.08 years (n=207). The mean
weight and BMI were 112.4kg (n=157) and 31.88 kg/m2 (24–58.9, n=261)
respectively.
Most common procedures performed were SG with 120 patients (46%)
followed by RYGB with 104 patients (39.3%). Insulin requirements
changed from 90.77 IU/day (36.2–174) pre-operatively to a mean of 36.5
IU/day (5–75) post-operatively. No significant trend was found for
changes of HbA1c levels. Main side effects were episodes of
hypoglycaemia and DKA; mortality was not reported in any article.
The mean %EWL was 72.3% (60–90.5%) at ≥6 follow up months.
Reductions in co-morbidities such as hypertension and CVD were
recorded in multiple studies.
Conclusion: Obese patients with T1DM can expect significant weight
loss, potential resolution of co-morbidities, and reduction of insulin
requirements, but it does not usually result in improved glycaemic
control.
Abstract citation ID: znac247.020
SP2.1.6 A Systematic Review of the Incidence and Predictors of
Incisional Hernias in Robotic Prostatectomy
Rabiya Aseem1,2, Ashley Lau1,2, Samip Prakash1,2, Chijioke Ikechi1,2,
Ashish Shrestha1,2
1
William Harvey Hospital
2
East Kent Hospitals University NHS Foundation Trust
Aims: To conduct a systematic review of the literature to identify the
incidence and predictors of incisional hernia (IH) following robotic
prostatectomy; and to provide recommendations to reduce the risk
factors for IH development post-operatively.
Methods: The review was performed adhering to PRISMA guidelines,
using search terms pertaining to robotic prostatectomy and incidence
of IH via electronic databases (MEDLINE, EMBASE and Cochrane
database). All original peer-reviewed articles in English were assessed
for inclusion and quality by two independent reviewers. A
quantitative analysis was conducted to evaluate methodologies,
patient demographics, and the incidence of IH following robotic
prostatectomy.
Results: We included 18 studies with a total of 17,965 patients. Average
age of patients was 61.83 years and with an average BMI of 27.35. A
transperitoneal, 6 port technique was the commonest robotic
approach. Main sites of herniation included supraumbilical and lateral
ports. The estimated incidence of IH was 1.49% (95% CI 1.28 to 4.25).
Studies examining risk factors found age, high BMI, previous hernia
repair and wound infections to be contributory to IH development.
Only 6 studies reported surgical repair of IH with 3 patients requiring
emergency operations. 5 studies reported reduction in IH following
modifications in surgical technique.

Conclusions: Incisional hernias following robotic prostatectomy are a
rare complication which can result in high patient morbidity. Our
review demonstrated a variable incidence rate with increasing age
and high BMI as common potential risk factors. Prevention strategies
can result in reduction of IH; however, the studies were heterogenous
with inconsistent data quality.
Abstract citation ID: znac247.021
SP2.1.7 The Croydon Elective Centre - Surgical Hub supporting
patient care and surgical training
Georges Rizkallah, Tarak Agrebi Moumni Chouari, Sarah Zhao,
Narisu Yang, Stella Vig, Nikheel Patel, Akriti Nanda
Croydon University Hospital
Aims: NHSE/I and the RCS England have advocated that the separation
of elective and surgical care is fundamental in recovering surgical
services. It is suggested that the separation is physical and many
Trusts are transforming pathways into elective and emergency
hospitals. Croydon Hospital (CHS) have created an alternative, with ‘a
Hospital within a Hospital’, separating these pathways within one
estate, and considers whether this is a successful model for the future.
Methods: The day surgery unit on the ground floor was converted into
an emergency centre with an ambulatory surgical hub, a hot clinic,
clinical space, 4 emergency theatres and an USS room. The main
theatre suite was converted into the Croydon Elective Centre (CEC)
with a 12-bedded coronary catheter suite, a lift onto the second floor,
10 theatres, a 12 bedded children’s day unit, Moorfields’ eye unit, a
new canteen, an admissions unit as well as a 28-bedded elective ward
with a new 4-bedded level 1.5 critical care unit.
Results: At the end of wave 1, 3,068 patients awaited treatment, an
increase of 30.44% of baseline activity with theatre activity at 28% of
normal activity. Activity resumed to 100% within 6 weeks of CEC go
live. 2/9,606 patients were Covid-19 positive in the first year. During
wave 2, 60% of pre-Covid-19 activity continued. Currently, 2,098
patients await treatment.
Conclusion: The implementation of a surgical hub has supported the
treatment of patients as well as provided continuous training
opportunities for surgical and anaesthetic trainees as well as the
theatre team.
Abstract citation ID: znac247.022
SP2.1.8 Informed consent – Are we appropriately assessing the
process?
Liam Convie1,2, Joshua Clements1,2, Scott McCain1, Jeffrey Campbell1,
Mike Clarke2, Stephen Kirk1
1
Department of Surgery, Ulster Hospital, Dundonald, Belfast
2
Centre of Public Health, Queens University Belfast, Northern Ireland
Aims: There is no standardised measure of the validity of consent. Over
300 million invasive procedures take place globally each year. This study
aims to define a core outcome set (COS) for informed consent for
therapy.
Methods: A prospective mixed method study was undertaken in line
with a published protocol and the COS was developed in accordance
with Core Outcome Measures in Effectiveness Trials (COMET)
methodology. This included a systematic review of outcomes in
studies of consent, semi-structured interviews and prioritisation of
outcomes using a 2-round modified Delphi technique. Two
consensus webinars were used to ratify outcomes for inclusion in the
final COS.
Results: 36 outcome domains for valid consent were identified and
developed by systematic review. 41 semi-structured interviews were
conducted with key consent stakeholders (with significant patient
involvement) 164 participants from key stakeholder groups across 8
countries completed Delphi Round 1 and 125 completed round 2. 11 of
40 outcomes met the “consensus in” criteria, with 6 meeting
“consensus in” in all stakeholder groups. These were included directly
in the final COS and the other 5 that met “consensus in” in some but
not all stakeholder groups were discussed in consensus webinars. 9
outcomes were defined for the final COS.
Conclusion: This is the first study to define a COS for research into
informed consent for therapy. It defines what outcomes are most
important to all key stakeholders in the consent process and is a step
forward in standardising consent research.
Abstracts | v11
Abstract citation ID: znac247.023
SP2.2.1 Surgical Resection of metastases to the adrenal
gland
Jennifer Allan, Hannah Anderson, Fiona Eatock
Regional Endocrine Surgery Department, Royal Victoria Hospital, Belfast
Aims: The adrenal gland is a common metastatic site for lung, breast,
skin, renal, thyroid, and colorectal cancers. Our aim was to review
resection of adrenal metastases and their primary pathology and the
impact of adrenalectomy on the survival and disease free survival rate.
Methods: Retrospective review of adrenalectomy for adrenal
metastases in a single regional centre between June 2010–2020.
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Results: 34 adrenalectomies in 33 patients were performed. Median age of
patients was 70 (39–82). All adrenal lesions were diagnosed on staging or
surveillance CT scan. Isolated adrenal metastases were seen in 26 patients.
The most common primary malignancy was renal cell carcinoma (RCC)
(n=20), followed by non small cell lung cancer (NSCLC) (n=6), colorectal
adenocarcinoma (n=2) and infiltrating ductal breast carcinoma
(n=2). Other primaries include malignant melanoma, oesophageal
adenocarcinoma, prostate adenocarcinoma and hepatocellular
carcinoma (each n=1).
Adrenalectomy was carried out for diagnosis in 5 cases, 4 where no
resection of the primary lesion was performed. Median time from
resection of primary lesion was 4 years (1–16). 5 patients had synchronous
adrenal metastases, 1 with synchronous resection of primary.
At the time of writing, there was a 38% mortality. 84% of deaths were due to
disease progression. Median survival from adrenalectomy was 23 months
(4–52 months). Of the surviving patients 76% are disease free and under
oncological or clinical surveillance. 24% underwent further systemic or
localised oncological therapy.
Conclusions: Survival rate following adrenalectomy for metastatic
deposits is 62%. Better outcomes are observed in patients with RCC
metastases.
Abstract citation ID: znac247.024
SP2.2.2 Thyroid Ultrasound reporting – an audit of practice
Emmanuel Oladeji, Matthew Dunstan, Konstantinos Katsos,
Yasmin Tabbakh, Kashif Burney, Karim Jamal
Epsom and St Helier University Hospitals NHS Trust, UK
Aims: Ultrasound (US) is the first line investigation for evaluating
thyroid nodules. British Thyroid Association (BTA) guidelines set out a
structured characterisation of thyroid nodules to guide further
investigation. We conducted a closed loop audit at a District General
Hospital to assess compliance of US reporting with BTA guidelines.
Methods: 208 examinations were retrospectively analysed in the initial
audit cycle. The reports were assessed for U status; number,
measurements, characteristics and locations of nodules; comment on
lymph nodes; whether FNA was performed or recommended; FNA
histology; and the number of examinations performed by each
radiologist/radiographer. Departmental teaching was then provided. A
re-audit of 100 thyroid ultrasounds was then conducted.
Results: In the initial audit and re-audit, respectively, the number of
reporting clinicians decreased from 21 to 15, however the vast
majority had reported fewer than 5 scans in each time period. Where
nodules were present, the use of U classification in reports increased
from 32.5% to 85.3%. Reporting of measurements, characteristics and
location of nodules increased from 86.4%, 92.9% and 96.8% to 96.0%,
100.0% and 100.0% of reports, respectively. In both audits, 4.5% of U1/2
nodules were recommended for FNA. For U3–5 nodules, FNA or
referral to specialty increased from 71.4% to 75.0%. Comment on
lymph nodes increased from 89.4% to 95.9%.
Conclusions: Following education, improvement in compliance was
seen in nearly all domains, particularly in the utilisation of U
classification. Further work is needed regarding the appropriate use of
FNA, and caseload variation between clinicians.
Abstract citation ID: znac247.025
SP2.2.3 Mapping the Landscape of Surgical Registries in the
United Kingdom: A Review According to the Synthesis Without
Meta-Analysis (SWiM) Methodology
Connor Moore1,2, Kerry Avery1, Amber Young1, Robert Hinchliffe1,2,
Xavier Griffin3,4, Shelley Potter1,5
v12 | Abstracts
1
Centre for Surgical Research, University of Bristol
2
North Bristol NHS Trust
3
Barts Bone and Joint Health, Barts and The London School of Medicine and
Dentistry, Queen Mary University of London, London, UK
4
Department of Trauma and Orthopaedic Surgery, Barts Health NHS Trust,
London, UK
5
Bristol Breast Care Centre Southmead Hospital, Southmead Road,
Westburyon-Trym, Bristol
Aims: Well-designed surgical registries are essential for high-quality
patient-centred evaluation of implantable devices and surgical
procedures. However, there is currently a lack of information about
how existing registries are designed and funded; what data is
collected and how this can be used. The aim of this work is to identify
existing surgical registries in the UK and describe and summarise
their key characteristics to inform recommendations for how surgical
registries may be improved.
Methods: Existing surgical registries were identified using multiple
different sources, including: society websites; search engine review; a
targeted search of Medline and Embase databases and expert
knowledge. Details of each registry were extracted using a
standardised data extraction proforma developed by the study team.
Characteristics of identified registries were summarised into a
narrative review.
Results: 47 active national surgical registries have been identified, with
further identification of registries ongoing. 29 (62%) registries monitor
surgical devices and all monitor surgical procedures, with 18 (38%)
being mandatory. 40 (87%) registries were accessible online, and 24
(51%) linked with other datasets. 39 (83%) collected clinical outcomes
with no core outcome set, and 1 collected clinical outcomes with a
core outcome set. 15 (32%) collected patient-reported outcome
measures. All registries operated in England with 41 (87%) active in
Wales, 28 (60%) in Scotland, and 24 (51%) in Northern Ireland. Length
of follow up varied from in hospital to 10 years.
Conclusions: There is considerable heterogeneity in existing surgical
registries. Further work is needed to establish a consensus for surgical
registry development.
Abstract citation ID: znac247.026
SP2.2.4 Structured prehabilitation reduces physical
deconditioning and improves emotional and physical
well-being during neo-adjuvant chemotherapy prior to
surgery for oesophageal cancer
William Knight1, Janine Zylstra1, Greg White2, Andy Lane3,
Mike Browning4, Andrew Davies1
1
Guy’s and St Thomas’ Hospital
2
Liverpool John Moore’s University, Liverpool, UK
3
University of Wolverhampton Research Centre for Sport, Exercise and
Performance (RCSEP)
4
Maidstone and Tunbridge Wells NHS Trust Hospitals, Maidstone, UK
Introduction: Neo-adjuvant chemotherapy (NAC) prior to
oesophagectomy is associated with a decline in cardiovascular fitness,
sarcopenia and reduced health related quality of life. This study
aimed to determine if a structured exercise programmed mitigated
these effects.
Methods: A prospective non-randomised trial compared a standard
care pathway to a structured prehabilitation exercise programme
undertaken before and during NAC and surgery for oesophageal
cancer. Cardiopulmonary Exercise Testing (CPEX), body composition
analyses and Health Related Quality of Life questionnaires were
performed at multiple time points.
Results: Comparison of the Intervention (n=22) and Control (n=20)
groups demonstrated a decline in patient fitness following NAC,
measured by VO2peak. This was blunted by 7.86% in patients
undergoing the structured exercise prehabilitation program (-21.40%
Control vs -13.54% Intervention p=0.02). Fat Free Mass increased
(intervention 16.1 vs. 17.3 kg/m2; control 15.4 vs. 14.8 kg/m2, p=0.056)
and Fat Mass Index to Fat Free Mass Index ratio (-5.51% Intervention,
10.74% control p=0.043) decreased in the treatment group. An overall
improvement in Mental Wellbeing and Cognitive and Emotional
function in HRQL after neo-adjuvant chemotherapy was seen in the
intervention group.
Conclusion: A structured exercise programme prior to neoadjuvant
chemotherapy blunts cardiopulmonary deconditioning, reverses
sarcopenia and improves the quality of life in patients undergoing a
highly debilitating treatment regimen. Further studies will be needed
to validate these findings.
Abstract citation ID: znac247.027
SP2.2.5 Sarcopenia and lymphopenia in patients undergoing
chemotherapy and surgery for oesophageal cancer. Can
prehabilitive exercise be used to reverse the decline?
William Knight1, Janine Zylstra1, Louise Gervais-Andre1, Vicky Goh1,2,
Greg White3, Andrew Davies1,2
1
Guy’s and St Thomas’ Hospitals
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2
King’s College London
3
Liverpool John Moore’s University, Liverpool, UK
Introduction: Studies have demonstrated that sarcopenia and
lymphopenia are associated with poor oncological and survival
outcomes in patients with oesophageal cancer. Neo-adjuvant
chemotherapy (NAC) for oesophageal cancer is associated with muscle
wasting and sarcopenic obesity. Lymphocytes are essential
component of anti-tumour immunity. This study assesses the body
composition and peripheral blood markers in patients undergoing a
structured exercise program, during neo-adjuvant chemotherapy, as
part of a non-randomised trial.
Methods: A prospective non-randomised trial compared a standard
care pathway to a structured prehabilitation exercise programme
undertaken before and during NAC and surgery for oesophageal
cancer. CT determined body composition analysis and peripheral
blood markers were collected at multiple timepoints.
Results: Comparison of the Intervention (n=21) and Control (n=19)
showed Fat Free Mass increased during NAC in the intervention group
(16.1 to 17.3 kg/m2; control 15.4 vs. 14.8 kg/m2, p=0.056) and Fat Mass
Index to Fat Free Mass Index ratio (-5.51% Intervention, 10.74% control
p=0.043) decreased in the treatment group. Lymphocyte subsets
showed a marked increase in the intervention group after
chemotherapy (CD3 10.92% vs 84.92% p=0.015, CD4 13.27% vs 107.75%
p=0.0147, CD8 12% vs 69% p=0.033).
Conclusion: A structured exercise programme prior to neoadjuvant
chemotherapy reverses levels of sarcopenia, reduces visceral adiposity
and increases levels of lymphocytes in patients with oesophageal
cancer. Further studies will be needed to assess the oncological and
clinical implications.
Abstract citation ID: znac247.028
SP2.2.6 Long-term outcome predictors in laparoscopic minor
hepatectomy for hepatocellular carcinoma in the UK
Crispin Schneider, Diana Bogatu, John Leahy, Priya Patel, Nigel Heaton,
Krish Menon
Department of HPB Surgery, King’s College Hospital NHS Foundation Trust
Aims: Minor hepatectomy, which is increasingly carried out
laparoscopically (LLR), is a cornerstone of curative treatment for
hepatocellular carcinoma (HCC). The majority of relevant publications
however originate from regions with endemic viral hepatitis. Although
the incidence of HCC in the UK is increasing, little is known about
outcomes following LLR.
Methods: Consecutive patients undergoing minor (involving ≤2
segments) LLR or open resection (OLR) at our institute between 2014–
2021 were compared. Selection from a plethora of factors potentially
impacting disease free survival (DFS) was optimised with Lasso
regression. To enable analysis of patients having repeat resection,
multivariate frailty modelling was utilised to calculate hazard ratios
(HR).
Results: There were 111 liver resections with 55 and 56 patients
undergoing LLR or OLR, respectively. LLR patients had a shorter
hospital stay (5±2 vs. 7±2 days; p<0.001) and a lower comprehensive
complication index (4.43 vs. 9.96; p=0.006). Mean DFS (33.9±3.4 vs. 36.5
±3.6 months; p=0.59) were comparable between LLR and OLR,
respectively (median not reached). Presence of mixed
cholangiocarcinoma/HCC (HR 3.79; C.I. 1.56–9.22; p=0.0033) or satellite
lesions (HR 3.32; C.I. 1.80–6.10; p=0.0001), tumour size (HR 1.15; C.I.
1.03–1.28; p=0.0107) and AFP level (HR 1.01; C.I. 1.00–1.01; p=0.016)
predicted DFS.
Conclusions: In the studied population minor LLR was associated with
shorter hospital stay and fewer complications while offering

non-inferior long-term outcomes. Neoadjuvant and adjuvant therapy
for HCC are increasingly being employed and it is hoped that the
outcome predictors identified here, may aid in selecting patients who
are most likely to benefit from these adjuncts.
Abstract citation ID: znac247.029
SP3.1.1 Follow-up After Acute Diverticulitis: Can We Reduce
the Burden on Endoscopy Services?
Harry Dean, Emily Britton, Emily Farrow, Sameerah Abdel-Khaleq,
Molly Bradbury, Tim Cook
Gloucestershire Hospitals NHS Foundation Trust
Background: Acute diverticulitis (AD) is a common cause of
presentation to emergency surgical services. Follow-up with
endoluminal investigation to exclude colorectal cancer (CRC) remains
controversial. Guidelines are increasingly moving to a more restrictive
follow up based on severity of disease and age. The purpose of this
study was to assess the prevalence of CRC in AD patients and the
impact of follow-up on endoscopy services.
Methods: Patients admitted with a diagnosis of AD over a 2-year period
were reviewed. The proportion of patients undergoing endoscopic
follow-up and the CRC detection rate were recorded. The potential
impact of a more conservative approach to follow-up was evaluated.
Results: There were 484 patients with AD presenting 546 times (M:F =
198:286; median age = 63 years). 80% of admissions were aged 50 or
older. There were 43 emergency interventions in 39 patients (10
percutaneous drain; 33 surgery). The remainder were managed
conservatively. 28 patients (5.1%) underwent colonic resection with
cancer found in one specimen (3.6%). 286 patients underwent
endoluminal follow-up with cancer diagnosed in 3 cases (1.0%). There
was no significant difference in the prevalence of CRC between
patients requiring emergency surgery and those managed
conservatively, or between patients with complicated versus
uncomplicated diverticulitis.
Conclusion: CRC masquerading as acute diverticulitis is rare. The
incidence of neoplasia both at endoscopic follow-up and in patients
requiring emergency intervention is low. Conservative follow-up
strategies appear safe, but their effectiveness in reducing the burden
on endoscopy services may be limited by current age-based
recommendations.
Abstract citation ID: znac247.030
SP3.1.2 Antibiotics therapy may not be required in patients
with CT proven uncomplicated acute diverticulitis: A
systematic review
Anja Imsirovic1, Dimitra V Peristeri2, Hussameldin M Nour2,
Christie Swaminathan2, Muhammad S Sajid2
1
Brighton and Sussex Medical School, University of Sussex
2 1
University Hospitals Sussex NHS Foundation Trust
Aims: Acute diverticulitis (AD) is one of the major acute surgical
conditions which need either hospital admission or a dedicated
ambulatory care services in order to provide conventional antibiotics
therapy. Regular use of antibiotics for all cases of acute diverticulitis
has recently been challenged. The aim is to evaluate the necessity of
antibiotics in patients presenting with CT proven uncomplicated AD.
Method: A systematic search was undertaken and relevant published
randomized controlled trials (RCT) were shortlisted according to the
inclusion criteria. Summated outcomes, including failure to response
to intervention, recurrence rates and surgery during the acute
admission, were analyzed using the principles of meta-analysis on
RevMan 5 statistical software.
Result: Four RCTs on 1756 patients who presented with CT-proven
uncomplicated diverticulitis were included in this review. There were
879 patients in the antibiotics group (AG) and 877 patients in the
no-antibiotics group (NAG). The failure to response to intervention
(use of intravenous antibiotics) was not statistically significant
between the two groups, however slight statistical favour was
observed in AG [OR 0.49, 95% CI (0.22–1.06), z=1.81, p=0.07]. There was
no statistical difference related to recurrence rates of acute
diverticulitis between the two groups. Finally, the need of surgical
intervention following both interventions was also statistically similar
[OR 0.63, 95% CI (0.29–1.36), z=1.18, p=0.24].
Abstracts | v13
Conclusion: The use of antibiotics in patients with CT proven
uncomplicated AD does not seem to improve the short-term
outcomes; therefore it can be carefully omitted in selected patients.
More RCTs of robust quality are required to validate these findings.
Abstract citation ID: znac247.031
SP3.1.3 Optimum treatment for sigmoid volvulus remains
elusive but surgery may provide considerable benefit
Mohamed Issa1,2, Richard Guy2
1
Price Charles Hospital
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2
Wirral University Teaching Hospital
Background: Sigmoid volvulus is a surgical emergency and patients are
often elderly with significant comorbidities. Whilst endoscopic
decompression is easy and effective in the short-term, recurrence and
repeated admissions are common with surgery generally being
reserved for non-resolution or complications. Consensus an optimum
management is lacking.
Methods: A retrospective audit of all patients admitted with sigmoid
volvulus to a DGH General Surgery service between 01/01/2015–20/10/
2020 was undertaken. Patient demographics, comorbidities, clinical
findings, investigations and treatment were recorded.
Results: Sixty-three patients were identified (median age 71.5 years;
58.7% male]. Some 50.8% had more than one previous presentation
(range 1–6), 19% presented after 3 days of symptoms and 3.2%
presented with perforation. Plain radiography and CT scanning was
undertaken in 90.5% and 54%, respectively.
Endoscopic detorsion was performed in 77.77% and repeated in the
same admission for 33.3% of cases. Flatus tubes and rigid
sigmoidoscopy was used in 47.6% with a 59.6% success rate.
Seventeen patients (27%) underwent sigmoid resection, 14 having
open surgery and 3 laparoscopic. Primary anastomosis was
undertaken in 64.7% (11 patients), with only one anastomotic leak; the
remaining 6 patients had a colostomy. The re-admission rate was
30.1% (19% non-operated patients, 11.1% operated patients).
Conclusion: Most patients with sigmoid volvulus are managed
non-operatively with endoscopic detorsion which may be associated
with a considerable healthcare burden and high readmission rates.
Selective resection can be associated with low morbidity and good
outcomes. Clinicians could reasonably adopt a lower threshold for
surgical intervention, particularly for recurrent volvulus.
Abstract citation ID: znac247.032
SP3.1.4 Benign Lymph Node Ratio (LNR) and Lymph Node Yield
(LNY) as predictors of survival in resected colorectal cancer
(CRC)
Mohamed Issa1,2, Salma Ahmad2, Jeremy Wilson2, Conor Magee2
Prince Charles Hospital
2
Wirral University Teaching hospital
Background: Lymphadenectomy is central to tumor prognosis. 12 LNY
during CRC resection is a standard of good oncological resection, but
30–50 percent of resections do not achieve this. LNR was suggested to
be a more accurate predictive factor.
Aim: To examine the prognostic significance of LNY and LNR on survival
in patients with non-metastatic CRC.
Methods: A retrospective study on patients with CRC treated at a DGH
from January 2015 to February 2017. Outcome measures were
Disease-Free (DFS) and Overall Survival (OS).
Results: 265 cases were identified. The mean age was (71.4±11.3) years
with a median follow-up of 56 (range 0–72) months. Median LNY was
18 (range 0–66) nodes. 74.9% of the cases have> 12 LNY and only 25.1%
of the cases have < 12 LN yielded in the specimen; however, 76.4%
have LNR of 0-<0.25. Increasing LNR was associated with poorer OS
and DFS (p-value 0.0001). An LNR of (0.75–1) was associated with a
very poor prognosis (p-value 0.0001); it showed 30 and 33 months less
in median OS and DFS retrospectively than LNR (0-<0.25). LNY did not
show any statistically significant predictive factor in survival.
Multivariate analysis showed OS and DFS are affected (R2= 27.3% and
26.1% retrospectively) mainly by LNR. It did not show statistical
significance with the other variables, including TNM, LNY, and Dukes’
stages.
v14 | Abstracts
Conclusion: Increasing LNR was a marker of poor survival; however,
LNY was not a statistically significant predictive factor. LNR is better
in predicting survival than TNM and Dukes’ staging.
Abstract citation ID: znac247.033
SP3.1.5 Can Acute Uncomplicated Diverticulitis be managed
Ambulatory?
Madara Kronberga, Shaista Hussain, Bawan Hama, Kate McLaughin,
Mark Peter, Arin Saha
Calderdale and Huddersfield NHS Trust
Introduction: The most common complication of diverticulosis is
diverticulitis, which can be described as complicated or
uncomplicated if the inflammation is confined to the bowel wall and/
or pericolonic fat. Acute uncomplicated diverticulitis (AUD) is
traditionally managed by inpatient admission for bowel rest,
intravenous fluids and intravenous antibiotics. However, newest
World Society of Emergency Surgery (WSES), ACPGBI and NICE
guidance suggest that AUD should be managed in ambulatory setting.
Aims: To establish if Calderdale and Huddersfield NHS Foundation
Trust is complaint with national standards and if this can be carried
out safely.
Methods: Retrospective data collection of patients diagnosed with AUD
between June and August 2021. Inclusion criteria used: CT proven AUD,
age <80, patient able to tolerate oral intake, have full capacity and be
immunocompetent.
Results: 69 patients were diagnosed with acute diverticulitis between
June and August 2021. 31 of these patients matched inclusion criteria,
with 17 been treated as inpatient (IP) and 14 as outpatient (OP). The
average length of hospital stay was of 24h for IP vs 4,5h for OP. The
average deprivation index for IP was 16891 vs 15961 for OP. From
the OP group, 2 patients re-presented in hospital, however, none of
them needed admission.
Conclusions: Our results show that despite our low compliance with
national standards (45%), patients with AUD can be safely managed in
OP setting with low risk of re-admission. Additionally, by improving
our compliance, Trust resources could be saved and bed pressures
alleviated without compromising patient safety.
Abstract citation ID: znac247.034
SP3.1.6 Robotic versus Laparoscopic and open colorectal
resections – comparison of short term postoperative outcomes
over 3 years
Nandu Nair, Matthew Kobylarz, Anne Gaunt, Veerabhadram Garimella,
Sudipta Roy, Philip Varghese
Royal Stoke University Hospital
Aim: To compare the short terms surgical and oncological outcomes of
elective robotic versus laparoscopic and open colorectal resections done
over a period of 3 years at a single centre.
Methods: All robotic colorectal resections performed during a three
year period (2017–2019) at a single centre were compared with
laparoscopic and open resections from the same period. Data
including patient demographics, preoperative and postoperative
oncological staging, length of stay, 30 day readmission, need for
critical care stay, 30 day complication rate (using clavien dindo
classification) and immediate oncological outcomes were collected
from electronic patient records.
Results: During the three year period, 188 robotic resections (82.9% -
rectal resections, 17.1% colonic resections) of which 178 were cancer
resections were performed. In the same period 585 laparoscopic and
116 open colorectal resections were performed. Conversion rate for
robotic resections was 3.72%. Median lymph node harvest for the
robotic resections was 20. Major complication rate in the robotic group
was 5.3% as compared to 6.1% for the open and laparoscopic group.
Median length of stay in the robotic group was 5 days which was
significantly lower than for open rectal resections (11 days, p<0.0001).
Although there was no statistically significant difference in length of
stay between robotic (5 days) and laparoscopic rectal resections and
colonic resections (7 and 6 days respectively).
Conclusion: Robotics is a safe approach for colorectal resections with
good oncological outcomes and our experience demonstrates a
shorter length of stay and reduced complications.
Abstract citation ID: znac247.035
SP3.1.7 Does using intra-operative indocyanine green impact
the clinical suspicion of anastomotic leak?
Samantha Ng, Olusegun Komolafe
University Hospital Wishaw, NHS Lanarkshire
Aims: To see if the beneficial impact of indocyanine green (ICG)
angiography on anastomotic leak (AL) rate was reflected in the
“suspicion” of leak in patients undergoing rectal or sigmoid cancer
resection.
Methods: Patients who have intra-operative ICG fluorescence have
reduced clinical AL rates, with a shorter length of stay (LOS). Recent
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publications have suggested stricter criteria to categorize AL. A
prospectively-maintained database was reviewed to see if there was a
difference in the suspicion of AL between patients who did and did
not receive intra-operative ICG. A total of 159 rectal and sigmoid
cancers were diagnosed between 1 April 2020 and 31 March 2021 in
our health board, with 75 patients proceeding to surgery. Only
patients receiving primary anastomosis were included in this study
(n=33). Post-operative CT scans performed, diagnosis of AL,
Clavien-Dindo complication rates, use of antibiotics beyond 48 hours,
and LOS, were studied.
Results: 39.4% (n=13/33) received intra-operative ICG whilst 60.6%
(n=20/33) did not. The median LOS was 3 days in the ICG group and
6.5 days in the non-ICG group. There were less CT scans, antibiotic
use, complications, and post-operative interventions in the ICG cohort.
Conclusion: This is a small-sized snapshot audit, however it
demonstrates that the reduced AL rate in patients having
intra-operative ICG is reflected in their post-op journey of care, with a
clear difference in interventions, and no greater number of
“sub-clinical” leaks in the ICG cohort. The study will be expanded to
see if this data is consistent in a larger study.
Abstract citation ID: znac247.036
SP3.1.8 2ww Colorectal referral proformas: is the inclusion of
recent bowel investigations relevant?
Rebecca Nunn, Adil Hassan, Carol Allgrove,
Shanmugam Vivekanandan, Vardhini Vijay
Princess Alexandra Hospital NHS Trust
Aims: Straight-to-test (STT) decisions are made on the basis of the
details contained within the referrer’s documentation. This is
particularly important for Two-week wait (2ww) referrals where
incomplete or missing information may result in unnecessarily
duplicating investigations- incurring a cost to resources as well as
exposing patients to potential harm. Through reviewing GP 2ww
referrals, we highlight the prevalence of incomplete information
relating to recent bowel investigations.
Methods: A prospectively maintained database consisting of 2ww
Colorectal referrals from primary care was analysed over a 12-month
period (January 2021- December 2021). The agreed local standard is
that any bowel investigations within the last 3 years are included on
the referral proforma. Proformas compliant with this requirement
were marked as ‘Yes, complete’. A total of 3410 referrals took place
during this period- 36 were excluded from analysis as no information
regarding their status was available.
Results: Only 37% of proformas included a complete history of recent
bowel investigations over the past 3 years, and 62% had no
documentation regarding this information. Between January-April
2021 the proportion with complete documentation was 42%, which fell
to 30% by September-December 2021.
Conclusions: Including details of recent bowel investigations over
the past 3 years appears to be an area that is commonly
overlooked by referring local GPs. Given that patients may have
had investigations at different Trusts, in the absence of a
cohesive data sharing network between Trusts, GPs are best
placed to collate this important information when referring to the
Colorectal unit.
Abstract citation ID: znac247.037
SP3.1.9 Implementation of colon capsule endoscopy (CCE) into
the clinical setting – an early analysis

Alasdair Pollock, William Pollock, Susan Moug, Jack Winter,
Rob Boulton-Jones, Paul Witherspoon
NHS Greater Glasgow and Clyde
Aim: Analysis of the collaborative implementation of colon capsule
endoscopy (CCE) within NHS Greater Glasgow and Clyde
Methods: Database collected prospectively from first 175 patients
referred. Demographic data collected for those undergoing CCE.
Primary outcomes: negative, positive and incomplete/complications.
Secondary outcomes: those requiring further investigation and
outcomes (normal, abnormal and not performed). Abnormal findings:
benign disease, dysplastic changes, malignancy and unresulted.
Results: Of the first 175 patients put forward for CCE, 128 (73%)
underwent CCE: n=47 deemed unsuitable due to patient preference
(n=21) and consultant decision (n=15).
Mean age 57.8 (+/-13.9 SD), 56% female, 32% had ≥2 co-morbidities, and
6% having colorectal cancer family history.
CCE findings: negative 16% (n= 21), positive 71% (n=91), incomplete/
complications 12.5% (n= 16).
Time from referral to CCE (Mean 130 days, Median 86 days). Time from
CCE to reporting (Mean 9.4 day, Median 8 days). Time from referral
(CCE report) to colonoscopy (Mean 127 days, Median 106 days).
Colonoscopies still awaited (Mean 271 days, Median 269 days).
80% required further tests: 77% (n=98) colonoscopy or sigmoidoscopy
and 4% (n=5) imaging. Results: 20% normal, 48% abnormal, 30% not
yet performed and 2% inadequate/no longer required. Pathology:
benign disease 38%, dysplastic changes 45%, invasive malignancy 9%,
9% unreported.
Conclusions: CCE has received significant investment to attempt
to reduce the workload of endoscopy departments. However, 77%
of the patients who underwent CCE require further investigation
by scope. With an excellent safety profile, defining patient
selection is key to optimising the clinical applicability of this
evolving technology.
Abstract citation ID: znac247.038
SP3.1.10 The use of predictive severity scoring for lower
gastrointestinal bleeding in a tertiary colorectal unit
Sarina Yao1,2, James Balfour1,2, Connor Boyle1,2, Nicholas Ventham1,2
1
NHS Lothian, Edinburgh
2
Western General Hospital
Introduction: Lower GI bleeding (LGIB) has an estimated 1-year
prevalence of 10% in the UK, accounting for 3% of emergency surgical
referrals. The British Society of Gastroenterology (BSG) recommend
risk scoring for LGIB to categorise severity and plan management.
Experience in a tertiary colorectal centre suggests this potentially
overestimates the severity of bleeding and the requirement for
inpatient admission.
Method: Data was retrospectively collected for all patients referred from
primary care or emergency departments with LGIB from 01/05/20–01/04/
21. Demographics and an Oakland score (OS), recommended in BSG
guidelines, were collected. OS >8 suggests admission. Outcomes
following referral, including admission, discharge, blood transfusion
and radiological/surgical intervention, were assessed.
Results: 294 patients were assessed. 176 patients (59.9%) were admitted
for further management. The median OS for admitted patients was 12
(IQR 9–17). 30 patients (10.2%) required blood transfusion, 3 required
radiological/surgical intervention (1%). 118 (40.1%) patients were
discharged. The median OS was 10 (IQR 8–12). 80 patients discharged
had a score >8, recommending admission; 4 patients required
readmission (5.0%), however, none required intervention. 38 patients
were discharged with a score ≤8; again, 4 patients (10.5%) required
readmission for LGIB, with none requiring intervention. Fisher’s exact
test showed no statistical significance between OS and readmission
(p=0.22).
Conclusion: Risk assessment scoring recommended admission for a
large cohort of patients safely discharged after initial assessment in
our centre. A small number required readmission, however, none
suffered significant adverse outcomes. Further investigation should
assess whether such scoring systems are too cautious for use in
specialist colorectal centres.
Abstracts | v15
Abstract citation ID: znac247.039
SP3.2.1 Management and outcomes of patients with small
bowel obstruction in Denmark – a multicentre prospective
cohort study
Henry Smith1, Anders Peter Skovsen2, Thomas Korgaard Jensen3,
Ida Lolle4, Mette Astrup Tolver5, Liv Bjerre Nielsen1
1
Bispebjerg Hospital, University of Copenhagen, Denmark
2
Nordsjælland Hospital, University of Copenhagen, Denmark
3
Herlev Hospital, University of Copenhagen, Denmark
4
Hvidovre Hospital, University of Copenhagen, Denmark
5
Sjællands Universitetshospital, Denmark
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Aims: The optimal management of small bowel obstruction (SBO)
remains a matter of debate and treatment varies internationally. In
Denmark, the traditional approach to patients with SBO is less
conservative than that of the UK, but to what extent patient outcomes
differ is unknown. This study aimed to describe the current
management and outcomes of patients admitted with SBO in Denmark.
Methods: This was a prospective cohort study conducted at 6 acute
hospitals in Denmark over a 4-month period. Patients aged > 18 years
with a clinical or radiological diagnosis of SBO were eligible. Primary
outcomes were 30-day mortality and major complication rates.
Results: 316 patients were included during the study period. The median
age was 72 years and 56.0% were female. Diagnosis was made by
computed tomography (CT) in 314 patients (99.1%), with the remaining
2 diagnosed clinically. Non-operative management was the initial
strategy in 152 patients (48.1%) and successful in 120 (78.9%).
Immediate surgery was performed in the remaining 164 (51.9%), with a
laparoscopic approach used in 84 patients (51.2%). The 30-day mortality
rate was 7.3% with major complications occurring in 61 patients (19.3%).
Conclusions: The management of SBO in Denmark differs significantly
to that of the UK, with more liberal use of CT, a higher proportion of
patients undergoing immediate surgery and a higher success rate of
non-operative management. Despite these differences, patient
outcomes are broadly similar. Adoption of the best components of
both strategies may improve patient outcomes in both nations.
Abstract citation ID: znac247.040
SP3.2.2 Improving Acute Surgical Services and Establishing
Same Day Emergency Care Clinic in a District General Hospital
Mohamed Swamad, Marwa Badawi, Raimundas Vitkauskas,
Dilan Cutcu, Michail Klimovskij
Conquest Hospital, East Sussex Healthcare NHS Trust
Introduction: Surgical Same Day Emergency Care (SDEC) clinic service is
a new challenging trend nationwide. We would like to share our
experience establishing SDEC in a DGH setting. Our clinic runs two
sessions daily Monday to Friday with capacity of 16 patients.
The patients presented for; clinical follow-up post-discharge,
radiological imaging and blood tests. All referrals are triaged by
specialist nurses, seen by doctors of different grades - core surgical
trainees and specialty doctors and supervised by the Consultant
on-call.
Methods: Prospective ongoing audit carried out in SDEC monitoring the
number of patients reviewed, diagnosis, investigations and outcome.
We audited the documentation on the hospital’s electronic system.
Results: In October 2021, 62 patients were reviewed, 97% had decisions
made same day and only 3% required admission to SAU, 50% were
allocated to a named consultant, 69% had blood tests, 53.2% had
radiological investigations, 25% of patients were discharged with
plans to follow up in elective clinics, and 1 patient was booked for
elective operation.
Our recommendations to improve quality of service were to allocate a
dedicated staff nurse and healthcare assistant for more efficient
workflow. Improving documentation of outcomes and allocating
patients to named consultant for follow up.
Conclusion: Our model demonstrated successful service to provide
semi-urgent care to surgical patients. SDEC has the capacity for more
patients and subsequently will offload pressure from the emergency
services provided by A&E and surgical admissions unit. This also
v16 | Abstracts
makes a significant impact for on-call team to allow more focus on
treatment of acute emergencies.
Abstract citation ID: znac247.041
SP4.1.1 An Audit of Negative Appendicectomy Rates at the
Borders General Hospital
Jasmine Brown, Kirsty Lennon, Richenda Rae, Jamie Young
Borders General Hospital
Aims: Appendicitis is the most common abdominal surgery emergency
globally with 50,000 acute appendicectomies in the UK annually. Despite
improvements in diagnostic techniques, negative appendicectomies
still occur.
We aimed to audit local results of negative appendicectomy rates (NAR)
against the 2012 National Appendicectomy Audit which recommends
an NAR <20%.
Methods: Retrospective data of patients who underwent
appendicectomy from January 2016-October 2021 was collected
using electronic records. Patients who underwent elective
appendicectomies, were not suspected appendicitis or did not have
pathology results were excluded. Data was collected on patient
demographics, surgical approach, pathology and radiological
investigations prior to surgery.
Results: A total of 518 patients were included. 54.1% (280) were male and
45.9% (238) were female. The age range was 5–87 years with an average
of 36.4 years.
48.9% (253) had CTs with 98.4% reporting appendicitis, 16.2% (84) had
ultrasounds with 50% reporting appendicitis, 34.9% (181) had no
imaging prior to surgery. Of those imaged the NAR was 12.8% (6.3%
CT, 32.1% ultrasound) and no scan was 17.1% (p=0.188).
26.2% (135) of appendicectomies were open, 69.5% (358) laparoscopic
and 4.3% (22) converted.
Pathology showed that 14.3% (74) appendixes were negative and 85.7%
(444) positive. Males had a lower NAR of 11.1% vs females with 18.1%
(p=<0.05).
Conclusions: Our result of a 14.3% NAR shows that we are working
within the recommended national guidelines of a <20% NAR. The NAR
was higher in females than males. The use of imaging in addition to
clinical evaluation helps reduce the NAR, with CT being more effective
than ultrasound.
Abstract citation ID: znac247.042
SP4.1.2 Management and Ambulation of Uncomplicated Acute
Diverticulitis during the COVID-19 Pandemic – A Clinical Audit
in a District General Hospital
Hussein Elghazaly1,2, Payman Dahaghin1, Panagiotis Drymousis1
1 2
London Northwest University Healthcare Trust
2
Imperial College London
Aims: To audit the management (ambulation versus admission) of
acute diverticulitis presenting to a London DGH.
Methods: A retrospective clinical audit. Data on cases of acute
diverticulitis presenting to the general surgical department at Ealing
Hospital were collected over a period of 92 days. The medical notes
were screened and the indication for admission in hospital was
recorded. Each admission was then assessed for compliance with
standard criteria for appropriate admission, derived from national
guidelines by NICE. Patients admitted despite not meting these criteria
were deemed as inappropriate admissions.
Results: mAll patient referrals to General Surgery at Ealing Hospital
were screened from 1/7/21 to 30/9/21. 618 patients were identified. A
total of 18 patients presented with radiologically-confirmed
diverticulitis in this period (2.9%). Of these, 14 patients were admitted
(77.8%). None of the patients ambulated met the criteria for
admission. If the admitting teams were to adhere to National
Guidelines, 15 of the 18 patients presented and 11 of the 14 patients
admitted could have been safely ambulated. In
inappropriately-admitted cases, none received surgical intervention.
The mean number of days spent in hospital for inappropriate
admissions was 3.27 (Range 1–8 days). This translates to 49
patient-days that could have been safely avoided according to
national guidelines. The cost incurred by the NHS by the inappropriate
admission of these patients is estimated at £78,400 p.a.
Conclusions: Safe ambulation of patients presenting with acute
uncomplicated diverticulitis can improve departmental efficacy,
patient flow and ultimately reduce bed pressures and expenditure
associated with hospital admissions.
Abstract citation ID: znac247.043
SP4.1.3 Validation of the Emergency Surgery Score (ESS) in the
UK patient population and comparison with NELA scoring: a
retrospective multi-centre cohort study
Darja Clinch1, Michael Wong2, Emma Imbert3, Laura Haddow3,
Keith Simpson3, Dimitrios Damaskos1
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1
Royal Infirmary of Edinburgh, UK
2
Royal Alexandra Hospital, Paisley
3
University of Edinburgh
Aims: Accurate risk scoring in emergency general surgery (EGS) is vital
for consent, resource allocation and benchmarking quality of care. The
emergency surgery score (ESS) is a reliable predictor of post-operative
outcomes in EGS, but has only been studied in the US population. Our
primary aim was to perform an external validation study of the ESS in
a UK population. Our secondary aim was to compare the accuracy of
ESS and NELA scores.
Methods: We conducted an observational cohort study of adult patients
undergoing emergency laparotomy over three years in two UK centres.
ESS was calculated retrospectively. NELA score and all other variables
were obtained from the prospectively held Emergency Laparotomy
and Laparoscopic Scottish Audit (ELLSA) database. Primary outcome
was 30-day mortality. Secondary outcome was need for post-operative
ICU admission.
Results: 609 patients were included. Both ESS and NELA were good
predictors of 30-day mortality (c-statistic=0.78 [95% CI: 0.71–0.85] for
ESS and c-statistic=0.83 [95% CI: 0.77–0.88] for NELA). Similarly, both
scores were good predictors of need for post-operative ICU admission
(c-statistic=0.76 [95% CI: 0.71–0.81] for ESS and 0.80 [95% CI: 0.76–0.85]
for NELA). There was no significant difference in performance
between the two scores for predicting 30-day mortality (p=0.20) or
need for ICU admission (p=0.09).
Conclusion: We recommend that ESS can be used in the UK population.
It is non-inferior to NELA in predicting 30-day mortality and need for ICU
admission, but has been validated for a wider range of outcomes and
does not require scoring of intra-operative variables.
Abstract citation ID: znac247.044
SP4.1.4 Bowel injury in gynaecological laparoscopic surgery: a
systematic review
Kealan Westby1, Evan Mannion2
1
Galway Clinic, Galway
Galway Clinic, Galway, Ireland
Aims: Often general surgical opinion or assistance is sought in the
presence of an iatrogenic bowel injury. The objective of this review
was to analyse the literature on bowel injury in those undergoing
laparoscopic gynaecological surgery and determine incidence rate,
nature & site of injury and treatment.
Methods: Data sources included Pubmed, EMBASE, ClinicalTrials.gov
and the Cochrane library databases. Timeframe for studies included
was from 1990–2021. All studies in English reporting the incidence of
bowel injury were included. Those not in English, case reports or that
did not define bowel injury were excluded. Preferred Reporting Items
for Systematic Reviews and Meta-Analyses (PRISMA) were used when
assessing the studies.
Results: Two reviewers extracted data from each study. A total of 515
papers were initially identified, 134 met inclusion criteria. Total of 512,098
laparoscopic gynae procedures were represented with 720 bowel injury
reported giving an incidence rate of 1/711 (0.14%, 95% CI 0.13–0.15%) The
rate of bowel injury varied with type of procedure, highest being in a
hysterectomy. Small bowel was most common structure injured and the
majority of bowel were identified intraoperatively. Delayed recognition of
bowel injury led to high mortality rate.
Conclusion: The incidence for bowel injury in laparoscopy
gynaecological procedures is 1/711. There is a variation in incidence
rate & complexity of procedure. Early recognition and collaboration
between gynaecologists and general surgeons is essential for a
favourable outcome.

Abstract citation ID: znac247.045
SP4.2.1 Emergency management of lower GI bleeds: a
full-cycle audit of practice at a district general hospital
Esha Khanderia1, Riana Patel1, Rohit Chandegra1, Harriet Gass1,
Akshay Doshi1, Hesham Morsy2, Drostan Cheetham1
1 2
West Hertfordshire Hospitals NHS Trust
2
Barking, Havering and Redbridge University Hospitals NHS Trust
Introduction: Lower GI bleeds (LGIB) are a common cause of emergency
surgical admission. National Guidelines on the management of LGIB
were published by the British Society of Gastroenterologists (BSG) in
2019. The aim of our audit was to determine whether local practice of
managing LGIB adhered to these guidelines.
Method: Our initial audit cycle retrospectively reviewed 47 patients
with LGIB who had presented to our Hospital. Subsequently, a
departmental teaching session was conducted and posters outlining
BSG guidelines were placed on surgical wards and the surgical
assessment unit. A re-audit of local practice was prospectively
undertaken with 30 patients.
Results: In the initial audit cycle 37/47 (78.7%) patients had a major
LGIB (Oakland score >8) where admission is advised. Of these, 6
(16%) were discharged on the same day. Of the 10/47 (21.3%)
patients who had a minor LGIB, 6 (60%) were discharged on the
same day. In the re-audit cycle, 29/30 (96.7%) patients had a major
LGIB and 1/30 had a minor LGIB, none of these patients were
discharged on the same day. The re-audit population had a higher
rate of inpatient endoscopy, 66.7% vs 14.9%. 50% of unstable
patients had a CT angiogram on admission in the re-audit vs 0%
patients in the first cycle.
Discussion: Following education, compliance to BSG guidelines
improved. Discharges in patients with major LGIB reduced to zero
following this audit and more patients received appropriate inpatient
investigations. Further work is required to see if change in local
practice has an impact on clinical outcomes.
Abstract citation ID: znac247.046
SP4.2.2 Recovery after Emergency Laparotomy – what do
patients want?
L Silva1,2, C Crole Rees2, T Watts2, J Bisson2,1, JA Cornish1
1
Cardiff and Vale University Health Board
2 1
Cardiff University
Aim: Recent focus on Emergency Laparotomy outcomes has improved
mortality, but little attention has been given to recovery. The aim of
this qualitative study was to explore recovery after EmLap.
Method: A focus group was established of ten EmLap patients. Inclusion
criteria: EmLap<5 years ago, non-palliative. Patients were selected to
provide balance of age, sex and pathology. Thematic qualitative
analysis was performed by two researchers.
Results: Several key themes were highlighted;
Lack of communication on diagnosis/expectations after surgery. Little
continuity of care. Long delays in seeing doctors after surgery and no
way to contact them and GPs unable to help.
Financial consequences are significant, with no guidance. Took longer
to recover than expected, difficult to explain to employer. Led to early
retirement or change of hours/role.
Hernias; Some patients aware of hernia risk but given conflicting advice,
e.g avoid lifting and rest for 6 weeks, others told to exercise regularly.
Difficult to access support garments.
Diet – Conflicting advice on what they could/couldn’t eat, especially
fibre. Felt more by patients who had stoma or bowel resection. Poor
quality food in hospital and lack of options for diet (e.g. vegan, coeliac).
Poor mental health after surgery with anxiety, depression and loss of
confidence all having large impact, especially on relationships and
intimacy. Key issues lack of access to services and waiting times. Too
‘complex’ for primary care.
Conclusions: The impact of emergency surgery on patients is
significant, particularly mental health and financial impact.
Recommend standardised information (leaflets/website/signposting)
and key support worker.
Abstracts | v17
Abstract citation ID: znac247.047
SP5.1.1 Novel in vitro model of neurotrauma to study
neurotherapeutics
Raja Haseeb Basit1,2, Jessica Wiseman1, Divya Maitreyi Chari1
1
Neural Tissue Engineering, Keele University
Bradford Royal Infirmary
Introduction/Aims: Penetrating traumatic brain injury (pTBI) is a surgical
emergency, with poor clinical outcomes. Management is supportive
including surgical wound debridement, anti-epileptic administration and
infection prophylaxis; no clinical neuroregenerative therapies exist.
Surgical biomaterial scaffolds have therapeutic potential, but
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developmental testing relies heavily on highly invasive live animal injury
models which are low throughput, expensive, technically challenging,
and present significant ethical challenges. We recently developed a high
throughput, multi-glial and facile in vitro pTBI model within which
neural cell interactions with a surgical grade scaffold, DuraGen PlusTM
could be investigated. A key limitation was the lack of a neuronal
component, meaning axonal transection and regeneration could not be
assessed. Here, we report an advanced version of the model, which (i)
encompasses all the major neural cell types including neurons; (ii) within
which penetrating lesions can be induced and biomaterials implanted.
Methods: Cerebral cortices from postnatal mice were extracted and cultured
in vitro with a novel supporting medium. Cultures were transected at
8 days post-culture simulating penetrating injury in vitro, with
immunocytochemistry used to analyse neural-cell responses/interactions.
Results: We demonstrate the utility of the model in reproducibly
simulating pTBI in vitro with key pathological features such as glial
scarring, microglial invasion and axonal outgrowth, p<0.05, n=5). The
benefit of the model to study nanomaterial-neural cell interactions is
demonstrated.
Conclusion: Our new model offers significant benefits for high
throughput, facile developmental testing of novel nano/biomaterials
in preclinical studies.
Abstract citation ID: znac247.048
SP5.1.2 Splenic Artery Embolisation: Reviewing 10 years of
practice at a Major Trauma Centre
Benjamin Jones1, Adil Salim Elbakri1, David McLaughlin2,
Christopher Murrills3, Pradeep Patil1, John Scollay1
Department of General Surgery, Ninewells Hospital, Dundee
2
Department of Haematology, Ninewells Hospital, Dundee
3
Department of Radiology, Ninewells Hospital, Dundee
Introduction: Splenic Artery Embolisation (SAE) has transformed the
management of splenic trauma. The aim of this project was to review
the outcomes and post procedural management of splenic trauma
patients managed by SAE at a Major Trauma Centre over a 10-year period.
Methods: Details of all patients undergoing SAE for trauma between
2011–2021 were acquired from a prospectively maintained database.
Patient records were reviewed for demographic information and details
of mechanism / grade of splenic injury, success of embolisation,
complications, associated injuries and mortality. Data relating to
post-procedural practice (vaccinations, antibiotic prescribing, follow-up
imaging) were also obtained.
Results: 26 patients (19 male, 7 female) with a median age 44 years
(range 13–97) were identified. 25/26 injuries were due to blunt trauma.
AAST splenic injury grades were III (n=5), IV (n=16) and V (n=5). SAE
succeeded first time in 25/26 cases, and upon second attempt in 1/26
case. 3 patients died prior to discharge; 2 due to associated traumatic
injuries and 1 from multi-organ failure. Complications secondary to
SAE occurred in 4/26. Vaccinations were administered in 12/26 cases,
and long-term antibiotics initiated in 11/26 cases. Formal follow up
imaging was arranged in 5/26 cases.
Discussion: These data shows SAE is an effective means of controlling
splenic haemorrhage with no patient requiring subsequent
laparotomy. Complications occurred in 15% of cases. Great variance
was found in terms of follow up practice regarding further imaging,
antibiotics, and vaccinations. Increasing knowledge about SAE offers
the opportunity to standardise post-procedure care for these patients.
v18 | Abstracts
Abstract citation ID: znac247.049
SP5.1.3 Early initiation of chemical venous thromboembolism
(VTE) prophylaxis following traumatic spleen injury is safe and
effectively reduce VTE events
Sheah Lin Lee1,2, Georges Rizkallah1, Adel Mahmoud1, Joe Long1,
Sachin Modi1, Hassan Elberm1
1 1
University Hospital Southampton
2 2
University of Southampton
Aims: Within the first 48 hours (h) of trauma, hyper-coagulation state
occurs which put trauma patients at risk of developing deep vein
thrombosis (DVT) and pulmonary embolism (PE), leading to an
increase rate of mortality. Non operative management (NOM) is now
the standard of care for traumatic splenic injuries (TSI). However,
timing of initiating chemical venous thromboembolism (VTE)
prophylaxis, heparin or low molecular weight heparin (LMWH),
remains controversial due to concern of rebleeding. This study
examines the safety and timing of initiating VTE prophylaxis post TSI.
Methods: Patients with TSI were identified from prospectively
maintained Trauma Audit and Research Network (TARN) database
from 2015–2020 in a single tertiary trauma centre. Clinical and
radiological information were collected retrospectively. TSI were
graded using AAST classification. VTE prophylaxis initiation were
categorised as not given, <48h and >48h following the injury.
Results: In total 102 patients were included. Fifty-three percent (54/102)
had Grade 3 injury and above. Majority 90/102 (88%) of patients were
treated non-operatively. VTE prophylaxis was not given for 31 (30.4%),
initiated for 37 (36.3%) within 48h and given to 34 (33.3%) patients
after 48h. Seven (7%) patients developed thromboembolic events,
majority of which (6/7) received VTE prophylaxis after 48h. None of
the patients who received VTE prophylaxis had rebleeding.
Conclusions: This study showed that early initiation of chemical VTE
prophylaxis (<48h) is safe, resulted in lower incidence of DVTs/PEs
without increase risk of bleeding. Results from this study supports
recommendation from other studies to initiate chemical VTE
prophylaxis after TSI as early as 24h post injury.
Abstract citation ID: znac247.050
SP5.1.4 Prevention, Diagnosis, and Management of Fracture
Related Infections in accordance with the BOA FRI Guidelines
Victor Lu1, James Zhang1, Azeem Thahir2, Matija Krkovic2
1
University of Cambridge
2
Addenbrooke’s Hospital, Cambridge
Aim: Fracture related infections (FRI) are common and serious
complications of musculoskeletal trauma. With average hospital
health care costs for infected patients being 6.5 times higher than
uninfected patients, FRI poses a significant social-economic burden to
the patient and healthcare system.
We aim to audit current practice in preventing and diagnosing FRIs, and
improve management of infections in patients with fractures. The
guidelines covered are the British Orthopaedic Association (BOA) FRI
guidelines.
Method: Our sample included patients who suffered an infection as a
direct consequence of fracture and/or subsequent surgical management
procedures over a seven-year period. Surgical procedures were
performed for fractures in 8826 patients. In total, 102 patients with a FRI
were reviewed. Audit results and recommendations have been
presented at a clinical governance meeting.
Results: Seven out of sixteen items had poor compliance (<80%
compliance). Ultrasound-guided aspiration was done in 21.6% (22/102),
even if debridement surgery is delayed. 1.96% (2/102) received adequate
advice about responding to a suspected FRI. 56.9% had recommended
2-week antibiotic-free duration before sampling. Our recommendations
include pre-written template in discharge documentation providing
guidance on responding to a suspected FRI, better communication
between microbiology, surgical team, and GPs regarding antibiotic
prescription timing, including weekly bone and joint infection MDT
review for FRI patients.
Conclusions: Lowering FRI-related burden requires a three-pronged
approach: uniform set of standards for infection prevention in trauma
and orthopaedic surgery, robust diagnostic workup for suspected FRI
cases, effective management scheme for confirmed FRI cases. These
systems should be a key element of orthopaedic trauma service.
Abstract citation ID: znac247.051
SP5.1.5 Risk factors for Septic Arthritis and need for
Arthroscopic Washout: Minimum two year follow-up at a
major trauma centre
Victor Lu1, Andrew Zhou1, Hassan Hussain1, Azeem Thahir2,
Matija Krkovic2
University of Cambridge
Addenbrooke’s Hospital, Cambridge
Introduction: A hot swollen joint is commonly encountered in
orthopaedics and rheumatology. With a broad range of differentials,
septic arthritis (SA) is perhaps the most concerning, with delayed
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treatment leading to osteonecrosis, loss-of-joint-function, and
mortality. To facilitate clinical decision making, we aimed to
determine the risk factors for development of SA.
Methods: All patients presenting to the emergency department,
orthopaedic and rheumatology clinics at our major trauma centre
between January 2020 and January 2021 with a hot, swollen joint were
retrospectively evaluated.
The frequency of variables of interest in the three-month period
preceding the diagnosis of SA were compared between SA and
non-SA patients using univariate analysis. A multiple logistic
regression model was formed for covariates that were significantly
associated with SA (p<0.05), which underwent a backwards
elimination process to identify a predictive model for SA.
Multi-collinearity was assessed between covariates and variables
with significant intercorrelation were removed. Statistical
significance was set at p<0.05.
Results: 221 patients were included (SA: 28; periprosthetic joint
infection: 24; pseudogout: 32; gout:26; other conditions: 111).
Multivariate analysis showed that RA, skin infection, and liver disease
were risk factors for SA, with odds ratios of 2.656 (95%CI:1.090–6.475;
p=0.032), 3.162 (95:CI:1.269–7.883;p=0.013), 4.993 (95%CI:1.156–21.559;
p=0.031), respectively.
Conclusion: With a high mortality and morbidity rate, early diagnosis of
septic arthritis is crucial. This requires understanding what the risk
factors are, namely RA, skin infection, and liver disease. We believe
that the models in this study are of prognostic value to clinicians who
are presented with the common presenting compliant of a hot
swollen joint.
Abstract citation ID: znac247.052
SP5.2.1 Intra-muscular interposition of nerve endings to
minimise neuropathic and residual pain in lower limb
amputations
Victor Lu1, Andrew Zhou1, Matija Krkovic2
1
University of Cambridge
2
Addenbrooke’s Hospital, Cambridge
Introduction: A major cause of morbidity in lower limb
amputees is phantom limb pain (PLP) and residual limb pain (RLP).
This study aimed to determine if surgical interposition of nerve
endings into adjacent muscle bellies at the time of major lower
limb amputation can decrease the incidence and severity of PLP
and RLP.
Methods: Data was retrospectively collected from January 2015 to
January 2021, including eight patients that underwent nerve
interposition (NI) and 36 that received standard treatment. Primary
outcomes included the 11-point Numerical Rating Scale (NRS) for pain
severity, and Patient-Reported Outcomes Measurement Information
System (PROMIS) pain intensity, behaviour, and interference.
Secondary outcome included Neuro-QoL Lower Extremity Function
assessing mobility. Cumulative scores were transformed to
standardised t scores.
Results: Across all primary and secondary outcomes, NI patients had
lower PLP and RLP. Mean ‘worst pain’ was 2 out of 10 for RLP in the NI
group, compared to 3.58 in the control group (p=0.045). Mean PROMIS t
scores were lower for NI cohort for both RLP (pain intensity [41.2 vs
48.1;p=0.035]; pain interference [44.9 vs 46.3;p=0.260]; pain behaviour
[44.4 vs 50.8;p=0.039], and PLP (pain intensity [50.8 vs 58.5;p=0.029];
pain interference [49.1 vs 54.0;p=0.009]; pain behaviour [53.4 vs 55.6;
p=0.061]). Mean Neuro-QoL t score was lower in NI cohort (45.4 vs 41.9;
p=0.03).

Conclusion: Surgical interposition of nerve endings during lower limb
amputation is a simple yet effective way of minimising PLP and RLP,
improving patients’ subsequent quality of life. Additional comparisons
with targeted muscle reinnervation should be performed to determine
the optimal treatment option.
Abstract citation ID: znac247.053
SP5.2.2 Our Management of Distal Femoral Comminuted
Fractures with Femoral Defects
Andrew Zhou, Eric Jou, Shaan Patel, Victor Lu, James Zhang,
Matija Krkovic
University of Cambridge
Aim: Distal femoral fractures account for 3–6% of all femoral fractures.
Current management of distal femoral fractures involve reducing
bone fragments and placing a locking plate against it. In this study,
the surgeon used a ‘selective approach’, whereby only key bone
fragments in the comminuted fracture were reduced and fixed whilst
the rest were either removed or left unreduced/unfixed.
Method: All patients underwent AxSOS plate/less invasive stabilisation
system (LISS) surgery for their comminuted femoral fracture after
adopting the “selective approach” during pre-surgical planning. A
significant proportion of patients had a degree of bone defect, and
most had open fractures. Primary outcomes included post-operative
functional ability, quality of life assessed using EQ-5D-5L, Oxford Hip
Score (OHS), Oxford Knee Score (OKS), range of movement.
Results: Average OKS and OHS for our cohort (n=10) is 23 and 35,
respectively, with a mean knee-flexion of 86° (45°-120°). Average
EQ-5D- 5L index value is 0.551; the most common response for
mobility, self-care, usual activities, pain/discomfort, and anxiety/
depression was moderate. 20% developed pin site infections, 40%
reported significant knee stiffness.
Conclusions: Despite a complex cohort whereby many patients had
bone defects, and 80% had open fractures, the “selective approach”
adopted in the present study achieved comparable outcomes to other
studies with less-severe fracture characteristics, with similar
operation times and range of knee-flexion. These results suggest that
this alternative should be considered as a treatment option, although
more studies on a similar cohort of patient to ours is needed to allow
better comparison of the surgical approaches.
Abstract citation ID: znac247.054
SP5.2.3 Protocolised MRI as an Adjunct to CT in the Diagnosis
of Femoral Neck Fracture in High Energy Ipsilateral Femoral
Shaft Fractures – a Breakeven Analysis
Thomas MacKinnon, Hussein Selmi, Peter Reilly, Khaled Sarraf,
Sanjeeve Sabharwal
Imperial College London NHS Trust
Background: In high-energy femoral shaft fractures, ipsilateral femoral
neck fractures can be missed by conventional trauma
computed-topography (CT) imaging, resulting in increased treatment
costs and patient complications. Evidence suggests that a rapid,
limited-sequence pelvis and hip magnetic resonance imaging (MRI)
protocol can identify these occult fractures and be feasibly
implemented in the trauma setting. This study aims to analyse the
economic viability of implementing a such an MRI protocol for all
high-energy femoral shaft fractures.
Methods: We used an adapted break-even economic tool to determine
whether the costs of an MRI protocol can be offset by cost-savings
achieved through prevention of missed fractures (thus avoiding
prolonged inpatient admission, re-operation and implant costs).
Sensitivity analyses were performed to demonstrate the reliability of
the economic modelling across a range of assumptions.
Results: Assuming a baseline of hip fractures missed on CT of 12%, an
MRI cost of £129 and cost of treating each missed hip fracture of
£2633.5, the equation yielded a breakeven rate of 7% and absolute risk
reduction (ARR) of 5%, indicating that for every 100 femoral shaft
fractures, MRI would need to diagnose 5 of the 12 missed hip fractures
to be economically viable (NNT=20). Economic viability was
maintained even at double the cost of MRI, while increasing the cost
Abstracts | v19
of treating each complication served to reduce the ARR further,
increasing cost effectiveness.
Conclusion: A rapid, limited-sequence MRI protocol to exclude occult
ipsilateral hip fractures in all femoral shaft fractures would be an
economically justified measure.
Abstract citation ID: znac247.055
SP5.2.4 Machine learning development of novel triage tools for
major incidents
Nabeela Malik1,2, Yuanwei Xu3, Saisakul Chernbumroong3,
Douglas Bowley4,5, Antonio Belli1,2, Georgios Gkoutos1,3
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1
NIHR Surgical Reconstruction and Microbiological Research Centre (SRMRC),
Heritage Building, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston,
Birmingham, B15 2TH, UK
2
Institute of Inflammation and Ageing, University of Birmingham, Birmingham,
B15 2TT, UK
3
Institute of Cancer and Genomic Sciences, University of Birmingham,
Birmingham, B15 2TT, UK
4
Academic Department of Military Surgery & Trauma, Royal Centre for Defence
Medicine, Mindelsohn Way, Edgbaston, Birmingham, B15 2WB, UK
5
University Hospitals Birmingham, Mindelsohn Way, Edgbaston, Birmingham,
B15 2WB, UK
Aims: Major incidents (MI) are an important cause of death and
disability. Triage tools are crucial to identifying patients requiring
time-critical, life-saving surgery and/or resuscitation (Priority 1 (P1)
patients). We employed machine learning to develop novel primary
and secondary triage tools, including external validation.
Methods: Adults from the Trauma Audit and Research Network (TARN)
registry (January 2008-December 2017) acted as surrogates for MI
victims, divided chronologically (70:30) to yield model training and
internal testing datasets, respectively. P1s were identified using
predefined criteria. Input variables included physiology, age,
mechanism and injury location. Random forest, extreme gradient
boosted (XGB) tree, linear regression and decision tree models were
trained, including cross-validation, to predict P1 status. Primary and
secondary tool candidates were selected; the latter was validated
using the UK military’s Joint Theatre Trauma Registry (JTTR). Existing
tools served as comparators.
Results: Models were internally validated in 57,979 TARN patients.
Several outperformed the best existing tool (Battlefield Casualty Drills
Triage Sieve: sensitivity 68.2%, AUC 0.688). Inability to breathe
spontaneously, presence of chest injury and mental status were most
predictive of P1 status. A three-variable decision tree model
(sensitivity 73.0%, AUC 0.782) was selected as a candidate primary
tool. A four-variable XGB model (sensitivity 77.9%, AUC 0.817) is
proposed as a secondary tool, applicable via a portable device; and
validated amongst 5,956 JTTR patients (sensitivity 97.6%, AUC 0.778).
Conclusions: Models outperformed existing triage tools in a nationally
representative trauma population, these may serve as evidence-based
novel tools. The proposed secondary tool demonstrates excellent
external validity.
Abstract citation ID: znac247.056
SP5.2.5 Optimising Communication during Damage Control
Surgery- a survey of adult Major Trauma Centres in England
Ethlinn Patton, Ilans Lisagors, Stella Smith
Manchester Foundation Trust
Aims: Snap briefs (truncated WHO checklists) and Sit Reps (situational
reporting), are long established practices within the military,
developed from their vast experience in treating patients requiring
Damage Control Surgery (DCS)[1,2].
Our aim was to establish if formal systems like these are in place in
Major Trauma Centres (MTCs) in England, and gather staff’s
experiences of using these systems.
Methods: An online survey was devised and distributed to MTCs in
England via the Major Trauma Network. It consisted of 14 questions,
relating to use of modified WHO checklists and Sit Reps during DCS.
Results: Results were received from all 23 adult MTCs in England. Eight
centres (34.8%) reported using a modified WHO checklist for DCS. Most
commonly these were modified to include reference to blood products
v20 | Abstracts
used and available, other specialties needed, and presence of surgical
equipment prior to start (eg. thoracotomy.)
12 centres (52.2%) are using Sit Reps during DCS. Many respondents
from centres without a formal policy in place stated that they
personally endeavor to maintain communication when they are
involved in DCS cases, and recognised that a formal system would be
greatly beneficial.
Conclusion: Many MTCs are not using truncated WHO checklists and Sit
Reps for DCS. From the centres who have adopted these methods, staff
have reported they improve shared decision making. Wider
implementation of these techniques could therefore lead to both
improved patient care and staff experiences.
Abstract citation ID: znac247.057
SP5.2.6 The Challenges Experienced by Female Surgeons in
Africa- A Review of the Existing Literature
Damilola Jesuyajolu1, Charles Okeke2, Otomi Obuh3
1 Kofi Cox1, Cleo Kenington2
Surgery department, First Graceland Hospitals, Abijo, Lagos
2 St. George’s, University of London
Surgery department, EYN Primary Healthcare Center Mubi, Kwarhi, Hong,
Adamawa State, Nigeria
3
Vascular Surgery, Imperial College Healthcare Trust, UK
Aims: There has not been any comprehensive analysis of the challenges
faced by female surgeons in Africa on a continental scale. These
challenges, when brought to the forefront, can be tackled by the
necessary stakeholders to increase the participation of women in
surgery. This article will review the existing literature, across the
African continent, to highlight the challenges experienced by female
surgeons.
Methods: We conducted a search using keywords ‘Challenges’ ‘Female’
‘Surgeon’ ‘Africa’ and ‘Bias’ on PubMed, Google Scholar, and AJOL from
inception till 21st of January 2022. We then searched these keywords
on Google in addition to the names of each of the individual countries.
10 papers satisfied the eligibility criteria by discussing the specific
challenges that female surgeons faced in practice.
Results: There was a paucity of data from most of the individual African
countries, highlighting the need for more research in this aspect. Out of
the 10 published papers that were eligible, problems with work-life
balance was the most common challenge with underrepresentation
being second. Harassment, insufficient support, disrespect from
colleagues, exclusion from activities, and stereotypes were also part of
the challenges identified.
Conclusion: Despite the increasing participation, female surgeons
continue to face different challenges ranging from the unfavorable
work environment to the pressures put on them by society. This
narrative review serves as a stimulant for major health stakeholders
in Global surgery to promote gender inclusivity in the African surgical
workforce; a feat that will ultimately benefit the people who need
access to quality surgical care.
Abstract citation ID: znac247.058
SP5.2.7 Direct line: Implementation of a novel clinician triage
service to safely prevent unnecessary surgical admissions
Mishal Shahid, Louise Gurowich, Rebecca Dru, Jessica Barton, Kate Lock,
Marianne Hollyman
Musgrove Park Hospital, Taunton
Introduction: With the NHS under increasing pressure, the number of
patients being referred to secondary care is increasing. Ambulatory
clinics are being set up to reduce admission in some patient groups.
In our unit, GP referrals to General Surgery were previously being
accepted to the admissions ward, without triage. A new system which
allowed referrers to contact senior on-call team members was trialled
to identify whether patients could be safely diverted to an ambulatory
clinic, avoiding inpatient admission.
Methods: A cascade triage system of referrals was trialled between
September 2021 and January 2022, over a total of 30 days. Data were
collected on who triaged the call, outcome of the call, and admission
rate of patients.
Results: Some 195 calls were analysed. Consultants were able to divert
62%(66/106) of patients to an ambulatory clinic compared to 30%(14/
46) for junior doctors and 35%(15/43) for specialist nurses(p<0.001).
The overall admission rate was 50%, with half of patients being
successfully managed ambulatorily.
Improvement was shown over time in triage by junior doctors, with 1/10
in first 10 patients versus 4/10 in the final 10 patients triaged to the
ambulatory clinic.
Average weekday admissions to the ward dropped from 12.1, to 7.5 on
trial days.
Conclusion: The trial has demonstrated senior decision makers are the
most effective at directing patients to an ambulatory pathway, while
junior doctors have scope to improve their skills with experience.
Clinician triage is successful at reducing the number of surgical
admissions when there is access to an ambulatory clinic.
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Abstract citation ID: znac247.059
SP5.2.8 Management of Small Bowel Obstruction: Are we
improving?
1
2
St. George’s University Hospitals NHS Foundation Trust
Aims: Recently 2 national audits evaluating the management of small
bowel obstruction (SBO) have been published, recommending areas
for improvement (NASBO and NCEPOD: delay in transit). We
conducted a retrospective audit to evaluate if the management of SBO
at a University Hospital reflects these recommendations.
Methods: The audit questionnaire and standards were designed using
recommendations from the national audits. Patients were identified
using hospital coding data over a 6-month period: February-July 2021.
Patient data was extracted using electronic patient records.
Results: 81 patients were identified. Adhesions (59%) and hernias (26%)
were the predominant aetiologies. 53% were managed conservatively,
36% with early surgery and 11% with delayed surgery. 93% of cases
received a CT; time to CT diagnosis was slower in patients also
investigated with abdominal radiographs. Mean time from triage to CT
diagnosis was 7.5 hours (2.2 days in NASBO). 84% of surgical cases
arrived in theatre less than 72 hours after triage and 65% of
conservatively managed cases received Gastrografin (28% in NASBO).
Dietician review occurred in 68% of patients at moderate-severe risk
of malnutrition (39% in NASBO). 48% of patients had urine output
recorded within 24 hours of admission and AKI incidence was 14% (8%
in NCEPOD: delay in transit). No surgical cases were successfully
managed laparoscopically and 20% of frail patients had geriatrician
input.
Conclusion: Whilst improvements have been made since the NASBO
and NCEPOD: delay in transit, fluid balance consideration, care of frail
patients, laparoscopic surgery and use of abdominal radiographs
remain key areas for improvement.
Abstract citation ID: znac247.060
SP5.2.9 Perioperative immunonutrition in reducing the
infectious complications in patients undergoing colorectal
cancer resections: a meta-analysis of randomized controlled
trials
Mazin Mohamed1, Hussameldin M Nour1, Muhammad Sajid1,
Parv Sains2, Mirza K Baig3,4
1
University Hospitals Sussex NHS trust
2
Spire St Anthony’s Hospital
3
University Hospitals Sussex NHS Trust
4
Worthing Hospital
Objective: Perioperative nutritional interventions have been reported to
improve colorectal rectal cancer surgery outcomes. The objective of this
article is to assess the influences of immunonutrition intervention
during perioperative period in patients undergoing colorectal cancer
resections.
Method: Meta-analysis was conducted according to the PRISMA
guidelines. Systematic search of medical databases like MEBASE,
MEDLINE and pubmed was performed to find studies exclusively
reporting the perioperative use of immunonutrition in patients
undergoing colorectal cancer resections and relevant published
randomized, controlled trials (RCT) were shortlisted according to the
 Abstracts | v21

inclusion criteria. The analysis of the pooled data was done using the
RevMan statistical software.
Result: Ten RCTs on 1218 patients with colorectal cancer fulfilled the
inclusion criteria. In the random effects model analysis, the use of
perioperative immunonutrition in patients undergoing colorectal
cancer resections statistically reduced the risk [odds ratio 0.59, 95% CI
(0.35–1.0), z= 1.96, p=0.05] of infectious complications. However, there
was significant heterogeneity [Tau2 = 0.35; Chi2= 19.11, df = 9 (P <
0.02; I2 = 53%)] among included studies. The variables of postoperative
mortality [odds ratio 2.1, 95% CI (0.33–12.36), z= 0.75, p=0.45] and
length of hospitalization [standardized mean difference 0.16, 95% CI
(-0.08–0.39), z= 1.31, p=0.19] were statistically similar in patients using
p=0.30), Charleston comorbidity index (4.0 vs. 4.0, p=0.73) and gender
(75.4% vs. 76.0% males, p=1.00) were comparable. Median days FJ
remained in situ was 162, 85.0% were placed in patients undergoing
cancer resection, while MIC tube was used in 80.5%. A higher
peri-catheter infection was seen with MIS (p=0.01); however, no
differences (p≥0.42) were observed between MIS vs. OA, in tube
dislodgement (9.0vs.6.0), fracture (2.0vs.2.0), blockage (2.0vs.0.0),
peri-catheter leakage (6.0vs4.0), bowel obstruction (5.0vs.2.0) and
perforation (0.0vs1.0). No feed inspissation or enterocolitis was
observed. Misplacing FJ beyond first jejunal loop caused volvulus,
necessitating reintervention.
Conclusion: FJ insertion via MIS is safe, provided standardised steps are

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immunonutrition or standard conventional perioperative nutrition.
Conclusion: Perioperative immunonutrition in patients undergoing
colorectal resections seems to reduce infectious complications but
this study failed to demonstrate its role in reducing the postoperative
mortality and length of hospitalization.
Abstract citation ID: znac247.061
SP6.1.1 The Safety of Laparoscopic Feeding Jejunostomy
Insertion in Patients with Oesophago-gastric Pathology
Babur Ahmed, Michael Dasa, Roshni Mitra, Mohamed Alasmar,
Bilal Alkhaffaf, Naheed Farooq
Salford Royal NHS Foundation Trust
Aims: Feeding jejunostomy (FJ) to support enteral nutrition has
traditionally been placed using an open approach (OA). As minimally
invasive surgery (MIS) for oesophageal and gastric surgery gains
popularity, it is imperative to develop a standardised technique and
examine its safety. We describe our MIS approach to FJ insertion and
compare outcomes to OA.
Methods: This was a retrospective analysis of patients undergoing FJ
insertion via MIS and OA in a high volume tertiary oesophago-gastric
centre, from 2018 to 2020. Identifying and placing FJ in first jejunal
loop at low pneumoperitoneum pressure, constructing Witzel
tunnel and placing antitorque sutures are our institution’s
standardised steps. Outcomes assessed included catheter-related
adverse events.
Results: Of 226 patients, 130 (57.5%) had MIS, while 96 (42.5%) had OA.
Median age (63.0 vs. 66.0 years, p=0.04), BMI (26.1 vs. 26.2 kg/m2,
followed meticulously. Evaluating confounding factors for better
understanding of MIS-associated peri-catheter infection is
recommended.
Abstract citation ID: znac247.062
SP6.1.2 Endoscopic versus Laparoscopic Surgical Management
of Achalasia: A Decision Analysis
Alison Bradley, Anna Sayers, Mei Ying Chin, Hannah Webb, Sinjini Basu,
Anton Buter
Royal Alexandra Hospital, Paisley
Aims: To compare achalasia treatment outcomes at one and two years
post intervention.
Methods: A decision-tree model was populated with data from 36
randomised controlled trials to compare: pneumatic dilation,
botulinum toxin injection, Heller myotomy (+/- Dor or Toupet), Dor
and peroral endoscopic myotomy (POEM).
Freeman-Tukey arcsine square root transformation under random effects
model, to account for heterogeneity, was used to calculate weighted
pooled model transition probabilities. Utility was 1, 0.5 and 0 for treatment
success without significant complication, success with significant
complications and treatment failure respectively. Deterministic sensitivity
analysis and Monte Carlo Probabilistic Sensitivity Analysis (PSA) set to
10000 iterations tested model uncertainty.
Results: Laparoscopic Heller myotomy had marginally superior utility
over POEM but only if the risk of significant complications remained
less than 7.2% and 7.9% at one and two years respectively.

Intervention Outcome at 1-year Outcome at 2-years

Utility Standard deviation; variance Utility Standard deviation; variance

(95% Credibility Interval) (95% Credibility Interval)

Laparoscopic Heller Myotomy 0.94 0.05; 0.00 (0.79–0.98) 0.85 0.06; 0.03 (0.72–0.93)
POEM 0.93 0.09; 0.01 (0.68–1.00) 0.84 0.01; 0.00 (0.81–0.85)
Dor 0.90 0.00; 0.00 (0.88–0.89) 0.66 0.15; 0.02 (0.34–0.91)
Heller + Dor 0.80 0.11; 0.01 (0.60–0.99) 0.73 0.16; 0.03 (0.41–0.99)
Heller + Toupet 0.75 0.37; 0.14 (0.00–1.00) No data 0.38; 0.14 (0.00–1.00)
Pneumatic dilataion 0.73 0.12; 0.01 (0.48–0.92) 0.40 0.22; 0.05 (0.17–0.96)
Botox Injection 0.51 0.27; 0.07 (0.03–0.96) 0.25 0.11; 0.05 (0.17–0.96)

Conclusion: Superior treatment selection depends on individual risk of
complications. Future research should therefore focus on personalised
risk stratification and cost-effectiveness implications.
Abstract citation ID: znac247.063
SP6.1.3 A Decision-Analysis Study of Endoscopic, Surgical and
Pharmacological Treatment Options for Chronic Gastro
Oesophageal Reflux Disease
Alison Bradley, Li Siang Wong, Paul Mcmillan, Anton Buter
Royal Alexandra Hospital, Paisley
Aims: To compare emerging endo-luminal interventions for the
treatment of chronic gastro-esophageal reflux disease (GORD) to
pharmacological and surgical interventions.
Methods: An advanced decision-tree model was constructed
and populated with data from 19 randomised controlled trials
to compare competing treatment pathways that included: Laparoscopic
Fundoplication, Stretta, Transoesophageal Incisionless Fundoplication
(TIF) and medical management with proton pump inhibitor (PPI). Model
transition probabilities were calculated using weighted pooled estimates
of proportions calculated using Freeman-Tukey arcsine square root
transformation under random effects model to account for heterogeneity.
Model uncertainties for all included components were tested with one-way
deterministic sensitivity analysis. Monte Carlo Probabilistic Sensitivity
Analysis (PSA) was set to 10000 iterations with model probabilities sampled
from the entirety of the data distribution of each variable.
Results: Base-case analysis at 12months follow-up showed that
Laparoscopic Fundoplication had the highest probability of treatment
success followed by TIF, Stretta and PPI respectively.
v22 | Abstracts
Intervention Follow-up Probability of
Interval Treatment Success
Laparoscopic 6months No Data
Fundoplication 12months 0.72
Transoral incisionless 6months 0.71
fundoplication 12months 0.52
Stretta Procedure 6months 0.83
12months 0.43
Proton Pump Inhibitor 6months 0.24
12months 0.37
Conclusion: Endo-luminal interventions, although not shown to be
superior to surgery, may have an emerging role in the management of
GORD, but data on long-term follow-up and cost-effectiveness is
lacking.
Abstract citation ID: znac247.064
SP6.1.4 Novel methods to enhance anti-tumour immunity in
oesophageal adenocarcinoma; hypofractionated radiotherapy
may be superior to CROSS regimen chemo-radiation
Noel Donlon, Maria Davern, Andrew Sheppard, Claire Donohoe,
John Reynolds, Joanne Lysaght
Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity
Translational Medicine Institute and Trinity St James’s Cancer Institute, Trinity
College Dublin, St James’s Hospital, Dublin 8, Ireland
Background: CROSS regimen (41.4Gy;carboplatin&paclitaxel) is a
standard trim-modality treatment for locally advanced oesophageal
adenocarcinoma (OAC). The addition of adjuvant immunotherapy
targeting PD-L1 may improve outcomes, hence the impact of radiation
therapy on the tumour microenvironment is of considerable interest.
The dosing has not been studied in this context, especially
hypofractionation, and this study explored immunogenic cell death,
specifically Damage Associated Molecular Pattern (DAMPs) release,and
the impact of immune checkpoint blockade(ICB).
Methods: The ability of CROSS-regimen (3×1.8Gy) and hypo-fractionation
(3×4Gy) to induce immunogenic cell death was assessed by flow cytometry
of DAMPs calreticulin&HMGB-1.Expression of DAMPs were evaluated on
OAC tumour and whole blood samples (n=10) pre and post conventional
therapies versus hypofractionation. The immunostimulatory effect of
CROSS and hypofractionation using post-treatment tumour cell
secretomes with/without ICB on the cytolytic ability of OAC-donor
lymphocytes was interrogated by CCK8-assay.
Results: The expression of Calreticulin&HMGB1 was significantly higher
on tumour tissue compared to whole blood post chemo(radio)
therapy(p<0.01). Hypofractionation increased TNF-α&IFN-γ production
by T-cells greater than CROSS fractions ex vivo(p<0.01). The
post-CROSS and hyporfractionated tumour cell secretome enhanced
lymphocyte mediated killing of tumour cells(p<0.01), further
enhanced with dual immune checkpoint blockade
(nivolumab&ipilimumab)(p<0.01). High expressors of DAMPs
pre-operatively had a significantly (P<0.01) better Tumour Regression
Grade (TRG1–2) compared to low expressors.
Conclusions: The current CROSS regimen radiation for OAC is
immunogenic,however,hypo-fractionated doses boosted the immune
response to OAC, and was synergistic with ICB. This may warrant
further exploration in a clinical and translational trial.
Abstract citation ID: znac247.065
SP6.1.5 The effect og major Oesophageal oncological surgery in
promoting a pro-tumour, pro-metastatic phenotype that is
partly inhibited by immunotherapy
Noel Donlon, Maria Davern, Andrew Sheppard, Fiona O’Connell,
John Reynolds, Joanne Reynolds
Cancer Immunology and Immunotherapy Group, Department of Surgery, Trinity
Translational Medicine Institute and Trinity St James’s Cancer Institute, Trinity
College Dublin, St James’s Hospital, Dublin 8, Ireland
Superior Treatment Selection Standard deviation; variance (95%
Frequency (Monte Carlo PSA) Credibility Interval)
No Data
82.2% 0.11;0.01 (0.5–0.9)
17.7% 0.12;0.01 (0.46–0.92)
12.8% 0.15;0.02 (0.24–0.81)
81.7% 0.04;0.00 (0.74–0.91
5% 0.16; 0.03 (0.13–0.74)
0.1% 0.17; 0.03 (0.02–0.66)
0% 0.02; 0.00 (0.34–0.4)
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Background: Adjuvant immunotherapy for oesophageal cancer is set to
become a standard of care following the Checkmate-577 trial proving
the efficacy of adjuvant nivolumab. Scientifically, the key mechanisms
are unclear. This study profiled systemic anti-/pro-tumour immunity
and circulating pro-metastatic factors perioperatively in patients, and
the impact of immune checkpoint blockade on key pathways.
Methods: Systemic immunity in oesophageal cancer patients (n=14) was
immunophenotyped prior to surgery (postoperative day(POD)-0) and
POD-1,3,7 and week-6, using flow cytometry. Longitudinal serological
profiling was conducted by multiplex ELISA characterising systemic
immunity and pro-metastatic signalling. The cytolytic ability of
circulating lymphocytes against oesophageal cancer cell lines was
assessed with and without immunotherapies; nivolumab/ipililmumab.
Results: PD-1+ and CTLA-4+ T-cells peaked on POD-1, significantly
decreasing by week 6(p<0.01). Circulating soluble checkpoints significantly
(p <0.001) increased from POD-3, with decreases in Th1 cytokines (IFN-Y,
IL-12p40,IL-1RA,CD28,CD40L) and increases in Th-2-cytokines(IL-4, IL-10)
observed(p<0.001). Circulating pro-inflammatory cytokines (TNF-α,MCP-1)
and pro-metastatic factors(VEGF-α,FLT-1,Tie-2,PIGF) significantly
(p<0.001) increased in the immediate post-operatively. In an ex-vivo
model, the cytolytic ability of circulating lympohcytes peri-operatively
(p<0.01) was propagated with the use of nivolumab/ipilimumab.
Surgery decreased the frequency of circulating Th-1 like cells, an effect
inhibited by nivolumab/ipilimumab.
Conclusions: Major oesophageal cancer surgery promotes a switch from
Th1 to Th2 cellular immunity, dampening the cytolytic ability of
T-lymphocytes. In an ex-vivo model, PD-1/CTLA-4 inhibition induced
a shift to a Th1-like cytotoxic phenotype, highlighting a potential
pathway through which such therapies can effect minimal residual
disease, and a need to study optimal timing of adjuvant therapy.
Abstract citation ID: znac247.066
SP6.1.6 Symptoms and Satisfaction after Nissen
Fundoplication – A 10 Year Follow Up
Ailsa Innes1,2, Georgina Hughes2, George Menon2, Suvi Virupaksha2
1
Health Education North East
2
University Hospital of North Tees
Introduction: Laparoscopic Nissen fundoplication remains a key option
for surgical treatment of refractory gastro-oesophageal reflux disease.
However, limited long term data are available on postoperative
symptoms and satisfaction. We aimed to evaluate these in our
patients 10 years following their operation.
Methods: 144 patients were contacted by telephone. Participants were
asked about heartburn and obstructive symptoms. If heartburn or
dysphagia was present they scored this on a scale of 1–5. Satisfaction
was scored from 0–5 and using a four point outcome scale.
Respondents were also asked whether they would recommend the
operation or have a reoperation if needed.
Results: We gained 49 participants with operation dates from 2009–
2011. 5 participants had since had a redo operation so were excluded
from the symptom analysis. There was a high prevalence of
obstructive symptoms in the respondents, and a significant minority
still experience a degree of heartburn.
Conclusion: Satisfaction with Nissen fundoplication remains high for
most patients 10 years post-operation. However, there remains a
significant obstructive symptom burden. This is important to consider

Symptom Heartburn On Dysphagia
PPI solids
% patients (mean analogue 42 (2.55) 53 56 (2.96)
score 1–5)
The mean satisfaction score was 3.6/5, and 50% respondents rated their outcome ‘excellent’, 19% ‘good’, 10% ‘fair’ and 21% ‘poor’. 79% would choose a reoperation if
required and 83% would recommend the operation to someone with similar symptoms.
as alternative procedures such as Toupet fundoplication become more
prevalent.
Abstract citation ID: znac247.067
SP6.1.7 Radio-frequency ablation using the STRETTA© is a
feasible treatment option for GORD and reduces need for
primary fundoplication
Abraham Joel, Alakh Konjengbam, Emily Hammond, Helen Franks,
YKS Viswanath, Stuart Cowie
James Cook University Hospital, Middlesbrough
Introduction: The STRETTA© system of using radiofrequency (RF)
energy to the gastro-oesophageal junction (GOJ) for management of
refractory gastro-oesophageal reflux disease (GORD) has shown to
improve baseline symptoms, PPI dependence and reduce the need for
anti-reflux operations in select group of patients. We aimed to review
our outcomes of STRETTA© for patients with medically refractory
GORD.
Methods: A retrospective review of a prospectively maintained
database was carried out in a tertiary British centre. All patients who
underwent STRETTA© procedure from 2015 were reviewed. General
practises and individual patients were followed up to obtain the
proton pump inhibitor (PPI) free time after undergoing STRETTA©
procedure.
Results: A total of 200 patients underwent STRETTA© procedure from
2015. All patients were reviewed once in clinic between 4–6 weeks
with an overall median follow-up of 34.5 months. Preliminary analysis
suggest over half of the patients (54%, n=108) remaining without PPI
usage. Data for median time before restarting proton pump inhibitors
(PPI) after STRETTA© is being collected. No patients needed further
STRETTA© treatment and 2 patients (1%) has gone onto have
anti-reflux procedure for non-resolution of symptoms.
Conclusion: Our preliminary findings suggest STRETTA© as a valuable
and feasible option for treating refractory GERD. It may help reduce
the need for fundoplication procedures and our data suggests that it
increases the time before which surgery is required.
Abstract citation ID: znac247.068
SP6.1.8 The Impact of Drain and Reinforcement on the
Outcomes of Bariatric Surgery: A Prospective Study
Khaled Noureldin1, Mohamed Salman1, Mohamed Tourky2,
Mohamed Issa3
1
Cairo University Hospital, Egypt
2
Great Western Hospital, NHS Foundation, Swindon
3
Prince Charles Hospital, Merthyr Tydfil
Purpose: Aimed to investigate the impact of reinforcement and
abdominal drains on the outcome of laparoscopic sleeve gastrectomy
(LSG).
Methods: A prospective study included obese patients scheduled for
LSG. Patients were assigned to receive drain, reinforcement, or both
according to surgeon’s preference and followed up for one month
after surgery. Primary outcome was identification of the association
between intraoperative drain/reinforcement and incidence of
postoperative complications.
Results: 125 (20.3%) patients received intraoperative drains. The
proportion of postoperative morbidity was comparable between the
drain and non-drain groups (3.2% versus 1.6%; p = 0.25). Drain group
had similar incidence of blood transfusion (2.4% versus 1.7% in
non-drain group; p = 0.43) and postoperative leakage (0.8% versus 0.2%
in non-drain group; p = 0.36). Incidences of blood transfusion (p =
0.56) and reoperation (p = 0.98) were comparable between the drain
and non-drain groups. There were no statistically significant
Abstracts | v23
Dysphagia Bloating Able to relieve bloating if Unable to
liquids present belch
9 (3.5) 65 48 63
differences between the drain and non-drain groups regarding
postoperative mortality and wound infection (p > 0.05). In contrast,
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440 (71.3%) patients received reinforcement. The proportion of
postoperative morbidity was comparable between reinforcement and
non-reinforcement groups (1.6% versus 2.8%, p = 0.07). Patients in
reinforcement group were less likely to develop postoperative
bleeding (0.7% versus 4% in the non-reinforcement group; p = 0.004),
while no significant difference was detected in terms of postoperative
leakage (p = 0.33) and in-hospital mortality.
Conclusion: Abdominal drainage did not reduce the complications of
LSG patients. Reinforcement has role in controlling the bleeding but
not leaks. Both techniques did not significantly impact the mortality
rate.
Abstract citation ID: znac247.069
SP6.1.9 Long-term Impact of Mini-Gastric Bypass on
Inflammatory Cytokinesin Cohort of Morbidly Obese Patients:
a Prospective Study
Mohamed Salman1, Khaled Noureldin1, Mohamed Issa2,
Mohamed Tourky3, George Bisheet1
1
Cairo University Hospital, Egypt
2
Prince Charles Hospital, Merthyr Tydfil
3
Great Western Hospital, NHS Foundation, Swindon
Bariatric surgery has become a wide world popular surgery. Evolution in
its techniques is progressive to achieve best outcomes. Purpose One
anastomosis gastric bypass (OAGB) is a promising bariatric procedure.
We performed this study to evaluate the changes in a group of
inflammatory cytokines 12 months after OAGB.
Methods: A single-arm prospective study was conducted on obese
patients who underwent OAGB. Serum levels of the following
adipocytokines were monitored pre- and 12 months postoperatively:
adiponectin, leptin, interleukin 6 (IL-6), interleukin 8 (IL-8) levels, tumor
necrosis factor-alpha (TNF-α), serum amyloid A (SAA), high-sensitivity
C-reactive protein (hs-CRP), and monocyte chemotactic protein 1
(MCP-1).
Results: A total of 62 patients were included with a mean age of 43.9 ± 6.8
years old. Serum adiponectin increased significantly from7.64 ± 0.29 to
8.76 ± 0.42 μg/mL 12 months after the operation (p < 0.001). hs-CRP
and IL-6 decreased significantly 12 months after the OAGB from
3323.35 ± 643.4 ng/mL and 3.72 ± 7.7 pg/mL to 1376.81 ± 609.4 ng/mL
and 3.64 ± 6.9 pg/mL, respectively (p < 0.001). The MCP-1 showed
significant increase in its level after OAGB as well (p = 0.014). In
contrary, there were no significant changes in serum levels of IL-8
(p = 0.12) and TNF-α (p = 0.84) 12 months after the operation. The
correlation analysis showed significant correlations between initial
body mass index (BMI) with serum adiponectin, IL-8, and serum SAA.
Conclusion: OAGB can significantly impact the inflammatory cytokine
profile in obese patients with possible subsequent protection from
obesity-related comorbidities such as insulin resistance,
cardiovascular diseases, and certain cancers.
Abstract citation ID: znac247.070
SP6.1.10 Prevention of internal hernia by closure versus
non-closure of the mesenteric defect in patients undergoing
Roux-en-Y gastric bypass- a meta-analysis of published
randomized controlled trials
Oluwamayowa Ojofeitimi, Amiya Ahsan, Muhammad Sajid,
Mansoor Khan, Krishna Singh
Royal Sussex County Hospital
Objective: The objective of this article is to evaluate the prevention of
internal hernia by mesenteric defect closure (MDC) versus non-closure
v24 | Abstracts
of the mesenteric defect (MDNC) in patients undergoing Roux-en-Y
gastric bypass.
Method: Standard medical electronic databases were searched, and
relevant published randomized controlled trials (RCT) were shortlisted
according to the inclusion criteria. Summated outcome of post-operative
surgical variables including the incidence of internal hernia were analyzed
using principles of meta-analysis on RevMan 5 statistical software.
Result: Five RCTs on 3285 patients undergoing Roux-en-Y gastric bypass
operation for any indication or approach were found suitable for
meta-analysis. There were 1635 patients in the MDC group and 1650
patients in the MDNC group. The duration of the operation was
statistically longer in MDC [random effects model, standardized mean
difference (SMD) 0.73, 95% CI (0.22–1.25), z=2.78, p=0.005]. There was no
statistical difference related to length of hospital stay [random effects
model, standardized mean difference (SMD) 0.15, 95% CI (-0.41, 0.44), z=
1.01; P= 0.31] between the two groups. The incidence of internal hernia
was significantly reduced in MDC group. This difference was statistically
significant [random effects model, odds ratio 0.36, 95% CI (0.19–0.66),
z=3.27, p=0.001]. However, there was significant statistical heterogeneity
(Chi2= 31.99, df = 4 (P < 0.00001) among included RCTs.
Conclusion: The routine closure of mesenteric defect in patients
undergoing Roux-en-y bypass may be an effective approach to reduce the
risk of internal hernia. However, more RCTs of robust quality recruiting
higher number of patients are required to validate these findings.
Abstract citation ID: znac247.071
SP6.2.1 Dysphagia in the perioperative period: Preliminary
audit of pre-operative weight loss in patients undergoing
oesophago-gastrectomy for primary locally advanced
oesophageal cancer
Claire Russell, Pranav H Patel, Carol Lane, Asif Chaudry, William Allum,
Sacheen Kumar
Upper GI Surgery, The Royal Marsden Hospital NHS Foundation Trust, 203
Fulham Road, London, UK
Background: Malnutrition and dysphagia are highly prevalent in
patients with oesophageal cancer. The International Dysphagia Diet
Standardisation Initiative (IDDSI) is a global standard to describe oral
intake for dysphagic individuals. Greater weight loss (WL) after
oesophago-gastrectomy is associated with increased length of stay (LOS),
rate of post-operative complications and worse five-year survival, placing
a burden on resources. This audit aimed to determine associations
between pre-operative IDDSI scores, WL and post-operative morbidity.
Methods: A retrospective audit of patients undergoing oesophago-
gastrectomy for locally advanced oesophageal cancer was conducted
in a single tertiary cancer centre between 2017 and 2018.
Pre-operative WL was compared with IDDSI scores, post-treatment WL,
post-operative complications, Critical Care Unit (CCU) and inpatient
LOS.
Results: 78 patients were included, 65 male and 13 female with mean
age 64 (range 40 to 80). Median pre-operative percentage WL was
greater in patients with moderate dysphagia (IDDSI 5-6) than those
with a normal swallow (IDDSI 7), though not statistically significantly.
There were 26 Grade 3/4 Clavien-Dindo complications. Pre-operative WL
correlated with rate of complications, and WL five to seven months
post-operatively (p=0.04, p=0.001). Greater pre-operative WL
correlated with a longer CCU LOS and total inpatient LOS, but this was
non-significant (p=0.09, p=0.07).
Conclusions: IDDSI scores 5/6 may be early indicators for nutritional
intervention in the peri-operative pathway. Each clinical interaction in
the cancer pathway provides an opportunity to identify and correct
malnutrition and improve outcomes.
A criteria-specific nutritional pathway has been implemented to
optimise patients peri-operatively. A prospective re-audit will indicate
improvements on patient-related and oncological outcomes.
Abstract citation ID: znac247.072
SP6.2.2 Oesophageal Perforation: The Experience of a Tertiary
Referral Centre 2009–2021
Mohamed Alasmar, Zak Shehata, Mohammad Altarawni, Patrick Casey,
Rachel Melhado, Javed Sultan
Salford Royal Foundation Trust, Greater Manchester, UK
Aim: Oesophageal perforation is a relatively rare surgical condition
associated with a high mortality risk. Currently there is no clear
consensus on a superior approach to treating this condition, and the
rarity of oesophageal perforation has led to a great variability in
treatment between centres. This study aims to report the experiences
of a tertiary referral centre over 12 years.
Methods: We collected data on patients presenting with oesophageal
perforation at a tertiary referral centre from 2009–2021 (n=83).
Demographics, presenting symptoms, length of stay and complications
were collected retrospectively using the electronic patient record.
Results: The most common cause of perforation in our dataset was
Boerhaave’s (50.6%), followed by Iatrogenic (37.4%); other causes
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included trauma, malignancy and foreign body ingestion. Typical signs/
symptoms included chest pain (54.2%), vomiting (48.2%), and pleural
effusion (42.2%). For all aetiologies, operative intervention was required
in 49.4% of patients. Patients presenting with Boerhaave’s were more
likely to be treated surgically (73.8%). Of these, thoracotomy/
laparotomy with t-tube repair was the most common procedure
performed (59.5%). The 30 day and 90 day mortality rates were 16.9%
and 21.6% respectively. The median length of hospital stay was 40 days.
Conclusion: Here we show the experience from a high intake tertiary
referral centre over 12 years. Our data confirms the severity of
oesophageal perforation and its association with prolonged hospital
stay and mortality. Further collaboration with other centres is needed
to understand more about this condition.
Abstract citation ID: znac247.073
SP6.2.3 Boerhaave’s Syndrome vs Iatrogenic Oesophageal
Perforation - A Comparison Between Aetiology
Mohamed Alasmar, Zak Shehata, Mohammad Altarawni, Patrick Casey,
Rachel Melhado, Javed Sultan
Salford Royal Foundation Trust, Greater Manchester, UK
Aim: Oesophageal perforation is a rare surgical condition with high
mortality. Boerhaave’s syndrome (BS) may be associated with worse
outcomes due to the degree of mediastinal contamination when
compared to ‘clean’ iatrogenic perforations. This study aims to assess
the differences in treatment and outcome between these two groups.
Methods: Data was collected from a tertiary centre from 2009–2021
(n=73, 42 BS, 31 Iatrogenic). Data was collected retrospectively using
the electronic patient record. Complications were quantified using the
comprehensive complication index (CCI). Univariate analysis was
used to determine statistical significance.
Results: BS had a higher 30-day mortality compared to iatrogenic
perforations (21.4% vs 3.2% p=0.025), however this was no longer
significant at 90 days and 1 year (21.4% vs 16.1% p=0.57, 21.4% vs
19.4% p=0.83). Iatrogenic perforations were more likely to be managed
non-operatively (73.8% vs 25.8% p<0.001). All of the iatrogenic deaths
that occurred between 30 days-1 year had been managed
non-operatively. Median length of intensive care stay was higher in BS
(15 days vs 6 days p=0.047), with no significant difference in median
overall length of stay (48 days BS vs 38 days iatrogenic p=0.88). Median
CCI was greater in BS (53.9 vs 29.6 p=0.002).
Conclusion: Whilst CCI and 30-day mortality was higher in Boerhaave’s
there was no difference in 90-day and 1 year mortality suggesting that
long-term survival is not dictated by aetiology of the perforation. Most
of the iatrogenic perforation were managed non-operatively which
raises the question whether iatrogenic perforation should be managed
more aggressively.
Abstract citation ID: znac247.074
SP7.1 Virtual classroom proficiency-based progression for
robotic surgery training (VROBOT): a prospective, cross-over,
effectiveness study
Sonam Patel1, Arjun Nathan2,3, Maria Georgi1, Man Kien Hang1,
Monty Fricker4, Ashwin Sridhar2,3
1
University College London Medical School, London, UK
2
Division of Surgery and Interventional Sciences, University College London,
London, UK
3
University College London Hospitals NHS Foundation Trust, London, UK
4
Newcastle University, Newcastle, UK
Aims: Robotic surgery is an evolving surgical technique, requiring
specialist training. The standardised Fundamentals of Robotic Surgery

(FRS) curriculum incorporates proficiency-based modules to certify the
skills of novice trainees. However, the curriculum is self-directed and
non-interactive. We aim to determine the effectiveness of interactive
virtual classroom training (VCT) in concordance with the FRS for
robotic skills training.
Methods: 11 novice surgical trainees were randomly allocated to two
training groups. Both groups completed a one-week robotic skills
induction. In week two, Group A received training with the FRS
curriculum and adjunctive VCT; Group B only received access to the FRS
curriculum. In week three, the groups received the alternate intervention.
The primary outcome was measured using the validated R-OSAT score.
This was collected post-intervention at time point 1(end of week two)
and time point 2(end of week three).
Results: Participants attained higher mean proficiency scores with both
the FRS curriculum and VCT, compared to the FRS curriculum alone. At
timepoint 1, Group A achieved a greater mean proficiency score
compared to Group B (44.80 vs 35.33, p=0.006). At timepoint 2, there
was no significant difference in mean proficiency score in Group A
from timepoint 1. In contrast, Group B, who received adjunctive VCT
showed significant improvement in mean proficiency by 9.67points
from timepoint 1 (95% CI 5.18–14.15, p=0.003).
Conclusion: VCT is an effective training adjunct to the FRS curriculum
for learning basic robotic skills. With the steep learning curve in
robotic surgery training, VCT offers interactive learning and can
increase training effectiveness and accessibility.
Abstract citation ID: znac247.075
SP7.2 Student reported outcomes of a novel virtual medical
work experience: results from an international cohort
Taner Shakir, Kabir Matwala, Bryony Lovett
Basildon University Hospital
Introduction: The COVID-19 pandemic had a deleterious effect not only
upon medical and surgical training, but also upon inspiring the medics
and surgeons of the future. Prior to applying for a career in medicine,
students often take part in work experience. This observership
provides in insight into what a medical career entails. Nationwide
lockdowns and hospital visiting restrictions rendered it impossible to
gain this understanding. We designed a novel virtual work experience
(VWE) aimed at mitigating this loss.
Methods: A timetable was created to simulate a chronological
progression throughout a medical career. A range of speciality talks
were given by junior and senior doctors. Students were invited to sign
up after contacting local schools, dissemination on social media and
word of mouth. The one day event was free and hosted using online
video conferencing software. Pre and post course questionnaires
assessed confidence with regards to a career in medicine.
Results: There were 434 student registrations which spanned
internationally to 9 countries. 140 post course responses were obtained.
131 students (94%) responded that the event was a good alternative to
face to face (F2F) experience. Confidence levels of above 3 (on a 5 point
Likert scale) improved from 54% to 99% regarding medical school
applications and the interview process. 96% of students were interested
in pursuing a career in medicine after the event.
Conclusions: This VWE event aimed to combat the loss of F2F
experience. Student reported outcomes were extremely favourable.
This may form the foundation of a hybrid work experience in the future.
Abstract citation ID: znac247.076
SP7.3 Behind Every Stereotype is a Grain of Truth: Perceptions
of a Career in General Surgery Amongst Doctors
Kelda Sheridan1,2, Naomi Quinton1
1 Marie Morris, Dara O Kavanagh
University of Leeds
2 Department of Surgical Affairs, Royal College of Surgeons in Ireland
Calderdale and Huddersfield NHS Foundation Trust
Introduction: General Surgery (GS) educational community of practice
faces crisis. Recruitment challenged by cultural norms of postponing
post-foundation training; and retention with perceptions of elitism,
discrimination and inflexibility. Surgical pedagogy has been examined
through skill acquisition but what of the hidden curriculum. Three
research aims were posed: who is a General Surgeon, what are the
enablers or barriers to pursuing this career and is our current UK
training system fit for purpose.
Abstracts | v25
Methods: Qualitative methodology within a constructivist research
paradigm was utilised. Recruitment via the snowballing technique
included representative sampling of junior doctors, including men,
women and those from diverse ethnic backgrounds. 1:1
Semi-structured interviews explored participant perspectives of
training, recruitment and work-life balance. Data was transcribed,
familiarised, de-constructed and generated. Latent data analysis,
coding and development, maintained reflexivity. ‘Data sets’ were
transformed to a thematic map and key themes identified.
Results and Discussion: Foundation, specialty doctors, core and higher
surgical trainees were included (60% men, 40% women). Fundamental
themes of support, attitudes and sacrifice were identified, interacting
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to influence educational narrative. Support comprised personal,
institutional, academic and cultural forms. Attitudes of elitism,
implicit and explicit gender bias, microaggressions and overt
discrimination concealed as surgical tradition. An overarching
concept of sacrifice was noted: personal, professional, fiscal and
emotional, the so-called surgical currency.
Conclusions: The study explored phenotype, motivation, intellect and
philosophy within GS. Highlighting issues in the system surrounding
negative attitudes, cultures and behaviours, education is a powerful
tool which can be used to challenge perceptions and improve training.
Abstract citation ID: znac247.077
SP7.4 Near-peer surgical simulation & teaching day for newly
qualified FY1 doctors
Joe Thompson, Eleanor Dodd, Rebecca Morris, Ashley Wragg,
Joe Gleeson
Mid Yorkshire Hospitals NHS Trust
Aims: The aims of this study were to ascertain how prepared newly
qualified Foundation Year 1 (FY1) doctors felt for their surgical
rotation and to evaluate the effectiveness of a surgical-themed
teaching day for new FY1 doctors.
Methods: A near-peer surgery-themed teaching day was delivered to 44
newly qualified FY1 doctors and delivered by clinical teaching fellows
(FY3 doctors). The day involved four surgical-themed simulation
scenarios: (i) haemodynamically unstable pancreatitis, (ii) anastomotic
leak following ileocaecal resection, (iii) septic shower post ureteric stent
and (iv) post-operative pulmonary embolism. Classroom-based teaching
included: (i) microbiology and antibiotic prescribing (ii) interpreting
abdominal films and (iii) insulin prescribing (including for nil by mouth
patients). FY1s were randomly allocated a participant number and
completed pre- and post-session anonymised questionnaires.
Results: Only 31.7% (13/41) agreed that Medical School had adequately
prepared them for their surgical foundation job and 46.3% (19/41) felt
less prepared for surgical rotations compared with medical rotations.
When compared with the pre-session scores: 93% (58% pre-session) felt
prepared to manage acutely unwell surgical patients and 84% (43.9%
pre-session) were confident with escalating patients to level 2/3 care.
Confidence improved across the board for classroom-based sessions.
Conclusion: This study has highlighted a need to ensure newly qualified
FY1 doctors feel better prepared for their surgical rotations. The
introduction of a mixed simulation and classroom teaching day has,
in this instance, improved confidence across a number of important
domains. Teaching delivered in the near-peer style may be the key to
imparting relevant knowledge to new FY1s.
Abstract citation ID: znac247.078
SP7.5 Psychomotor assessments of fundamental ability are
associated with the future operative performance of surgical
trainees
Conor Toale, Donncha M Ryan, Eva Doherty, Oscar J Traynor,
Introduction: Assessments of visuospatial, psychomotor and
perceptual ability correlate with simulated operative performance.
This study investigates the association between fundamental
technical ability and future operative performance as measured
through both in-theatre and simulation-based assessments.
Methods: Core surgical trainees in the Republic of Ireland recruited from
2016–2019 participated in validated assessments of fundamental
technical ability; Pictorial Surface Orientation (PicSOr) testing of
v26 | Abstracts
perceptual ability, ‘paper-based’ visuospatial aptitude assessments, and
psychomotor testing using a grooved pegboard. Operative performance
was assessed using the in-theatre Supervised Structured Assessment of
Operative Performance (SSAOP) tool, and Operative Surgical Skill (OSS)
assessments (multi-station simulation-based assessments) performed
over a 2-year core training period. SSAOP assessments were scored
using a 15-point checklist and a global 5-point Operative Performance
score. Univariate (Pearson) correlations and multiple linear regression
were used to explore the association between fundamental ability and
operative performance, controlled for both operative experience and
centile scores from the trainee’s undergraduate medical degree.
Results: Aggregated fundamental ability scores strongly correlated with
performance in all submitted SSAOP assessments using the Total
Checklist score (B = 0.75, t(168) = 3.17, p = 0.002) and weakly correlated
with Overall Performance scores (B = 0.04, t(168) = 3.16, p = 0.002),
independent of operative experience and centile scores. Fundamental
ability scores were also predictive of OSS assessment scores on
multivariate analysis (B = 0.219, t(168) = 2.22, p = 0.03).
Conclusion: Fundamental technical ability is predictive of future
performance in both in-theatre workplace-based assessments of
operative skill and simulation-based assessments of operative
performance.
Abstract citation ID: znac247.079
SP7.6 The SUNRRISE Trial – Lessons learned from
International Collaboration by Trainees
SUNRRISE Study Group
UK and Australia
Background: Trainee led collaborative research in surgery has become
widely accepted and highly effective in the UK in the last decade.
SUNRRISE is the first trainee led and delivered randomised controlled
trial to run across the UK and Australia.
SUNRRISE is an international, multi-centre, trainee devised, led and
delivered randomised controlled trial, funded by the NIHR (UK) and
MRFF (Australia). It investigates whether a Single Use Negative
Pressure Device (SUNPD) reduces the risk of surgical site infection
within 30 days of an emergency laparotomy. We present lessons
learned from running this study.
Methods: 840 patients were 1:1 randomised between SUNPD (PICO7©,
Smith and Nephew) and surgeon’s choice at 12 centres in Australia
and 22 centres in the UK between 2019 and 2021.
Results: International collaboration enabled the trial to continue when
the pandemic threatened to stop it entirely.
We believe that this collaboration has benefited all stakeholders;
research skills and knowledge have been successfully transferred to
trainees, clinician researchers have become established and research
professional staff have gained in experience and expertise in both
Australia and the UK. Importantly, patients will benefit from more
reliable and faster delivered results.
International RCT collaboration requires commitment, perseverance
and an acceptance of setbacks, inconvenient working hours and
misunderstandings which result from different systems, language and
research environments.
Conclusion: International collaboration has made the trial more
successful and increased the enjoyment and enthusiasm for the
study. SUNRRISE has demonstrated the resilience and efficacy of
multi-national, multi-centre trainee delivered RCTs.
Abstract citation ID: znac247.080
SP7.7 Open Appendicectomy Confidence and Experience Study
(OACES): a multicentre survey of UK non-consultant grade
surgeons
Fang Yi Cheung1, Katherine Bretherton2, Nicholas Wong3
1
West Midlands Deanery
2
East Anglia Foundation School
3
East of England Deanery
Aims: Minimally invasive technique has eclipsed open in most cases,
and reserved only when clinically necessary. However, surgeons must
remain able to employ and deploy open technique at will with
efficacy. This study aims to assess non-consultant grade surgeons’
confidence and experience to perform open appendicectomy.
Methods: Retrospective cohort study via digital survey consisting of 14
questions distributed to non-consultant grade surgeons in 3 UK
deaneries and a professional surgery association.
Results: 40 responses ranging from CT1 to ST8 surgeons below
consultant totalling 431 cases. 55% respondents disagreed to strongly
disagreed they felt confident to perform open appendicectomy
independently. 32.5% respondents agreed to strongly agreed they were
confident to convert from laparoscopic to open appendicectomy
independently if required. Table 1 summarises open and laparoscopic
appendicectomy quantitative experience.
Table 1 Open appendicectomy quantitative experience
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Mean Median Mode
Open appendicectomy - assisted 5.2 2 0
Open appendicectomy - supervised 3.9 2 0
Open appendicectomy - independent 2.6 0 0
Laparoscopic appendicectomy 51.3 20 0
(Independent)
Conclusion: Laparoscopic overwhelmingly exceeds open appendicectomy
confidence and experience amongst the cohort of trainee surgeons. The
majority have not assisted or performed open appendicectomy, and
those that have constitute low single digit case numbers. This may
translate into lower ability to perform open appendicectomy when
required. The decline in open experience and confidence could continue
increase as the minimally invasive uptrend continues. Programme
directors and trainers should be aware of this phenomenon to safeguard
training to mitigate lack of confidence and experience, as this could
jeopardise future surgical patient care and safety.
Abstract citation ID: znac247.081
SP7.8 The SUNRRISE Trial – Single Use Negative pRessure
dressing for Reduction in Surgical site infection following
Emergency laparotomy
SUNRRISE Study Group1, Australian SUNRRISE Group2, NorthWest
Research Collaborative3, West Midlands Research Collaborative3
1
UK and Australia
2
Australia
3
UK
Background: Surgical Site Infections (SSI) are common after abdominal
surgery, and more so after emergency laparotomy. Despite Single Use
Negative Pressure Dressings (SUNPDs) having mixed evidence
regarding effectiveness, they are recommended in the WHO SSI
Prevention guidelines.
SUNRRISE is an international, multi-centre, trainee devised, led and
delivered randomised controlled trial, funded by the NIHR (UK) and
MRFF (Australia). It investigates whether a SUNPD reduces the risk of
SSI within 30 days of emergency laparotomy.
Method: Patients were randomised between SUNPD (PICO7©, Smith and
Nephew) and surgeon’s preference of dressing. Patients were eligible if
they underwent an emergency laparotomy with an incision of at least
5cm that was primarily closed at the end of the operation. SSI was
assessed at day 5–10, via a patient diary while the patient was at
home and at day 30–44 by a blinded, trained wound assessor.
Results: 840 patients were randomised from 34 centres across the UK
and Australia.
Intention to treat analysis showed no difference in SSI between the two
groups (SUNPD-28%, Control-27%, p=0.75). There was also no difference
in all secondary outcomes- length of stay (9 vs 11, p=0.14), hospital
readmission for wound related complications (3% vs 3%, p-0.96, rates
of wound related complications (19% vs 18%, p-0.79), pain (1.8 vs 1.8,
p-0.61) and quality of life (SF-12 & EQ5D-5L).
Conclusion: SUNRRISE is a multicentre, assessor blinded, phase III RCT
that provides robust evidence that single-use negative pressure
dressings are not effective in reducing surgical site infections in
patients undergoing an emergency laparotomy.
Abstract citation ID: znac247.082
SP7.9 A systematic review and meta-analysis of potentially
contaminated and contaminated abdominal wall hernias/
defect repair using synthetic versus biological mesh

Anja Imsirovic1, Mirza K Baig2, Mansoor KhanProf3, Krishna K Singh3,
Parv Sains4, Muhammad S Sajid3
1
Brighton and Sussex Medical School, University of Sussex
2
Worthing Hospital, University Hospitals Sussex NHS Foundation Trust
3
Brighton and Sussex University Hospital, University Hospitals Sussex NHS
Foundation Trust
4 2
Spire St Anthony’s Hospital
Objective: The objective of this article is to evaluate the role of synthetic
mesh versus biological mesh in repair of potentially contaminated and
contaminated abdominal wall hernias/defects.
Method: Analysis was conducted according to PRISMA guidelines.
Systematic search of medical databases like MEBASE, MEDLINE and
pubmed was performed to find studies exclusively comparing the use
of synthetic mesh versus biological mesh in repairing the potentially
contaminated and contaminated complex abdominal wall hernia/
defects. Standard medical electronic databases were searched with
the help of local librarian and relevant published randomized
controlled trials (RCT) were shortlisted according to the inclusion
criteria. The analysis of the pooled data was done using RevMan
statistical software.
Result: Three RCTs and 10 comparative studies on 1138 fulfilled the
inclusion criteria. In the random effects model analysis, the use
synthetic mesh for complex abdominal wall hernia/defect repair in
contaminated or potentially contaminated zones reduce the risk of
hernia recurrence [odds ratio 0.44, 95% CI (0.33–0.60), z= 5.37,
p=0.00001] compared to implantation of biological mesh. Moreover,
risk of surgical site infection was statistically higher [odds ratio 0.66,
95% CI (0.47–0.92), z=2.44, p=0.01] following the use of biological mesh.
There was no heterogeneity (Tau2 = 0.10; Chi2= 16.15, df = 9 (p=0.06;
I2 = 44%) among included studies.
Conclusion: Use of biological mesh for complex abdominal wall hernia/
defect repair in potentially contaminated and contaminated situations
failed to demonstrate any superiority over conventional synthetic
mesh in both benchmark variables of surgical site infection and
hernia recurrence.
Abstract citation ID: znac247.083
SP7.10 Improving Our Preop Fasting Practice
Ayesha Khalid, Faisal Iqbal, Muhammad Irfan Keen, Mr Tiwari,
Hamza Waqar
University Hospital Birmingham
Aims: Preoperative fasting has always been a tussle between patient
and surgery staff. Keeping patient nil by mouth unnecessarily not
only increases the anxiety, thirst, hunger, postoperative insulin
resistance but can also lead to serious hypoglycemic events in
diabetic patients. The objective of our study to standardize the
habits of pre-operative fasting according to AABGI guidelines and
make sure to curtail the fasting period to the required minimum to
2 hours for liquids.
Method: This retrospective study included all inpatients who had any
vascular surgery done under general anaesthesia from Sep 2020 to
Nov 2020 in Birmingham Heartland Hospital. As per departmental
practices every patient is fasted from 0300. Anaesthesia induction
time was noted for every patient from theatre logbook to calculate the
fasting interval. After data analysis meetings were done with the ward
sister, anaesthetic & vascular surgery consultants to draw an action
plan.
Results: Data collected from a total of 50 patients showed that average
fasting period was 11 hrs 2 mins with longest fasting interval was 14
hrs 55 mins. Blanket allowance of clear fluids till 7 am, late dinner and
communication of theatre list priority to the ward resulted in
achieving an average fasting period of 2 hrs 53 minutes.
Conclusions: Identification of this simple but crucial problem is the first
step towards compliance with the standard. These unassuming
butchallenging implementations can significantly affect patient
satisfaction and help achieve recommended fasting intervals. Pre-op
fasting can easily be optimized by good communication between staff.
As further evidence arises, structured peri-operative care can progress.
Abstract citation ID: znac247.084
SP7.11 Preliminary results from the TACKoMesh RCT;
comparing the patient experience of pain following elective
Abstracts | v27
laparoscopic incisional hernia repair with ‘Protack™ versus
Reliatack™’, IPOM and sutured fascial closure
James Pilkington1,2, Fiona Wilkinson2, Jim Pritchett2, Shaneel Shah1,
Catherine Fullwood3, Aali Sheen1,2
1
Department of Surgery, Manchester Royal Infirmary
Centre for Bioscience, Manchester Metropolitan University
3
Medical Statistics, The University of Manchester
Aims: Provide a report on all patients who underwent laparoscopic
incisional hernia repair as part of the TACKoMesh RCT prior to
unblinding of treatment arms.
Methods: Trial recruitment was for primary incisional hernia with a
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defect diameter of 3–10cm. 63 patients (target 74–136) were operated
on prior to the outbreak of COVID-19. Post-operative pain is the
primary trial outcome.
Surgery was performed with spiral-tack mesh-fixation devices
(Protack™ (permanent) or Reliatack™ (absorbable)), Symbotex™ IPOM
mesh, and sutured fascial closure using extracorporeal knot ties.
Data was collected on trial forms and lifestyle questionnaires (SF-36 and
CCS). All data were explored and described in RStudio v1.4.1106.
Results: Patients were aged 36–80 and 57.1% male. Mean preoperative
BMI was 30.91.
Mean operating time was 81minutes. In 20.6% patients multiple hernia
defects were identified. A good degree of fascial closure was achieved in
all patients using a median 3 knots.
Median mesh-fixation time was 286seconds and a mean of 25 tacks/
patient were used. Median length of hospital stay was 3.5days.
Patients were asked “Please indicate on this scale [VAS 0–10] the pain
that you currently experience from your incisional hernia during
activity?”. Median responses for Day0/pre-op, Day1, Day6, Day30 and
Day365 were 4.5, 8.0, 6.0, 3.0 and 1.5 respectively.
At one year, 11% patients had experienced hernia recurrence and 52% a
post-operative seroma.
Conclusions: Target recruitment was not possible owing to COVID-19.
This technique has comparable recurrence rates. Reported pain
increases post-operatively but is reduced at post-operative day30 and
day365.
Abstract citation ID: znac247.085
SP7.12 Patient Initiated Follow-Up (PIFU)
Farzan Dholoo, Emily Moore, Alex Dinneen, Matthew Solan
Royal Surrey County Hospital
Introduction: There is a drive within the National Health Service
towards a more personalised approach to healthcare. Patient-centred
care gives individuals more control over their mental and physical
health. We have implemented a patient-initiated follow-up (PIFU)
system, within our trust. This provides patients with autonomy for
arranging follow-up appointments when needed and saves
unnecessary routine reviews.
Methods: Two consultant surgeons have offered a ‘PIFU style’ follow-up.
Selected patients seen in clinic were discharged but provided with a
PIFU card. Patients returned this card if they needed to be seen again
in clinic for the same complaint.
Results: During the study period 149 patients were discharged with a
PIFU card. There were 1370 appointments (New and Follow-up) over
the same period. Only 17% of PIFU patients (twenty-six) returned
within six months. One hundred and twenty-three patients (83%)
sought no further appointments. This reduced unnecessary, routine
follow-up visits. If a greater proportion of patients were discharged in
a timely fashion and offered a PIFU card, then outpatient clinic
efficiency would be further improved.
Conclusion: The potential benefits of a PIFU system include: financial
savings, patient autonomy, more clinic availability and fewer wasted
GP appointments for re-referrals. Adopting a PIFU based system, helps
to reduce service waiting times. PIFU is an important tool both for
improving outpatient clinic efficiency and increasing patient
autonomy. PIFU should be used widely, to help recovery after COVID-19.
Abstract citation ID: znac247.086
SP8.1.1 Emergency Vs Elective Common Bile Duct Exploration,
A District General Hospital Experience over 6 years
v28 | Abstracts
Mahmoud Al-Ardah1, Rebecca E Barnett2, Hannah Rottenburg1,
Michael Clarke1, James clark1, Ian Finlay1
1
Royal Cornwall Hospital
2
Royal Gwent Hospital
Introduction: Laparoscopic Common bile duct exploration (LCBDE) is a
relatively new approach for clearing choledocholithiasis. The aim of
this study is to assess the feasibility of this approach to clearing CBD
stones in an emergency setting.
Methods: Retrospective data collection and analysis was carried out for
207 consecutive cases of LCBDE performed over 6 years (2015–2020). The
patients were divided into two groups according to the operation
performed as an emergency or elective. We compared demographics,
perioperative data, post-operative complications, and outcomes.
Results: 207 cases of LCBDE were performed during the time period. 122
performed as an emergency, and 85 on an elective list. Of the emergency
cases, 37 performed because of cholangitis either mild or moderate in
severity according to Tokyo grading system.
Ninety-six percent of the emergency cases and 94.1% of the elective
cases were completed laparoscopically. Length of stay
post-operatively was 3.3 +6.3 days in the emergency and 3.5 +4.6 days
after elective.
Successful clearance achieved at the end of the operation in 99% of the
patients in the emergency group, clearance failed in one case. In the
elective group 100% of the patients has a successful clearance at the
end of the operation.
Twelve patients (emergency) and 8 patients of the elective cases
required post-operative ERCP to manage retained stones, recurrent
stones or bile leak (p=0.921). Three patient required re-operation for
post operative complications in each group.
Conclusion: Common bile duct exploration in emergency settings is
feasible, with high success rate if performed by surgeons with
advanced laparoscopic biliary skills.
Abstract citation ID: znac247.087
SP8.1.2 Group and Saves for Laparoscopic Cholecystectomies:
An Unnecessary Expense?
Kirsty Cole, Enakshee Jamnadass, James Ward, David Hou
Royal Hampshire County Hospital
Aims: The aim of this study was to analyse the necessity of routine
group and saves (G+S) in patients undergoing laparoscopic
cholecystectomies and to establish whether it would be safe to cease
this practice. In doing so, we aim to reduce financial burden and
workload, whilst maintaining safe clinical outcomes.
Methods: This was a retrospective study into all consecutive patients
that underwent an elective or emergency laparoscopic
cholecystectomy in Royal Hampshire County Hospital (RHCH) from
May 2019 - May 2021. IT systems and clinical notes were analysed to
identify the quantity of pre-operative G+S samples sent, and the
proportion of patients that required a postoperative blood transfusion.
Results: Over 24 months, 427 laparoscopic cholecystectomies were
performed in RHCH, 70% of which were elective. In total, 682 G+S
samples were processed (1.6/patient), resulting in a cost of £16504.
Two patients received a postoperative blood transfusion (0.5%). One of
these patients presented with an UGI bleed, whilst the other
presented with a haemolytic crisis. They were therefore predictable,
pre-operative conditions, for which a post-operative transfusion had
been planned prior to surgery.
Conclusion: In conclusion, this study suggests that performing routine
G+S for all laparoscopic cholecystectomy patients has created an
unnecessary workload and financial burden on this small DGH.
Furthermore, during this 24 months, this practice had no clinical
advantage. We therefore advise that sending pre-operative G+S
samples should be a clinical decision made on a case by case basis,
rather than a default for all patients.
Abstract citation ID: znac247.088
SP8.1.3 Biliary tract disease and deprivation: a Scottish
retrospective study
Lachlan Dick1, Jamie Young2
1 2
NHS Fife
2
NHS Borders
Introduction: Deprivation and poor health is a recognized association.
However, the impact of deprivation on biliary disease is less
understood. We aimed to determine the effect of deprivation on
admission with biliary tract disease at a Scottish district general
hospital.
Methods: Patients admitted with biliary tract disease were included
from June 2016 to June 2019. Carstairs Deprivation scores were
assigned to each patient by postcode with 5 being least deprived and 1
being most deprived. Statistical analysis was used to compare patient
demographics, diagnoses, and outcomes.
Results: 1116 patients were included. The majority (57.4%) were in decile
4. Only 2 patients were in decile 1 and so were excluded from the
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analysis. When comparing from decile 5 to 2, acute cholecystitis was
more likely in patients with a lower decile (19.3 vs 23.1 vs 22.2 vs
28.4%, p=<0.05) however there was no difference when comparing age
(63.3 vs 61.6 vs 62 vs 63 years, p=0.337), female gender (58 vs 60.7 vs
55.7 vs 56.7%, p=0.609) or mortality (0.6 vs 1.6, 1.3 vs 0.8%, p=0.687).
Conclusion: Whilst acute cholecystitis appears to be more prevalent in
patients from the most deprived areas, there is no difference in
demographics or outcomes when comparing them with those from
the least deprived areas. Given the relatively affluent cohort in our
study, future work should include a more balanced mix of patients
across the deprivation spectrum.
Abstract citation ID: znac247.089
SP8.1.4 Iatrogenic gallbladder perforation during laparoscopic
cholecystectomy and outcomes: a systematic review and
meta-analysis
Emily Sams1, Louis Evans1, Andrew Naguib2, Shahin Hajibandeh3,
Shahab Hajibandeh1
1
Royal Glamorgan Hospital, Department of General Surgery
2
Cardiff University Medical School
3
Queen Elizabeth Hospital, HPB Unit
Aims: to compare the outcomes of iatrogenic gallbladder perforation
versus no gallbladder perforation in patients undergoing laparoscopic
cholecystectomy.
Methods: In compliance with PRISMA statement standards, electronic
databases were searched to identify all studies comparing the
outcomes of iatrogenic gallbladder perforation versus no gallbladder
perforation in patients undergoing laparoscopic cholecystectomy. The
outcome of interest included surgical site infection (SSI), postoperative
collection, operative time and length of hospital stay. Random effects
modelling was applied to calculate pooled outcome data. The
certainty of evidence was assessed using GRADE system.
Results: A total of 5366 patients from 11 studies were included. Analysis
of 5366 patients from 11 observational studies suggested that iatrogenic
gallbladder perforation during laparoscopic cholecystectomy does not
increase the risk of SSI (OR 1.48, 95% CI 0.57–3.86, P=0.42) and
postoperative collection (RD 0.00, 95%CI -0.00–0.01, P=0.41) but may
result in longer operative time (MD 10.28, 95% CI 7.40–13.16, P
<0.00001) and length of hospital stay (MD 0.51, 95%CI 0.15–0.87,
P=0.005). The results remained consistent through sensitivity
analyses. The quality of available evidence was judged to be moderate
and the GRADE certainty of the evidence was judged to be high.
Conclusions: Relatively robust evidence with high level of certainty
suggests that iatrogenic gallbladder perforation during laparoscopic
cholecystectomy may not increase the risk of SSI and postoperative
collection but may result in longer operative time and length of
hospital stay. Whether prompt retrieval of spilled stones, adequate
peritoneal irrigation, and intraoperative use of prophylactic antibiotic
contribute to the above findings remains unknown.
Abstract citation ID: znac247.090
SP8.2.1 Robotic versus laparoscopic left lateral hepatic
sectionectomy: a systematic review and meta-analysis
Shahin Hajibandeh1, Shahab Hajibandeh2, Mohammed Kaif Qayum3,
Alexios Dosis4
1
Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital,
Birmingham, UK
Department of General Surgery, Royal Glamorgan Hospital, Cwm Taf University
Health Board, Pontyclun, UK

3
Department of General Surgery, Hereford County Hospital, Wye Valley NHS
Trust, Hereford, UK
4
Department of General Surgery, Bradford Royal Infirmary, Bradford, Yorkshire,
UK
Aims: To evaluate comparative outcomes of robotic and laparoscopic
left lateral hepatic sectionectomy (LLS).
Methods: A systematic search of PubMed, Web of Science, EMBASE
and bibliographic reference lists with application of a combination
of free text and controlled vocabulary search adapted to thesaurus
headings, search operators and limits was conducted. Overall,
minor (Clavien–Dindo grade<III) and major (Clavien–Dindo grade>III)
postoperative complications, mortality, volume of blood loss,
conversion to an open procedure, procedure time, length of hospital
stay, cost-effectiveness, and R1 resection were the evaluated outcome
measures.
Results: Seven comparative observational studies reporting a total of
319 patients of whom 150 underwent robotic LLS and the remaining
169 patients underwent laparoscopic LLS were included. The robotic
approach was associated with significantly longer procedure time
(MD: 29.40 minutes, p=0.01) and higher cost (MD: $4170, p<0.00001)
compared to the laparoscopic approach. There was no significant
difference in overall postoperative morbidity (OR: 1.29, p=0.62),
Clavien-Dindo grade <III (OR: 1.65, p=0.49), Clavien-Dindo grade > III
(OR: 1.18, p=0.85), perioperative mortality (RD: 0.00, p=1.00), volume of
blood loss (MD: 1.96 mls, p=0.91), conversion to an open procedure
(RD: -0.02, p=0.46), length of hospital stay (MD: 0.22 day, p=0.52) or R1
resection (RD:0.00, p=1.00) between two groups.
Conclusions: Meta-analysis of the best available evidence (level 2)
demonstrated that robotic LLS is associated with significantly longer
procedure time and higher cost and similar perioperative outcomes
compared to the laparoscopic approach. Future randomised studies
are required to evaluate short-term perioperative, long-term
oncological and surgeon-centred outcomes.
Abstract citation ID: znac247.091
SP8.2.2 Neoadjuvant chemoradiotherapy (CRT) versus
immediate surgery for resectable and borderline resectable
pancreatic cancer: meta-analysis and trial sequential analysis
of randomised controlled trials
Sadia Latif1, Shahin Hajibandeh2, Thomas Satyadas3,
Shahab Hajibandeh1
1
Department of General surgery, Royal Glamorgan Hospital, Pontyclun, UK
2 modulatory system
Hepatobiliary and Pancreatic Surgery and Liver Transplant Unit, Queen
Elizabeth Hospital, Birmingham, UK
3
Department of Hepatobiliary and Pancreatic Surgery, Manchester Royal
Infirmary Hospital, Manchester, UK
Aims: To compare resection and survival outcomes of CRT and
immediate surgery in patients with resectable and borderline
resectable pancreatic cancer
Methods: In compliance with PRISMA statement standards, electronic
databases were searched to identify all randomised controlled trials
(RCTs) investigating outcomes of neoadjuvant CRT versus immediate
surgery in patients with resectable and borderline resectable
pancreatic cancer. Two treatment strategies were compared using
direct comparison meta-analysis model. Random effects modelling
was applied to calculate pooled outcome data. The risks of Type1 or
Type2 error in the meta-analysis model were assessed using trial
sequential analysis (TSA) model. The certainty of evidence was
assessed using GRADE system.
Results: 400 patients from 4 RCTs were included. When resectable and
borderline resectable diseases were analysed together, neoadjuvant
CRT resulted in higher R0 resection rate (RR: 1.55, P=0.004), longer
overall survival (MD: 3.75, P=0.009) but lower overall resection rate
(RR: 0.83, P=0.008). When resectable and borderline resectable
diseases were analysed separately, neoadjuvant CRT improved R0
resection rate (RR: 3.72, P=0.004) and overall survival (MD: 6.64,
P=0.004) in patients with borderline resectable pancreatic cancer but
it did not improve R0 resection rate (RR: 1.18, P=0.13) and overall
survival (MD: 0.94, P=0.57) in patients with resectable pancreatic
cancer.
Conclusions: Evidence from RCTs suggests that neoadjuvant CRT
improves R0 resection rate and overall survival in patients with
borderline resectable pancreatic cancer but not in patients with
Abstracts | v29
resectable pancreatic cancer. Nevertheless, the best available evidence
does not include the contemporary chemotherapy regimens;
therefore, more definite conclusions would depend on the results of
future RCTs.
Abstract citation ID: znac247.092
SP8.2.3 Serial CRP in post operative elective general surgery
patients: analysis of usage and value
Shadi Abdelrahman1, Rabbiya Shahzadi-Sohail2, Priya Singh2,
Amir Khan1
1
Walsall healthcare NHS trust
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2
Medical school, Birmingham university
Aims: The aim of this project is to investigate the current practice in
measuring C-reactive protein (CRP) in the post-operative patients in
elective general surgery, to determine the current trends in using it
and its potential value in detecting post operative complications.
Methods: A retrospective analysis of a 100 consecutive patients
admitted for elective general surgery between January and July 2021
was conducted. This included analysis of patient demographics and
post-operative interventions including return to theatres and
interventional radiology. The CRP levels of the patients who required
interventions were compared against those who did not.
Results: 40 males; 60 females with a mean age of 61.1 years were
included, 11% of these patients had post-operative interventions. This
analysis showed CRP values were measured routinely post operatively
for at least 5 days in 91% of patients. There was a rise in CRP in all
patients in the early post-operative period (first three days). If CRP
continued to rise after this, it was more associated with a need for
post-operative interventions.
Conclusions: There is no diagnostic value for measuring CRP in the first
three days of the post operative period, as it will always show a rise in
that period. Continued rise after day 3 may indicate post operative
complications. Setting up pre-determined blood tests profiles for
elective surgical patients may help save time, effort and resources.
Abstract citation ID: znac247.093
SP8.2.4 Mindfulness-based Cognitive Therapy (MBCT) reduces
symptoms in patients with chronic visceral pain, and is
associated with the alteration of pain-evoked neural activity
and resting functional connectivity in the descending pain
Sarah Waldman1,2, Vishvarani Wanigasekera1, Julia Henrich3,
Maryanne Martin4, Bergljot Gjelsvik5, Irene Tracey1
1
Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical
Neuroscience, University of Oxford
2
Department of General Surgery, Milton Keynes University Hospital
3
Unit of Health-, Medical-, and Neuropsychology, Faculty of Social and
Behavioural Sciences, Leiden University
4
Department of Experimental Psychology, University of Oxford (Emeritus
Professor)
5
University of Oxford Mindfulness Research Centre, Department of Psychiatry,
University of Oxford
Aims: Chronic visceral pain can cause repeated presentations to
surgical services. Cognitive therapies show promise but are not often
considered in the surgical setting. This study aims to assess the
efficacy and mechanisms of MBCT-IBS, a mindfulness-based cognitive
intervention for irritable bowel syndrome (IBS).
Methods: Fifteen women with IBS underwent a 6-week MBCT-IBS
training course. Before and after this they completed validated
questionnaires on symptoms, and functional MRI brain scans during
thermal pain and at rest.
Results: MBCT-IBS led to improved symptoms (p<0.05). Increased
temperatures were required to achieve 5/10 pain ratings (mean 1.21°C,
p<0.001), indicating reduced pain sensitivity. Neuroimaging showed
that MBCT-IBS led to altered pain responses in the anterior cingulate,
the prefrontal cortex, the amygdala and the precuneus (Z>2.3, p<0.05).
In the left dorsolateral prefrontal cortex (dlPFC) this correlated with
reduced pain severity scores (rs(11)=-0.614, p=0.025). Altered
functional connectivity was seen between the right dlPFC and
multiple regions involved in emotional and sensory aspects of pain
processing, including the amygdala. There was also altered
v30 | Abstracts
connectivity between the amygdala and sensorimotor cortices (Z>2.3,
p<0.05).
Conclusions: MBCT-IBS was an effective treatment for IBS. The fact that
there was altered activity in and connectivity between key parts of the
descending endogenous pain modulatory system suggests that
MBCT-IBS may be an effective intervention for patients with
dysfunctional pain pathways in whom the pathological cause for their
pain is unclear. It is non-invasive and inexpensive, and has the
potential to reduce the incidence of unnecessary surgical intervention
in patients with chronic visceral pain.
Abstract citation ID: znac247.094
SP8.2.5 Weekend Presentation to Emergency Surgical Units
Results in Delayed Ultrasound Diagnosis and More Hospital
Visits
Sawsan Abdul-Hamid, Tanvir Sian, Rachel Xue Ning Lee, Oliver Ng,
Balamurali Bharathan
Nottingham University Hospitals NHS Trust
Aims: The principles of same day emergency care (SDEC) have been
around early assessment, access to point of care testing and criteria
led discharge. Supplementing clinical and biochemical assessment
with ultrasound (USS) may not always achieve a diagnosis but still
facilitates SDEC. Our 5-day SDEC USS service aims to achieve these
objectives with only limited dedicated slots over the weekend and
holidays. We present the results from our service, focusing on
differences in outcomes in those who present on weekdays versus
weekends.
Methods: Retrospective analysis of 558 patients who had USS between
2.2.21 and 12.4.21. Days from presentation to scan, number of
re-presentations, and need for admission were compared.
Results: 402 patients presented in the weekday and 156 at the weekend.
The proportion of patients having same day USS was higher for the
weekday group (65% vs 26%; χ2 p < .001). The number of days to
scanning was higher for weekend presenters (1.15 vs 0.38;
Mann-Whitney p<0.001). There was no difference in admission rate on
index presentation (weekday = 36% vs weekend = 37%; χ2 p = 0.74),
however, the average number of total attendances during the study
period was higher in those with an index presentation on a weekend
(1.74 vs 1.55; Mann-Whitney p=.007).
Conclusions: Patients presenting at weekends have longer waits for
USS, delaying diagnosis and discharge. Whilst admission rates on
index presentation are not affected, access to SDEC USS at the
weekend would allow for same-day discharge and fewer visits to
hospital for patients.
Abstract citation ID: znac247.095
SP8.2.6 Risk Prediction in Emergency Giant Hiatus
and Diaphragmatic Hernia Repairs
Mohamed Alasmar1,2, Eleanor Moore1, Iona McKechnie1,
Ram Chaparala1
1
Salford Royal Hospital
2
The University of Manchester
Aims: Emergency presentation of giant hiatus and diaphragmatic
hernias are associated with significant morbidity and mortality. The
preoperative risk prediction tools not only can help clinicians stratify
risk, but they can also be valuable tools to outline surgical risks to
patients and families. This study aimed to evaluate the suitability of
different risk prediction models when predicting morbidity and
mortality in emergency giant hiatus and diaphragmatic hernia repairs.
Methods: This was a retrospective cohort study of all emergency hiatus
and diaphragmatic hernia repairs at a tertiary upper gastrointestinal
centre from 2010 to 2021. We compared the outcomes to the predicted
mortality and morbidity of different risk prediction models. The
mortality models SORT, NELA and ACS-NSQIP were compared using
the area under the curve (AUC). We evaluated morbidity by calculating
the comprehensive complication index (CCI). Using Spearman
correlation, CCI was compared to P-POSSUM and ACS-NSQIP predicted
morbidity.
Results: 108 patients were included in the analysis. The 30-day
mortality rate was 6.93%. ACS-NSQIP had the highest predictive power
for mortality (AUC ¼ 0.845) in comparison to NELA (AUC¼0.809) and
SORT (AUC ¼ 0.740). Both ACS-NSQIP and P-POSSUM showed
moderate correlation to CCI (rho ¼ 0.489, p < 0.001 and 0.446, p < 0.001
respectively).
Conclusions: ACS-NSQIP is a better predictor of both mortality and
morbidity in emergency giant hiatus and diaphragmatic hernia repairs
when compared to NELA, P-POSSUM and SORT. Multi-centre
prospective studies could be used to validate these findings.
ACS-NSQIP may have a role in pre-assessment and consenting
emergency giant hiatus and diaphragmatic hernia repairs.
Abstract citation ID: znac247.096
SP8.2.7 Is “Hot” Laparoscopic Cholecystectomy in patients
with high BMI a safe option? - Outcomes of Emergency
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Laparoscopic Cholecystectomy in obese vs non-obese patients
Sabrina Bezzaa, Reeya Patel, Carine Boven, Ioannis Gerogiannis
Kingston Hospital NHS Foundation Trust
Aim: NICE guidelines currently recommend offering patients presenting
with acute cholecystitis a laparoscopic cholecystectomy within 1 week
of diagnosis. We compared peri-operative outcomes for patients
undergoing emergency laparoscopic cholecystectomy with a BMI of
<30 kg/m2 (Group 1) and ≥30 kg/m2 (Group 2).
Methods: A retrospective review of patients undergoing an emergency
laparoscopic cholecystectomy at a District General Hospital between
January 2018 and November 2020.
Results: 159 patients were included. Group 1 had 97 patients (BMI range
18.8–29.9 kg/m2, age range 27–82 years, 56 females: 41 males). Group 2
had 62 patients (BMI range 30–56.3 kg/m2, age range 19–88 years, 38
females: 24 males).
ASA breakdown was 1(25.8%), 2(64.9%) and 3(9.3%) for Group 1 and
2(71%) and 3(29%) for Group 2. Indications for surgery included biliary
colic, acute cholecystitis and gallstone pancreatitis. Operating
surgeons had training in both Upper GI and Bariatric surgery.
There were no significant differences between Group 1 and Group 2 for
anaesthetic time (minutes, 32.74 vs 32.50 p=0.91), operative time
(minutes, 95.82 vs 93.67 p=0.75), total length of stay (days, 6.15 vs 5.17
p=0.30) or readmission rate within 30 days (22.68% vs 19.35% p=0.62).
4 patients in each group had acute complications during the index
admission.
Conclusion: Emergency laparoscopic cholecystectomy for patients with
a BMI ≥30 kg/m2 has similar peri-operative outcomes when compared to
patients with a BMI <30 kg/ m2 and is safe to be performed in a District
General Hospital by operating surgeons with an interest in Upper GI and
Bariatric surgery.
Abstract citation ID: znac247.097
SP8.2.8 Resection and primary anastomosis is safe in selected
patients with perforated diverticulitis; a cohort study
Megan Dowdeswell, Jessica Chang, Viswa Rajalingam, Maria Wolos,
Joe McCloud, Mark Cheetham
Royal Shrewsbury Hospital
Aims: Historically, the preferred procedure for perforated diverticular
disease is Hartmann’s procedure (HP). Although reliably achieving
source control, it’s associated with a high rate of post-operative
complications and a stoma which often becomes permanent. We
reviewed our experience of patients undergoing HP vs primary
anastomosis (PA) for perforated diverticulitis.
Methods: All patients undergoing emergency resectional surgery for
perforated diverticulitis between March 2015 and Jan 2021 were
identified from the Hospital Episode Statistics (HES) data.
Demographics were collected and the patient groups were case
matched for age and Charleson Comorbidity Index (CCI), Computed
Tomography (CT) appearance and intraoperative contamination data.
Post-operative morbidity/mortality data was compared.
Results: 105 patients were included. 15 patients had PA (without
diversion) and 90 HP.
In the PA cohort were 10 males, median age 52 (range 27–76). There were
no anastomotic leaks. 30-day morbidities were superficial wound
dehiscence (1) and early incisional hernia (1). Median post-operative
stay was 9 days (range 5–25).
HP control group (age below 76, Charlson score 10 and below, Hinchey 1–
3 intraoperatively). Included 58 patients, 26 males, median age 60.5
(range 30–76). Median post-operative stay was 10.5 days (range 5–227).
2 patients required re-operation. 5 patients developed wound

infections. At the time of the study 18 patients have undergone reversal,
6 are on active waiting-list for reversal.
There was a single 30-day mortality (post-discharge).
Conclusion: We have shown that PA is safe in selected cohort of patients
and have identified that over 50% of patients undergoing HP could have
been considered for PA.
Abstract citation ID: znac247.098
SP9.1.2 Investigating the association between trust case
volume and perioperative outcomes in colorectal cancer
surgery
Mustafa Al-Zubaidy, Aos Al-Hasani, Tatiana Hamakarim
Imperial College London
Background: Whilst current colorectal cancer care pathways operate by
referral to local hospitals, there has been a recent drive to centralise
cancer services to improve patient outcomes. Centralisation will
inevitably increase trust case volume and the existing literature is
inconclusive regarding a possible volume-outcome association. This
study aims to investigate the association between case volume and
unplanned readmission or unplanned return to theatre (URTT) rates
in patients undergoing colorectal surgery across England and Wales.
Methods: A retrospective analysis was conducted of 14028 patients
across 135 trusts using the 2020 NBOCA dataset. Primary outcome
measures were 30-day unplanned readmission and 30-day URTT
rates. Trusts were dichotomised into low or high-volume sites.
Statistical analysis used Spearman’s ρ correlation, Mann-Whitney U
and Student T-test.
Results: 11.2% (2.30–24.5) and 8.31% (0.00–23.3) of 14028 patients
underwent an unplanned readmission and URTT respectively. There
was no significant correlation between the number of cases and
30-day unplanned readmission (r=0.0628, 95%CI: -0.112–0.234,
p=0.469), with no significant difference between low and high-volume
trusts (p=0.432). Similarly, no significant correlation was found
between the number of cases and 30-day URTT rate (r=-0.0848, 95%CI:
-0.255–0.0904, p=0.328), with no significant difference between low and
high-volume trusts (p=0.285).
Conclusions: No association was discovered between volume and
unplanned readmission or URTT in this cohort. Increasing volume
among trusts who demonstrate favourable outcomes, rather than
indiscriminately increasing volume may be beneficial. This study
increases our understanding of volume-outcome relationships,
however further prospective studies at a national level into other
outcomes should be conducted to rule out centralisation.
Abstract citation ID: znac247.099
SP9.1.3 Colorectal Cancer Referrals During COVID-19: The Use
of CT and qFIT in Triaging Patients in NHS Grampian
Fabbiha Ashad1, George Ramsay2, Brian Morrisey3
1
University of Aberdeen, School of Medicine, Medical Sciences and Nutrition,
Aberdeen, UK, AB25 2ZD
2
Health Services Research Unit, Foresterhill, Aberdeen, UK, AB25 2ZD
3
NHS Grampian
Introduction: The COVID-19 outbreak resulted in fundamental changes
to clinical practice for patients referred to secondary care with lower
gastrointestinal symptoms. The use of colonoscopy services was
reduced due to a perceived risk of viral transmission. Resultantly,
computed tomography abdomen pelvis (CTAP) scans were utilised to
triage patients. This study aimed to assess the accuracy of CTAP and
qFIT in triaging patients at risk of colorectal cancer.
Methods: This study retrospectively gathered data on patients referred
via the urgent suspected cancer (USC) pathway from the start of
lockdown over a 6-month period in a single Scottish Health Board. Data
were collected on presenting symptoms, qFIT levels, vetting decision,
investigations, and subsequent diagnosis. Patients were vetted into one
of five pathways: CTAP, direct to colonoscopy, downgraded from
assessment, flexible sigmoidoscopy, or CT colonography.
Results: The overall cancer detection rate was 6.4%. Of the patients with
cancer on the CTAP pathway, 22.9% had cancer undetected on CTAP
which was later identified on colonoscopy. In the cohort of patients
with colorectal malignancy, 7.5% had a negative qFIT value (<10 ug/g).
Abstracts | v31
Conclusion: CTAP alone may not be accurate in detecting colorectal
cancers. One should consider the whole clinical picture and decide
whether further imaging is warranted following a negative CTAP scan.
Additionally, qFIT remains the leading laboratory investigation within
screening programmes, however, it should not be used in isolation to
rule out colorectal malignancy.
Abstract citation ID: znac247.100
SP9.1.4 Performance and Cost-Effectiveness of a Virtual
Consultation Clinic for 2-Week-Wait Colorectal Cancer
Referrals – A Response to the Covid-19 Pandemic
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Christopher Davidson, Sinead Conlon, Othman Al-Fagih, Nauwab Khan,
Drostan Cheetham, Vanash Patel
Watford General Hospital - West Hertfordshire NHS
Aims: Measure performance and cost effectiveness of a Virtual
Consultation (VC) clinic, compared to face-to-face (FF) clinic, for
2-week-wait (2WW) colorectal cancer (CRC) referrals, which did not
meet the criteria for nurse-led Telephone Assessment Service.
Methods: 2WW CRC referrals were triaged by a colorectal surgeon to
either a doctor-led VC or FF clinic. Demographics, referral indications,
and primary outcome measures (time to clinic/results; investigation
type; cancer detection rate) were compared pre-pandemic (November
2019–January 2020) and during the pandemic (May–June 2021).
Results: 158 (pre-pandemic) and 160 (pandemic) consecutive patients
were analysed, with no difference in age (74 vs. 75 years, p=0.936).
During the pandemic, patients were referred with an increased
number of positive FIT tests (29 vs. 13%, p<0.001), were more likely to
have computerised tomography (65 vs. 45%, p=0.003), had a longer
time from referral to clinic assessment (10 vs. 8 days, p=0.002), but
were informed of results more promptly (59 vs. 138 days, p<0.001)
than pre-pandemic patients. During the pandemic patients were
assessed earlier via VC than FF clinics (9 vs. 11 days, p=0.049). There
were no significant differences in cancer detection rate pre or during
the pandemic (12 vs. 8%, p=0.187), or between VC and FF clinic during
the pandemic (6 vs. 12%, p=0.294). Cost effective analysis showed
£15,000 per annum saving with doctor-led VC clinic.
Conclusion: Virtual consultation for 2WW CRC referrals may improve
efficiency without compromising the cancer detection rate, as well as
reducing risk of Covid-19 transmission and being more cost effective.
Abstract citation ID: znac247.101
SP9.1.5 Occult appendix pathology in patients undergoing
colorectal cancer resection suggests a role for appendectomy at
left colon or rectal cancer resection
Prabhu Ravi, Francesco Di Fabio, Kashuf Khan, Abu Abduelraheim,
Steve Arnold, Brendan Moran
Colorectal Surgery, Basingstoke North Hampshire Hospital, Basingstoke, UK
Aims: There is epidemiological evidence suggesting that the incidence
of appendicular neoplasms is increasing. The purpose of this study is
to assess the incidence of appendix neoplasms in patients undergoing
colorectal cancer resection in a unit where standard of care is
appendectomy, with consent, when left colon or rectal cancer
resection is performed.
Methods: This is a retrospective single-centre study on a prospectively
collected data base of 718 consecutive patients undergoing colorectal
cancer resection between January 2015 and June 2021. The primary
outcome was the proportion of histologically abnormal appendix
specimens at incidental appendectomy. Secondary outcome was
complications from incidental appendectomy.
Results: Overall, 222/718(31%) patients had previous appendectomy. The
remaining 496 comprised 169/496 (34%) who had a right-/extended-
right hemicolectomy or sub-total colectomy which incorporates
appendectomy, and 327/496(66%) who had left-sided resection
(left-hemicolectomy, anterior resection or abdomino-perineal excision)
with incidental appendectomy.
At definitive histology, 454(92%) had a normal appendix, 13(2.6%) had
inflammatory appendix pathology, 17(3.4%) had a hyperplastic/serrated
polyp and 12(2.4%) had an appendix neoplasm, which included 5
carcinoids and 7 low-grade appendiceal mucinous neoplasms (LAMN).
In the 327 patients who had incidental appendectomy, 7(2.1%) had a
neoplasm (4 carcinoid and 3 LAMN). There were no complications
attributable to appendectomy.
v32 | Abstracts
Conclusion: Patients undergoing left sided colorectal cancer surgery
with an appendix in situ should be counselled on the benefits of
co-incidental appendectomy to treat the small proportion with
synchronous neoplasms and inflammation and eradicate the risk of
metachronous appendicitis or a subsequent appendix tumour.
Abstract citation ID: znac247.102
SP9.1.6 Save the scope - a 3-year analysis of follow-up
methods for acute diverticulitis and the incidence of colorectal
malignancy
Louise Gurowich, Marianne Hollyman
Musgrove Park Hospital Taunton
Aims: Previously, guidelines for the management of diverticular disease
have recommended endoscopic evaluation following acute
diverticulitis to exclude colorectal cancer (CRC). However, 2021
ACPGBI consensus guidelines recognised the sensitivity of modern CT
scanning and low incidence of CRC, and suggested no routine
re-imaging in CT-proven uncomplicated disease.
Methods: Patient were identified presenting between 2017–2019 at a
single centre. Records were retrospectively reviewed to evaluate the
incidence of CRC at a minimum of 18-month follow up in this patient
group. Secondary outcomes included the imaging method requested,
operative management, and complications following endoscopy.
Results: Of 486 admissions in 461 patients, 168 (35%) had CT-proven
complicated disease, 225 (46%) had uncomplicated, and 93 (19%) had
no imaging. 281 (59%) had follow-up investigations requested; 126 CT
colonoscopy (CTC) and 150 endoscopic. 133 investigations were
performed in patients with uncomplicated diverticulitis.
Only 6 patients (1%) were diagnosed with CRC; 2 at endoscopy, and 4 by
histology from colorectal resections during emergency admission; all
had CT-proven complicated diverticulitis. No malignancy was
identified in patients with uncomplicated diverticulitis.
Secondary outcomes identified that 26 (24%) flexible sigmoidoscopies
were poorly tolerated, necessitating further imaging.
Conclusions: At our centre, there was little consensus on whether
patients had follow-up imaging following acute diverticulitis, and
what modality was used. We identified no CRC in patients with
CT-proven uncomplicated disease, with 133 potentially unnecessary
investigations performed in this group. We recommend use of CTC or
endoscopy following acute CT-proven complicated diverticulitis in
line with ACPGBI guidelines, avoiding follow-up in uncomplicated
disease.
Abstract citation ID: znac247.103
SP9.1.7 The effect of the COVID-19 pandemic on Colorectal
Cancer (CRC) diagnosis, management and outcomes
Matthew Harris, Jamal Kuhdr, Paul Rooney
Royal Liverpool University Hospital
Aim: We studied differences in stage, treatment modality, morbidity
and mortality, two week wait referrals (2WW) and rate of 2WW cancer
diagnosis.
Method: All 2WW referrals to the NHS trust colorectal department were
analysed and their rate of diagnosis of any cancer. Using data extracted
from the Somerset Cancer Database, we compared CRC patients
diagnosed in the NHS trust 6 months prior to (Pre-PAN) and following
(PAN) national lockdown on 23/02/2020.
Outcome measures included: cancer stage, resection rate, stoma rate,
Clavien-Dindo score and 90 day mortality. Statistical analyses
included Chi-squared and Mann-Whitney-U tests.
Results: 2WW referrals dropped significantly during the pandemic
(p=0.02). However, the rate of diagnosis of cancer of any kind was not
significantly different (PAN=12.4%, Pre-PAN=11.4%,p=0.89).
There were significantly fewer CRC diagnoses during the pandemic
(Median monthly diagnoses: Pre-Pan=13.5, Pan=8.5 p=0.010). There
was a significantly higher proportion of Dukes A cancers in Pre-Pan
compared to Pan (Pre-PAN=31.3%, PAN=14.3%, p=0.036). There was a
significantly higher proportion of Dukes B cancers in Pan compared to
Pre-Pan (Pre-PAN=13.8%, PAN=33.9%, p=0.032). There was no excess
morbidity or mortality between the two groups.
Conclusion: There was no excess mortality or morbidity, demonstrating
the efficacy of COVID surgical protocols. PAN patients presented with
advanced tumour stage. There were fewer 2WW referrals from GP and
fewer diagnoses of CRC in the PAN group. However, the proportion of
cancers picked up from 2WW referrals was not significantly different.
Decreased diagnoses and stage migration may be due to loss of
investigative resource or patient factors such as fear precipitating late
presentation.
Abstract citation ID: znac247.104
SP9.2.1 Postoperative outcomes in patients undergoing Total
Pelvic Clearance for locally advanced Primary and Recurrent
Rectal Cancer: A Systematic Review to assess Perioperative
Mortality, Rate of R0 Resection and 5Year Overall Mortality
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Rehan Khan1, Chelliah Selvasekar2, Nayer Jamshed3, Ankit Sahu3
1
Royal Preston Hospital
2
Christie Hospital NHS Trust Manchester
3
All India Institute of Medical Sciences Delhi
Introduction: The outcomes of complex surgical procedures such as
Total pelvic clearance (TPC) have improved due to advances in
technology, improvements in surgical technique and experience.
Majority of Reviews include older studies diluting the benefits and
outcomes. Secondly, very few studies mention all important outcomes
in one leading to non-uniformity in reporting of data. Lastly, there
was further need of updating the previous reviews, the last one
published a decade earlier, hence, the review of Perioperative
Mortality, rates of R0 resection and 5-year overall survival were
carried out in patients undergoing TPC for primary or recurrent rectal
cancer in a systematic manner.
Methods: Literature searches were performed in three databases:
MEDLINE, PUBMED and Cochrane Library. Each study was evaluated
with regards to its design and statistical methodology. The quality
assessment of studies was carried out in this review as per the SIGN
grading system. Publication bias was assessed by drawing funnel plots
for each outcome. Each outcome was further analysed by creating
Forrest plot using fixed effect model.
Results: A total of 1632 articles were identified through electronic
databases. A total of 21 articles were finally included which met the
inclusion and exclusion criteria. Out of 963 resections carried out,
perioperative mortality was 3.4%. Overall R0 rection rates were 72.4%.
Out of total 374 patients, overall, 5-year survival rate was 42%.
Conclusion: TPC is safe in experienced hands at specialist centres
experienced in dealing with such cases with acceptable outcomes
outlined above.
Abstract citation ID: znac247.105
SP9.2.2 Implementation of a straight to test colorectal cancer
referral pathway significantly improves cancer targets and
reduces outpatient requirements
Suren Reddy Satti, Sevra McKenzie, Caroline Yao, Steve Arnold,
Arcot Venkatasubramaniam, Francesco Di Fabio
Basingstoke and North Hampshire Hospital
Aims: The main aim of this study is to determine the impact of the
“Straight to Test” (STT) colorectal cancer pathway on the NHS England
28-day faster diagnosis and 62-day-treatment targets. The secondary
aim is to evaluate the effect of the pathway on reducing outpatient
clinic appointments and the proportion of colorectal cancers
diagnosed within 2 week wait (2WW) referrals.
Methods: This case-controlled single-centre study included 1000
patients. Five-hundred consecutive patients were managed through
the STT colorectal cancer pathway between February 2021 to May 2021
(study group), with a dedicated colorectal nurse triaging the referrals
for straight to colonoscopy or outpatient clinic, for complex cases that
do not fit the STT criteria. This group was compared with 500
consecutive patients referred on the 2WW colorectal cancer pathway
prior to the implementation of the STT pathway and therefore all
reviewed in outpatient clinic, between April 2019 to July 2019 (control
group).
Results: The 28-day time-to-diagnosis and 62-day time-to-treatment
targets improved after the introduction of STT pathway from 59% to
86% (p<0.0001) and from 35% to 60% (p=0.095), respectively. In the
study group, 234/500 (47%) patients were triaged for straight to
colonoscopy, freeing up an equal number of outpatient colorectal
clinic appointments. The proportion of colorectal cancers diagnosed

within the 2WW referrals was 5.2% in the study group and 4.2% in the
control group.
Conclusion: Implementation of a STT 2WW colorectal cancer pathway
has significantly improved our colorectal cancer targets and reduced
outpatient clinic requirements.
Abstract citation ID: znac247.106
SP9.2.3 Role of single or double ringed circumferential wound
protectors in reducing surgical site infections following
colorectal resections: an evidence synthesis by the
meta-analysis of randomized controlled trials
Hussameldin M Nour1, Amiya Ahsan1, Mirza K Baig2, Parv Sains3,
Muhammad S Sajid1
1
University Hospitals Sussex NHS Foundation Trust
2
Worthing Hospital
3
Spire St Anthony’s Hospital
Objective: The objective of this article is to explore whether the use of
single or double ringed wound protectors (WP) in patients undergoing
colorectal resection (CRR) is associated with reduced risk of surgical
site infections (SSI).
Method: Analysis was conducted according to PRISMA guidelines. With
the help of expert local librarian, systematic search of medical
databases like MEBASE, MEDLINE and pubmed was conducted to find
appropriate randomized controlled trials (RCT) according to
predefined inclusion criteria. The analysis of the pooled data was
done using the principles of meta-analysis on statistical software
RevMan.
Result: Eighteen RCT on 3744 patients fulfilled the inclusion criteria.
There were 1885 patients in the WP group and 1889 patients in the
no-WP group. In the random effects model analysis, the use of WP
during CRR was associated with the reduced risk of SSI [odds ratio
0.63, 95% CI (0.47–0.86), z= 2.94, p=0.003]. However, there was
significant heterogeneity (Tau2 = 0.18; Chi2= 34.77, df = 17; (p=0.007; I2
= 51%) among included studies.
Conclusion: Use of WP seems to reduce the risk of SSI and therefore,
may routinely be used during both open and laparoscopic CRR.
Abstract citation ID: znac247.107
SP10.1.1 A retrospective study: Rectal foreign bodies, enter at
your own risk…
Ashim Chowdhury, Eva Havelka, Eoin O’Farrell, Anang Pangeni, Ashish
Kiran Shrestha
William Harvey Hospital
Aims: Entrapped rectal foreign bodies (FB) are being encountered by
acute surgical teams with increasing frequency and can be a challenge
to manage. This study aims to highlight typical patient demographics,
risk factors for presentation and management options for these
patients.
Methods: Between 2017 and 2021, 29 cases of rectal FB were diagnosed
and managed at East Kent Hospital University Foundation trust.
Retrospective data taken from theatre directory and electronic notes
was used to audit patient demographics, co-morbidities, the type of
foreign body and the extraction technique.
Results: The majority of patients were male (87%). The patient’s age
ranged from 15 to 78 years, with a median age of 48 years. In the
majority of cases, the FB had become entrapped during sexual
activity. Nineteen patients (65%) underwent examination under GA for
removal, seven patients (24%) were manually evacuated and three
required a laparotomy (10.3%). Nine patients (31%) had a history of
known mental health problems. The most common FB removed was a
roll-on deodorant (n=5).
Conclusion: Cases of rectal FB’s needing surgical management typically
involve male patients in their 40’s. While a small proportion can have
manual evacuation, the majority require examination under
anesthetic and in some cases a laparotomy. While a larger study
would be required for significance, it appears a history of mental
health problems may predispose patients to presenting with this
problem. Patients present with a wide range of foreign body type,
typically items commonly found in the home, the most common
being roll on deodorant.
Abstracts | v33
Abstract citation ID: znac247.108
SP10.1.2 Novel Predictors of Mortality in Emergency Bowel
Surgery: A Single Centre Cohort Study
Alexander Darbyshire1, Ina Kostakis2, Paul Meredith1, Simon Toh1,
David Prytherch2, Jim Briggs2
1
Portsmouth Hospitals University NHS Trust
2
Centre for Health Care Modelling and Informatics, University of Portsmouth
Aims: Pre-operative risk stratification is a key part of the care pathway
for emergency bowel surgery, as it facilitates the identification of
high-risk patients. A limitation of current risk models is that they
utilise operative data in their calculation and are not designed to
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provide pre-operative risk-predictions. This study aimed to
investigate the ability of variables that are routinely available
pre-operatively to predict 30-day mortality after emergency bowel
surgery.
Methods: A single centre cohort study was performed using local
National Emergency Laparotomy Audit database (01/12/2013 to 31/01/
2020). Further data was then extracted from electronic hospital
records (n=1,561). The National Early Warning Score (NEWS),
Laboratory-Decision-Tree-Early-Warning Score (LDTEWS) and Hospital
Frailty Risk Score (HFRS) were then calculated. The most abnormal
NEWS/LDTEWS scores in the 24/72-hours prior to surgery were used in
analysis.
Results: Individual NEWS, LDTEWS and HFRS scores were reasonable
predictors of mortality (c-statistic 0.689–0.735) but all poorly
calibrated. NEWS scores of ≥4 were associated with a high overall
mortality rate (>10%). A logistic regression model (Pre-Op) was
developed using age, NEWS, LDTEWS and HFRS scores as predictor
variables. The Pre-Op model demonstrated good discrimination
(c-statistic 0.778) and excellent calibration, but was outperformed by
the NELA score (c-statistic 0.855). Interestingly, APACHE II and
P-POSSUM displayed poor calibration and fair-to-good discrimination
(c-statistic 0.687–0.789).
Conclusion: Pre-operative patient vital signs, blood tests and markers of
frailty can be used to accurately predict the risk of 30-day mortality after
emergency bowel surgery.
Abstract citation ID: znac247.109
SP10.1.3 Can We Justify Routine Group & Screen Testing Prior
to Appendicectomies? - A Single Centre Analysis
Rita Deb, Gita Deb, Naresh Pore, Hemant Sheth, Durgesh Raje
London North West Healthcare NHS Trust
Aim: Numerous sources have suggested that routine preoperative
Group & Screen (G&S) testing prior to cholecystectomies 1–4, breast
surgery 5 and gynaecological procedures including Caesarean sections 6
may be unnecessary because perioperative blood transfusion incidence
remains low.
This project aimed to understand whether routine pre-appendicectomy
G&S testing can be justified by analysing blood transfusion incidence
for appendicectomies completed at our hospital. To further comment
on their relevance to clinical practice, we also aimed to investigate any
potential delay to surgery that G&S tests may pose, and their cost
implications.
Method: For all appendicectomies undertaken at our hospital from 2018
to 2021 (n = 257), we noted if the patient received a blood transfusion
anytime during their admission. The date and time of G&S sample
collection and of the surgery were recorded, including any
documentation of delays to surgery.
Results: 0% of appendicectomies between 2018–2021 required a blood
transfusion during the admission. On average, 3.9% of
appendicectomies per year were delayed due to preoperative G&S
testing with an average delay to surgery of 78.71 minutes.
The total cost of G&S tests undertaken for appendicectomy patients
between 2018–2021 was £5768.03.
Conclusion: It is difficult to justify routine pre-appendicectomy G&S
testing when our data suggests such a low risk of blood loss
necessitating transfusion, and that these tests delay treatment. This
may warrant pre-appendicectomy risk stratification to streamline
G&S testing. Additionally, should an emergency occur,
uncrossmatched blood is readily accessible and poses minimal risk
to patients7.
v34 | Abstracts
Abstract citation ID: znac247.110
SP10.1.4 Association between public holidays and acute
admission with biliary colic: a retrospective analysis
Lachlan Dick1, Jamie Young2
1
NHS Fife
2
NHS Borders
Introduction: Biliary colic symptoms are often post-prandial,
particularly following fatty foods. Public holidays and festive periods
are frequently celebrated using such foods. We aimed to determine
the rates of admission following public holidays at a Scottish district
general hospital.
Methods: Emergency admissions with biliary colic from June 2016 to
June 2019 were included. Public holiday dates were extracted from the
Scottish government website. To include those with delayed
presentation, the 3-days following a public holiday were also
considered to be public holiday-related (PHR). Statistical analysis was
performed to determine any differences in demographics or outcome.
Results: Of the 273 patients included, 1 (0.4%) was admitted on a public
holiday with a further 27 (9.9%) admitted on a PHR day. PHR days
accounted for 104 (9.2%) of the 1125 days included in the study.
Comparing those admitted on a PHR and non-PHR day, there was no
difference in age (61.6 vs 61.1 years, p=0.895), female gender (75 vs
66.5%, p=0.365), length of stay (6 vs 4 days, p=0.250) or operative
intervention (53.5 vs 37.6%, p=0.09).
Conclusion: The majority of PHR admissions with biliary colic occur
during the 3-days following a public holiday. It is therefore likely that
the need for radiological investigation and access to emergency
theatre will be greater during this period. Future work could assess
the impact of other cultural holidays which are not reflected in public
holidays.
Abstract citation ID: znac247.111
SP10.1.5 Hajibandeh Index and intraperitoneal
contamination: A cohort study and meta-analysis
Shahab Hajibandeh1,2, Shahin Hajibandeh3, Louis Evans2,
Bethany Miller2, Jennifer Waterman2, Andrew Maw4
1
General Surgery, Wales Deanery, Health Education and Improvement Wales, UK
2
Department of General Surgery, Royal Glamorgan Hospital, Cwm Taf University
Health Board, UK
3
Hepatobiliary and Pancreatic Surgery and Liver transplant Unit, Queen Elizabeth
Hospital, Birmingham, UK
4
Department of General Surgery, Glan Clwyd Hospital, Betsi Cadwaladr
University Health Board, Rhyl, UK
Aims: To validate the performance of the Hajibandeh Index (HI) in
predicting the presence and nature of intraperitoneal contamination
in patients with acute abdominal pathology.
Methods: The STROCSS guidelines and the PRISMA statement
standards were followed to conduct a cohort study and a
meta-analysis, respectively. All adult patients undergoing emergency
laparotomy for acute abdominal pathology were eligible. The accuracy
of the HI was evaluated using ROC curve analysis in the cohort study
and using weighted summary AUC under the fixed and random
effects modelling in the meta-analysis. The QUADAS-2 criteria were
used for methodological quality assessment of the included studies.
Results: A total of 1437 patients were included (700 from the cohort
study and 737 from the literature search). ROC curve analysis of the
cohort study showed that the AUC of HI for presence of contamination
was 0.79 (P <0.0001) and meta-analysis showed that the pooled AUC of
HI was 0.79 (0.75–0.83). In terms of nature of contamination, the
cohort study showed that the AUC of HI for purulent and feculent
contamination was 0.76 (P<0.0001) and 0.83 (P<0.0001), respectively.
The pooled AUC of HI for purulent and feculent contamination was
0.78 (0.74–0.81) and 0.80 (0.77–0.83), respectively.
Conclusions: The HI is a strong and accurate predictor of the presence
and nature of intraperitoneal contamination. We encourage other
researchers to validate performance of HI in predicting the presence
of intraperitoneal contamination and more importantly in predicting
mortality following emergency laparotomy.
Abstract citation ID: znac247.112
SP10.1.6 Effect of hyaluronate-based bioresorbable membrane
(Seprafilm) on outcomes of abdominal surgery: a
meta-analysis and trial sequential analysis of randomised
controlled trials
Shahin Hajibandeh1, Shahab Hajibandeh2
1
Hepatobiliary and Pancreatic Surgery and Liver Transplant Unit, Queen
Elizabeth Hospital Birmingham, Birmingham, UK
2
Department of General Surgery, Royal Glamorgan Hospital, Cwm Taf University
Health Board, Pontyclun, UK
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Background: We aimed to evaluate comparative outcomes of
abdominal surgery with and without hyaluronate-based bioresorbable
membrane (Seprafilm).
Methods: We conducted a systematic search of electronic databases
and bibliographic reference lists with application of a combination of
free text and controlled vocabulary search adapted to thesaurus
headings, search operators and limits. Small bowel obstruction,
anastomotic leak, surgical site infections, ileus, and severity of
adhesions were the evaluated outcome measures.
Results: Thirteen randomised controlled trials reporting a total of 3,665
patients evaluating outcomes of abdominal surgeries with (n=1,800) or
without (n=1,865) use of Seprafilm were identifed. Use of Seprafilm
was associated with significantly lower risk of small bowel obstruction
(RR:0.53, 95% CI 0.38–0.73, P=0.0001) but significantly higher rate of
anastomotic leak (RR: 1.85, 95% CI 1.15–3.00 P=0.01). Moreover, while
Seprafilm resulted in significantly more adhesions-free patients
(RR:5.57, 95% CI 3.37–9.19, P<0.0001) compared to no Seprafilm, its use
was associated with significantly lower grade 2 (RR:0.57, 95% CI 0.35–
0.95, P=0.003) or 3 (RR:0.31, 95% CI 0.17–0.55, P<0.0001) adhesions.
There was no significant difference in surgical site infection (RR:1.21,
95 CI 0.86–1.70, P=0.28), intra-abdominal abscess (RR: 1.46, 95 CI 0.92–
2.32, P=0.11) or paralytic ileus (RR:0.97, 95 CI 0.68–1.38, P=0.87)
between two groups. The trial sequential analysis demonstrated that
the meta-analysis findings are conclusive.
Conclusions: Seprafilm reduces the risk of small bowel obstruction and
severity of adhesions after abdominal surgery. However, it may increase
the risk of anastomotic leak. We recommend use of Seprafilm in any
abdominal surgery which does not involve an anastomosis.
Abstract citation ID: znac247.113
SP10.1.7 Assessment of interhospital transfers of acute
surgical patients within an NHS trust
Yasmin Hazemi-Jebelli1, Katharina Weigel1, Rachel Gunnell1, Maisie de
Wolf1, Mital Patel1, Darren Patten1,2
1
Department of General and Emergency Surgery, Queens Hospital and King
George Hospital, Barking, Havering and Redbridge University Hospital NHS
trust, Romford, London, UK
2
Department of Surgery and Cancer, The Imperial Centre for Translational and
Experimental Medicine, Imperial College London, Hammersmith Campus, London,
UK
Acute surgical services at our trust were moved from two sites to a single site,
due to COVID-19. This project was inspired by cases of transfer whereby
significant time delays resulted in poorer patient clinical outcome.
Aims:
• To assess the times and delays in the transfer of an acute surgical
patient at Site A to Site B for either continuing or definitive surgical
intervention
• To assess the risks to patient safety and patient outcomes resulting
from transfer
• To assess whether NCEPOD guidance for urgent surgery were adhered
to
Methods:
• Total transfers were audited over a three month period. The following
parameters were recorded:

1) Patient demographics
2) Time patient referred to on call surgical team at Site A
3) Time patient seen by on call surgical team at Site A
4) Times to diagnosis and subsequent decision to transfer
5) Time patient reached Site B
6) Any procedure or operation or higher lever treatment the patient
received
7) Length of stay
8) Any complications noted during inpatient stay
Results:
Total cases of transfer 188
No. cases that went for CEPOD 78
No. of cases for procedures of any sort 99
Complications post/during procedure 37
Deaths 7 921 (83.3%) patients had pre-operative G&S. 42 (3.8%) patients also had
Average time from decision to transfer until arrival time at 11:11
Site B
Average decision to transfer until procedure time 46:54
Conclusion: Interhospital transfer must focus on maintaining optimal
health and outcomes for the patient. A guideline and framework for
safe transfers must be implemented and adhered to strictly.
Abstract citation ID: znac247.114
SP10.1.8 Acute uncomplicated diverticulitis: to scope or not to
scope?
Emma Howie1,2, Ibrahim Almafreji1, Charlotte Cole1, David Watt1
1 Victoria May1,2, Sara Katherine Drever1,2, George Ramsay1,2
Crosshouse University Hospital
2 University of Aberdeen Medical School
University of Edinburgh
Aims: To investigate whether endoscopic follow up after a CT proven
diagnosis of acute uncomplicated diverticulitis detected additional
pathology, specifically colorectal cancer, and if our findings support
the European Society of Coloproctology’s consensus statement that “a
single episode of CT verified uncomplicated diverticulitis endoscopic
follow-up remains controversial and may not be necessary”.
Methods: A retrospective study evaluated every General Surgical
emergency admission with acute uncomplicated diverticulitis to our
unit in a 5 year period (2015–2020) to assess for radiological diagnosis
and endoscopic follow up.
Results: Over the 5 years there were 685 admissions with acute
uncomplicated diverticulitis affecting 547 individuals. 74.3% of
admissions and 80.3% of individuals underwent a Computerised
Tomography (CT) during admission. 244 admissions (48%) went on to
have an endoscopic examination, with 12.3% of these being inpatient
investigations. 50% (122) of patients undergoing endoscopy had
confirmed uncomplicated diverticulitis. Of the remaining patients
undergoing endoscopy, 79.5% had no pathology detected. Only 1
malignant polyp was discovered on endoscopy with no tumours
detected.
Conclusions: CT has a high sensitivity and specificity in the diagnosis of
acute uncomplicated diverticulitis. We suggest that it is reasonable not
to utilise endoscopy as a screening tool after uncomplicated
diverticulitis and the risks versus benefits must be carefully
considered, especially in the era of Covid-19 where resources are tight
and waiting lists ever growing. An endoscopic procedure is a costly,
uncomfortable procedure that puts the patient at risk of morbidity
and mortality.
Our findings support the European Society of Coloproctology’s
statement regarding endoscopic follow-up.
Abstract citation ID: znac247.115
SP10.1.9 Routine preoperative group and save is not necessary
for emergency appendectomy in adults – A retrospective
multicentre study
Karuniya Sundarraj1, Khurram Khan1,2
1
Glasgow Royal Infirmary
2
University of Glasgow
Abstracts | v35
Aims: The use of routine Group and Save (G&S) for appendectomy is
practised commonly with little evidence behind this practise. Our aim
was to assess whether routine pre-operative G&S before
appendectomy is required by identifying rate of perioperative blood
transfusion.
Methods: A multicentre retrospective observational study of all adult
patients who had emergency appendectomy across four hospitals
between August 2018 and November 2020. Patients were identified
through pathology records. Data was extracted for demographics, pre
and post-operative imaging and operative details, G&S, cross
matching and peri-operative blood transfusion.
Results: 1,105 patients were identified, 635 (57.4%) were male. Median
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age was 37 years (IQR 26–52). 1,012 (91.6%) were ASA 1 or 2. Surgical
approach: 890 (80.5%) laparoscopic, 79 (7.1%) converted to open, 119
(10.8%) open and 17 (1.5%) laparotomy. Severity of appendicitis: 804
(72.8%) inflamed, 56 (5.1%) gangrenous, 235 (21.3%) perforated and 10
(0.9%) were normal.
cross match (36 patients had 1 unit and 6 patients had 2 units). None
of the patients required blood transfusion in 30 days post
appendectomy. The total cost of G&S is estimated to be £56,733 in this
cohort.
Conclusions: The need for peri-operative blood transfusion is rare in
patients undergoing appendectomy via any surgical approach. It has
significant cost impact as well as it causes unnecessary delays if not
done in timely manner. Our study suggests that routine G&S policy is
not necessary and we suggest a more ‘selective’ G&S policy.
Abstract citation ID: znac247.116
SP10.1.10 Management of Acute Sigmoid Volvulus in a Single
Scottish Health Board
1
2
Aberdeen Royal Infirmary
Aim: The Emergency General Surgery guidelines from the ACPGBI were
recently published and recommend that definitive management should
be planned on index admission with sigmoid volvulus. However, the
evidence base for these recommendations was low. We aim assess the
current practice of Sigmoid Volvulus (SV) in a Single Scottish Health
board.
Method: A retrospective review of patients with acute SV managed at
two hospitals between 2011 and 2021 was conducted. Individuals were
identified through inpatient coding and case notes reviewed
electronically. Operative intervention, colonoscopic decompression
and short and long term outcomes were noted.
Results: Of 105 patients treated, 41 were female. The mean age at
presentation was 73.2 (range: 38–94 years). In total, 70 patients (66.7%)
underwent decompression alone and 35 (33.3%) were treated with
surgical intervention. There was no difference in mean age, number of
co-morbidities and number of previous operations between the two
groups. Of the decompression group, 35 (50%) presented on a single
occasion. However, the mean number of re-presentations was 3.3
(range 2–29) and the mean time to re-presentation was 136.5 days
(range 5–1224 days). There were no recorded inpatient deaths
following surgical intervention.
Conclusion: The most common method of acute SV management has
been decompression on its own. There were no differences observed
in patient demographics between the intervention groups, suggesting
that there are no set criteria to determine method of intervention.
However, representation remains commonplace and operative
intervention had few complications indicating a likely required
increase in definitive surgical approaches.
Abstract citation ID: znac247.117
SP10.1.11 What happens when you VAC?
Tasabeeh Abdalazeez, Rosie McDonald, Andrew Miller
University Hospitals of Leicester NHS Trust
Aims: Abdominal VAC dressings are part of the surgical
armamentarium in the management of the open abdomen. This study
examined the number, indication and outcomes of patients with VAC
dressings in a tertiary surgical unit.
v36 | Abstracts
Methods: Retrospective review of the operating theatre database
identified all patients with abdominal VAC dressing between February
2016 and July 2021. Medical records were reviewed for demographics,
operative, outcome and discharge data.
Results: 76 patients had abdominal VAC dressings. 40 (53%) were female
and 57 (75%) were aged >50 years. For 54 (72%) the primary surgery was
an emergency. Major indications for VAC included intra-abdominal
sepsis 41 (53.9%) and wound dehiscence 16 (21.1%). Mean VAC
changes under GA 2.07 (range 0–10). Mean VAC changes on the ward
2.1 (range 0–11). Mean length of hospital stay 48.6 days (range 4–258).
49 (70%) had the VAC removed in hospital, in this cohort mean
duration of VAC therapy was 22 days. 11 (15%) were discharged to
community hospitals and 56 (77%) directly home. 4 (5.3%) patients
developed entero-atmospheric fistulae, 1 (1.3%) bleeding and 1 (1.3%)
wound infection.
Conclusions: Abdominal VAC therapy is safe. However, it comes with
significant immediate and medium-term burdens, in terms of hospital
bed days, theatre time and specialist staff input, all of which are
costly. Longer term, incisional hernias are associated with morbidity
for patients and a financial cost for the Trust. The authors therefore
advocate an attempt at early fascial closure where possible, through
techniques such as mesh mediated fascial closure.
Abstract citation ID: znac247.118
SP10.2.1 The FLIP Study – Fluid Resuscitation in Pancreatitis
Julia McGovern1, Sam Tingle2, Northern Surgical Trainees Research
Association (NOSTRA)3, John Moir2, Stuart Robinson2
1
Health Education North East, Newburn Riverside, Newcastle Upon Tyne, NE15
8NY
2
Hepato-pancreato-biliary (HPB) Unit, Newcastle Freeman Hospital, Freeman Rd,
High Heaton, Newcastle upon Tyne, NE7 7DN
3 suffered delays and cancellations due to the reduction of elective
Northern Surgical Trainees Research Association (NOSTRA)
Aim: Acute pancreatitis (AP) is an emergency surgical presentation
which can range in severity from mild to life-threatening. Intravenous
fluids are the cornerstone of management. However, there is poor
quality evidence regarding optimal intravenous fluid administration.
We aimed to establish clinical practice regarding intravenous fluid
administration in AP and the effect this has on mortality.
Methods: Prospective multi-centre audit of patients with AP. Data was
collected on intravenous fluid administration within 72-hours of
admission. Primary outcome was 30-day mortality and multivariable
logistic regression was used to identify predictors of this.
Results: 254 participants were included. Volume of intravenous fluid
delivered over the first three days (median and range) are as follows;
Day 1=2L (0–10.5L), Day 2=1L (0–5L), Day 3=0L (0–7.5L). Those with
severe pancreatitis (Glasgow score>=3) received more fluid; median
5.7L versus 4L in 72hrs (P=0.003). The following factors were
significant predictors of 30-day mortality in our multivariable model:
age, Glasgow score, CRP, IHD and pancreatitis aetiology. Overall,
volume of intravenous fluid was not associated with mortality in this
model (adjusted OR=0.932;0.766–1.134;P=0.483). However, the effect of
intravenous fluid volume on mortality differed significantly depending
on pancreatitis severity (interaction term P=0.042). In the severe
pancreatitis group increased volume of intravenous fluid was
associated with significant reductions in mortality (OR=0.655;
0.459–0.936;P=0.020).
Conclusion: In severe pancreatitis more aggressive fluid prescribing is
associated with decreased mortality. This is not the case in milder
disease. The lack of published literature regarding the impact of fluid
regime on outcomes in acute pancreatitis is reflected by the variation
of fluid prescribing.
Abstract citation ID: znac247.119
SP10.2.2 Emergency Management of Incisional Hernia
Islam Omar, Abby Townsend, Catrin Williams, Annabel Jones,
Jeremy Wilson, Conor Magee
General Surgery Department, Wirral University Teaching Hospital, Wirral, UK
Introduction: Incisional hernia is a common complication after
abdominal surgery. Operating on a hostile field renders the
management of incisional hernia quite challenging. Presentation with
incarcerated or obstructed incisional hernia can further complicate
the picture. This study aims to describe the outcomes and burden of
emergency management of incisional hernia.
Methods: A retrospective study has been conducted. We reported the
patients’ demographics, primary surgery details, hernia
characteristics, and mode of presentation and management.
Results: Forty-five patients were included in the analysis. Mean age was
66.78;SD±15.32. Thirty-one (69%) were females. Mean BMI was 35.49;SD
±10.46. They had significant comorbidities including diabetes, CKD,
COPD, and malignancy; 31.1%, 13.3%,11.1%, 11.1% respectively.
Twenty-two (48.8%) had incisional hernia after midline incision.
25(55.6%) presented with bowel obstruction. Thirty-two had a surgical
repair, and ten were managed conservatively. The mean time from
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admission to surgery was 1.4;SD±2.1. Meshes were used in 10(31.25%)
patients. The mean duration of surgery was 114.03;SD±60.55 minutes.
Ten patients needed HDU/ITU; 9 of them were managed surgically.
Complications rate (CD≥III) was 20%. The 30-day mortality rate was
8.89%. Six (18.75%) patients had recurrence after surgical repair.
Thirty patients had CT, 7 had X-rays, and one had US. The mean hospital
stay was 8.71;SD±8.8, with an overall hospital stay of 392 days. Fifteen
patients were readmitted, and seven came back without staying >24
hours.
Conclusion: Emergency presentation of incisional hernia carries a high
risk of morbidity and mortality and represents a high burden.
Abstract citation ID: znac247.120
SP11.1 What happens to hernias if we don’t operate? A
Covid-19 waiting list study
Nikki Bruce, Jamie Young
NHS Borders
Aims: Many patients with symptomatic abdominal hernias have
operating lists. This waiting list study looks to examine what has
happened to patients who were on the waiting list on the day of the
first lockdown in March 2020, and whether there were any adverse
outcomes.
Methods: We used coding data, TrakCare IT information and op notes to
identify the outcomes of those patients between March 2020 and
December 2021. We looked at whether elective surgery had been done,
waiting times, if the patient had presented as an emergency, and if
they had been removed from the list. We included any symptomatic
abdominal hernia ie inguinal, incisional, paraumbilical, ventral.
Results: There were 78 patients included. 33 had elective repair, min
waiting time 6 months, max 18 months. There were 5 emergency
presentations for operative repair (6.4%) including 1 death (3 inguinal,
2 incisional). A further 3 required expedited repair at 5, 8 and 9
months. 4 patients removed themselves due to improvement in
symptoms and 27 patients remained on the list (min 19 months, max
27 months).
Conclusions: Waiting lists for benign surgery have been adversely
affected by the pandemic and this difficulty is seen clearly in our
small district general. Patients who have been waiting a long time are
at risk of emergency presentations and ongoing symptoms. Those
with the fewest symptoms are waiting over two years and are at risk
of continued waits due to ongoing service pressures.
Abstract citation ID: znac247.121
SP11.2 Tackling the post pandemic NHS waiting lists- Mission
impossible?
Shruti Bodapati1, Raghvinder Pal Singh Gambhir2, Shiori Kimura2
1
University Hospitals Plymouth NHS Trust
2
King’s College Hospital NHS Foundation Trust
Aim: The office of national statistics (ONS) has estimated that around
5.8 million people are currently, waiting for treatment and the
government has allocated £ 1.5 billion to tackle the backlog. The study
aimed to analyze the likely effectiveness of these measures.
Methods: We looked at various government and NHS resources
pertaining to the recovery plan.
Results: The actual numbers currently waiting to be treated is predicted
to be closer to 13 million. Working within the current timeframes it will
take up to 12 years to clear this backlog. Among the surgical specialities
the numbers waiting are Orthopaedics- 700,547, Ophthalmology -

595,824, ENT - 459,087, Gynaecology - 438,703, General Surgery - 409,823.
The £1.5 billion for elective recovery, includes £500 million capital
funding (£250 million for increasing operating theatre capacity and
hospital productivity and £250 million for an elective recovery
technology fund).
The private setup has been utilized in fits and starts to ensure there is no
undue delay for cancer surgeries. Pop up centers and surgical hubs are to
speed up the diagnosis and treatments for things like day case cataract
surgeries.
Conclusion: Without disruptive thinking, clearing the backlog is
mission impossible. The existing capacity has to be utilized beyond
the conventional working hours and Hospital at weekend has to
designated for pandemic backlog. This will give 104 additional full
time days in each of the NHS Hospitals and paying the staff a “new
pandemic bank rate” may help get the job done in 4–5 years.
References: 1. https://www.england.nhs.uk/statistics/statistical-work-
areas/rtt-waiting-times/rtt-data-2021-22/; 2. https://www.ons.gov.uk/
search?q=nhs+waiting+lists; 3. https://committees.parliament.uk/
publications/8352/documents/85020/default/; 4. https://nhswaitlist.lcp.
uk.com/; 5. https://ifs.org.uk/publications/15557
Abstract citation ID: znac247.122
SP11.3 Impact of Covid on emergency laparotomy activity
Madara Kronberga, Arin Saha
Calderdale and Huddersfield NHS Trust
Aims: National surgical guidance during the Covid-19 pandemic
cautioned against surgical intervention with subsequent unsurprising
falls in emergency activity.
Our unit, in contrast to national guidance, treated patients normally but
with enhanced quality measures and without withholding surgery
where indicated; key measures introduced included two-consultant
operating, early consultant decision-making and daily consultant
ward rounds to facilitate early discharge. This study outcomes from
these locally developed guidelines.
Methods: All emergency laparotomies are entered contemporaneously
on to the NELA database. Activity and outcomes from two time
periods, from before and after the advent of Covid-19 (March 2019–
2020 vs. March 2020–2021) were compared.
Results: Emergency laparotomy activity increased from 154 cases to 192
cases (24%). There were no pre-operative differences in frailty scores,
ASA, pre-operative predicted mortality (7.4% vs. 6.9%) or predicted
morbidity between the two periods.
Although 2% of patients developed Covid-19 infection, there was no
increase in crude mortality (9% to 8%) or post-operative complications.
The proportion of patients who went to critical care after surgery fell
though post-operative length of stay also fell (mean 18.8 days vs. 12
days).
Conclusions: With local guidelines and enhanced consultant-delivered
care, emergency surgery was increased during the Covid pandemic
without increased complications. This may reflect the marked
reduction in activity in neighbouring hospitals and additional capacity
due to falls in elective activity. Given the reduction in emergency
surgery nationally, it is likely that guidance which cautioned against
surgery has led to patients unnecessarily missing out on operative
treatment with subsequent poorer outcomes and greater mortality.
Abstract citation ID: znac247.123
SP11.4 Imaging recommendations during the Covid pandemic
for the investigation of right iliac fossa pain: an unachievable
and unnecessary burden on radiology services?
Alice Doughty, Stephanie Cheetham, Melisa Kenber, Eloise Smellie,
Arin Saha
Huddersfield Royal Infirmary
Aims: Initial Covid-19 surgical guidance, produced without radiological
input, recommended that patients with right iliac fossa (RIF) pain
should have imaging before intervention. This study quantified the
burden on imaging services from these guidelines.
Methods: Patients who presented to our surgical unit with RIF pain from
March to October 2020 were identified. Clinical parameters, radiology
and final diagnosis were recorded. Minimum follow-up was 12 months
to identify re-admissions and morbidity.
Abstracts | v37
Results: There were 417 patients. There was a drop in admissions in the
first months of each new wave of Covid (March/April, September/
October) compared with intervening months (36% vs. 64%, P=0.036).
266 patients (64%) had a CT scan increasing from 42% of patients in
March to 75% in September (P=0.019). The proportion of patients with
normal imaging increased correspondingly with over a third (34%) of
CT scans being normal. 93 CT scans (35%) showed appendicitis, which
was the suspected diagnosis in all but 7 of these patients.
Patients with normal imaging had lower white cell counts (Mean
10.1×109 vs. 14.8×109/L, P<0.001) and CRPs (Mean 21 vs. 99, P<0.001).
Patients seen first by a consultant were less likely to require imaging.
Conclusions: During the first year of Covid-19, two-thirds of patients
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with RIF pain had a CT scan with a third being normal. Most scans
showing appendicitis had clinical parameters consistent with this
diagnosis. Current guidelines may lead to unsustainable pressures on
radiology services; ensuring consultant assessment prior to imaging
requests may reduce the burden on these teams.
Abstract citation ID: znac247.124
SP11.5 Effect of COVID-19 Pandemic on Thyroid Surgery
Emad Rezkallah, Wael Elsaify
South Tees NHS Foundation Trust
Introduction: The rapidly expanding COVID-19 pandemic has affected
all aspects of daily life, including health care systems. The impact on
COVID 19 on thyroid surgery is clear due to the delay in most thyroid
related activities, including the delay in the thyroid investigations,
screening and surgery.
The aim of the current study is to illustrate the impact of COVID 19 on
thyroid surgery.
Methods: Retrospective review of our activities during 7 months
(January – July) in 2021 during COVID-19 pandemic and comparing it
with a similar period in 2019.
Results: During the period of seven months in 2019, we performed 69
thyroid surgeries, while during the same period in 2021 we performed
16 thyroid operations. In 2019, 35 patients had diagnostic
thyroidectomy (malignancy was found in 9 of them), while only one
case in 2021 had diagnostic thyroidectomy. Six patients in 2019 had
completion thyroidectomy; one of them had thyroid cancer, while
four patients in 2021 had completion thyroidectomy; all were benign.
Malignancy was diagnosed in 26 patients in 2019 and in 10 patients in
2021. Most patients in 2019 had early stage disease (T1: 14 patients, T2:
4 patients, and T3: 6 patients), while most patients in 2021 had high
stage disease (T1: 3, T2: 1, T3: 5, and T4: 1). Lymph node involvement
was found in 9 patients from 24 in 2019, and in 9 patients of 10 in 2021.
Conclusion: Because of the COVID pandemic, most thyroid cancer
patients presented with advanced disease with high incidence of
lymphatic metastasis.
Abstract citation ID: znac247.125
SP11.6 End of Life Care and Advance Care Planning for
Outpatients with Inoperable Abdominal Aortic Aneurysms – A
Retrospective Cohort Study
Henry Davies1, Marie-José Vleugels2, Jing Yi Kwan1, Alexander Aerden2,
Lucy Wyld3, Barend Mees2, D. Julian A. Scott1
1
Leeds Vascular Institute, Leeds General Infirmary, Leeds Teaching Hospitals NHS
Trust
2
Department of Vascular Surgery, Maastricht University Medical Center,
Maastricht, the Netherlands
3
Palliative Care, Leeds Teaching Hospitals NHS Trust
Introduction: A proportion of patients with aortic aneurysms (AA) do
not proceed to intervention after reaching treatment threshold
diameter due to a combination of poor cardiovascular reserve,
frailty and aortic morphology. This patient cohort has a high
mortality, however, there exist no studies on the palliative care (PC)
and advance care planning (ACP) they receive following discharge
from the clinic.
Methods: We conducted a multicentre cohort study of 220
conservatively managed AA patients referred to centres in Leeds and
the Maastricht for intervention between 2017 and 2021, from a
combined total of 1506 patients - a non-intervention rate of 15%.
Demographic details, mortality, cause of death, ACP and PC outcomes
v38 | Abstracts
were analysed to examine predictors of PC referral and consultation
efficacy.
Results: There was a 3-year mortality rate of 60%. Rupture was the
reported cause of death in 17% of the decedents. Only 9% of all
patients received PC referrals - a median of 3.5 days before death.
Patients over 80 were more likely to have PCCs. Almost half of the
decedents were readmitted to hospital before death and 37% died in
hospital. Only 5% of patients had a documented preferred place of
death. Patients with PCCs were more likely to have preferred place of
death and care priorities documented.
Conclusion: Only a small proportion of conservatively treated patients
with AAs had ACP, far below 2019 NICE end-of-life care guidance. It is
also far below the level offered to oncology patients. Pathways and
guidance should be implemented to ensure patients not offered AA
intervention are offered end-of-life care and ACP.
Abstract citation ID: znac247.126
SP11.7 Cost-effectiveness of carotid endarterectomy in
symptomatic patients
Ankur Thapar1,2, Daniel Perez-Troncoso3, Mohammad Hossain1,
Alun Davies4
1
Mid and South Essex NHS Foundation Trust
2
Anglia Ruskin University
3
University of Granada
4 Amenah Dhannoon, Ishwarya Balasubramanian, Arnold Hill
Imperial College London
Aims: In recent years, improvements in medical therapy for stroke
prevention have emerged. Recent analyses of medically treated
cohorts have suggested that early rates of stroke may have reduced,
whilst reports for safety of carotid surgery have also shown
improvements. Since the effectiveness of carotid surgery versus
medical therapy was established in 1990s, it is important to evaluate
whether surgery remains cost-effective.
Methods: A decision model was developed to estimate the lifetime costs
and utilities of modern medical therapy with and without carotid
endarterectomy in patients with symptomatic stenosis from
perspective of the UK National Health Service. The base-case
population consisted of adults 65 years of age with 70–99% stenosis.
Costs and utilities were obtained from National Health Service tariffs
and the literature. Univariate and probabilistic sensitivity analyses
were carried out. Data on surgical safety was taken from the 2020
National Vascular Registry Report. Data on modern medical therapy
was taken from Fisch et al. 2020.
Results: In the base-case scenario, the 5-year absolute risk reduction
with endarterectomy was 5%, and incremental cost-effectiveness ratio
was £23,632 per quality adjusted life year. Surgery was more
cost-effective if performed rapidly after presentation. In patients with
50–69% stenosis, surgery appeared clinically ineffective.
Conclusion: In symptomatic patients with 70–99% stenosis, carotid
endarterectomy would remain cost-effective if performed rapidly after
presentation. Surgery may have lost clinical efficacy in those with
moderate stenosis. However, these results are uncertain because of
limited data on modern medical therapy. A new randomised
controlled trial of surgery versus modern medical therapy is needed.
Abstract citation ID: znac247.127
SP11.8 Postoperative outcomes are significantly worse among
patients undergoing repair of ruptured versus unruptured iliac
artery aneurysms – a 10-year longitudinal cohort study
Ryan Laloo, Kelsey Aimar, Johura Khanom, Marc Bailey, Julian Scott
Leeds Teaching Hospitals Trust, Leeds, UK
Aim: The European Society for Vascular Surgery defines iliac artery
aneurysms (IAA) as beyond 1.5 times its normal diameter. Common
iliac arteries (CIA) beyond 1.8cm in men and 1.5cm in women are
considered aneurysmal. This study assessed outcomes following IAA
rupture as their natural history is poorly understood with treatment
recommendations based on low-level evidence.
Method: Patients with IAAs at a single vascular centre between 1st
January 2010 and 31st August 2021 were identified from a
prospectively collected departmental database and
Caldicott-approved data collection performed. The primary outcomes
included aneurysm rupture, rupture diameter, post-operative
complications, 30-day, 1-year and 5-year mortality rates. Statistical
analysis with SPSS® was performed using chi-squared tests.
Results: Of the 203 patients included, 90.6% were men and median(IQR)
age at detection was 77 (71–83). Co-morbidities included hypertension
(54.2%), hyperlipidaemia (42.9%) and ischaemic heart disease (35.5%).
IAA were in the CIA (85.2%), IIA (21.7%) and EIA (2.0%), mostly
asymptomatic (78.8%). Overall IAA rupture rate was 7.9% with CIA
(81.2%) and EIA (18.8%). Mean (SD) diameters at rupture were 4.6 (2.4)
cm for CIA and 4.6 (3.0)cm for IIA. Post-operative major adverse
cardiovascular events (MACE) more frequently occurred following
repair of ruptured compared to unruptured IAA (33.3% vs 3.5%,
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p=.011). Mortality at 30-days, 1-year and 5-years postoperatively were
higher following repair of ruptured vs unruptured aneurysms (88.9%,
88.9%, 100% vs 1.2%, 10.6%, 36.1% respectively).
Conclusion: Early detection and elective treatment of IAA aneurysms
before they approach 4.6cm may reduce rupture risk, morbidity and
mortality associated with emergency repair following rupture.
Abstract citation ID: znac247.128
SP11.9 Balancing Risk of Haematoma and Venous Thrombosis
in VTE Prophylaxis for Breast Cancer Surgery: A Systematic
Review and Meta-Analysis
Department of Breast Surgery, Beaumont University Hospital, Dublin, Ireland
Introduction: Venous thromboembolism (VTE) is a largely preventable
cause of morbidity and mortality in post-operative patients, however
Guidelines for VTE prophylaxis in breast cancer surgery are not
well-established.
Methods: A comprehensive search was undertaken of all studies that
described the role of VTE prophylaxis in breast cancer surgery.
Comparative studies that reported on postoperative outcomes
between patients who received VTE prophylaxis (prophylaxis) and
those who did not (no prophylaxis) were included in the analysis. A
meta-analysis using random-effects model was used to analyze key
outcomes, with data presented as odds ratio (OR).
Results: A total of 2470 patients from 6 studies were included in this study.
Of these patient, 60.9% (n: 1504) received prophylaxis. The haematoma rate
in this study is 0.05% (n: 133). The incidence of haematoma was significantly
associated with the use of prophylaxis (6.85% versus 3.11%, p: 0.001).
Surgical intervention for haematomas was also significantly associated in
this group (3.15% versus 0.83%, p: 0.004). However there was no difference
in VTE events between both groups (0.26% versus 0.36%, p: 0.88).
Conclusion: The use of VTE prophylaxis in breast cancer surgery is
associated with increased haematomas without any benefit in
preventing venous thromboembolic events. Further studies that
examine the use of risk assessment tools for VTE prophylaxis in high
risk patients may be beneficial.
Abstract citation ID: znac247.129
SP11.10 Assessing the utility of surgical instruments in breast
surgery at a tertiary referral centre
Lucinda Knight1, James Chean Khun Ng2, Constance Haigh1, Julie Cash2,
Jennifer Isherwood2, Georgette Oni2
1
University of Nottingham
2
Nottingham University Hospitals NHS Trust
Introduction: Most surgical specialties have standardised surgical trays,
which are used for a variety of their operations. Any unused instruments
require re-sterilisation, with costs relating directly to the number of
instruments. This has further environmental implications. In 2019, we
performed over 1600 breast surgeries in our unit. This study aimed to
look at the utility of the breast reconstruction tray (BRT), which is the
most commonly used surgical tray, in the unit to see if there was scope
for cost efficiencies.
Methods: All BRTs (averaging 55 instruments) used for breast operations
were recorded from October to November 2021. Data collection included
operation type, individual instruments used and additional instruments
requested during the procedure. Quantitative analysis was performed
on the collected data.

Results: A total of 55 BRTs were used during the study period. 17 were
bilateral cases. An average of 42% (n=23, range 10–33) of instruments
were used from each tray, with 16% (n=9) of instruments never used.
There was no difference in instruments used in relation to the
type of surgery performed (range 42%-46% across operation types).
67% (n=12) of bilateral cases required an additional tray to allow
simultaneous operating on both sides. Despite this, 20% (n=11)
of the operations required specific additional instruments to be
opened.
Conclusions: This study has shown a significant number of
instruments remaining unused but being re-sterilised. If a
reconfiguration of the standard instruments were to occur this
could lead to a potential cost saving of over £25000 per annum
purely on sterilisation costs.
Abstract citation ID: znac247.130
SP11.11 Developing the Mobile App ‘ABCs of Breast Health’ -
Pioneering Digital Innovation to raise awareness of Breast
Health in India
Sai Pillarisetti1,2, Raghu Ram PillarisettiOBE3
1
University of Central Lancashire
2
British International Doctors Association (BIDA)
3
Ushalakshmi Breast Cancer Foundation
Abstracts | v39
Aims: Breast cancer is the most common cancer affecting women, both
in India & the world. Due to a lack of awareness and the absence of an
organised population-based screening programme in India, more than
60% of breast cancers present in the advanced stages, with most
succumbing to the illness within a year of being diagnosed.
This mobile app aims to empower people about various aspects of Breast
cancer & Benign breast disease explained in simple, easy-to-understand
format.
Methods: To help address these striking realities, I worked with a Breast
Cancer Charity based out of India, to create the Mobile App - ‘ABC’s of
Breast Health’ - available in English and 11 regional Indian Languages.
The app has an interactive ‘Myths & Facts’ section which is aimed at
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debunking many of the common myths surrounding breast cancer
and ensuring that users are well informed with accurate information,
thus filling a huge void in the delivery of Breast Health Care in India
where counselling is not given much importance.
A dedicated breast health helpline was launched in 2021 to further
support users.
Results: This App is South Asia’s First Mobile App on Breast Health and is
also the World’s first breast health app available in so many languages.
Within the first month of its launch, it recorded 9000+ downloads.
Conclusion: The content of the app in 11 commonly spoken regional
languages has ensured that accurate information relating to breast health
is accessed by women in rural India, where 70% of the population resides.

Talking Posters
Abstract citation ID: znac248.001
TU1.1 Applying Lessons from MI6 and the Stockmarket to the
Management of Paraoesophageal Hernias: Creation of a
Bayesian Computer Model to Support Clinical Decision-Making
Alison Bradley1,2, Jennifer Dougal1, Li Siang Wong1,
Branavan Vakeesan1, Anton Buter1
1 undesirable results from primary surgery. Laparoscopic revisional
Royal Alexandra Hospital, Paisley
2 surgery can be performed after both failed open and laparoscopic
University of Strathclyde
Aims: Decision-making in the management of paraoesophageal hernias
is complex. Surgery carries the risk of significant complications yet a
‘watch-and-wait’ approach can result in the need for emergency
surgery. The aim of this study was to create computerised models that
makes personalised predictions of morbidity and mortality for
patients undergoing both elective and emergency surgery for their
paraoesophageal hernia.
Method: Using AgenaRisk software, Bayesian Network models were
created that made personalised predictions of postoperative morbidity
and mortality. Bayesian Networks are based on probability theory and
have been widely used in military intelligence and finance to perform
risk assessment and predict outcomes across competing strategies.
Through Baye’s theorem, they can explicitly represent the conditional
probability of dependencies between multiple variables. The prior
probabilities within these model algorithms were calculated from
published studies that identified variables associated with morbidity
and mortality following paraoesophageal hernia repair (n=22483). The
model’s performance was validated against a prospectively
maintained dataset of 35 patients.
Results: The model had an area under the receiver operator curve of
0.875 (P value 0.0027; standard error 0.125, 95% confidence interval
0.717 – 0.962) and a sensitivity of 75% and specificity 100% for
predicting significant postoperative morbidity (Clavien-Dindo grade 3
+). There were no cases of 30day or 90day mortality in the dataset and
the model correctly predicted this.
Conclusion: This study marks a move towards the delivery of more
personalised realistic medicine by potentially supporting better
shared decision-making. The predictive performance of these models
was strong but further prospective validation is required.
Abstract citation ID: znac248.002
TU1.2 Revisional Bariatric Surgery: 7-Year Experience from a
Tertiary Institution
Harrypal Panesar, Chaitya Desai, Guleed Mohamed, Nader Ghassemi,
Sian Davies, Chandra Cheruvu
University Hospitals of North Midlands NHS Trust
Background: Revisional surgery is an expanding area in bariatric
surgery which reflects a rising need to treat adverse sequelae of
primary procedures. Despite the increase, their safety and efficacy
remain unclear. We aimed to review revisional bariatric surgery
indications and outcomes at our tertiary centre.
Methods: Data on revisional bariatric surgery was collected
prospectively from 2013 and analysed retrospectively, including
indications and postoperative outcomes.
Results: From January 2013 to December 2021, 80 patients (mean age:
51.4 years) undergoing revisional surgery were identified: 38
laparoscopic gastric band (LGB) to Roux-en-Y gastric bypasses (RYGB),
34 sleeve gastrectomies (SG) to RYGB, 6 mini-gastric bypasses (MGB) to
RYGB and 2 RYGB revisions. The most common indication for revision
was weight regain (56.4%) followed by intolerable reflux (21.3%). Other
indications included band complications (15%), obesity-related
problems (2.5%), excessive weight loss (2.5%), corkscrewing of sleeve
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BJS, 2022, 109(Supplement 5) v40–v107
https://doi.org/10.1093/bjs/znac248
Abstracts
(1.3%), and dumping syndrome (1.3%). There were 11 post-operative
complications, with mean length of stay of 2.8 days. In addition to
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treating primary complications, the mean change in BMI at 12 months
for LGB to RYGB revisions and SG to RYGB revisions was -9.5 and -5.3
respectively. Average change in BMI at 24 months for LGB to RYGB
revisions and SG to RYGB revisions was -9.4 and -8.6 respectively.
Conclusion: Revisional bariatric surgery effectively treated the
procedures with minimal complications. In experienced hands, with
careful patient selection & education, satisfactory additional weight
loss can be achieved.
Abstract citation ID: znac248.003
TU1.3 A pilot survey of surgeons’ knowledge regarding vagus
nerve injury
Matt Dunstan, Vasha Kaur, Sabrina Bezzaa, Dhiren Nehra
Epsom and St Helier University Hospitals NHS Trust
Aims: Vagus nerve injuries occur in up to 42% of patients following anti-
reflux operations. Vagal nerve injuries may have a significant impact on
patients’ quality of life after benign Upper GI hiatal surgery, and may go
unrecognised. We aimed to explore surgeons’ knowledge and practice
regarding consenting, identifying the vagus nerve intraoperatively,
and managing vagus nerve injuries.
Methods: A pilot survey was distributed to General Surgical Trainees
and Consultants in South East England via social media groups and
Twitter. Respondents from other regions were permitted.
Results: Nineteen respondents comprised 1 SHO, 14 Registrar grades/
fellows and 4 Consultants. Seventy-four percent reported routinely
discussing vagus nerve injury, of whom over 70% discussed symptoms
of fullness and/or bloating, but only 36% discussed the need for
further procedures. Eighteen respondents were involved in anti-reflux
and paraoesophageal hernia procedures, of whom 94% routinely
visualised the posterior vagus nerve during these procedures, whilst
around 60% visualised the anterior vagus nerve. Ten respondents
were involved in gastric band insertion, of whom 60% did not identify
either vagus nerve. Only 7 respondents had experience of managing
patients with vagus nerve injury.
Conclusions: Work is required to guide education around informing
patients of the risk of vagus nerve injury, and around managing this
complication. This pilot survey informs wider national work to
explore this topic.
Abstract citation ID: znac248.004
TU1.4 Adequacy of endoscopic photo-documentation in an
OGD: Closing the loop!
Iayla Fatima1,2, Adham Sadoon1, Umer Mehmood1
1
St. Luke’s General Hospital, Kilkenny, Ireland
2
Manchester Royal Infirmary, England
Aims: The technical competence of Oesophago-Gastro-Duodenoscopy
(OGD) is rapidly acquired but to support the practice of complete
examination, the British Society of Gastroenterology (BSG) and
Association of Gastrointestinal Surgeons of Great Britain and Ireland
(AUGIS) recommend documentation of 8 anatomical stations. Photo-
documentation ensures a complete examination, gives an opportunity
to inspect area of interest and serves as legal record of an adequate
procedure. Our Aim was to assess the hospitals practice of photo-
documentation against the BSG and AUGIS guidelines and to improve
practice by conducting teaching sessions and designing a poster for
the endoscopy rooms.

Methods: 1st Cycle: 100 OGD reports were randomly selected from 1/1/
2018 to 31/3/2020 and were reviewed on the hospitals electronic
reporting system (Endorad). Data on patients demographics, speciality
of Endoscopist and the documented stations was collected. Data was
presented at the departments meeting and a simultaneous teaching
session was conducted. A poster was designed and displayed outside
the endoscopy rooms.
2nd Cycle: 100 OGD reports were selected from 1st January to 30th June
2021 and re audited.
Results: 66% of the OGD reports had photo-documentation of all 8
stations and 81% of reports had 7 documented stations which was a
significant improvement in practice as the first audit had no report
with photographic documentation of all the stations. The highest
number of stations documented in the first audit were 5 and that too
in only 40% of the cases.
Conclusions: The audit cycle showed significant improvement in photo-
documentation of all the stations, highlighting the benefit of the
process.
Abstract citation ID: znac248.005
TU1.5 Endoscopic electroporation for inoperable
oesophagogastric cancer: Preliminary results from a phase II
clinical trial (The VECTOR Trial)
Andrew Jackson, Eleanor James, Ravinder Vohra, David Humes,
Simon Parsons
Nottingham University Hospitals NHS Trust
Aims: Electrochemotherapy (ECT) combines the use of low-dose
chemotherapy with reversible electroporation to increase intracellular
uptake of chemotherapeutic agents and improve tumoral cytotoxicity.
Although a well-established treatment modality in primary skin and
cutaneous metastases, the effects of ECT in the treatment of advanced
oesophagogastric cancer are unknown. Development of the endoVE/
ePORE system now allows endoscopic delivery of ECT.
We aim to recruit thirty patients to the VECTOR trial to assess the
efficacy of endoscopic ECT in the local treatment of inoperable
oesophagogastric cancer.
Methods: The study began recruitment in March 2020. Patients undergo
a single treatment of endoscopic ECT alongside a dose of intravenous
Bleomycin. Validated dysphagia and QoL scores (Ogilvie, EORTC QLQ-
C30/ OES18) are used to assess symptomatic response to treatment.
Local tumour response is assessed with interval gastroscopy and
cross-sectional imaging.
Results: Six males and one female with a mean age of 71 years (41–88)
have received endoscopic ECT.Four patients had received oncological
therapy prior to enrolment. The mean procedural time was 22
minutes.All patients were discharged within 24 hours of
treatment.Over 50% of patients reported significant improvements in
their dysphagia score at 6-week follow-up with concomitant
improvement in their QoL metrics.
Conclusions: Early experience of endoscopic ECT is safe, well tolerated
and can be performed in the endoscopy suite with sedation and
analgesia. Improvements in patients’ symptomatology are promising
and may indicate this as an alternative to stenting.We are yet to
demonstrate favourable tumour response on follow up imaging and
endoscopy.Careful patient selection is key to negate post procedural
complications.
Abstract citation ID: znac248.006
TU1.6 Endoscopic Management of Broncho-Oesophageal
Fistula Caused by Impacted Denture
Ahmed Elnabil-Mortada, Mariana Rita Afonso Matias
Sheffield Teaching Hospitals, NHS Foundation Trust
Background: Oesophageal foreign body impaction in adults is fairly
common. Although, dentures being often accidentally ingested among
the elderly, it is very unusual to develop a broncho-oesophageal fistula
(BOF) secondary to a retained denture. The few cases reported in the
literature were mostly managed with thoracotomy.
We present a clinical case of a BOF successfully treated by endoscopic
approach following a combined assessment and planning between
intervention radiology, general and cardiothoracic surgery.
Case Report: A 60-year-old male was transferred from neighbouring
DGH to our centre due to worsening of dysphagia. Patient reported
Abstracts | v41
that he had swallowed a denture 6 month earlier. The CT scan
showed the denture along with a left BOF. Imaging was further
reviewed and discussed amongst interventional radiology,
cardiothoracic, and upper gastrointestinal surgeons. Endoscopic
retrieval of impacted denture plate was successful, followed by the
insertion of left bronchial stent, and percutaneous gastrostomy tube.
The left bronchial stent was removed after three months with
successful closure of the fistula.
Conclusion: Our clinical case highlights that multidisciplinary team
discussion is crucial in the management of complex surgical cases in
order to achieve the best outcome possible. Additionally, endoscopic
management of BOF is a safe alternative option to thoracotomy when
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the required resources are available.
Abstract citation ID: znac248.007
TU1.7 The correlation between BITE score and weight
outcomes in Mini/One Anastomosis Gastric Bypass patients –
an update with 24-month post-operative results
Tharun Muthu Gurunath1,2, Olivia Edwards2, Pratik Sufi2,
Chetan Parmar2
1
University College London (UCL)
2
Whittington Hospital
Background: The Bulimic Investigatory Test, Edinburgh (BITE) self-
report questionnaire is used to assess the risk of bulimic and binge
eating habits in bariatric patients preoperatively. This study aimed to
investigate the correlation between preoperative BITE scores and
weight loss at 3, 6, 12, 18 and 24 months follow up in patients with
Mini-Gastric Bypass (MGB-OAGB).
Method: Consecutive patients who received MGB-OAGB between 2016–
2018 completed the BITE questionnaire at initial assessment and were
included in this prospective study. Baseline demographics were
measured. Excess body weight loss (%EBWL) and total weight loss (%
TWL) were calculated on the day of surgery and at 3, 6, 12, 18 and 24
months follow up.
Results: 120 patients were eligible with an average age of 43 (± 10.84)
years. 21.67% (n=26) had high BITE scores (≥20), 44.17% (n=53) had
medium BITE scores (10–19), and 34.17% (n=41) had low BITE scores
(≤9). Low and Medium BITE groups had similar outcomes at each
follow up. The low BITE group had greater %EBWL and %TWL
compared to high BITE group across all the follow ups, however this
difference was not significant. There were no reoperations or mortality.
Conclusion: MGB-OAGB results in good weight loss at 3, 6 and 12 months
post-operatively independent of BITE scores. There was no significant
difference between pre-operative binge eating behaviours on post-
operative weight outcomes. To extend the study, further research
between the effect of pre-operative psychological input on weight
outcomes could be investigated. Going forward, comparative study in
patients with RYGB and sleeve gastrectomy would be recommended.
Abstract citation ID: znac248.008
TU1.8 Laparoscopic partial gastrectomy as day-case surgery:
Our 12-month experience
Dimitra Peristeri, Shameen Jaunoo
Surgery Department, Brighton and Sussex University Hospitals NHS Trust-
esophagogastric research group
Aim: Procedures performed in ambulatory surgical centers (ASC) can
provide several advantages over hospital-based surgery. We present
our experience in same-day discharge after laparoscopic partial
gastrectomy (LPG) in 19 consecutive patients during 2021. Our aim was
to review our outcomes and assess the safety and efficacy of
outpatient LPG over 12 months to determine if this procedure can be
safely performed in the ambulatory setting.
Methods: Retrospective review of all consecutive patients who
underwent ambulatory LPG from January 2021 to December 2021.
Patient age, social circumstances, and other demographics were
recorded as well as any comorbidities and ASA score. All patients
were discharged home the same day after surgery without an
overnight stay at the hospital. Incidence of complications and re-
admission to the hospital after discharge were reviewed up to 30 days
from surgery.
Results: From January 2021 to December 2021, 19 consecutive patients
underwent LPG. The mean age was 47 years (range, 23–74 yr). 17
v42 | Abstracts
patients (89%) had gastric GIST tumor resected. Mean recovery room
time was 131 minutes (30–385 min). No patients (0%) were readmitted
within 30 days. There were no complications and no open conversions
or deaths occurred in the series.
Conclusion: With stringent patient selection and utilization of
enhanced recovery pathways, our study indicates that LPG may be
suitable for the outpatient setting. Our low overall readmission and
complication rate portends to the feasibility of laparoscopic PG as a
safe outpatient procedure.
Abstract citation ID: znac248.009
TU1.9 Oesophageal manometry and ambulatory pH
monitoring prior to laparoscopic anti-reflux surgery – is it a
necessity? An evaluation of a newly established anti-reflux
surgery service at a district general hospital
Naim Slim, Awad Shamali, James Williamson
Great Western Hospitals NHS Trust
Background: Laparoscopic fundoplication is an effective surgical option
for patients with symptoms of reflux refractory to proton-pump
inhibitor (PPI) use. Oesophageal manometry and ambulatory pH
monitoring are typically advocated as part of the evaluation of gastro-
oesophgeal reflux disease, when anti-reflux surgery is considered.
However, the requirement for these as a mandatory procedure
remains controversial, particularly in the context of large hiatus
hernia or presence of endoscopic reflux oesophagitis.
Methods: A retrospective review of all cases performed since the
inception of the anti-reflux service at a single-centre district general
hospital was undertaken. All patients who underwent an elective
laparoscopic anti-reflux operation were included. Data pertaining to
preoperative symptoms, preoperative investigations and
postoperative outcomes (resolution of symptoms and PPI cessation)
was collected.
Results: Over the three-year period, 22 anti-reflux operations were
performed, of which 17 were followed up. The mean length of follow-
up was 9.5 months. Most patients (91%) had typical reflux symptoms
with a large hiatus hernia or endoscopic reflux oesophagitis. Only 4
(18.2%) patients underwent oesophageal manometry and ambulatory
pH monitoring—each of these had either a normal preoperative OGD
or barium swallow, or atypical symptoms. Alleviation of symptoms
was achieved in 14 (82.3%) patients; 9 (52.9%) of which achieved
complete resolution. PPI cessation was achieved in 12 (70.1%) patients,
comparable with current literature.
Conclusion: Anti-reflux surgery can safely be performed without
routine oesophageal manometry and ambulatory pH monitoring in
the context of typical symptoms, a large hiatal defect or evidence of
endoscopic reflux oesophagitis, as exemplified in our newly
established anti-reflux service.
Abstract citation ID: znac248.010
TU1.10 Oesophageal/ Oesophagogastric Junction Cancer: EUS
Role Revisited
Nakul Gokhare Viswanath, Ashok Bohra
Royal Derby Hospital
Introduction: Oesophageal and Oesophago-gastric junctional (OGJ)
cancer remains a challenge both from the perspective of early
diagnosis, prompt staging and subsequent treatment. The prognosis
of these cancers is directly related to the stage of the disease at
diagnosis. CT scan followed by Endoscopic ultrasound (EUS) are
investigations which help with the T and N staging. In conjunction
with staging tools like PET and laparoscopy there is a resultant delay
with frequent breaching of treatment targets. Reducing the number of
investigations potentially avoids delays in the management pathway.
Methods: We conducted a retrospective audit on patients who have had
oesophageal cancer resections from 2017 to 2021. We compared the
accuracy of the CT scan in comparison to EUS staging preoperatively
with final histopathological staging. Patients who had neo-adjuvant
therapy were excluded from the final histological comparisons.
Results: CT is routinely performed in all patients with oesophageal
cancer. All oesophageal cancers going for treatment had EUS staging.
EUS staging was found most useful for Tx and T1 stages. We did not
find EUS additionally useful for T2 and T3 stages. EUS is useful for T4
stages to help exclude inoperability.
Conclusion: Modern multi-slice CT scans provide a comparable
accuracy to EUS for T2 and T3. This suggests that EUS staging can be
avoided for CT stage T2 and T3 cancers of the oesophagus and GOJ.
This is in keeping with current NICE guidance. EUS has a role in TX, T1
and T4 cancers and can be selectively used as per other specific
indications.
Abstract citation ID: znac248.011
TU1.11 Patients’ views on laparoscopic cholecystectomy
consent process: Consent in clinic improves quality of
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informed consent and patient satisfaction
Peiming Yang
Airedale General Hospital
Aims: Informed consent for elective laparoscopic cholecystectomy
should begin at first clinic consultation. Due to clinic time pressures,
informed consent is often obtained on the morning of surgery for the
first time. This study aims to assess whether consent quality and
patients’ consent satisfaction are better in clinic compared to day of
surgery.
Methods: Retrospective review of all elective laparoscopic surgeries
between April and June 2021. Self-administered questionnaire was
also completed by the same cohort to ascertain consent satisfaction.
Results: 38 patients in total during study period. 16(42.1%) were
consented in clinic, and 22 were first consented on day of surgery. 25/
38(65.8%) patients prefer to be consented in clinic, 13(34.2%) prefer
consent on day of surgery. Significantly higher proportion of consent
forms from clinic had full documentation of risks and benefits of
cholecystectomy (P<0.001) compared to consents from day of surgery.
Significantly higher proportion of patients consented in clinic felt
adequately informed of procedure, had alternative options explained
to them, were informed regarding recovery process, and felt there was
adequate time for consent (P<0.05). Insignificantly higher proportion
of patients consented in clinic received information leaflet about
procedure.
Overall consent satisfaction was significantly higher in patients
consented in clinic (77% versus 55%, P=0.048%)
Conclusions: Consent quality and patient satisfaction levels for elective
cholecystectomy were statistically significantly higher when consent
was carried out in clinic prior to surgery compared to on the day of
surgery. We recommend that all elective cholecystectomy consent is
performed formally in clinic prior to surgery.
Abstract citation ID: znac248.012
TU1.12 Video Presentation: The OVESCO Clip for Endoscopic
Treatment of Gastrocutanoeus Fistula
Konrad Zugaj, Roland Fernandes, Rebecca Black
East Kent Hospitals University Foundation Trust
Background: Percutaneous endoscopic gastrostomy (PEG) is an
important route of nutrition in many patients. PEG removal usually
leads to spontaneous closure in a few days. Gastrocutaneous fistula
(GCF) after PEG removal is an uncommon complication occurring in
2% of patients. Despite its rarity, it is responsible for significant
morbidity and reduced quality of life. Treatment is initially focused on
medical management and endoscopic clipping, with advanced
endoscopic techniques and surgery reserved for selected cases.
Method: We present a video presentation demonstrating successful
endoscopic treatment of GCF using the OVESCO Over the Scope clip
with resolution of symptoms and closure of the fistula tract. The
device is a novel innovation designed to achieve tissue apposition and
compression without ischaemia. It is licensed for Gastrointestinal
iatrogenic defects, endoscopic perforation, bleeding and GCF. The 72
year old patient had debilitating symptoms of gastric leakage for over
a year despite previous attempts at endoscopic clipping, fibrin glue
and curettage of the fistula tract.
Results: As shown in the video, the clip achieved good opposition with
no post procedural leak. The patient was reviewed at 3 and 12 months
with no recurrence of their symptoms. The external cutaneous
opening had closed at 3 months. The patient reported an increase in
weight, improved mood and a greater quality of life following the
intervention.

Conclusion: The OVESCO clip has been proven to facilitate successful
endoscopic closure of GCF in selected patients in whom initial
treatment measures have failed. This mitigates the need and risks of
surgical closure.
Abstract citation ID: znac248.013
TU2.1 Colonoscopic Polyp Tattooing: To Tattoo or Not to
Tattoo?
Milad Jeilani, Michael Mosoneke, Mahmud Riad, Mohamed Hassan,
Kirolos Abdelsaid
Maidstone and Tunbridge Wells NHS Trust
Aims: Colorectal cancer is often investigated with colonoscopy, where
tattooing is performed to identify the location of potentially tumorous
polyps to aid surgery and colonic surveillance. BSG guidelines state
that polyps ≥20mm in size should be tattooed, except those in the
rectum/caecum. Tattoos should be recorded and local policy should be
in place. At our trust, St Mark’s protocol is used which advises all
suspicious lesions be tattooed except those in the rectum/caecum,
and 3 tattoos be placed circumferentially. Here, we audit adherence to
these guidelines.
Methods: Retrospective analysis of data collected from Endobase for
endoscopies revealing polyps during 2020 at DGH.
Results: 325 polyps were found in 255 patients (70% male). Sessile and
pedunculated polyps were most common, accounting for 77%. Smaller
polyps (15–19mm) were most prevalent (52%). Tattooing of smaller
polyps (15–19mm) remains low (30%), whereas tattooing of
larger polyps has improved (85%). Tattooing of rectal/caecal polyps
remains prevalent (19%). Only 30% of tattooed polyps had 3 tattoos.
Tattoo information was recorded well in certain sections of Endobase
(83% in ‘conclusion’) but poorly in others (61% in ‘therapeutic’).
Conclusions: There has been an increase in male predominance, and in
smaller and pedunculated polyps. These demographic changes are
useful to be aware of. Teaching and clearer display of guidelines is
required to improve tattooing of smaller polyps, and reduce tattooing
of rectal/caecal polyps. However, clearer trust guidelines should
accommodate operative variability. Recording tattoo information in
Endobase is technically challenging and requires improvement to
avoid loss of data.
Abstract citation ID: znac248.014
TU2.2 Endo-Sponge Carries Good Outcome for Low Rectal
Anastomotic Leak; Case Series study
Salma Ahmed1, Malaz Abbakar1, Karim Hassan1,
Mohammed Mohammed1, Conor Magee2, Jeremy Wilson2
1
Research Fellow, Department of General Surgery, Wirral University Hospital
NHS Foundation Trust
2 1
Consultant Surgeon, Department of General Surgery, Wirral University Hospital
NHS Foundation Trust
Introduction: Rate of anastomotic leak is considered rare, and the low
rectal ones are approximately 10% of all leaks. Management of
anastomotic leak is variable and could be challenging. ENDO-SPONGE
is advised by experts to be considered given some criteria to be met
but in general, ENDO-SPONGE is thought to improve patients’ life
quality and maintains the possibility of stoma reversal after resolution
of the leak.
Objective: To assess the management of anastomotic leak using ENDO-
SPONGE in our hospital and to compare our practice with the
international published data.
Methods: Case study of patients diagnosed with anastomotic leak and
treated with ENDO-SPONGE. All cases from 2016 to 2021 were
included. Concordance with the NICE briefing and recommendation
which was published in 2019 was studied. All data were collected in a
Microsoft forms then transcribed into an Excel sheet.
Results: 13 patients treated with ENDO-SPONGE were identified –
median age is 66. Guidelines suggest that ENDO-SPONGE changes
should occur within 24–72 hours and the compliance from the trust
was only 25%. However the compliance with the number of changes,
place of insertion, and the outcome was 100%. 99% of the ENDO-
SPONGE replacement took place in the theatre, only one patient’s
ENDO-SPONGE was replaced in endoscopy department. Complete
Abstracts | v43
resolution of the leak occurred in 11 of the 13 patients and only 2
required open drainage. 5/13 were eventually reversed.
Conclusions: More Compliance with timing of replacement of
ENDO_SPONGE should be improved but overall ENDO_SPONGE carried
a good outcome with complete resolution in nearly 85% of patients.
Abstract citation ID: znac248.015
TU2.3 Flexible sigmoidoscopy after management of CT proven
uncomplicated acute diverticulitis: a closed loop audit of local
practice at tertiary care centre
Amiya Ahsan, Jenifer Ma, Dominica Krasicka, Kausik Ray,
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Christi Swaminathan, Muhammad S Sajid
University Hospitals Sussex NHS Foundation Trust
Background: Routine practice of offering a flexible sigmoidoscopy after
patients undergoing medical management of CT proven uncomplicated
acute diverticulitis (UAD) has been revisited recently and is not required
in the absence of red flag symptoms as per the recommendations of the
World Society of Emergency Surgery (WSES). The aim of this audit
project is to evaluate whether local practice in requesting flexible
sigmoidoscopy after the medical management of UAD is in line with
WSES guidelines.
Methods: The data of all patients undergoing medical management of
CT proven UAD for 19 months (2019–2021) was collected and analysed
as per guidelines provided by the WSES.
Results: The study cohort included the subjects treated both as in-
patients as well as out-patients in the ambulatory care unit. Out of 115
admissions with acute diverticulitis during first loop of the audit,
there were 80 (69.5%) patients diagnosed with CT proven UAD. Thirty-
nine patients (48/8%) with UAD were booked to undergo flexible
sigmoidoscopy and only 10 patients (25.64%) were diagnosed with
sub-centimetre colonic polyps. Second loop included 49 patients, of
which 34 patients were diagnosed with UAD and 10 (29.4%) patients
underwent flexible sigmoidoscopy showing polyps in 3 (8.8%) patients.
Conclusion: This audit project successfully has shown reduced booking
rate of flexible sigmoidoscopy following the medical management of
UAD. Given the low rate of positive findings, the high rate of
outpatient request for sigmoidoscopy in the uncomplicated group
appeared unjustified.
Abstract citation ID: znac248.016
TU2.4 Synthesis review with meta-analysis on risk of
incisional hernia following transverse versus vertical midline
incision for specimen extraction in patients undergoing
laparoscopic colorectal resections
Amiya Ahsan1, Hussameldin M Nour1, Mirza K Baig2, Parv Sains3,
Muhammad S Sajid1
University Hospitals Sussex NHS Foundation Trust
2
Worthing Hospital
3
Spire St Anthony’s Hospital
Objective: The objective of this article is to explore the risk of incisional
hernia (IH) occurrence at the site of specimen extraction following
laparoscopic colorectal resection (LCR), highlighting the comparison
between transverse incision versus midline vertical abdominal incision.
Method: Analysis was conducted according to PRISMA guidelines.
Systematic search of medical databases like MEBASE, MEDLINE and
pubmed was performed to find all types of comparative studies
reporting the incidence of IH at the specimen extraction site of
transverse or vertical midline incision following LCR. The analysis of
the pooled data was done using the RevMan statistical software.
Result: Twenty-five comparative studies (including 2 RCTs) on 10362
patients fulfilled the inclusion criteria. There were 4944 patIents in the
transverse incision group and 5418 patients in the vertical midline
incision group. In the random effects model analysis, the use of
transverse incision for specimen extraction following LCR reduced the
risk of IH development [odds ratio 0.30, 95% CI (0.19–0.49), z= 4.88,
p=0.00001]. However, there was significant heterogeneity (Tau2 = 0.97;
Chi2= 109.98, df = 24(p=0.00004; I2 = 78%) among included studies.
Conclusion: Transverse incision used for specimen extraction following
LCR seems to reduce the risk of postoperative IH incidence compared to
vertical midline abdominal incisions.
v44 | Abstracts
Abstract citation ID: znac248.017
TU2.5 Compliance of colonic polyp surveillance with British
Society of Gastroenterology (BSG) and the Association of
Coloproctology of Great Britain and Ireland (ACPGBI)
guidelines
Muhammad Ali, Adam Heyes, Annly Stephen, Sherwin Ng,
Zulfiqar Hanif
Great Western Hospital, Marlborough Road, Swindon, SN3 6BB
Introduction: The guidelines for post-polypectomy and post-colorectal
cancer resection have recently been changed after consensus by the
British Society of Gastroenterology, the Association of Coloproctology
of Great Britain and Ireland and Public Health England. The aim of our
study is to evaluate the rate of compliance with the recommended
guidelines following polyp removal.
Methods: The data was collected retrospectively by reviewing the
colonoscopy database in a single centre district general hospital for all
patients who underwent polypectomy during April-September 2021.
We excluded patients who had prior history of colorectal malignancy.
The frequency of subsequent colonoscopic surveillance were
evaluated against the BSG/ACPGBI guidelines based on the clinico-
histological characteristics of the removed polyps.
Results: There were 104 colonoscopies with polypectomies performed
during April-September 2021. The patient cohort had a mean age of 65
years (range, 35–85 years), with the most common diagnosis being
tubular adenoma with low grade dysplasia (n=86, 82.7%). Adherence
to BSG/ACPGBI colonoscopic post-polypectomy surveillance
guidelines, based on the characteristics of the colonic polyps at
colonoscopy and histology, was 86.5% (n=90). There were 5 (4.8%)
patients who had their surveillance endoscopy requested earlier than
recommended and 8 (7.7%) patients had a surveillance colonoscopy
requested but did not require any surveillance. 1 patient had
colonoscopy requested later than recommended. There was no
significant difference in compliance between physicians (87.5%) and
surgeons (86.1%).
Conclusion: There is a high compliance with post-polypectomy
surveillance guidelines. However more efforts and staff training are
required to improve compliance even further.
Abstract citation ID: znac248.018
TU2.6 Pre-Operative Optimisation of Elective IBD Patients: Are
we meeting the standard?
Jennifer Allan, Sarah Craig, William Wallace
Belfast City Hospital, Belfast Health and Social Care Trust
Aim: Inflammatory bowel disease represents a significant healthcare
burden. Management requires a multi-disciplinary approach and a
combination of both surgical and medical considerations. The aim
of this study was to compare current practice within our colorectal
unit for pre-operative optimisation of IBD patients with ACPGBI
recommendations, with the view of introducing a proforma for
these patients to ensure pre-operative optimisation standards are
met.
Methods: This was a retrospective study identifying patients
undergoing elective surgery for IBD in our unit between January 2019-
October 2020. Data was collected on pre-operative management and
compared to the broad principles of optimisation outlined by ACPGBI
in their 2018 guidelines. Clavien-Dindo classification was used to
define post-operative complications.
Results: 94 patients were identified, 67 in 2019 and 27 patients in
2020. 4.3% had active intra-abdominal sepsis. No patients had a
clearly documented comprehensive nutritional assessment. 15.6%
patients were on oral steroids pre-operatively (Dose ≤30mg). 43.8%
were on biologic therapy. Mean length of stay was 11.3days. 39.7%
of patients experienced post-operative complications. However,
only 12.8% of patients had a Clavien-Dindo score of ≥3. There was
no mortality.
Conclusion: ACPGBI guidelines highlight key areas for adequate pre-
operative optimisation. Our study highlighted that our morbidity
following IBD surgery was comparable to those in literature.
However, key areas of improvement were identified including
comprehensive nutritional assessment. Current work involves
creating a pre-operative proforma to encompass this and will be
followed by a re-audit.
Abstract citation ID: znac248.019
TU2.7 Surgical Management of Synchronous Colorectal Liver
Metastases – A Systematic Review and Meta-Analysis
Veera Allu
East Kent Hospitals University NHS Trust
Aims: Surgery with curative intent is the mainstay in management of
Colorectal cancer, with timing and sequencing of the surgical
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resection of tumour and the metastases highly important in
improving prognosis in patients diagnosed with synchronous
Colorectal liver metastases. The current review aims to identify data
around simultaneous and staged resection to evaluate if there is a
significant difference in either approach.
Methods: PubMED and EASE’s searcher® database were searched, a
modified PRISMA checklist used to identify relevant data from the
search results and fifteen studies were included in the quantitative
analysis, defined by inclusion and exclusion criteria, and scored with
the use of MINORS criteria. Meta-analysis is performed with the use of
Odds Ratio or Weighted Mean Difference.
Results: There is significant heterogeneity within the pooled studies
potentially due to varied techniques and surgical skills. There was no
significant statistical difference in postoperative morbidity, with a
slight skew in favor of the staged procedure. There was a statistically
significant skew towards a higher mortality in the simultaneous
resection group. Intra and Post Operative Complications showed no
statistically significant difference in either group. Lack of
randomization was observed in underlying studies.
Conclusion: The analysis does not show a statistically significant
difference in outcomes with either intervention. There are distinct
methods of thought around which method to employ in various
patient scenarios, left to the discretion of the treating specialist.
Research suggests further enquiry into use of neoadjuvant and
adjuvant chemotherapy to treat the underlying metastases associated
with primary tumor.
Abstract citation ID: znac248.020
TU2.9 Under-investigation of iron deficiency anaemia in QFIT-
negative suspected colorectal cancer patients
Oreoluwa Bajomo, Jessica Omassoli, Lara Alsadoun, Simon Lascelles
Medway Maritime Hospital, Gillingham
Introduction: QFIT (Quantitative faecal immunochemical testing) has
become the first-line screening tool for suspected colorectal cancer
due to a lower risk profile, higher sensitivity and specificity than
routine colonoscopy and faecal occult blood testing.
Patients with QFIT measurements <10micrograms/ml are considered
unlikely to have colorectal cancer and may be discharged from the 2-
week wait (2WW) pathway without further investigations, in the
absence of other concerning features including iron deficiency
anaemia (IDA). We present our findings on the under-investigation
of IDA in a cohort of QFIT-negative patients.
Method: We collected data on 100 patients in a district general hospital,
referred via the 2WW suspected colorectal cancer pathway with QFIT
measured as <10 micrograms/ml, over a 2-month period. Our data-
points included whether iron, ferritin and haemoglobin were
measured in the 6months preceding QFIT measurement.
Results: Our patients included 67 females and 33 males, with a median
age of 67.5. 32 out of 100 patients underwent neither iron nor ferritin
blood tests; 21 of which did not have their haemoglobin measured
either. 25 out of 100 patients underwent iron, ferritin and
haemoglobin blood tests in the specified time period.
Discussion: Failure to investigate IDA in QFIT-negative suspected
colorectal cancer patients increases the risk of missed pathology.
Studies have found patients with right sided colon cancer sometimes
have false negative QFIT results but often present with IDA. We
propose that mandatory investigation of IDA is incorporated into
existing 2WW suspected colorectal cancer pathways, alongside QFIT
measurement, to mitigate this risk.

Abstract citation ID: znac248.021
TU2.10 Clinicopathological Factors Affecting Lymph Node
Yield and Positivity in Left-Sided Colon and Rectal Cancers
Nikhil Nanjappa Ballanamada Appaiah, Wenyi Cai, Laeeq Khan,
Bryony Lovett
Basildon & Thurrock University Hospital
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<0.001), perineural
invasion (PI) (p<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.
Abstract citation ID: znac248.022
TU2.11 Adherence to post-polypectomy surveillance
guidelines in a district general hospital
Aye Myintmo1, Daniel Butler1, Harriet Flashman2, Robert Bethune1
1
Royal Devon and Exeter NHS Foundation Trust
2
University of Exeter Medical School
Aims: National guidelines instruct clinical decision making around
post-polypectomy surveillance. The current polyp surveillance
guidelines were jointly published by the British Society of
Gastroenterologists (BSG), the Association of Coloproctology of Great
Britain and Ireland (ACPGBI) and Public Health England (PHE) in 2019,
updating the 2010 surveillance guidelines. Adherence to polyp
surveillance guidelines is historically poor, both in the UK and globally.
This audit set out to establish the adherence rate of clinicians to the 2019
polyp surveillance guidelines in a district general hospital and to
compare this to the adherence rate to the 2010 surveillance guidelines.
Methods: We aimed to collect 300 patients who had been treated under
the 2010 or 2019 polyp surveillance guidelines. After exclusion criteria
were applied we collected 152 and 133 patients who had respectively
been treated under the 2010 and 2019 guidelines. Each patient record
was analysed and it was determined by our team whether the chosen
polyp surveillance was adherent to the respective guidelines or not.
Results: Of 152 patients treated under the 2010 guidelines, 41.4% (63) of
patients were adherent. Of 133 patients treated under the 2019
guidelines, 66.2% (88) of patients were adherent. This represents a
score difference of 24.7% (95% confidence interval of 13.5% to 35.9%,
p<0.0001).
Conclusions: Our results show that following the introduction of the
2019 guidelines, adherence to polyp surveillance guidelines increased.
Increased adherence to guidelines has significant implications for
improving patient safety, financial savings and protecting endoscopy
capacity.
Abstract citation ID: znac248.023
TU2.12 Experience of Elective Colorectal Cancer Surgery at
District General Hospital (DGH): Single centre study
Ahmed Elzaafarany, Ahmed Tawfik, Andrew Day
East Surrey Hospital
Abstracts | v45
Background: Elective colorectal resection surgery is one of the most
common surgical procedures performed for bowel cancer treatment.
This study evaluates the whole practice of colorectal cancer surgery in
a DGH in England.
Aims: The primary outcome is to measure postoperative length of stay
(LOS), with secondary outcomes including approach of surgical operation
and conversion rate, R0 resection, VTE prophylaxis and its compliance
with NICE guidelines, postoperative DVT over a period of one year,
readmission rate within 30 days of discharge and reasons for readmission.
Methods: A single centre, retrospective, observational study was
performed over a period of a year from January 2018 –January 2019.
Patients were eligible for study inclusion if they had undergone
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planned surgical resection for colorectal cancer after being discussed
in the local colorectal cancer MDT.
Results: A total of 123 patients were included. Mean length of stay was
7.97 days. 74.7% of the procedures were performed by laparoscopic
approach with conversion rate of 6.5%. R0 resection was achieved in
95.1%. 96.7% of patients who underwent surgery for colorectal cancer
received extended VTE prophylaxis as per NICE guidelines. Six
patients had developed post-operative DVT and one inpatient death
recorded. 13.8% of patients that underwent colorectal surgery for
cancer were readmitted within 30 days of discharge. SBO, abdominal/
pelvic collection, wound dehiscence and SSI as the most common
reasons for readmission.
Conclusion: Laparoscopic approach is the preferred method for elective
colorectal resection surgeries with acceptable measures of patient
outcome including R0 resection, postoperative length of stay, DVT and
readmission rate.
Abstract citation ID: znac248.024
TU2.13 Laparoscopic/robotic restorative proctectomy in the
District General Hospital setting
Maitreyi Patel1, Xavier Aguayo1, Christine Robinson2,
Saswata Banerjee1, Matthew Hanson1, Nirooshun Rajendran1
1
Department of General Surgery, Barking, Havering and Redbridge University
Hospitals NHS Trust
2
Barking, Havering and Redbridge University Hospitals NHS Trust
Aims: Ileal pouch anal anastomosis/restorative proctectomy is a
standard surgical treatment for ulcerative colitis performed in a few
specialist centres. We report the evolution of the service at our trust
which originally carried out open pouch surgery but has moved
practice towards laparoscopic and robotic-assisted pouch surgery. The
aim of this study was to assess the surgical and functional outcomes
of patients undergoing laparoscopic/robotic-assisted IPAA.
Methods: Data were prospectively collected from consecutive
laparoscopic/robotic IPAA cases from 2014 to 2021. Patient
demographics, operative details, postoperative complications,
functional outcomes were collected. Patients were selected by IBD
specialized surgeons and reviewed by a pouch nurse. Follow-up
consisted of clinical examination and assessment of pouch function.
Results: 18 patients underwent laparoscopic or robotic IPAA during the
study period, 13 (72.23%) were males. Median age was 28 years.
Indication for surgery was ulcerative colitis. Median duration of
surgery was 7 hours. Four patients (22.23%) developed postoperative
intra-abdominal collection, managed conservatively in all except one,
who required laparoscopic washout. The median duration of stay was
8 days. The rate of severe complications, Grade 3 and 4 on Clavien-
Dindo classification was 11.12%. During a median follow up of 75
months, there were no pouch failures. The median stool frequency
was 6 daily.
Conclusion: Our data suggests that with good patient selection and
guidance from an experienced pouch nurse, laparoscopic/robotic IPAA
is safe and feasible. Good perioperative outcomes and acceptable
pouch function can be achieved in a DGH setting with a team to
ensure consistent care of patients.
Abstract citation ID: znac248.025
TU3.1 Effect of COVID-19 on stoma formation rates in elective
left sided colorectal cancer resections
Hisham ElZanati, Mohamed Zohdy, Sajanee Samuel,
Kalimuthu Marimuthu
George Eliot Hospital
v46 | Abstracts
Aims: The primary aim of the study was to assess the effect of COVID-19
on rate of stoma formation in elective left sided colorectal cancer
resections. Other possible effects of COVID-19 on the management of
these patients were explored too.
Methods: Retrospective review of elective left sided colorectal cancer
resections over a 2 years period. Patients were divided into 2 groups,
Pre-COVID (4/2019–3/2020) and Post-COVID (4/2020–3/2021) There were
43 resections in the Pre-COVID group and 21 resections in the post-
COVID group
Results: Patient demographics were comparable in both groups. There
was a 30% reduction in total number of colorectal cancer resections
and 50% reduction in left sided resections. There was a 3 fold increase
in patients not anastomosed primarily post-COVID (from 20.5% to
61%). There was a 2 fold increase in patients ending up with a stoma
including patients undergoing primary anastomosis but with
defunctioning stomas(from 38.4% to 72.2%). Procedures completed
laparoscopically were more or less comparable in both groups.
Conversion rate was slightly higher in the post-COVID group (from
14.3% to 21%).
Conclusion: Significant increase in stoma formation in the post COVID
group most likely due to guidelines from the royal college early in the
pandemic but other possibilities include delay in treatment. More
studies are required as the pandemic continues to explore this further
and determine whether this was justified and to enable us to adapt to
the new normal and assess whether we can return safely to our pre-
COVID practice without compromising patient outcomes or adding to
their morbidity.
Abstract citation ID: znac248.026
TU3.2 Has Covid-19 Pandemic affected the management of
patient’s with colorectal cancer?
Duaa Gumaa, Aarushi Agrawal, Mansoor Akhtar
East Kent Hospitals NHS Foundation Trust
Introduction: Patients on the cancer pathway should be investigated on
the 2 weeks wait pathway, but Covid-19 pandemic had universal impact
on the Healthcare systems. One of the main worries was the impact on
cancer patients due to delayed diagnosis and management. Our study
looks at the timeframe of investigations for colorectal cancer during
the second wave of the pandemic compared to pre covid time.
Method: Retrospective study looking at the waiting time to investigate
patients with +ve qFIT test during the second wave of pandemic (from
November 2020 till March 2021).
Results: During this period 150 patients had +ve qFIT test, the main
presenting symptom was Change in bowel habits. 90 patients were
investigated with colonoscopy, only 16 (17%) patients had the
colonoscopy done within 2 weeks from the qFIT result. 23 patients
had colonoscopy 2–3 weeks from the result. 30 patients (33%) had the
colonoscopy between 3–4 weeks, and 21 patients had to wait between
1–6 months to have the colonoscopy.
Out of the 150 patients, 60 patients were investigated primarily with CT
scan or CT colon.
Conclusion: During the covid-19 pandemic, majority of patients in our
trust were investigated within one month of +ve qFIT test but yet
there was some delay in carrying out the investigations compared to
the normal pathway and more patients had CT scans as primary
investigations before being referred for colonoscopy.
Abstract citation ID: znac248.027
TU3.3 Impelling Factors for Contracting COVID-19 Among
Surgical Professionals During the Pandemic: a Multinational
Cohort Study
1,2 3,2
Wah Yang , Ali Haider Bangash , Mohamed Abouelazayem , 4,2
Chetan Parmar5,2, Chandra Cheruvu6,2, Yirupaiahgari Viswanath7,2,
Alakh Konjengbam7
1
Department of Metabolic and Bariatric Surgery, The First Affiliated Hospital of
Jinan University, Guangzhou, China
2
TUGS Level of Harm Collaborative group
3
STMU Shifa College of Medicine, Islamabad, Pakistan
4
St George’s University Hospitals NHS Foundation Trust, London, UK
5
Whittington Health NHS Trust, London, UK
6
University Hospital North Midlands, Stoke-on-Trent, UK
7
The James Cook University Hospital, Middlesbrough, UK
Background: Medical workers, including surgical professionals working
in COVID-19 treating hospitals, were under enormous stress during the
pandemic. This global study investigated factors endowing COVID
amongst surgical professionals and students.
Methods: This global cross-sectional survey was made live on the 18th
of February, 2021, and closed for analysis on the 13th of March, 2021. It
was freely shared on social and scientific media platforms. It was also
sent via email groups and circulated through a personal network of
authors. Chi-square test for independence, binary logistic regression
analysis was carried on determining predictors of surgical
professionals contracting COVID-19.
Results: This survey captured the response of 520 respondents from 66
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countries. 92.29% (503/545) were working in a hospital receiving patients
with COVID-19. More than one-fourth (25.5%) caught COVID-19, which
was more frequent in participants working in public sector hospitals
(P=0.001). 75.7% of those who did not contract Covid (283/376) were
vaccinated (P<0.001). Surgical professionals undergoing practice in the
private sector (OR: 0.33; 95% CI: 0.14–0.77; p=0.011) and getting two
doses of vaccines (OR: 0.55; 95% CI: 0.32–0.95; p=0.031) had decreased
odds of contracting COVID-19. Only 6.9% of those who reported not
contracting COVID-19 (26/376) were calculated to have the highest
Level of Harm score (LH4) (P<0.001).
Conclusions: High prevalence of respondents caught COVID-19, which
was more frequent in participants working in public sector hospitals.
Self-isolation or shield, getting two doses of vaccines decreases the
odds of contracting COVID-19. Those who reported contracting
COVID-19 were calculated to have the highest Level of Harm score.
Abstract citation ID: znac248.028
TU3.4 A relook into the effects of Covid-19 on emergency
theatre utilisation
Nagy Rizkalla, Ayesha Khalid, Jack Merrit, Abdual Khaliq,
Harmeet Khaira
University Hospital Birmingham
Background: In 2020 we assessed changes in delivery of emergency
surgeries due to the pandemic in a local district general hospital.
Significant delays in emergency theatre utilisation were partly
abrogated with the early introduction of a second emergency theatre
so that Covidpositive, negative and unknown cases could be operated
in series (and occasionally in parallel) with minimal disruption.
Aims: We aimed to re-audit emergency theatre utilisation later on
during the pandemic to assess the effects of having more established
protocols and following recommendations from our first audit.
Methods: Retrospective study of all emergency theatre cases performed
during the month of July 2021 compared with previously presented
November 2020. Parameters of theatre utilisation included: sending
times, anaesthetic times, operating times, recovery time in theatre
and total recovery time
Results: The mean time taken to send for patients from wards decreased
by 27% in late pandemic versus early (n=110 vs 111, p=1.25*10–7); this
was also an improvement on pre-pandemic figures by 17%.
Anaesthetic time decreased by 31% (p=0.0001, n=110 vs 111). Recovery
time required in theatre decreased by 26% (p = 0.06, n=110 vs 111).
Total recovery time however increased by 19% (p=0.097, n=110 vs 111).
Conclusion: Improved Covid testing and testing protocols have most
likely had a positive impact on theatre utilisation by reducing sending
times, anaesthetic times and recovery times in theatre.
Increases in total recovery time are likely a by-product of increased
elective work.
Abstract citation ID: znac248.029
TU3.5 Increasing stoma requirements during the COVID-19
pandemic
Naren Kumaran1, Vishal Vijayaregu2, Bushra Abdelqader2,
Wen Yuan Chang2, Sam Sangal2, Robin Polson2
1
Northampton General Hospital NHS Trust
2
University Hospitals of Leicester NHS Trust
Aims: The COVID-19 pandemic has led to a change in working practices
in the diagnosis and management of colorectal cancer. Guidelines
emerged which recommended changing anastomotic practice in
favour of forming a defunctioning stoma or end stoma in patients who
would have previously had an anastomosis. This study aimed to

identify whether these changes have resulted in an increase in patients
requiring a stoma and its potential impact.
Methods: All patients diagnosed with colorectal cancer in the authors’
tertiary surgical unit in three 4-month intervals were included. These
corresponded to before the pandemic (March–June 2019), during the
UK’s first wave of COVID-19 (March–June 2020), and during the second
wave (December 2020–March 2021). The incidence of stomas was
compared between groups.
Results: In patients undergoing elective surgery the incidence of stomas
was 13% pre-pandemic. However, this tripled to 39% during the first
wave and increased to 54% in the second wave. Similar trends were
seen in patients undergoing emergency surgery with 36% having
stomas before the pandemic which rose to 50% during both the waves.
Conclusion: A change in stoma practice was observed with patients
having a stoma when they would usually have had an anastomosis
only. As COVID-19 continues to have a severe effect on planned
surgery in the UK, patients requiring stoma reversal adds to the
backlog. As the huge task of clearing the backlog begins, surgical
teams must be provided with appropriate resources, professional and
mental health support.
Abstract citation ID: znac248.030
TU3.6 Surgical training salvage during COVID-19: a hospital
quality perspective
Oliver Luton, Katie Mellor, Catherine Eley, Wyn Lewis, Richard Egan
Health Education and Improvement Wales’ School of Surgery, Tŷ Dysgu, Cefn
Coed, Nantgarw, UK, CF15 7QQ
Introduction: Vicissitudes including re-deployment, elective
cancellations, and remote educational events have restricted training
opportunities during the COVID pandemic. This study aimed to
analyse COVID’s impact on global Higher Surgical Trainee (HST)
performance metrics including hospital adaptability and variance.
Materials and Method: Intercollegiate Surgical Curriculum Programme
(ISCP) portfolios of 50 HSTs (median age 36 (range 29–46) yr., female 15,
male 35), including 191 six-month rotational placements, were analysed
over two years (March 2019 to 2021). Primary effect measures were:
operative logbook numbers, index procedures validated against
curriculum requirements and Work Based Assessments (WBA).
Results: During COVID-19, operative experience per placement declined
26.1% (median 211 vs. 156, p<0.010), with a 32.1% decline in trainee
primary surgeon experience (162 vs. 110, p<0.010). Regarding index
procedures: cholecystectomy declined 45.5% (11 vs. 6, p=0.027) and
inguinal hernia 62.5% (8 vs. 3, p<0.010). WBAs were similar (17 vs. 13,
p=0.364). Despite relative equivalence before COVID, median total
number of operative procedures performed in District General
Hospitals (DGH, n=65) were 40.9% fewer than Tertiary Hospitals (TH,
n=110, p<0.010). Radar plots of composite metrics ranged from 11.1 to
75.6% coverage before (p=0.011) vs. 13.3 to 68.9% after COVID (p=0.015).
Discussion: Hospital training metrics varied over five-fold, a difference
likely amplified by COVID, with THs more adaptable to existential
shared lessons.
Abstract citation ID: znac248.031
TU3.7 Increased incidence of gallbladder dysplasia and cancer
during COVID19 pandemic
Francesca Muscara, Jennifer Jebamani, Bogdan Ivanov
Princess Alexandra Hospital NHS Trust
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<0.001).
Abstracts | v47
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
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other biliary tract sites. Our data demonstrated a statistically
significant increase of incidence of GD and adenocarcinoma (p-
value<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.
Abstract citation ID: znac248.032
TU3.8 Advice and Guidance: an effective communication tool
between primary and secondary care in the COVID era?
Irina Radnaeva, Stephen Ward
Queen Elizabeth Hospital Birmingham
Introduction: Advice and Guidance is a digital communication tool that
allows primary care physicians to seek advice from secondary care
clinicians prior or instead of direct referrals.
Aims: Our audit aims to analyse the number of Advice and Guidance e-
referrals made to General Surgery consultants at the Queen Elizabeth
Hospital Birmingham and measure the outcomes of those
conversations in order to determine the usefulness and value of the
given platform as well as analyse the timescale of the replies.
Methods: We have retrospectively analysed the outcomes of all the
referrals to General Surgery made via Advice and Guidance platform
between July 2020 and September 2021. The responses were
categorised into 7 different outcomes, main ones being “outpatient
clinic referral”, “further investigation required”, “advice from a
different specialty is needed” and “advice on management only”. Time
taken to reply to the referrals was also analysed.
Results: At total of 2244 referrals were included in this audit. 61% of the
referrals were deferred to outpatient clinic for further review, 18%
required further investigations, in 10% advice only was given and 8%
were referred to a different specialty. Time taken to reply to a referral
was 5 days on average.
Conclusions: Advice and Guidance is an appropriate tool that allows
direct communication between GPs and General Surgical consultants
and is set to reduce the number of unnecessary outpatient clinic
referrals made. This in turn reduces pressure on the already stretched
secondary care system, especially in the ongoing COVID-19 pandemic.
Abstract citation ID: znac248.033
TU4.1 Single-center experience in robotic-assisted colorectal
surgery during COVID pandemic: First 72 cases
Ahmer Mansuri, Valentin Butnari, Sandeep Kaul, Joseph Huang,
Nirooshun Rajendran
Barking, Havering and Redbridge University Hospitals NHS Trust
Aim: To present an analysis of the first 2-years’ experience of robotic-
assisted colorectal procedures (RACP) using the DaVinci Xi platform.
Methods: This data were prospectively collected and include 72 RACP
between February 2020 and December 2021.Indications were:
malignancy in 74.3%, diverticular disease 10%, inflammatory bowel
disease 8.6%, rectal prolapse 4.3%, intussusception 1.4% and recurrent
volvulus 1.4%.
Results: Over the 13-month study period, 72 RACP were performed
including elective 57 cases and 15 semi-elective cases. These
comprised: 25 right hemicolectomies, 25 high anterior resections, 6
extended right hemicolectomies,4 low anterior resections, 4 subtotal
colectomies 2 restorative proctectomies, 3 abdominoperineal
excisions of the rectum, 3 rectopexies that were performed. 51.2%
were female and 48.6% were male with a median age of 45 years (22–
85 years) and the median body mass index was 31 (18–46) kg/m2.
Preoperative American Society of Anaesthesiology scores were
v48 | Abstracts
reported as 1–2 in 72.9% (n=51) of patients and 27.1%(n=19) as 3. The
median length of stay was 5 days (1–35), with readmission rate within
30 days of 8.6% (n=6) that were resolved conservatively. The mean
operating time was 268 minutes and the mean console operative time
was 158 minutes, with only 3 (4.3%) reported cases of conversion to
open. The incidence of postoperative complications was 24.3%
(Clavien–Dindo (CD) I/II- 12.9%, CD III- 10%, and CD V-1 case with
superimposed COVID 19 within 30 days.
Conclusion: RACP is a safe and viable modality in the treatment of
colorectal conditions and can be introduced safely with appropriate
guidance and proctorship.
Abstract citation ID: znac248.034
TU4.2 Robotic surgery for colorectal cancer: a single-center
experience
Valentin Butnari, Ahmer Mansuri, Sandeep Kaul, Joseph Huang,
Rajendran Nirooshun
Barking, Havering and Redbridge University Hospitals NHS Trust
Aim: To present our learning-curve data for patients that
underwent robotic-assisted colorectal surgery (RCRS) at a large NE
London DGH.
Methods: We report our data from 50 initial colorectal cancer resections,
performed by two surgeons. We report the gender, age, histopathology,
surgery performed, surgical time, conversion, post-operative
complications, and hospital stay.
Results: The first 50 patients who underwent RCRS between February
2020 and December 2021 for malignancy were included. Twenty-one
were right hemicolectomies, 16 high anterior resection, 6 extended
right hemicolectomies, 4 low anterior resections (including a planned
robotic boari flap in 1 case by a trained urologist), 3 abdominoperineal
excisions of rectum. The male to female ratio was 1:1 and the mean
age was 65 (range: 22–85) years. The ASA class distribution was 4%
ASA I, 64% ASA II, 32% ASA III.
The median surgical time was 263 minutes (120–620) with median
console time 136 minutes (50–540), the median hospital stay 5 days
(range: 2–35) and a conversion rate of 6% (3/50 patients). The most
common post-operative complications were ileus 4% (4/50), wound
infection 6% (3/50), anastomotic leak 6% (3/50), and abscess formation
2% (1/50). 1 mortality occurred in a patient with an operated leak who
contracted COVID-19. All patients underwent confirmed R0 resections
with a negative CRM.
Conclusion: We report our first 50 robotic cases for colorectal
malignancy, showing that robotic-assisted surgery can be performed
with low rates of conversion 3 cases (6%) and low rates of post-
operative complications despite a challenging patient demographic
and a sharp learning curve.
Abstract citation ID: znac248.035
TU4.3 Caecal volvulus: A District General Hospital Experience
and Review of the Literature
Ashim Chowdhury, Anang Pangeni, Sujata Rai, Jann Yee Colledge,
Ashish Kiran Shrestha
William Harvey Hospital
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.
Abstract citation ID: znac248.036
TU4.4 ‘Nurse led Colorectal 2ww clinic’: Impact on early
assessment and faster diagnosis of colorectal cancer
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Ashim Chowdhury, Anuj Shrestha, Larissa Williams, Biju Aravind,
Pradeep Basnyat, Ashish Shrestha
William Harvey Hospital
Background: Colorectal cancer (CRC) is the second most common
cancer death in the UK with a 5-year relative survival rate is 57%,
which has improved over the last 30 years. Early detection of the
cancer has a great impact on its prognosis. In our large district general
hospital, we receive GP 2 week pathway referrals for suspected CRC
with an average monthly referral of 726. Therefore, the aim of this
study is to assess if recently introduced nurses led colorectal rapid
access clinic has any impact on early assessment that can facilitate
faster diagnosis.
Method: A retrospective analysis of a prospectively collected data of the
patient referred through a 2-week colorectal clinic pathway from
outpatient referral system, was carried out from April, 2021 to
November, 2021. Patient feedback and clinician advice and guidance
were also evaluated in the same period.
Result: A total of 900 patients were reviewed in our Nurse led clinic with
CRC detection rate of 2% approximately. Final diagnosis of cancer been
made within the 28th day. Increment of 21% was seen in referrals per
month. Optimal slots of 195/week are required but the nurse led clinic
capacity is only 40/week. Despite the increased referral, patients are
being provided with results within day 13 with positive feedback from
the patients.
Conclusion: Despite of overwhelmed referrals, final diagnosis
is provided within 28 days. Nurse Led Colo-rectal Clinic could
be the answer to relieving the capacity, financial pressures
and providing high quality safe patient care for our already
strained NHS.
Abstract citation ID: znac248.037
TU4.5 qFIT test: the future of colorectal cancer investigation
Aarushi Agrawal, Duaa Gumaa, Mansoor Akhtar
East Kent University Hospitals NHS Foundation Trust
Introduction: Colorectal cancer is one of the most common cancers. In
2013 in the UK, 41,112 people were diagnosed with colorectal cancer
and 15,903 people died from it.
The qFIT(quantitative faecal immunochemical test) is now widely used
in the National Bowel Cancer Screening Program (NBSCP). It is also a
good test to identify symptomatic people at higher risk of having a
diagnosis of colorectal cancer. We present single center experience
with Q fit testing.
Methods: Retrospective cohort study performed in a large district
general hospital looking at the outcome of patients with +ve qFIT test
(≥10 micrograms).
Results: Over the period from July 2020 till November 2021, over 2000
patients had qFIT tests to investigate red flag lower GI symptoms. Out
of the 2000 patients, 448 patients had +ve qFIT. Over 70% of the
patients Referred by the GP with Change in bowel habits, the test was
organized by the hospital not the primary care.
260 patients were investigated with colonoscopy, 17 patients had
histology confirming colorectal cancer. 172 patients were not fit
enough for colonoscopy and were investigated with CT colon/CT, only
3 patients out of this group had features suggesting colorectal cancer
on the CT scan.
Conclusion: 20 out of 448 patients were diagnosed with colorectal
cancer, the rest of the patients had either benign colorectal polyps or
diverticular disease. As the qFIT test is now more widely used, it
needs to be organised by the primary care centers to speed up the
process of diagnosis and management.

Abstract citation ID: znac248.038
TU4.6 Comparison between the outcome of patient’s with
qFIT>120 and patients with qFIT<120.Can qFIT<120 be
considered a negative test??
Aarushi Agrawal, Duaa Gumaa, Mansoor Akhtar
East Kent University Hospitals NHS Foundation Trust
Introduction: When FIT is used for symptomatic patients presenting to
primary care a positive result is considered ≥10 mcgHb/gStool. When
qFIT is used for the asymptomatic screening population (i.e NBCSP) a
positive result is ≥120mcgHb/gStool.
During covid-19 Pandemic the 120 cut off was used in some of the
hospitals to triage patients who require further investigations for
either colonoscopy or CT scan.
Methods: Retrospective cohort study done in general district hospital
comparing the pathology identified in patients with Qfit results>120
and patients with result <120.
Results: In the period between July 2020 and November 2021, 448
patients had +ve qFIT result (≥10 micrograms).In the first group, 340
patients had qFIT result <120. 191 patients had colonoscopy with 8
confirmed colorectal cancer, and 137 patients had CT/CT colon with
only 1 patient was found to have colorectal cancer. Overall 2.6% of the
patients had cancer.
While in the second group, 108 patients had qFIT>120. 69 patients had
colonoscopy with 9 confirmed cancer. the rest of the patients had CT/
CT colon with 2 patients showing features of malignancy. Overall
10.1% of the patients had cancer.
Conclusion: The incidence of colorectal cancer in patients with qFIT
result >120 is much higher than the other group, but the incidence of
colorectal cancer in patients with qFIT<120 is still significant and the
patients shouldn’t be discharged without investigations.
Abstract citation ID: znac248.039
TU4.7 Audit of pilonidal sinus surgery – our experience in a
district general hospital
Hamed Hajiesmaeili, Aidan Clack, Pradeep Thomas
Queen’s Hospital - Royal Derby and Burton NHS Trust
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>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.
Abstract citation ID: znac248.040
TU4.8 An Analysis of Rectal Cancer Patient Treatment
and Outcomes in a large NHS Trust
Natalie Hamer1, Rebecca Hand1, Japsimar Kaur1, Prem Thambi2,
Nicholas Wadd2, Madan Jha2
1
Newcastle University Medical School
2
James Cook University Hospital
Abstracts | v49
Introduction: Rectal cancer (RC) is a common cancer in the UK.
Treatment options include surgery, chemotherapy, radiotherapy or a
combination of these in the form of neoadjuvant or adjuvant treatment.
Aim: To analyse the treatment type and outcomes of our RC patients.
Methods: We performed an analysis of prospectively collected data on
patients diagnosed with RC between Jan-2013 and Dec-2020 in our
trust. Details included demographics, histology, staging, treatment
and mortality. Twenty patients out of 1202 were excluded due to
missing information leaving 1182 for further analysis.
Results: 404 patients did not receive resectional surgery due to patient
choice (30), inoperability of the tumour (259), or co-morbidity (115).
A total of 778 patients were found to have operable disease with TNM
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staging as follows; Stage1–291, Stage2–231, Stage3–217, Stage4–39.
Among them 302 went on to receive neo-adjuvant treatment of which
67 (22.2%) had a complete response to treatment (ypT0). The
remaining 476 patients received primary surgery; 268 did not require
any additional treatment and 199 went on to have adjuvant chemo/
radiotherapy. Nine patients had further intervention due to
incomplete resection or disease recurrence.
The majority of the tumours were adenocarcinomas (97%). Other types
included; malignant melanoma, neuroendocrine tumours, and
squamous cell carcinomas. The overall 1-year and 5-year mortality for
the group receiving primary surgery were 5.0% and 20.4%. In the
neoadjuvant group these were 3.6% and 20.9%.
Conclusion: We present data from a large NHS trust demonstrating a
multimodal approach which has enabled us to achieve good overall
outcomes.
Abstract citation ID: znac248.041
TU4.9 Major elective colorectal surgery at a non-acute site: is it
safe or not?
Zaid Hammoudeh, Gethin Williams, Rhodri Codd
Aneurin Bevan University Health Board
Introduction: Recent reorganisation resulted in elective surgical
services being separated from emergency facilities due to a new
hospital site in our Health Board. Clinicians were initially concerned
with regards to postoperative complications and the potential need
for transfer to the acute site (6 miles away) for ongoing emergency
management. There are no ICU or emergency theatre facilities at the
cold site. We audited the first year of the service reconfiguration.
Methods: This study looked at unexpected transfer of major colorectal
surgical patients occurring between December 2020 to 2021 from the
elective hospital to the acute site. The prospectively maintained
departmental database was interrogated.
Results: There were 263 patients undergoing colorectal operations over
12 months. 31 patients (12%) required step-up to the acute hospital for
further post-operative care. 10 returned to theatre (4 anastomotic
leaks, 1 anastomotic bleed, 1 fluid collection washout, 3 SBO, 1 stoma
revision). The remaining 21 patients were managed conservatively by
the surgical team (8) or taken over by the medical team (13). The main
surgical reason for step-up was due to anastomotic leakage (7). Other
step-up reasons included cardiorespiratory compromise (9), infection
(6), bowel obstruction (3) and bleeding (2). Median time for transfer
was day 4 (range 0–11 days) postoperatively. No transfer delay causing
harm was reported. The 30-day mortality rate for all 263 patients was
0%.
Conclusion: Transfer to the acute site seems to have been safe, timely
and effective in its first year. Patients have received appropriate and
emergency care for these unpredictable complications.
Abstract citation ID: znac248.042
TU4.10 Short term outcomes of patients undergoing transanal
total mesorectal excision versus robotic low anterior resection
Sadia Jaskani, Aftab Khan, Neil Kukreja
Medway Maritime Hospital
Introduction: Robotic Low anterior resection has a potential benefit
because of its technical difficulty to access the narrow pelvic cavity.
The aim of the study was to compare short-term outcomes of patients
who underwent TaTME versus Robotic TME for low rectal cancers.
Methods: Retrospective analysis of cases from a single institution was
undertaken. Data including demographics, operative details, inpatient
v50 | Abstracts
complications, and clinical outcomes were collected from patients’
notes. Comparative analysis between the two groups was performed
using non-parametric statistical tests.
Results: The total sample size was 35 patients who underwent low
anterior resection at a single center. Of the 17 patients who had
Laparoscopic Transanal Total mesorectal excision (LLAR), (15 LLAR + 2
RLAR converted to LLAR), and Robotic Low anterior resection (RLAR)
was performed in 18 patients. Mean age in both groups was
comparable (66.5±9.93). There was no significant difference in patient
demographics in both groups including Gender (Males 88.2% vs 61.1%),
ASA grade, BMI (29.4), and WHO status. There was a statistically
significant difference in tumor height from anal verge between both
groups, mean LLAR 13.78cm, RLAR 7.5cm (p-value 0.04). There was no
difference in circumferential resection margins (p-value 0.366) and
number of lymph nodes harvested (mean LLAR 17 vs RLAR 20). Post-
operative margins (R0) were positive in 3/17 patients in LLAR group
and 1/18 patients in RLAR group (p-value 0.261). There was no
difference in post-operative calvin-dindo complication rate and
hospital readmission rate.
Conclusion: There was no significant difference identified in clinical
and short term oncological outcomes between the two groups
Abstract citation ID: znac248.043
TU4.11 Colonic Polyps Surveillance and outcomes - are we
using a magnifying glass?
Balaji Jayasankar, Dinesh Balasubramaniam, Kirolos Abdelsaid,
Kyle Frowde, Emily Galloway, Laura Leeves
Maidstone and Tunbridge Wells NHS
Introduction: Colonoscopic polypectomy is a well established screening
and surveillance modality for malignant colorectal polyps. Following a
detection of a malignant polyp patients are either put on endoscopic
surveillance or planned for a surgical procedure. We studied the
outcome of colonoscopic excision of malignant polyps and their
outcomes.
Methods: We performed a retrospective analysis of patients over a
period of 5 years who underwent colonoscopy and resection of
malignant polyps. Size of polyp, follow up with tumour markers, CT
scan and biopsy were considered individually for pedunculate and
sessile polyps. The main outcome was to look at the percentage of
patients who underwent surgical resection, the percentage of patients
who were managed conservatively and the percentage of recurrence
post excision. We also identified 5 year outcome of completely
removed malignant polyps in accordance with the Maastricht
guidelines.
Results: The study was a retrospective analysis of 46 patients from 2015
who underwent colonscopic resection of malignant polyps. The male:
female ratio of 1.4:1. 9% (4/44) of the patients went on to have a
surgical resection of the malignant part and another 9% (4/44) had a
trans-anal procedure for resection; 82% (36/44) were managed
successfully by conservative follow up with colonoscopy, radiology
and tumour markers.
Conclusions: Colonoscopic polyp resection may prove to be beneficial
by avoiding a major resection. A reduction in the frequency and the
battery of surveillance may be considered looking at the number of
recurrence and surgical intervention.
Abstract citation ID: znac248.044
TU5.1 Challenges Faced by Female IMGs practicing medicine in
the U.K
Sabreen Elbakri1, Islam Mohammed Noaman2, Adeel Abbas Dhahri3,
Esraa Moustafa Abohatab4
1 in our DGH have had their clinical experience adversely affected by
East of Scotland Deanery
2 COVID due to missed or cancelled patient contact, absence, or
Southeast of Scotland Deanery
3 cancelled placements earlier in the curriculum. We sought to improve
West Midlands Deanery
4 the experience by designing a new simulation programme of acute
North West Deanery
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%
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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.
Abstract citation ID: znac248.045
TU5.2 Lifting the LiDCO on Haemodynamic Monitoring. Which
would you PiCCO?
Sarah Jane Afify1, Nge Nge Thida2
1
Chelsea and Westminster Hospital
2
Northwick Park Hospital
Aims: Surgical patients in the intensive care unit (ICU) are frequently
critically unwell with varied abnormal physiology1. The use of
haemodynamic monitors in such cases is invaluable in permitting
early intervention of complications such as multi-organ failure (MOF),
yet is often overlooked1.
A Trust-wide study was performed utilising guidelines outlining criteria
for haemodynamic monitor instigation2.
Methods: We retrospectively reviewed the records of 20 surgical
patients to determine whether standards were achieved.
Concurrently, we conducted a survey of junior doctors in order to
establish knowledge and identify areas for improvement.
Results: 20% of patients were new admissions with sepsis and MOF. 10%
had inotropic requirements in accordance to Trust guidance. 35%
required fluid bolus >2l within 12 hours of ICU stay; 40% did not and
there was no documentation for 25% of patients. 85% were within the
1st 48 hours post-operatively. Only 4 patients received haemodynamic
monitoring, LiDCO and PiCCO monitors being used equally.
12 responses were received from our survey of junior doctors. 66.7%
were familiar with different haemodynamic monitor types. 58.3%
stated they would be confident knowing when to initiate usage. 83.3%
added they would be able to use these monitors independently. Only 2
individuals had read the Trust guidelines on haemodynamic
monitoring. All participants stated they would benefit from teaching
on this subject.
Conclusions: Our study showed Trust guidance for haemodynamic
monitor instigation was not being adhered to optimally. Increased
awareness via education programmes would be beneficial, ensuring
more favourable outcomes for patients- surgical or otherwise.
Abstract citation ID: znac248.046
TU5.3 Surgical Simulation – Does it improve the
undergraduate surgical experience?
Laura Irvine, Nikki Bruce
NHS Borders
Aims: Many final year undergraduate students rotating through surgery
surgical presentations to become embedded in the teaching schedule
and to audit the feedback from this and make improvements.
Methods: We held a small focus group with FYs and medical students to
identify surgical presentations that they would benefit from practice on.
We wrote a package of simulated cases including “unwell pancreatitis”,
“wound dehiscence” and “post op pyrexia”. All scenarios had the aim of
encouraging A-E assessment by the student pitched at incoming-FY1

level, and available equipment in the SIM lab includes SIM man, real-
time obs, and general ward equipment. Scenarios were written to
include multidisciplinary input from nursing, anaesthetic and surgical
colleagues and include flexible options depending on student
performance. The hospital resus officer helped to run the scenarios.
Results: The scenarios were run with 4 consecutive blocks of students.
All feedback was positive with all students grading feedback as “very
good” or “excellent”. Other feedback included “more scenarios” and
“helps prepare for FY1”. Small improvements were made to the
written documentation through PDSA cycles over the 4 blocks and are
now embedded in the curriculum.
Conclusions: Availability of surgical simulation helped students to
become more confident in A-E assessment of unwell surgical patients
despite loss of patient interactions due to COVID.
Abstract citation ID: znac248.047
TU5.4 ‘Learning lessons, inspiring change and driving
improvements’ - A review of morbidity and mortality meetings
in General and Vascular surgery
Hannah Byrne1, Arya Krishnan1, Delphine Couderq2, Vasilica Marcu1,
Bim Paseda1, Ayman Zayda1
1
Northampton General Hospital
2
Leicester General Hospital
Aim: According to RCS/ASGBI guidance all surgeons should regularly
attend Morbidity and Mortality meetings (M&Ms), as they are a key
activity for reviewing the performance the team and ensuring quality
of care. We aimed to review General and Vascular Surgery M&Ms at
our site – are they in keeping with guidelines and can improvements
be made?
Methods: A retrospective review of General and Vascular Surgery M&Ms
was performed. Presentations were assessed against 12 key
performance indicators (KPIs) as recommended by RCS/ASGBI.
Following audit Cycle 1, a standardized M&M presentation proforma
and an M&M outcome form were introduced, with subsequent second
and third audit cycles completed.
Results: In comparison to Cycle 1, overall improvements were seen in 9/
12 KPIs in both General and Vascular Surgery M&Ms. 100% compliance
was demonstrated in both General and Vascular Surgery M&Ms in 7
KPIs. Improvements can still be made in the completion of Clavien-
Dindo scoring, NCEPOD classification, as well as M&M outcome forms.
Literature review discussions were not included in any General
Surgery M&Ms in either cycle and in only 14% of Vascular Surgery cases.
Conclusion: Significant improvement in RCS/ASGBI compliance was
demonstrated with the introduction of an M&M presentation
proforma. Emphasis and encouragement should still be placed on the
importance of literature reviews to promote learning, although we
appreciate time limitations can have an impact on this. By improving
the quality of M&Ms, surgical teams can learn lessons, inspire change
and drive improvements.
Abstract citation ID: znac248.048
TU5.5 Examining the Benefits of One-To-One African
Caribbean Mentoring for Prospective Medical Students
Charles Carey1, Chloe Jordan2, Monique Wheatle3, Shikila Edward4
1
Manchester University NHS Foundation Trust
2
Queen Mary University of London
3 Chaitya Desai, Daniel Hern, Nader Ghassemi, Supanki Veliah, Vittal Rao
University of Birmingham
4 University Hospitals of North Midlands NHS Trust
East and North Hertfordshire NHS Trust
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.
Abstracts | v51
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.
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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.
Abstract citation ID: znac248.049
TU5.6 Teaching to transform surgical culture: An educational
programme and thematic analysis in a general surgery
department
Madhav Dave, Shahd Mobarak, Munir Tarazi, Christian Macutkiewicz
Manchester University NHS Foundation Trust
Introduction: General surgery departments are busy, meaning
educational opportunities may be sporadic. Clinical priorities can
sometimes supersede teaching and trainees may feel alienated at the
periphery of the working community. In this study, we demonstrate
how a reflective, multidisciplinary general surgery teaching
programme was established and use this to assess the impact of
structured teaching on surgical doctors of all grades in the department.
Methods: Twelve semi-structured telephone interviews were
conducted with participants of varying grades. Transcripts were
analysed using a grounded theory thematic analysis, revealing four
themes: the value of teaching; learning as a community; barriers to
successful training; and culture of surgery.
Discussion: Teaching helped juniors construct healthy narratives
around general surgery and encouraged a process of professional
identity formation. Pairing junior and senior colleagues allowed both
to develop their skills, and reflective learning revealed new learning
opportunities. Transparency across the ‘community of practice’ was
achieved and the programme helped juniors overcome negative
stereotypes of intimidation embedded in the hidden surgical
curriculum.
Conclusion: Reflective, multidisciplinary learning can challenge the
hidden curriculum and encourage team cohesion. A commitment to
critical reflective teaching will be vital in cultivating surgeons of the
future.
NB: submitted to previous ASGBI congress 2020 but later withdrawn due
to COVID-19 and congress being cancelled. We wish to re-present our
work.
Abstract citation ID: znac248.050
TU5.7 The Nutritional Management of Emergency and Elective
Surgical Patients – Are we doing enough in the COVID-19
pandemic?
Aim: Malnourished patients make poor surgical candidates, with an
increased risk of post-operative complications. We assessed the peri-
operative nutritional status of patients undergoing elective and
emergency general surgical operations.
Methods: Data was collected from 1 September 2021 to 1 November
2021. The inclusion criteria included: underwent surgery for gastro-
intestinal pathology, length of stay ≥5 days, and high risk of
malnutrition as per the Malnutrition Universal Screening Tool (MUST).
Results: 50 emergency patients were identified. In the pre-operative to
post-operative period, these patients had a mean albumin decrease
from 30.5 to 23.7, against a decrease in CRP of 146 to 105.5, suggesting
worsening nutrition rather than worsening inflammation. 48% of
v52 | Abstracts
these patients had dietician referrals in-place with 54% of these on oral
supplementation. Post-surgical complications increased in these
patients without a dietician referral, with wound infection the most
common cause (n=4).
50 elective patients were identified. 40% of these patients had dietician
referrals in-place with 70% of these on oral supplementation. Post-
surgical complications increased in these patients without a dietician
referral with the most common complication being acute kidney
injury followed by wound infection.
Conclusion: Optimal nutrition is key to optimal recovery. Most patients
with dietician referrals had a plan of oral supplementation. This
intervention can be commenced by the immediate surgical team. 56%
of patients meeting the MUST tool criteria for high risk of malnutrition
had no dietician referral. This can be addressed through early
consideration for dietician referral, teaching sessions and educational
posters distributed across surgical wards.
Abstract citation ID: znac248.051
TU5.8 Audit on Adherence to NICE Guidelines for VTE
Prophylaxis in Patients Undergoing Surgery for Appendicitis
Sreekar Devarakonda, Paul Shuttleworth, Edwin Clark
Stockport NHS Foundation Trust
Background and Aims: According to the Nice Guidelines (NG89), for any
person (over 16 years) undergoing abdominal surgery, pharmacological
VTE prophylaxis must be added for a minimum of 7 days (if the risk of
VTE outweighs the risk of bleeding). Also, mechanical VTE prophylaxis
must commence on admission. We wanted to audit our adherence to
these guidelines in the patients undergoing surgery for appendicitis.
Methods: A review of the electronic pharmacy records of the patients
(over 16 years) who underwent surgery for appendicitis (proven with a
CT scan or diagnosed intra-operatively) was performed from October
to December 2021. We used the Department of Health VTE risk
assessment form, and only the patients whose risk of VTE outweighed
the bleeding risk were included.
Results: Of the 23 patients, 22 (95.6%) underwent laparoscopic
appendicectomy and, open appendicectomy was done in 1 (4.4%)
patient. 11 (47.8%) patients were females, and 12 (52.2%) were males.
The mean age was 38.3 (±16) years, and the mean duration of hospital
stay was 2.8 (±1.6) days. VTE risk assessment form was completed
only for 12 (52.2%) patients. During the hospital stay, 15 of 23 (65.2%)
patients received TEDS, and 18 (78.2%) patients received Enoxaparin. 4
(17.4%) patients did not receive any form of VTE prophylaxis. None of
these patients was prescribed seven days of pharmacological
prophylaxis.
Conclusions: VTE prophylaxis prescription in patients with short
hospital stays is often missed. We must explore the necessary
interventions to ensure that patients are given seven days of VTE
prophylaxis and regularly audit this practice.
Abstract citation ID: znac248.052
TU5.9 Do Surgical In-patients prefer to use first names or titles
when greeting and being greeted by Surgical Doctors?
Lucia Dunlop, Kathryn Steele, Eunice Minford
Northern Health and Social Care Trust
Aims: Using first names between staff and patients could potentially
help in reducing medical paternalism and encourage a shift to an
equal partnership relationship. A survey was performed to determine
surgical patients preference for greeting and being greeted by Surgical
Doctors.
Methods: 100 surveys were distributed around three surgical wards over
two time periods and collected anonymously.
Results: 67 surveys were returned and analysed, 21 males, 45 females, 1
unspecified with age range 20 to >80 years.
The majority of surgical in-patients prefer junior (85%) and senior
doctors (87%) to greet them by their first names. Yet only 27% wished
to greet Senior surgical doctors by their first name, compared to 57%
for Juniors. In contrast 51% preferred to address seniors by title, but
only 22% for juniors. Remaining patients preferred to address doctors
by their full name or role only. 50% surveyed believed first names
could improve patient-doctor relationships, making it easier to raise
concerns but 12% felt tradition restricted them, with 27% believing it
would devalue the medical profession.
Conclusions: Majority of surgical in-patients prefer to be addressed by
their first name. However, many are reluctant to address Senior
surgical doctors by their first name and are more comfortable doing so
for juniors. Although half realise it could improve doctor-patient
relationships and ease voicing concerns, some recognise that they are
curtailed from doing so by tradition. The shift to equal partnership
doctor-patient relationship may be curtailed by the persistence of
power differential that occurs through using titles.
Abstract citation ID: znac248.053
TU5.10 Development of a Novel Near-peer Surgical
Simulation-based Teaching Programme for Intern Doctors
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Bridgid Ferriter1,2, Barbara Julius1,2, Sinead Burke3, Natasha Slattery3,
Shona Tormey1, Anne Merrigan1
1
University Hospital Limerick
2
Royal College of Surgeons, Ireland
3
University of Limerick
Background: Trends in healthcare have caused a shift in training
towards more competency based programmes. The COVID-19
pandemic has reduced time available for direct exposure and clinical
learning, necessitating incorporation of simulation in training. The
objectives of this study were to develop, pilot and evaluate a four
week simulation based surgical teaching programme.
Methods: Interns pursuing a career in surgery joined a near-peer
surgical training programme delivered by NCHDs. A survey
established a baseline competency. Four skills workshops were
delivered. Outcomes were measured using data from pre and post
course surveys as well as a surgical skills competition.
Results: Of the 12 trainees, 71% had scrubbed in theatre before. 50%
were already confident to scrub independently, increased to 75% post
training. 28% were confident gowning/gloving, increased to 75% post
training. 28% were confident to place a simple suture in theatre, this
did not increase despite training. 42% were confident performing an
instrument tie, increased to 75% post training. 14% were confident
hand tying knots, this increased to 62%. 14% of participants were
comfortable performing excisional biopsy in theatre, increased to 62%
post training. Preparation and administration of local anaestetic could
be performed confidently by 14% before training, this increased to 87%.
On completion, a surgical skills competition showed that 100% were
able to satisfactorily perform basic skills.
Conclusions: Near-peer delivery of surgical training has enhanced the
basic surgical skills of interns. Similar programmes in other sites
would ensure that interns have the skills required to safely care for
surgical patients.
Abstract citation ID: znac248.054
TU5.11 Do surgical discharge summaries meet national
standards? A closed loop clinical audit
Bridgid Ferriter1,2, Amie Lynch3, Shona Tormey1
1
2
University Hospital Limerick
Royal College of Surgeons, Ireland
3
University College Cork
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.
Abstract citation ID: znac248.055
TU6.1 Tackling the training deficit due to COVID-19
disruptions
Shruti Bodapati1, Raghvinder Pal Singh Gambhir2, Shiori Kimura2
1
University Hospitals Plymouth NHS Trust
2
King’s College Hospital NHS Foundation Trust
Aim: Surgical training has been severely affected by stop, start and stop of
elective surgical activity during the COVID pandemic. The aim of this study
was to analyze the effectiveness of strategies put in place to tackle them.
Methodology: We looked at the four UK Statutory Education Bodies
(SEBs) published guidance and trainee led resources to see what
measures were put in place to mitigate the severe disruptions in
surgical training due to COVID-19 pandemic.
Results: Across the world, training programmes have been affected
and craft specialities have fared the worst. Lesser operative experience
and redeployment to non-surgical critical areas being the top 2 causes.
A Post Graduate Medical Education (PGME) Recovery Programme was
established in April 2021 to reset, recover and reform PGME with one to
one trainee recovery discussions. Simulations and virtual CME sessions
are being put in place to help mitigate the deficiencies in the current
training programmes. These measure may be suitable for Medical
specialities, but Surgical specialities need hands on training on human
cadavers in lieu to catch up and prevent extension of period of training.
Conclusion: The COVID 19 pandemic has not only affected the physical and
mental well-being of trainees but has also restricted training opportunities,
professional development and severely dented trainee confidence. The
plans put in place are not good enough for surgical trainees who need
hands on experience. Increased didactic teaching around cadaveric
training programs is the quickest way of overcoming this deficit.
References: 1. https://www.hee.nhs.uk/covid-19/training-recovery-
support; 2. https://www.hee.nhs.uk/covid-19/covid-19-training-recovery-
programme
Abstract citation ID: znac248.056
TU6.2 A review of feedback on simulation sessions while
following Covid-19 SOPS
Nadia Gulnaz, Khurram Siddique
Royal Oldham Hospital
Aims: To assess the usefulness of simulation sessions with social
distancing in managing critical issues on a surgical ward.
Methods: Simulations sessions were run from September 2020 to April
2021 for the foundation doctors and medical students following
standard social distancing rules and using mannequins for patients. A
feedback questionnaire was sent over to the candidates after each
session and the data was analyzed.
Results: 4 sessions were held with a total of 20 participants. The feedback
response rate was 100%. On the Likert scale of 0–10, the majority (Score
range 9–10) responded that they were likely to recommend these
sessions. 90% were likely to change and improve their daily practice
based on their responses.70% rated the sessions as excellent and all the
rest as very good no negative response was received. A 100% agreement
was seen among all participants on the arrangements to be well co-
ordinated and organised.95% found the training staff very helpful.75% of
the participants thought the allocated time was just about right while
15% thought it was slightly short. In response to an open question, the
majority of participants appreciated the concept of simulation while
following social distancing rules and enjoyed the session as a whole.
Conclusions: Overall we received positive feedback. Although the number
of participants was limited in each session but positive responses from the
Abstracts | v53
participants imply that sessions could be easily carried out with social
distancing without compromising the learning outcome. Carrying out
more sessions was strongly favored by a vast majority.
Abstract citation ID: znac248.057
TU6.3 Limited geriatrician input is better than none:
Geriatrician led team meetings improve understanding of
frailty and medical management of older general surgical
patients, meeting NELA standards of care
Murray Hudson1, Rong Luo1, George Reese1, Louis Koizia2,
Michael Fertleman2, Ganan Sritharan2
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1
Imperial College Healthcare NHS Trust, London
2
Cutrale Perioperative and Ageing Group, Imperial College, London
Aims: General surgical teams are treating an increasing number of frail,
older patients.1 Geriatrician involvement has shown improvement in
length of stay.2
We sought to demonstrate that even with limited geriatrician involvement
we could meet NELA targets of completing frailty scores, increasing
frequency of geriatrician reviews and improving team education.
Methods: We introduced twice-weekly geriatrician-led team
meetings followed by selected patient reviews to best optimise the care
of older patients. Surgical trainees, nurses and allied health staff
attended each meeting. The team was educated by the geriatrician about
geriatric medicine and the importance of recognising frailty. They were
also supported in performing independent frailty assessments.
We measured frequency of frailty score recorded and geriatrician
involvement pre- and post-set up of this limited service. We also
conducted semi structured interviews of staff pre- and post-intervention
related to educational impact.
Results: 94% (29/31) of patients aged over 65 had a clinical frailty score
recorded post intervention compared to 9% (3/35) originally. All 31 had
geriatrician involvement. Comments from the surgical team included:
‘pro-active approach to identifying frailty’, ‘early identification of
barriers to discharging complex patients’ and ‘improvement in
understanding of geriatric giants’.
Conclusions: The Emergency Laparotomy and Frailty (ELF) study
recognised that frailer individuals were vulnerable to adverse
outcomes and longer hospital stays.3 Our limited geriatrician-led
service supported surgical doctors and the MDT in understanding
frailty and considering its impact. Within a short space of time we
aligned with NELA recommendations, improved patient outcomes and
improved MDT understanding of geriatric medicine.
Abstract citation ID: znac248.058
TU6.4 Inspiring future surgeons: comparing open vs
laparoscopic simulated surgical skills
Gita Lingam, Taner Shakir, Seiver Karim
East and North Hertfordshire NHS Trust
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
v54 | Abstracts
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.
Abstract citation ID: znac248.059
TU6.5 Motivation in the Surgical Workforce
Neale Marlow
Oxford University Hospitals NHS Foundation Trust, Nuffield Department of
Surgical Sciences, University of Oxford
Number of respondents per subscale of motivationa
Job role Amotivation External Introjected
Regulation Regulation
Consultant
Trainee
Nurse
HCA
Sum
a b
Intrinsic Regulation is the most self-motivated category on the subscale. Relative Autonomy Index (RAI) quantifies degree of self-motivation, maximum score 120.
The degree of self-motivation to work in the theatre environment was
higher in the surgeon group (p=0.037) but there was no significant
difference by age (p=0.119) or duration of theatre experience (p=0.227).
Conclusion: Theatre staff demonstrated a high degree of self-motivation
and explanations are likely multifactorial (personal fulfilment, sense of
duty, team dynamics, technical challenge) although the Hawthorne
effect may bias results. These data could inform targeted recruitment
and retainment of staff, whilst further work could compare findings
with other medical specialties.
Abstract citation ID: znac248.060
TU6.6 The value of immersive endoscopy training for the
surgical trainee
Eleanor Massie, Rebecca Hughes, Mark Vella, Susan Moug,
Helen Mackie, Andrew Renwick
Golden Jubilee National Hospital
Aims: Achieving endoscopic targets for CCT is problematic for General
Surgery trainees. COVID-19 has negatively impacted all aspects of
surgical training. Nationally, only 19% of colorectal trainees report
completing 300 colonoscopies by CCT. We report on an immersive
endoscopy training programme to achieve CCT targets.
Methods: To confirm reduced access to endoscopy, local General Surgery
trainees (n=95) were invited to complete our survey assessing their
endoscopic experience during their training to date. We compared the
results to outcomes from a new 6-month immersive endoscopy
programme. 2 out-of-programme (OOP) trainees; one had no endoscopy
experience (completed core training; OOP 1); one had attempted 70
colonoscopies and 130 UGI endoscopies (ST4; OOP2).
Results: 42 trainees completed the survey (44% response rate), ranging
from ST2-ST8 (74% ST2-ST6, 14% ST7/ST8, 12% OOP). UGI endoscopies
attempted by all trainees: mean 119 (range 10–306). 55% had attended
or secured a place on the JAG UGI endoscopy course. Colonoscopies
attempted by all trainees: mean 67 (range 2–233). 45% having
attended or secured a place on the JAG colonoscopy course. 29% of
trainees anticipated not reaching target CCT endoscopy numbers. In
comparison, in 6 months; OOP1 attempted 49 OGD, 199
colonoscopies with a place secured on colonoscopy course. OOP2
attempted 109 OGD and 216 colonoscopies with both courses
completed.
Conclusion: Shortcomings in endoscopic training and courses,
particularly for colonoscopy, have been confirmed. Implementation of
immersion endoscopy training can achieve CCT target numbers and
competency within a short time, irrespective of previous experience.
Aims: To investigate the motivational spectrum amongst those
choosing to work in the theatre environment according to Deci and
Ryan’s Organismic Integration Theory.
Methods: The Survey of Current Regulation of Behaviour In Theatres
(SCRUB-IT) was adapted from the Behavioural Regulation in Exercise
Questionnaire (BREQ-3) and administered to theatre staff at a UK
university hospital in April 2019.
Results: 48 staff members (surgical consultant n=6, surgical trainee n=9,
nurse n=24, healthcare assistant n=9, male(%) 15(31.3), mean age 34 (27–
59) years) completed the survey. Respondents had been working in
theatres for an average of 11 (2–39) years.
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Identified Integrated Intrinsic Mean RAIb
Regulation Regulation Regulation (range)
3 3 96 (87–104)
3 6 86 (84–102)
3 3 18 53 (27–105)
9 43 (9–63)
9 3 36
Abstract citation ID: znac248.061
TU6.7 How to solve the problem of endoscopy training for
General Surgery trainees
Eleanor Massie, Rebecca Hughes, Mark Vella, Susan Moug,
Andrew Renwick
Golden Jubilee National Hospital
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.
Abstract citation ID: znac248.062
TU6.8 An Audit of Day case surgery for cholecystectomy
Nadia Gulnaz, Farhan Akram, Michael Dixon, Khurram Siddique
Royal Oldham Hospital
Aims: To compare the trust-wide performance with the standard by the
British Association of Day Surgery in the management of cholecystectomy

Methods: 4 months of Electronic data of patients undergoing elective
laparoscopic cholecystectomy in 2020 was analyzed. Those who had
emergency cholecystectomy were excluded.
Results: 112 of 145 total patients were female and 33 were male. The age
range was 18–82 Around 65% of patients were sent home the same day.
51 Patients ended up being admitted. 33 of these were Pre-booked as
inpatients’ intent. 39% (13/33) had no specific reason for being booked
as an inpatient. The rest Majority had medical issues quoted as the
reason for booking.35% (18) of the 51 admitted patients were actually
brought in as day-case lap-chole. 6 of these were admitted for
perioperative surgical issues and 8 had no documented reason. The
Mean length of stay was 2.56 days(0–13). Our Performance was noted
to be 10% lower than the BADS standard.
Conclusion: Relatively more patients are being treated as inpatients
than the recommended standard. About 1/4th of those who were
inpatient had no specific/genuine grounds to be kept in. There is a
need for improvement in pre and perioperative documentation to
explain the reason for inpatient management. Development of
inpatient surgery booking criteria and adherence to set criteria.
Abstract citation ID: znac248.063
TU7.1 “When Can I Go Home?”- Unplanned Admissions
following day case elective surgery
Lara Armstrong, Paul Hughes, Peter McLoughlin
Daisy Hill Hospital, Northern Ireland
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.
Abstract citation ID: znac248.064
TU7.2 Preoperative Indications for Coagulation Screening in
the Elective Setting- A Single Centre Review
Amy Ross, Lará Armstrong
Daisy Hill Hospital, Northern Ireland
Aim: NICE Guidelines 2016 state that coagulation screens should be
carried out in all patients with chronic liver disease, anticoagulation
use or those with an ASA 3 or 4. We aimed to review coagulation
screening in elective patients according to current guidelines.
Methods: A single centre, retrospective review was carried out over a 3
month period, of patients undergoing elective procedures in a district
general hospital. Data was retrieved from an institutional data base, with
follow up information reviewed in an up to date electronic data base.
Results: 64 patients were included with a median age 41 years (range 19–
85) and 56.3% male. Nineteen patients had an ASA of 3 or 4, however
only one of these patients underwent a pre-operative coagulation
screen. Four patients were taking anticoagulation medication prior to
their procedure, however only one patient underwent pre-operative
screening. Neither of these patient groups experienced any intra or
Abstracts | v55
post- operative bleeding. 3.1% of patients within the cohort
experienced bleeding, all without pre-operative coagulation screening.
Overall, screening was indication in 39.1% of patients, but was only
performed in 3.1%.
Conclusion: Whilst a small number of patients within this study had
bleeding related complications, it is evident that recommendations for
patients with ASA 3 and 4 or those on anticoagulation therapy are not
being met. Teaching and education on these guidelines will be
provided and a further audit cycle completed.
Abstract citation ID: znac248.065
TU7.3 Laparoscopic Cholecystectomy for Ultrasound Proven
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Gallbladder Polyps – An Unsound Indication?
Sabrina Bezzaa, Caterina Clements, Puja Patel, Leonora Kumapley,
Kashif Burney, Dhiren Nehra
Epsom & St Helier University Hospitals
Aim: Current European guidelines recommend cholecystectomy for
ultrasound proven gallbladder polyps based on size. Over-diagnosis of
gallbladder polyps by conventional transabdominal ultrasound may
lead to unnecessary surgery. The aim of this study is to correlate the
ultrasound findings of gallbladder ‘polyps’ with histology of the
removed gallbladder specimens.
Methods: Data from transabdominal ultrasound reports was collected
over a 5-year period and cross-referenced with the histology from
patients undergoing a laparoscopic cholecystectomy over the same
time-period.
Results: 60 patients who underwent laparoscopic cholecystectomy with
ultrasound proven gallbladder polyps were identified. The age range
was 19–79 years. There were 36 females and 24 males.
On imaging 30 patients (50%) had a solitary polyp (size range
2–24mm) and 30 (50%) had multiple polyps (largest polyp size
range 4–13mm).
The indication for cholecystectomy was gallbladder polyps with or
without gallstone disease in 32 patients (53%) and gallbladder or
gallstone disease with incidental polyps in 28 patients (47%).
Only 2/60 (3.3%) patients had adenomatous polyps on histology
(9mm and 9.7mm on ultrasound), whilst 18/60 (30%) had
pseudopolyps and in the remaining 40 specimens, no lesion of
polypoidal type was found. No specimens had evidence of
dysplasia or malignancy.
Conclusion: We propose that an ultrasound abdomen is an inadequate
imaging modality alone to diagnose gallbladder polyps and that patients
require further imaging or MDT discussion as adjuncts to decision
making for those referred for consideration of cholecystectomy.
Abstract citation ID: znac248.066
TU7.4 Service Evaluation Audit of Virtual Outpatient Clinics in
the Post-COVID-19 era
Matthew Caine1, Lydia Wickstone1, Charlotte Rogers2,
Christian Macutkiewicz1, Anthony Chan1
1
Manchester University NHS Foundation Trust
2
University of Manchester
Introduction: The COVID-19 pandemic has significantly changed
outpatient clinic services which now involve virtual (telephone/video)
rather than face-to-face consultations. For both new clinic patients or
follow-up patients after a recent emergency admission, these changes
may impact on their perceptions and confidence in the outpatient
service. The aim of this service provision audit is to ascertain both
patient satisfaction and confidence in virtual consultations in our unit.
Methods: A retrospective evaluation of all General Surgery virtual clinic
appointments between January and March 2021 was undertaken.
Patients were contacted for feedback about their surgical consultation
based on questions from the National Health Service Outpatient
Department Survey (2011).
Results: In total, 151 patients were contacted. Overall satisfaction
regarding telephone consultations was significantly higher when
compared to survey results of face-to-face appointments in the pre-
COVID era. The majority of patients were confident (51%) or
confident to some extent (27%) of being listed for surgery without
further examination. Only 8% of patients were not confident at the
way surgery was explained and 10% were not confident of the risks
v56 | Abstracts
of surgery. Finally, more than a third were not happy to be discharged
from clinic following a telephone consultation.
Conclusion: Follow-up appointments are an integral part of the patient
journey following an emergency admission. The COVID-19 recovery
phase has necessitated a service reconfiguration towards virtual
appointments. We show that patients were satisfied with virtual
consultations, although further quality improvement should be
undertaken to ensure outpatient discharge is satisfactory for all
patients following an emergency admission.
Abstract citation ID: znac248.067
TU7.5 Prostate cancer pick up rate in pure LIKERT 3 lesions on
MRI prostate? A retrospective review of 157 cases in a district
general hospital
Jaginkere Chiran, Abid Farooq, Baseerat Anwar, Paul Billington,
Muhammad Abuismaeil
Blackpool Victoria Hospital, Blackpool, FY3 8NR, UK
Introduction: LIKERT 4 and 5 lesions picked up on MRI prostate have a
high chance of picking up high grade high volume prostate cancer so
they under biopsy. It is quite challenging to decide whether to biopsy
pure LIKERT 3 lesions. In our retrospective review of 500 prostate MRI
scan we looked for correlation between pure LIKERT 3 lesions and the
risk of finding prostate cancer after biopsy.
Materials and Methods: Pre-biopsy Multi parametric MRI prostate was
done in 500 cases and reported by two consultant radiologists. 157 mp
Prostate MRIs showed one or more pure LIKERT 3 lesions . All 157
cases underwent targeted and saturation biopsies. 91 biopsies (57.96%)
out of 157 were benign. 66 biopsies (42%) out of 157 showed prostate
cancer. Gleeson score is shown in the table below
Prostate cancer in 66 out of 157 biopsies
GS 3+3 = 6 15 (22.7%)
GS 3+4 = 7 40 (60.6%)
GS 4+3 = 7 8 (12.1%)
GS 4+4 = 8 1 (1.5%)
GS 4+5 = 9 2 (3%)
Conclusion: 157 cases with pure LIKERT 3 lesions on MRI prostate 58%
were benign. 42% who had positive biopsies low and intermediate risk
i.e. Gleeson 6 or 7 (95.4%) prostate cancer was found. High grade
prostate cancer i.e. Gleeson 8 and 9 was seen in 3%. Patients with pure
LIKERT 3 lesion on mp MRI prostate should be counselled about the
risks of finding prostate cancer, likely grade to help them make an
informed decision about PSA monitoring only or undergo prostate
biopsies.
Abstract citation ID: znac248.068
TU7.6 Comparing Cholecystectomy Day Case Rates during the
pre-COVID and COVID Era at a Rural District General Hospital
Tsitsi Chituku1, Eammon Lim1, Raekulan Nithiyabhaskaran2,
Catherine Anderson1, Mahmoud Ali1, Milind Rao1
1
Pilgrim Hospital
2
Grantham Hospital
Aims: 67 000 cholecystectomies performed every year in the UK and 92%
are laparoscopic. 75% of operations should be done as day cases.
National rates vary between 6–50% with the most successful centres
at 70%. Our aim was to audit the day case rate at our Trust pre-COVID
and compare it to during COVID.
Methods: A retrospective audit of patients identified via clinical coding
who had an elective cholecystectomy at one hospital in the Trust
between 1 December 2018 to 31 November 2019. During COVID we did
a prospective audit of patients identified via Theatreman who had an
elective cholecystectomy at the Trust’s designated “Green Hospital”
between 21 September 2020 to 21 December 2020. Data for all patients
was collected from electronic discharge summaries, clinic letters and
patient notes.
Results: Pre-COVID our day case cholecystectomy rate was 73%
compared to 54.7% during COVID. Pre-COVID conversion rate from
planned day case to inpatient stay was 16.3% and during COVID the
conversion rate increased to 44%. The waiting time for a
cholecystectomy doubled during COVID to 26.3 weeks from 13.6 weeks
pre-COVID. Average re-admission rate with symptomatic gallstones
was 0.79 pre-COVID and 0.95 during COVID, with 64% of patients
having at least one admission prior to surgery. The average length of
stay pre-COVID was 0.75 days compared to 0.57 days during COVID.
Summary: COVID adversely affected our day case cholecystectomy
rates with resultant increased waiting times for surgery and re-
admissions with symptomatic gallstones however the average length
of hospital stay was reduced.
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Abstract citation ID: znac248.069
TU7.7 Cheques and Balances: A Five Year Review of Surgical
Settlements
Caterina Clements, Sabrina Bezzaa, Oliver Curwen,
Joseph Vance-Daniel, Trystan Lewis, Dhiren Nehra
Epsom and St Helier NHS Trust
Aim: The litigious burden in the NHS has been increasing yearly, costing
an estimated £2.5 billion per year in financial settlements. We
investigated the causes of general surgical settlements and attributed
costs at a district general hospital over a five-year period.
Method: A retrospective analysis of all general surgical claims between
2016–2021 using the NHS Resolutions Case Management System.
Selected cases were those which resulted in out of court financial
settlements; whilst these claims have been settled, the trust admitted
no negligence in each case.
Results: A total of 12 settlements were made with a total cost of £249,918
(£8000-£60,000, mean £20,827). Eight of the claims (67%) related to
elective cases with four (33%) emergency cases. Of the total cases, 41%
and 33% related to management of gallstones and appendicitis
respectively.
The majority of claims (58%) related to delays in treatment with a total
cost of £103,500 (£8000-£35,000), accounting for 41% of total
settlement costs. Five cases (42%) were due to harm with a
combined total of £146,418 (£9000-£60,000), 59% of the total
settlement. Of the claims due to harm, 80% suffered recognised
complications of the procedure.
Conclusions: Increasing litigation in the NHS over the last decade now
accounts for 2% of the total NHS budget. The majority of settlements
reviewed here were for avoidable delays in elective treatment, with
higher financial settlements for well documented surgical
complications related to the consent process. Better access to
investigations, earlier clinical review, and reductions in delays to
elective surgeries may reduce the financial burden of litigation.
Abstract citation ID: znac248.070
TU7.8 Pay Per View: Cost and Satisfaction of Virtual Video
Clinics
Caterina Clements, Sabrina Bezzaa, Gemma Graham,
Emmanuel Tharmarajah, Karim Jamal, Trystan Lewis
Epsom and St Helier NHS Trust
Aims: The Covid-19 pandemic necessitated use of video consultations
to provide continued patient care. It is not clear if video clinics are
well received by patients, or if they are cost efficient. We evaluate the
benefits of video consultation and review the impact on waiting times
and cost implications to a trust.
Methods: 100 patients referred between January - December 2021 with
gallstones were invited to complete a patient satisfaction
questionnaire after initial clinic consultation. Patients were divided
into three groups based on consultation type; face-to-face, telephone
and video consultation (via the Attend Anywhere platform).
Secondary outcome measures included time from referral to
appointment, time to final outcome and cost implications.
Results: 93 patients responded; 33 video, 30 face-to-face and 30
telephone consultations. Of these patients 62% were female and 38%
male with an average age of 51 (25–84).
Average time from referral was 22 days in the video cohort, 22 in the
telephone cohort and 32 for face-to-face appointments. Of the video
cohort, 44% were booked for cholecystectomy from initial consultation
and 56% sent for further investigation. The conversion rate from video
to face-to-face consultation was zero.

50% of respondents stated face-to-face consultations as their preferred
method of future consultation, 49% of patients opted for video and 1%
preferred telephone consultation. 79% reported increased satisfaction
due to convenience of consultation.
Conclusion: This study demonstrates video consultations decrease
costs and waiting times. Patient satisfaction is comparable to in-
person visit. Specific referral criteria and patient selection is essential
to maximise the benefits of video consultations.
Abstract citation ID: znac248.071
TU7.9 Validation and comparison of new scoring clinical
systems to predict uncomplicated versus complicated
appendicitis
Andrew McGuire1, Siobhan Clifford2, Amenah Dhannon1, Arnold Hill1
1
RCSI
2 Abstract citation ID: znac248.073
Beaumont Hospital
Aims:
1) To validate the APSI and Atema proposed scoring systems in the
diagnosis of uncomplicated versus complicated appendicitis
2) To compare these scoring systems to standard radiological CT
findings
Methods: This was a retrospective review of a sample of patients whom
underwent appendicectomy between 2018 and 2021 in a tertiary
university teaching hospital. Inclusion criteria consisted of CT imaging
prior to surgery to confirm diagnosis, along with clinical and
laboratory data needed to analyse the two scoring systems. Final
histological diagnosis of complicated versus uncomplicated
appendicitis was employed as the gold standard. Positive predictive
(PPV) and negative predictive values (NPV) were calculated for CT,
Atema and APSI scoring systems.
Results: In total, 92 patients were included in the study, whereby 55
patients (59.8%) presented with uncomplicated and 37 patients (40.2%)
with complicated appendicitis. With regards to predicting complicated
appendicitis: Atema score had a PPV of 47.5% and a NPV of 73%. APSI
had a PPV of 43.9% and a NPV of 62.7%. CT had a PPV of 50% and NPV
of 65.5%.
Conclusion: The accurate diagnosis of uncomplicated versus
complicated appendicitis may aid in selection of patients to
conservative versus surgical management of acute appendicitis. Our
study has shown that radiological findings alone have low positive
and negative predictive values. The use of the new Atema scoring
system was found to have a higher NPV when compared to radiology
findings and the APSI scoring system. This may improve accuracy in
discriminating uncomplicated versus complicated appendicitis when
selecting treatment pathway.
Abstract citation ID: znac248.072
TU7.10 Short and medium-term symptom response to
fundoplication in reflux-associated chronic cough in a UK
Centre
Eloise Dexter1, Francesca Siracusa1, Ayla Brown1, Alexander Wilkins1,
Ciaran Dolan2, Michael Pellen1
1
Hull University Teaching Hospitals
2
Doncaster Royal Infirmary
Aim: To identify whether anti-reflux surgery is an effective treatment
for reflux-associated cough in a single specialist unit.
Method: A retrospective analysis of patients referred for suspected
reflux-associated cough undergoing anti-reflux surgery over a 12
month period in a single centre. Pre-operative oesophageal physiology
and imaging, operative technique and follow up records were
examined. Symptom resolution and relapse was assessed four years
postoperatively.
Results: 15 patients underwent anti-reflux surgery following referral
with suspected reflux-associated respiratory symptoms. 6 patients
had hiatus hernia (40%). There was no correlation between symptom
improvement and presence of hiatus hernia, lower oesophageal
sphincter (LOS) pressure or DeMeester score (DS).
13 of 15 patients attended initial follow-up. 12 (92.3%) reported complete
or partial resolution of symptoms. Acid suppression medication was
Abstracts | v57
discontinued in 7 (53.8%) patients at follow up. 100% of patients with
marked oesophageal dysmotility (OD) and elevated DS reported their
symptoms either partially or fully resolved. One patient who reported
no symptom improvement had normal LOS pressures and normal DS
but marked OD.
At four-year follow up, 7/13 reported symptoms (53.8%). Of these 3 have
been re-referred for recurrent cough (23.1%), 1 for dysphagia (7.7%) and 2
experienced symptomatic reflux (15%). The final patient (7.7%)
underwent revision surgery (partial reversal of Nissen Fundoplication)
and was satisfied postoperatively.
Conclusion: Patients referred by the respiratory service for reflux-
associated cough show good symptom improvement which is largely
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maintained following anti-reflux surgery. Relative contraindications of
dysmotility did not appear to be predictive of worse outcome in this
group.
TU7.11 Skin Grafts Vs. Local Skin Flaps in Management of
Contracted Scar Finger
Khaled Noureldin1,2, Mohamed Issa2, Sally Maryosh2, Samuel Xerri2
1
Cairo University Hospital, Egypt
2
Prince Charles Hospital, Merthyr Tydfil
Introduction: In our study, we reviewed the outcome of using skin grafts
and different regional flaps of the hand in order to correct flexion
contractures of the Proximal Interphalangeal (PIP) joints of fingers. In
both techniques, vigorous postoperative exercises were advised for an
interval of time between 3–6 months.
Patients and Methods: 16 patients were included. All the scar tissue was
excised, and the resultant raw area was covered. In Group A consisting
of 8 patients, skin grafts were used. Split thickness grafts were selected
in 3 cases and full thickness grafts in 5 cases. While in group B, Z-plasty
and Cross finger regional flaps were used in 4 cases per each flap. The
cause of the contracture was thermal burn in 8 patients, mechanical
trauma in 7 cases, and a case of contracture secondary to dupytrene’s
disease. The mean follow-up period was 6 months.
Results: The mean flexion contracture/further flexion in the joints were
improved markedly at the last follow-up. More extension was gained by
exercising after the operation. Near full ROM was achieved in 15 cases
with strong hand grip and cosmetic satisfaction. There were no major
complications.
Conclusion: Wise selection between different skin grafts and regional
skin flaps is important, to achieve best outcome in managing finger
contractures and gain satisfactory ROM. Choosing the best
reconstruction method depend on the size, extent and depth of the
raw area. Exposure of the deep structures is an indication to use skin
flaps over grafts. Vigorous extension exerc
Abstract citation ID: znac248.074
TU8.1 Evaluation of drain insertion after appendicectomy
for complicated appendicitis: A systematic review and
meta-analysis of 17 studies
Malaz Abbakar1, Ali Yasen Mohamedahmed2
1
York and Scarborough Teaching Hospitals NHS Foundation
2
Sandwell and West Birmingham NHS Trust
Introduction: Surgical drains are used to reduce post-appendicectomy
collections. However, they can cause considerable discomfort or
increase the risk of surgical site infection (SSI), among other problems.
Our aim is to review the literature systematically and conduct a meta-
analysis to assess the advantages of using drains (DG) versus no drain
(NDG) in complicated appendicitis.
Methods: This systematic review was conducted in accordance with the
Cochrane Handbook for Systematic Reviews and the Preferred Reporting
Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.
All randomized control trials, comparative observational studies
comparing outcomes of drain or no drain after appendicectomy for
patients with complicated appendicitis were considered.
Results: Seventeen studies (n=4255 patients) who underwent
appendicectomy for complicated appendicitis with drain (DG=1580)
without a drain (NDG=2657) were included. There was no difference
between the two groups regarding abdominal collection [Odd ratio
(OR)=1.41, P=0.13] and mortality [ risk difference (RD)= 0.01, p= 0.18].
NDG was superior to the DG regarding SSI [OR=1.93, P= 0.0001], faecal
v58 | Abstracts
fistula [OR=4.76, P= 0.03], Intestinal obstruction [OR=2.40, P= 0.04], and
ileus [ OR=2.07, P=0.01]. The No-drain group showed statistically
significant shorter LOS when compared to the drain group [MD 1.79,
95% CI (1.25, 2.34), P= 0.00001].
Conclusion: In conclusion, this meta-analysis has shown that drains
have no effect on the development of intra-abdominal collections in
complicated appendicitis, but it can significantly increase the risk of
post-operative complications such as fistula, surgical site of infection
(SSI), bowel obstruction, ileus, and prolonged hospital length of stay.
Abstract citation ID: znac248.075
TU8.2 Percutaneous cholecystostomy for acute calculous
cholecystitis an observational study from a single institute
Kirolos Abdelsaid, Milad Jeilani, Mohamed Hassan, Balaji Jayasankar,
Haythem Ali
Maidstone and Tunbridge Wells NHS
Introduction: Although percutaneous cholecystostomy (PC) is generally
accepted as a bridge to definitive therapy for acute cholecystitis (AC),
which remains cholecystectomy, some patients did not undergo
cholecystectomy mostly due to contraindications to surgery. Here, we
aimed to audit our clinical practice from a single institute.
Methods: 153 patients presented with AC and initially managed with PC
were included. The proportion of patients who did not undergo
subsequent LC and their characteristics were analysed.
Results: 27% (41/153) of the study cohort underwent LC while the
remaining patients (n=112) did not receive any surgical
intervention.22/122(20%) were presented with AC and coexisting
hepatobiliary malignancy. The mean age of the remaining patients
(n=90) was 75±13 years and the median length of drain insertion of
those patients 40 days.
The majority (57%) was presented with sever AC while 8% had AC with
adjacent liver abscess. 55% of those patients did not develop any further
attacks of AC after PC removal while 25% deemed unfit for surgery. The
rest of the patients (20%) either refused the operation or died before LC.
The American Society of Anaesthesiologists (ASA) score was 3 IV in 9% of
patients (8/90).
15% (13/90) experienced post PC complications including either blocked
stent, pain and cellulitis around tube. The 60-day mortality rate of
patients who did not underwent LC was 11% (10/90).
Conclusion: The majority of AC patients treated initially with PC did not
undergo subsequent LC. PC in high surgical risk patients with AC could
be consider as definitive treatment.
Abstract citation ID: znac248.076
TU8.3 The optimal timing of Laparoscopic cholecystectomy
following percutaneous cholecystostomy in Acute
cholecystitis
Kirolos Abdelsaid, Majid Sultan, Thomas Rae, Mohamed Hassan,
Balaji Jayasanakar, Yasser AbdulAal
Maidstone and Tunbridge Wells NHS Trust
Introduction: Percutaneous cholecystostomy (PC) is an effective option
for high risk and/or delayed presented Acute cholecystitis (AC).
However, the optimal timing for subsequent laparoscopic
cholecystectomy (LC) as a definitive treatment remains controversial.
Methods: This study includes 41 patients underwent LC following PC for
severe AC. We compared the length of tube insertion, period from PC till
LC and period from PC removal till LC against co-morbidities, another
attack of AC, subsequent pancreatitis/jaundice and operative
difficulties in terms of intraoperative adhesions, drain insertion,
conversion to open, length of operation.
Results: The median time of length of tube insertion was 36 days (range
5–208) while the median time of PC insertion till LC was 144 days (range
31–744) and for period from PC removal till LC was 78 days (range 0–714).
Patients with prolonged tube insertion (more than a month) showed
higher risk of developing subsequent pancreatitis and or jaundice
(P=0.04) while intraoperative adhesions was associated with
prolonged time from tube insertion till operation (more than 4
months). There was no significant association between neither the
length of tube insertion, period from PC insertion till LC nor period
from PC removal till LC and other studied parameters.
Conclusion: Prolonged time of PC insertion and/or prolonged time form
PC insertion till LC in patients with AC have higher risk of pancreatitis
and surgical difficulties. Further studies including larger number of
patients’ sample is warranted to confirm the outcomes and determine
the optimal time of LC following PC in those patients.
Abstract citation ID: znac248.077
TU8.4 Standard of Operation Notes in General Surgery
Stephen Agboro, Esther Yomi-orungbe
Trust SHO Northwick Park Hospital, London Northwest University Healthcare
NHS Trust
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Aims: To assess the quality and precision of operation notes, as well as,
ensure that they were written in accordance to requirements and
standards set by the Royal College of Surgeons England as stated in
“Good surgical practice”.
Method: It was a retrospective local audit and re-audit of patients
admitted under the General Surgery department where 50 & 30
patients were selected randomly in May 2021 and October 2021
respectively. Data was extracted from applications on secure trust
servers and analyzed on Microsoft Excel with patient information
carefully anonymized.
To establish the standard of best practice for this audit, guidelines
published in The Royal College’s “Good Surgical Practice” were used to
devise a comprehensive list of criteria that should be present on every
operation note. These can be found at: http://www.rcseng.ac.uk/
standardsandguidance.
Results: The results of the initial audit were compared with that of the
re-audit. Significantly noted in the re-audit, was the 50% improvement
in documentation of criteria such as the name of anesthetist, anticipated
blood loss, operative diagnosis, and antibiotic prophylaxis. There was also
more clarity in the documentation of post-op plans in the re-audit (e.g
duration of post-op antibiotics/VTE prophylaxis and wound care) for
each patient as recommended in the initial audit.
Conclusion: The improvement in clear and precise documentation of
operation notes noted in this re-audit helped to improve the quality
and safety of patient care delivered. Further audits and re-audits, as
well as, quarterly re-education of surgeons have been recommended
to attain and maintain targets.
Abstract citation ID: znac248.078
TU8.5 Management of acute lower gastrointestinal bleeding
(LGIB) remains largely conservative and the impact of BSG
recommendations largely unseen: results of a 4 year audit
Salma Ahmed, Alan Patten, Richard Guy
Emergency General Surgical Unit, Wirral University Teaching Hospital
Background: LGIB accounts for 3% of all emergency referrals in the UK.
BSG Guidelines for management were recently published, largely based
upon the findings of the 2015 UK Nationwide Audit. A retrospective 4-
year audit was conducted to assess the impact of these guidelines.
Methods: All patients presenting to an EGS service with LGIB, 2 years
before and after BSG guidelines, were identified. Data on
demographics, mode of presentation, investigation,management and
diagnoses were retrieved. A comparison was then made with The UK
Audit and BSG Guidelines.
Results: Some 98 patients were identified. Re-admission rate was 19%
and median length of stay 2.7 days compared with 3 days and 21.4%,
respectively, in the UK audit. Diverticular disease accounted for the
majority of known diagnoses but with a higher proportion of
malignancies. The usage of Oakland score as a criterion for safe
discharge was significantly evident following BSG guidelines, an
increase from 7.1% to 14.6% was noted (P. value 0.005). 41.8% of the
patients underwent CT scans compared with 25.9% in the UK audit.
Similarly, higher percentages of colonoscopy/ flexible sigmoidoscopy
were noted, 65.3% compared with 25.4%. Surprisingly, 0% of the
patients underwent angioembolization, not very different from the
national average of 0.8%.
Conclusion: This audit demonstrates a practice that is largely in line
with national experience but with variations potentially related to
social deprivation. Access to urgent inpatient colonoscopy remains
a problem but CT rates are high and need for surgical intervention
is low. A significant impact of the BSG guidelines is not
demonstrable.

Abstract citation ID: znac248.079
TU8.6 Pharmacological management of post-operative pain
following appendicectomy: a meta-analysis
Benyamin Alam1, Amir Reza Akbari2, Afolarin Awodiya2, Bader Alali3,
Shaida Ekhlacy4
1 2
Queen Elizabeth Hospital, Birmingham
2
King’s Mill Hospital
3
Mubarak Al-Kabeer Hospital
4
University of Birmingham
Introduction: Appendicectomy is an increasingly common procedure
internationally, and is the most frequent emergency surgery
performed in the UK. Post-operative pain is common after surgery, if
poorly controlled it can cause many negative outcomes for patients.
Despite the large number of patients that undergo appendicectomy
and the potentially severe outcomes of post-operative pain, there is no
clear guidance on how best to control pain following appendicectomy.
The aim of this meta-analysis is to compare the efficacy of different
modalities of analgesics following appendicectomy, to identify which
is best at controlling post-operative pain
Methods: A literature search was conducted across online libraries for
trials assessing pain scores after appendicectomy with different
analgesics administered. These were grouped based off modality.
Using the data in these trials a forest plot was created for each
modality with an effect estimate and confidence intervals calculated
for each trial
Results: 6 studies investigated nerve-blocks; an estimated effect of -1.01
with CIs of -1.39 to -0.4 was calculated. 3 studies investigated NSAIDs; an
estimated effect of -0.46 with CIs of -0.70 to -0.23 was calculated. 3
studies investigated local anaesthetics; an estimated effect of -0.83
with CIs of -1.91 to 0.26 was calculated. 1 study investigated
opiates with an estimated effect of -0.82 with CIs of -1.47 to -0.17 was
calculated
Conclusion: Nerve-blocks were the most effective modality of analgesic
followed by NSAIDs. No clinically significant effect was proved for local
anaesthetics as the CIs crossed the null hypothesis. Opiates were not
compared due to insufficient data
Abstract citation ID: znac248.080
TU8.7 An audit of the investigation and management of acute
appendicitis at a tertiary referral centre in Ireland
Uchechukwu Alanza, Barbara Julius, Anne Merrigan, Chanrow Baban,
Shona Tormey
University Hospital Limerick, Department of Breast Surgery, Limerick, Ireland
V94 F858
Aim: Acute appendicitis (AA) is among the most common emergency
surgical presentations to Irish hospitals. In 2020, the World Society of
Emergency Surgery (WSES) updated its Jerusalem guidelines for the
investigation, diagnosis, and management of AA. We aimed to
evaluate our institutional compliance with these guidelines in the
COVID era and outline potential areas for improvement.
Methods: We performed a retrospective chart review of all patients
admitted to our institution with the diagnosis of AA in July 2021 and
compared them against the standards outlined in the WSES Jerusalem
guidelines.
Results: 39 patients were identified. Average age was 25.4 years. 2.6%
(n=1) had clinical scores documented. 33.3% (n=13) had computerised
tomography scans performed, 33.3% (n=13) underwent ultrasound
scans and 33.3% (n=13) had no diagnostic imaging. 100% proceeded
with surgical management. Average time to theatre was 16.9 hours.
23.1% (n=9) were open appendectomies, 74.4% (n=29) were
laparoscopic appendectomies and 2.6% (n=1) was a laparoscopic
converted to open appendectomy. 100% had histopathological
analyses. 69.2% (n=27) were true AAs, 15.4% (n=6) were negative
appendectomies and 15.4% (n=6) were non-inflamed appendices with
other pathology including lymphoid hyperplasia, fecolith or
enterobius. Average length of stay (AvLOS) was 3.6 days.
Conclusions: As regards timely surgical intervention and routine
histopathology, we are compliant with the guidelines. However
increased utilisation of validated clinical scoring systems could
potentially reduce negative appendectomy rates and AvLOS. We
believe an educational intervention is required to improve our
compliance with these standards.
Abstracts | v59
Abstract citation ID: znac248.081
TU8.8 Fundoplication or gastropexy in emergency giant hiatus
hernia repair?
Mohamed Alasmar1,2, Iona Mckechnie1, Ram Chaparala1
1
Salford Royal Hospital
The University of Manchester
Aims: Operative management of emergency presentation with a hiatal
hernia aims to reduce the herniated stomach, dissect the hernial sac
and reapproximate the crura. This will often be followed by
fundoplication or gastropexy to minimise the risk of recurrence. This
study compares the recurrence rates between patients who
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underwent fundoplication and gastropexy.
Methods: From October 2012 to November 2020, 80 patients were admitted
to a tertiary oesophagogastric centre requiring emergency surgery to repair
a giant hiatal hernia. We conducted a retrospective review and analysis of
their admission and follow-up. The primary outcome measure was acute
and post-discharge symptomatic recurrence of hiatal hernia.
Results: Of the 80 patients requiring emergency hiatal hernia surgery,
38% had fundoplication procedures, 53% had gastropexy, and 3% had
both (n 30, 42, 2 respectively). One patient had neither, and 6% (n 5)
patients had a complete or partial stomach resection due to necrosis.
Eight patients (10%) had a symptomatic recurrence of hiatal hernia
requiring a repeat operation; three within the index admission, five
postdischarge. 50% had undergone fundoplication, 38% underwent
gastropexy and 13% underwent a resection (n 4, 3, 1)(p-value 0.5). 19%
(n 15) patients were readmitted. Post-operative mortality was 6% (n 5).
Conclusions: There is no conclusive evidence in the literature favouring
fundoplication versus gastropexy. The surgeon’s experience and patient
factors influence choice of technique. This review, which includes the
largest cohort of patients available in the literature, demonstrates that
surgical technique does not influence the symptomatic recurrence
rate in our patient group.
Abstract citation ID: znac248.082
TU8.9 Emergency Giant Hiatus hernia repair, Single Centre
Experience
Mohamed Alasmar1,2, Iona Mckechnie1, Ram Chaparala1
1
Salford Royal Hospital
2
The University of Manchester
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.
Abstract citation ID: znac248.083
TU8.10 Should patients with a predicted NELA mortality of
5–10% be managed on ICU? An audit of the management of
high-risk laparotomies as per NELA Guidelines
Jessica Banks, Robert Macadam
Whiston Hospital
v60 | Abstracts
Aims: The National Emergency Laparotomy Audit (NELA) has been
pivotal in improving the care of patients undergoing emergency
laparotomy. One key recommendation is ‘high-risk’ patients are
managed on ICU post-operatively. We aimed to identify if there was a
difference in outcomes between ‘high-risk patients’ (predicated NELA
mortality >5%) managed on ICU or a surgical ward post-operatively.
Methods: We retrospectively analysed all patients registered to our
hospitals NELA database from January 2019-September 2021,
assessing if ‘high-risk’ patients were managed on ICU or general
CCU admission (n=203)
Median age (IQR)
Range NELA predicted mortality (median)
Actual
Mortality
Conclusions: NELA predicted mortality helps to guide which patients
may need a higher level of post-operative care. However, this study
indicates that for some patients with a predicted mortality of 5–10%,
ward-based care may be appropriate. In the context of increasingly
stretched ICU resources, we believe further research is needed to
identify whether some patients with a NELA mortality over 5% would
be appropriate for ward management.
Abstract citation ID: znac248.084
TU8.11 Improving the efficiency of the EGS service in a
University Teaching Hospital. Smarter application of
standards and use of resources
Sayantan Bose, Minas Baltatzis, Gordon Carlson
Salford Royal NHS Foundation Trust
Aim: Effective utilization of resources for emergency general surgery
(EGS) is essential for operational efficiency. Many patients have
pathology with a time-dependent outcome and clinical standards
have been established regarding timing of surgical intervention. The
aim of this study was to investigate barriers to the delivery of timely EGS.
Methods: The delivery of EGS between 31/01/21 and 30/08/21 was
studied. All cases were reviewed to determine clinical urgency,
appropriateness of “urgency” within the clinical context (diagnosis,
NEWS-2 score) and timing of EGS. Discrepancies between theatre
booking and clinical need and delay in undertaking EGS compared
with the relevant clinical standards were identified.
Results: EGS was undertaken in 520 patients (262M:258 F), mean age 49
(16–101) years. 34(6%) were booked as needing “immediate”, 130 (25%)
“urgent 2–6hr”, 242 (47%) “urgent 6–18 hr” and 114 (22%) “expedited”
EGS. In 373 (71.7%), EGS was undertaken in a time frame which met
(or exceeded) relevant standards. In 235 (45%) cases, the urgency of
booking exaggerated clinical need. EGS was “delayed” in 147 (28.3%)
cases when compared with urgency as booked, but when actual
clinical need was reviewed EGS was delayed in only 66 cases (12.7%).
Delay was due to unavailability of facilities in 25 (38%) of cases,
whereas in 24 (36%) treatment was delayed purely “overnight”.
Conclusion: Inappropriate allocation of clinical urgency resulted in the
majority of “delayed” EGS. The routine application of RCS18 standards
would prevent this. Avoiding delay overnight and an increase in
theatre resource would improve efficiency.
Abstract citation ID: znac248.085
TU8.12 Group and Screen for Laparoscopic Appendicectomies:
Is It Necessary?
Rebecca Bradley, Cortland Linder, Max Marsden, Adjit Abraham
Royal London Hospital
Background: Blood transfusion is rarely required in laparoscopic
appendicectomies. The incidence of major vessel injury is 0.04%, yet
many trusts require two valid G+S samples prior to the operation. A
retrospective review was conducted to assess the incidence of peri-
operative blood transfusion in laparoscopic appendicectomies in a
large tertiary centre, to challenge the requirement for these G+S
samples in the hope to reduce clinical and financial burden.
surgery wards post-operatively and the difference in outcomes
between these two groups.
Results: 249 patients were included (138 Female). Over 80% of
‘high-risk’ patients were admitted to a ICU bed over the three-year
period, as per NELA guidelines. 46 high-risk patients were managed
on the ward post-operatively. Although there was no difference
in age between the two groups, those admitted to ICU had a
significantly higher predicated NELA mortality and higher
mortality rate.
Ward admission (n=46)
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73 (63–80) 76.5 (66–81) p=0.4
5.0–87.1% 5.1–20% p <0.00001
(22.1%) (9.3%)
43 (21.2%) 4 (9%) p=0.05
Methods: A retrospective case note review of patients undergoing
emergency laparoscopic appendicectomies in the Royal London
Hospital was conducted from 01/06/21 – 01/12/21. Patients under 18
years and those who received an appendicectomy as a concurrent
procedure during other operations were excluded. The monetary
value of each G+S sample was investigated through discussion with
laboratory staff, and a total saving was calculated.
Results: 95 patients were included. 93 patients had two valid G+S
samples prior to their appendicectomy. No patients required
perioperative blood transfusion (within two days pre and post op).
One patient required a blood transfusion in the 5th postoperative day.
An estimated total of £10,500 could be saved per year in this hospital
alone, should G+S samples not be required for laparoscopic
appendicectomies based on this data.
Conclusions: We concluded that two G+S samples are not necessary for
every patient undergoing a laparoscopic appendicectomy. The incidence
of transfusion is scarce throughout literature, and it appears that the
financial and clinical burden of these blood samples far outweighs the
population transfusion requirement in this particular surgery
Abstract citation ID: znac248.086
TU8.13 How can we help things move along? – A review of the
management of the acute bowel obstruction
Muzammil Tijani, Nabeel Anjum, Hannah Byrne, Umeyma Musse,
Munirashirwa Abdulkadir, Jamil Ahmed
Northampton General Hospital
Background: Acute bowel obstruction (ABO) is a common surgical
emergency and is associated with significant morbidity and mortality.
Currently there is no national guidance for the management of ABO
and an NCEPOD study highlighted the resulting variance in care
nationwide. This study recommended several standards of care for
the management of ABO and we aimed to review our practice against
this guidance.
Method: A retrospective review identified all adult patients admitted
with a radiologically confirmed diagnosis of ABO, over an 8 month
period. 8 key performance indicators (KPIs) were adapted from the
NCEPOD recommendations and data was collected from patient notes,
drug charts and computer records. A total of 22 patients are included
in this study to date.
Results: The median length of time from referral to surgical review and
from surgical review to CT scan was 112 mins and 134 mins respectively.
31.8% of patients underwent emergency surgery. Pain documentation
was the only KPI that met 100% target compliance. A MUST score was
completed in 72.7% of cases, a treatment escalation plan in 36.4% of
cases, hydration status was documented in 4.5% of cases and no
patients had a frailty score documented.
Conclusion: Our results demonstrate that significant improvements
can be made in the management of ABO and the recognition of
aspects known to impact patient morbidity and mortality. In
keeping with NCEPOD recommendations we suggest the
implementation of an ABO pathway. We hope this will assist
clinicians in caring for patients with ABO, promote MDT
collaboration and highlight clinical concerns early.

Abstract citation ID: znac248.087
WE1.1 Bilateral Gracilis Reconstruction following Extra-
Levator Abdominoperineal Excision: an updated case-series
Evan Jenkins1,2, Hannah Humphrey1, Andrew Watts1, Patrick Rogers1,
Patrick Rogers1, Ian Daniels1
1
Royal Devon and Exeter
2
Nelson and Marlborough District Health Board
Introduction: Circumfrential resection of low rectal or anal cancers
poses a challenge to the reconstructive surgeon. Resective
procedures including the extralevator abdomino-perineal excision
or pelvic exenteration utilise a wide margin of excision, creating a
significant tissue deficit. The aim of this case series is to
demonstrate that use of bilateral pedicled gracilis muscle flaps
(BPGMF) may offer several advantages to other methods of perineal
reconstruction. This technique avoids any disruption to the
abdominal wall; a benefit in laparoscopic surgery. Fashioning both
muscles into a ‘weave’ creates a muscular sling across the
perineum. This offers support to pelvic contents following the
excision of the pelvic floor muscle groups.
Methods: This is a retrospective, single centre study, of patients
undergoing reconstruction of perineal defects using BPGMF. All cases
took place between January 2008 to July 2021.
Outcomes: There were 56 patients who underwent perineal
reconstruction using BPGMF. The indications for surgery were
cancer (52 patients) and perineal hernia repair (4 patients). There
were 24 female patients and 27 male patients in the patient. The
average age of patients was 60 years. The 30 day mortality was 2%
(1 patient).
A healed perineal wound was seen at 30 days following surgery
in 82% (46/56) of patients. The complication rate for the donor site
and reconstructed site was 14% and 23% respectively.
Complications included infection, hematoma, dehiscence and
seroma formation.
Conclusion: BPGMF offers a reliable and technically simple muscle flap
to reconstruct large perineal defects. It is associated with low morbidity
and recreates support to the pelvic floor.
Abstract citation ID: znac248.088
WE1.2 Introducing the “Safe-Anastomosis” Checklist to
Reduce Overall Anastomotic Leak Rates post Right
Hemicolectomies
Nadeen Alamin1, Maathusha Jeyarajah1, Esther Cook2,
Gandra Harinath1, Ashish Shrestha1
1
General Surgery, East Kent Hospital University Foundation Trust
2
Anaesthetics, East Kent Hospital University Foundation Trust
Aims: The ‘Safe-anastomosis’ Quality Improvement Intervention has
been demonstrated with an overall reduction in anastomotic leak
rates post right colectomy. Our study aims to demonstrate this
reduction rate at a district general hospital.
Methods: This is a retrospective analysis of post-anastomotic leak
rates in the hospital prior to the introduction of the anastomotic
checklist as part of an international collaborative study (EAGLE
study). Patient eligibility criteria included patients aged 18 and
above who underwent a right hemicolectomy between February
2019 and June 2021. The inpatient mortality, 30-day re-admission
and 30-day re-operation rates were included in the analysis.
Results were compared with the prospectively collected EAGLE
Study intervention data.
Results: A pre-interventional cohort of 57 patients was included. 12% (5
elective, 1 non-elective) were found to have an anastomotic leak. The
median length of inpatient stay was 8 days. No patients were re-
admitted within 30 days. 11% were re-operated on within 30 days.
Mortality rate was 6% (none associated with a leak). When compared
to the EAGLE study results, there was a 46.9% reduction rate in
anastomotic leaks. No change was demonstrated in inpatient
mortality rates.
Conclusion: Post-surgical anastomotic leaks create a drastic health and
economic burden on hospitals. Working on reducing their rate can
significantly improve outcomes. Hence, introducing the anastomotic
safety checklist is an effective intervention which may reduce
anastomotic leak rates. Hopefully, EAGLE study final outcomes may be
able shade a light on this matter.
Abstracts | v61
Abstract citation ID: znac248.089
WE1.3 Surgical Multi-disciplinary Team’s engagement with
the Implementation of the New “Safe Anastomosis” Checklist
Nadeen Alamin, Maathusha Jeyarajah, Natali Vigneswaran, Jen Collins,
Ashish Shrestha
General Surgery, East Kent Hospital University Foundation Trust
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
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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.
Abstract citation ID: znac248.090
WE1.4 Laser haemorrhoidoplasty (LHP) is an efficacious
alternative to excisional treatment of haemorrhoidal disease:
Results from a single centre retrospective study
Edidiong Essiet, Shrinivas Kalaskar, Fiona Wu, Qurrat Atif
Dartford and Gravesham NHS Trust
Purpose: LASER haemorrhoidoplasty (LHP) is a novel procedure in the
management of the symptomatic haemorrhoidal disease. LHP is a
non-excisional procedure to treat haemorrhoids in which
hemorrhoidal arterial flow feeding the hemorrhoidal plexus is
abrupted by laser coagulation.
Methods: We conducted a retrospective review on 121 consecutive
patients treated with LHP over 2018 to 2020 at a District General
Hospital. A diode laser device is used to seal the terminal branches of
the hemorrhoidal plexuses. Routine follow-up was at 12 weeks. Our
aim was to investigate the efficacy and safety profile of LHP. Efficacy
was associated with symptom resolution, the degree of patients’
perception of improvement, and the number of procedures required to
treat recurrence. Safety was determined by more than one hospital
follow-ups and complications necessitating treatment.
Results: Follow-up was achieved in 100 patients. 21 patients with
incomplete data were excluded. The mean age was 45 years old. LHP was
utilised in 2% of patients with grade I haemorrhoids, 24% with grade II,
67% with grade III and 7% with grade IV. At follow-up, 57% reported
complete symptom resolution and 94% reported symptom improvement.
Residual symptoms were observed in 29% of patients. Only 9% underwent
a re-operation. 38% attended hospital for more than one outpatient visits
and 5% of those required antibiotics to treat local infections.
Conclusion: LHP is a safe and efficacious non-excisional surgical
alternative to the management of the haemorrhoidal disease. Our
patients reported a high degree of symptom resolution and satisfaction.
Key words: haemorrhoids, benign anorectal conditions, bleeding, laser
haemorrhoidoplasty
Abstract citation ID: znac248.091
WE1.5 Management of Anorectal trauma - A UK trauma centre
based experience
Karekin Keshishian1, Rebecca Bradley2, Katrina Forsyth1,
Charles Knowles3, Kate Hancorn4
v62 | Abstracts
1
Department of Colorectal Surgery, The Royal London Hospital, Barts Health NHS
Trust, UK
2
Department of General Surgery, The Royal London Hospital, Barts Health NHS
Trust, UK
3
Blizard Institute, Barts and the London SMD, Queen Mary University of London,
London, UK
4
Trauma Service, The Royal London Hospital, Barts Health NHS Trust, UK
Introduction and Aim: The evidence base supporting the management
of traumatic anorectal injuries is poor. Previous case series provide
some general observations on management decisions. The aim of the
current study was to describe the largest UK experience of anorectal
trauma management from a national major trauma centre.
Methods: Retrospective review of prospective data, collected
systematically as part of routine trauma practice locally, was
performed. Data were extracted on mechanism of trauma, immediate
hospital care, diagnostics and operative management. Outcome data
were extracted, where available, from follow up. Data are presented
descriptively in a case series format.
Results: 37 patients (35 male vs 2 female) presented with traumatic
anorectal injury between March 2012 and December 2021. The median
age was 34 (6–93), 20 (54%) were penetrating injuries (11 stabs, 5 GSW,
5 other) vs 17 (46%) blunt (13 RTA, 4 other). Median Injury severity
score was 16. Of the 37 cases treated, there were 18 intra peritoneal (8
both intra and extra) vs 16 extra peritoneal injuries. 30 patients had
defunctioning stoma (DS), 8 cases had primary repair (PR) (with or
without DS). Mean length of stay was 27 days. 15 out of 37 have had GI
continuity restored, out of which 13 had a water-soluble contrast
study and 5 anorectal physiology preoperatively.
Conclusions: Traumatic anorectal injuries are uncommon within UK
practice, affect predominantly young men and have high morbidity. In
the majority of cases defunctioning stomas are still the mainstay of
treatment. Primary repair of extraperitoneal injuries is a viable procedure.
Abstract citation ID: znac248.092
WE1.6 Effects of prehabilitation programme on outcomes after
colorectal cancer surgery
N Kumaran, Y Al-Eryani, U Ihedioha
Northampton General Hospital NHS Trust
Aims: Surgery for colorectal cancer is associated with risks of
complications and death. These are associated with higher mortality
and morbidity rates, lower quality of life and increased expenditure in
healthcare. We aimed to determine the impact of prehabilitation on
patient outcomes with regards to length of hospital stay and
postoperative complications.
Methods: The prehabilitation programme was introduced to our unit in
March 2021. We compared outcomes of all patients undergoing elective
colorectal cancer surgery before and after introduction of the
programme from a prospectively maintained database. Records of
patients in the non prehabilitation group (NP) between January to June
2019 and those in the prehabiltation group (PhP) between April to
October 2021 were analysed. Our primary aim was to compare the
length of stay between the groups with a secondary aim to compare
postoperative complications.
Results: A total of 151 elective colorectal cancer patients were included.
There were 64 patients in the NP group and 87 patients in the PhP group.
The median length of stay in the NP group was 7 days and in the PhP
group was 5 days. 30% of patients in the NP group developed post-
operative complications while only 19% of patients in the PhP group
developed post-operative complications.
Conclusion: Prehabilitation is a vital component in a patient’s treatment
journey. Results from our study have shown an improvement in
postoperative outcomes. It should therefore be an element of all
enhanced recovery programmes. Further research in this domain could
include individualised programs to obtain more benefits
Abstract citation ID: znac248.093
WE1.7 Comparing the white cell count (WCC) and C-reactive
protein (CRP) in robotic and laparoscopic colorectal resections
within the immediate post-operative period
1 1 2 2
Mamie Liu , Mayur Gami , Bradley Hopson , Christy Saju
1
Broomfield Hospital
2
Anglia Ruskin Medical School
Aims: Determining factors affecting the WCC and CRP in laparoscopic
and robotic colorectal cancer resections within the immediate 48-hour
period.
Methods: Single centre data was collected retrospectively.100 robotic
and 193 laparoscopic cases were included.
Cut offs for WCC and CRP were set at >11 and >50. Fisher’s Exact test was
used for analysis.
Results: Robotic group had 67% left sided operations vs 43%
laparoscopically. Stoma formation was higher in the robotic group
(61% Vs 15%). Other patient demographics including male to female
ratio, BMI, ASA and tumour size were comparable.
Average length of stays (LOS) and operation times were longer for
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robotic than laparoscopic approaches of the same operation. Average
lymph node yield was higher for robotic right hemicolectomy 26.6 (vs
23.5 laparoscopic) (P=0.05).
Median WCC within 48-hours was higher in the laparoscopic group 10.9
(vs 11.3 robotic). More laparoscopic cases 53% (vs 35% robotic) had WCC
>11 (P=0.006). Median 48h CRP was higher in robotic 51.6 (vs 45.6
laparoscopic).
CRP was consistently higher in operations involving stoma formation
(P= 0.008) and operative time >4 hours (P=0.001) both laparoscopically
and robotically.
Conclusions: Absolute median immediate WCC and CRP were similar
between laparoscopic and robotic colorectal resections although
operative times were longer and stoma formation higher in the
robotic group. Stoma formation and longer operations correlated with
higher CRPs. No firm conclusions can be drawn about differences in
the immediate serum WCC and CRP between laparoscopic and robotic
cases in this study due to confounding factors.
Abstract citation ID: znac248.094
WE1.8 Is colon capsule effective at reducing the requirement
for colonoscopy in symptomatic patients with a faecal
immunochemical test (FIT) <100? Do patients find this an
acceptable investigation?
Ian Lord, Winona Fajardo, Ruth Owen, Nichole Durango,
Krishna Basavaraju, Antonia Wells
West Suffolk Hospital
Aim: To assess the effectiveness of colon capsule in reducing the need
for colonoscopy and to review patient satisfaction for this investigation.
Method: Potentially suitable patients for colon capsule were identified
from 2 week wait referrals and patients referred to colorectal clinic.
Inclusion criteria for consideration were; FIT <100, performance status
0–1 and aged 18–75. Data was collected for our first 20 patients for age,
gender, FIT result, quality of the bowel preparation, pathology and the
follow up outcome. Following completion of the investigation patients
were invited to complete a feedback questionnaire.
Results: The median age of patients was 58 (IQR 50–64) with 12 (60%)
female patients. The median FIT result was <7 (IQR <7 to 33). The
bowel preparation was excellent to good for 18 (90%) patients.
Colon capsule was able to avoid colonoscopy for 14 (70%) patients.
6 (30%) patients required flexible sigmoidoscopy to complete the
investigation or assess identified pathology. 15 (75%) patients
completed patient satisfaction questionnaires, with all patients
reporting little to no pain and little to no embarrassment. 9 of 13
(69%) respondents would choose to have a colon capsule again if
further investigation was required. Overall patient experience was
positive with a median satisfaction score 8/10 (IQR 5–10) with 10
being very satisfied.
Conclusions: Our units initial experience supports the findings of other
pilot studies, that the majority of symptomatic patients with a FIT <100
do not require a colonoscopy following colon capsule. Patients appear to
find this an acceptable method to investigate their symptoms.
Abstract citation ID: znac248.095
WE1.9 The learning curve for stoma care; can it be shortened
by Stoma CNS input at weekends or affected by day of surgery?
Priya Shah, Michelle Hill, Rosie McDonald, Andrew Miller
University Hospitals of Leicester NHS Trust
Aims: Length of hospital stay for colorectal patients can be
prolonged by stoma training. This study explores the impact of

2 variables on time to stoma competency; day of the week that
surgery is performed and whether stoma education was available
at the weekends.
Methods: Retrospective review of a prospectively maintained
stoma database identified all patients who had a GI tract
No. patients
Operation to first stoma education session (days)
Operation to stoma competency (days)
First stoma education session to competency (days)
Stoma team education sessions
Day of surgery Mon Tues
No. patients 24 39
Operation to stoma competency (days) 10.3 (3–31) 11.0 (2–49)
Conclusions: Time to stoma competence was shorter when stoma
education was available at the weekends, despite similar numbers of
reviews being provided. This suggests that length of hospital stay
could be reduced for this cohort by providing stoma education 7 days
a week. The day that surgery was performed did not have a clear
impact on time to stoma competence.
Abstract citation ID: znac248.096
WE1.10 Acute Diverticulitis: Are We Following National &
International Guidance On Antimicrobial Strategy For
Uncomplicated Cases?
Nikheel Patel, Emmanuel Oladeji, Parisha Bains, Nigel Day,
Ashish Gupta
Epsom & St Helier University Hospitals NHS Trust
Aims: Uncomplicated acute diverticulitis is conventionally
treated with antibiotics. Emerging evidence has suggested a
non-antimicrobial approach in systemically well patients is a
safe alternative strategy. Our aim was to assess adherence to
national (NICE) & international (WJES) guidelines for
uncomplicated cases.
Methodology: Data was gathered from PACS imaging & discharge
summaries retrospectively (1st October 2020–1st March 2021).The
inclusion criteria was: CT confirmed cases of modified Hinchey stage 0
or 1a. The cohort was stratified into systemically well or unwell based
on: admission CRP <150, observation score <2 (NICE sepsis
stratification), immunocompetance status & Charlson score <3, as
evidenced in the literature.
Results: There were 48 patients included (female 29 vs male 19). The
number of systemically well patients was 32 (67%) & unwell 16 (33%).
Compliance to guidance 1 (NICE) - ‘systemically well & therefore no
antibiotics’, was low with only 2/32 (6%) patients. Of the remaining,
14/30 (47%) were given intravenous antibiotics. Compliance to
guidance 2 (NICE) - ‘systemically unwell & therefore oral antibiotics’,
was 4/16 (25%) with the remaining majority of 12/16 (75%) treated with
intravenous form. The median number of inpatient nights was 1.48
(well: 1.28 vs unwell: 1.88).
Conclusions: The majority of patients with uncomplicated diverticulitis
were systemically well. Compliance with guidelines on antimicrobial
strategy was low. The incorporation of a risk stratification tool as
demonstrated, allows for identification of patients that be discharged
(with ambulatory follow up) after assessment. CT scans should be
reviewed by radiologists with a multidisciplinary discussion on the
most appropriate antimicrobial strategy.
Abstract citation ID: znac248.097
WE1.11 Auditing the quality of operation notes in colorectal
surgery at University Hospitals of North Midlands
Abstracts | v63
stoma formed between 1st January and 31st December 2020.
Demographics, operative details and time to stoma competence data
was collated.
Results: 158 patients had a stoma formed. Mean age was 59 years (range
13 – 94).
Stoma team Stoma team
(Mon – Fri) (Mon – Sun)
104 54
3 (1 – 27) 2.6 (1 – 12)
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11.4 (3 – 49) 8.9 (2 – 23)
9 (1 – 48) 7.4 (2 – 20)
6.5 (1 – 22) 6.1 (2 – 15)
Wed Thurs Fri Sat Sun
30 24 19 17 5
8.9 (5–21) 10.2 (4–29) 7.5 (4–14) 10.2 (4–33) 32 (11–48)
Yanish Poolovadoo, Aizad Malik, Haseeb Aziz, Nandu Nair,
Gigi Varghese, Philip Varghese, Nakulan Nantha Kumar
University Hospitals of North Midlands
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.
Abstract citation ID: znac248.098
WE2.1 An Audit of MRCP usage in patients with suspected
biliary disease in a major teaching hospital in Dublin
Martin Safari Aketch1, Yazan Qaoud2, ADK Hill2
1
Beaumont Hospital, Dublin 9, Ireland
2
RCSI, Dublin 2, Ireland
Aim: To assess MRCP usage in patients with suspected biliary disease in
a major teaching hospital in Dublin
Background: Our surgical team in this hospital regularly admits
patients with complications arising from gallstones e.g. acute
pancreatitis. This audit is aimed at looking at the appropriateness of
using MRCP in this cohort of patients.
Methods: We accessed Beaumont’s electronic patient records and its
radiology system to gather the data. Data was collected over 3-months
between September and December 2021 which included 91 patients.
Results: There were 82 inpatient and 9 outpatient requests performed
over the 3-month period. The average inpatient wait for MRCP was 3.2
days. The commonest clinical indication was CBD stones. There were
v64 | Abstracts
55 females and 36 males with suspected biliary disease with an average
age of 58 years. Majority of our patient cohort had deranged LFTs and
had symptoms suggestive of a biliary disease. Ultrasound abdomen
was performed in 41 patients (45%) prior to MRCP. CBD stones were
only found in 15 patients (16%). 20 patients (22%) had surgical
decompression of their biliary system.
Conclusion: Our clinicians use BSG guidelines on gallstones as an
adjunct whether a patient needs an urgent MRCP. We still place a
strong emphasis on the patient’s clinical presentation and background
history prior to ordering this scan.
Recommendation: Work with our radiology and gastroenterology
colleagues, come up with a tailored approach and hospital guideline,
to diagnose and treat our cohort of patients with biliary disease.
Abstract citation ID: znac248.099
WE2.2 Video Presentation of performing a Laparoscopic
Cholecystectomy on a patient diagnosed with Situs Inversus
Totalis
Kusum Asnani, Chijioke Ikechi, Ankur Shah, Roland Fernandes
The William Harvey Hospital, Ashford, Kent
Background: Situs inversus totalis (SIT) is a condition in which the
arrangement of the internal organs is a mirror image of normal
anatomy, occurring in 0.0001% of patients. A thorough understanding
of the human anatomy and anatomical variances is crucial in
everyday clinical practise and emergency surgical care. We present a
video on a patient with SIT who underwent a Laparoscopic
Cholecystectomy (LC).
Case: Our patient is a 40-year-old lady with a known diagnosis of SIT.
She presented with jaundice and left upper quadrant pain (LUQ). An
ultrasound and CT scan confirmed the diagnosis of gall stones, CBD
stones and SIT. She underwent an ERCP to clear CBD stones.
LC is one of the commonest general surgical procedures, however, this
case proved challenging due to reversed anatomy. Intraoperatively,
operating positioning was reversed with mirror imaging of ports used
normally. Standard 10mm ports were placed in the infraumbilical and
epigastric regions and the remaining ports placed in the LUQ.
Abdominal organs were inspected and SIT was confirmed. It was
ensured that a slow, meticulous delineation of Calot’s triangle and
window of safety was performed. The cystic duct and artery were
clipped. The rest of the procedure was uneventful.
Results: The patient was discharged on the same day as the procedure.
There were no immediate or short-term complications. Gallbladder
histology showed chronic cholecystitis, cholelithiasis and
cholesterolosis.
Conclusion: This case demonstrates that with appropriate planning and
an advanced skill set, a LC can be performed in a patient with SIT, with
little or no complications.
Abstract citation ID: znac248.100
WE2.3 Comparative study of early versus delayed laparoscopic
cholecystectomy following endoscopic sphincterotomy for
mild to moderate acute biliary pancreatitis
Bhavesh Devkaran1,2, Shivam Sharma2, Surinder Sodhi2,
Arun Chauhan2
1 Altnagelvin Area Hospital - WHSCT
Royal Liverpool and Broadgreen University NHS Trust, Liverpool, UK
2
Indira Gandhi Medical College, Shimla, India
Background: Acute pancreatitis is an inflammatory disease of the
pancreas with acute biliary pancreatitis (ABP) accounting for 75% of
cases. Current recommendations favour early laparoscopic
cholecystectomy (LC) for mild acute gall stone pancreatitis during the
same index admission to prevent recurrent attacks reported to be as
high as 18–61% in various studies. Endoscopic sphincterotomy in
cases who are unfit for cholecystectomy during the index admission
or there is delay in cholecystectomy due to logistics may benefit from
ES while waiting for elective cholecystectomy, in terms of reducing
the number of recurrent attacks and decreasing morbidity.
Methods: A total of fifty-seven (57) patients of mild to moderate ABP
were included in this study and were divided into three groups
undergoing LC within 5 days of admission, ES within 7 days of onset of
pain abdomen and LC within 4 weeks of initial illness and LC after 8
weeks of attack in the three respective groups and evaluated for level
of difficulty of cholecystectomy, recurrent attacks and associated
morbidity.
Results: Difficult LC in terms of adhesions, calots anatomy was seen in
17(n=57) patients. 13(n=38) patients had recurrent attack of pancreatitis
during the waiting period for cholecystectomy, 2(n=19) in the ER group
and 11(n=19) in the conservative management group, with all patients
in the conservative group having more than 2 recurrent attacks.
Conclusion: LC in early period is a safe, effective, in patients of gallstone
induced pancreatitis. ES is well tolerated and viable alternative to
cholecystectomy to prevent recurrent pancreatitis until definitive
treatment.
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Abstract citation ID: znac248.101
WE2.4 Optimal timing of Laparoscopic Cholecystectomy for
symptomatic gallstone disease: the importance of symptom
duration
Abhishek Dey, Nikhil Lal, Afolarin Otunla, Sandeep Singh,
Jeffrey Gilmour
John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust
Aims: This study aims to assess outcomes of laparoscopic
cholecystectomy (LC) performed in patients presenting with acute
cholecystitis or symptomatic gallstone disease within 7 days of onset
of symptoms compared to 7 days of diagnosis.
Methods: A prospective case note analysis was conducted for all
patients undergoing laparoscopic cholecystectomy in a tertiary center
between February and April, 2018. Outcome measures were compared
between 2 patient cohorts: A- those undergoing laparoscopic
cholecystectomy within 7 days of diagnosis and B-within 7 days of
onset of symptoms.
Results: 86 patients met inclusion criteria. The mean duration between
LC and diagnosis was 5 days, and 16 patients (18%) had surgery over a
week after diagnosis. The mean duration between LC and symptom
onset was 9 days, and 44 patients (51%) underwent LC over 7 days
after symptom-onset.
There was a statistically significant reduction in the number of pre-
operative ERCPs(p-0.08) and MRCPs(p<0.01) in patients of group B
compared to A. A similar decline was noted in surgery length(p<0.01)
and incidence of complicated gallbladder disease (characterised by
adhesions, empyema, retrograde dissection, perforation, necrosis,
pancreatitis) (p<0.01) in the former group when measured against the
latter. We further observed significantly better post-operative
outcome in group A with reduced rates of complications(p<0.01)
(urinary retention, bile leak and hepatic artery pseudoaneurysm) and
readmission(p-0.03).
Conclusions: This is the first study to demonstrate the advantages of
using symptom onset to guide practice, and whilst higher power
studies are needed to confirm our findings, could represent the
beginning of an important shift.
Abstract citation ID: znac248.102
WE2.5 Laparoscopic Common Bile Duct Exploration using
disposable Bronchoscope and Cystoscope: Case Series in a
District General Hospital
Lauren Hackney, Asim Eta, Omar Eltayeb
Aims: Case Series performing Laparoscopic Common Bile Duct
Exploration (LCBDE) using single use bronchoscope and cystoscope in
a district general hospital. Aim is to explore the safety and efficacy of
using single use instruments.
Methods: Retrospective study of all LCBDE from a single consultant
using single use scopes from May 2019 to January 2022. Data collected
from Electronic Care Record, notes and theatre management system.
Both choledochotomy and transcystic approaches were used.
Operations were recorded and outcomes of patients explored.
Results: Fifteen laparoscopic CBD explorations were carried out during
the identified period. Indications included young patients (<50yr)
33.3%, Failed ERCP 13.3%, Referral by gastroenterologist 13.3% and
other reasons 40%.
The mean age (+/- SD) was 58 (+/-17) and 80% of patients were
female. 66.6% of cases were emergencies, 40% had intraoperative
cholangiograms, 100% underwent primary closure. The average length

of stay (±SD) after the operation was 10 (±8). One patient developed a
haemoserous collection that required a laparoscopic washout, one
developed post-operative atrial fibrillation and one patient was
readmitted with post-operative infection. There were no
intraoperative complications or equipment failures.
Conclusions: The use of disposable bronchoscope and cystoscopes are
safe and effective way of performing LCBDE. This approach is also cost
effective compared to the more expensive reusable choledocoscope
particularly when considering delays due to sterilisation as well as
issues with availability in departments. Providing this service in
district general hospitals will assist in extensive waiting lists and
potentially avoid morbidity associated with ever lengthening waiting
lists and reduce pressure on tertiary centres.
Abstract citation ID: znac248.103
WE2.6 Procedural outcomes of laparoscopic caudate lobe
resection: A systematic review and meta-analysis
Amal Azhar Anwer1, Shahab Hajibandeh1, Ahmed Kotb2, Louis Evans1,
Emily Sams1, Shahin Hajibandeh3, Thomas Satyadas4
1
Department of General Surgery, Royal Glamorgan Hospital, Cwm Taf University
Health Board, Pontyclun, UK
2
Department of General Surgery, Glan Clwyd Hospital, Betsi Cadwaladr
University Health Board, Rhyl, UK
3 Abstract citation ID: znac248.105
Hepatobiliary and Pancreatic Surgery and Liver transplant Unit, Queen Elizabeth
Hospital, Birmingham, UK
4
Department of Hepatobiliary and Pancreatic Surgery, Manchester Royal
Infirmary Hospital, Manchester, UK
Aims: to evaluate the procedural outcomes of laparoscopic caudate lobe
resection.
Methods: We performed a systematic review in accordance with
PRISMA statement standards to identify all studies reporting the
outcomes of laparoscopic resection of caudate lobe of liver. The
population of interest included adult patients with benign or
malignant lesions located in caudate lobe of liver. The intervention of
interest included laparoscopic resection of caudate lobe of liver.
Random-effects models were applied to calculate pooled outcome data.
Results: 196 patients from 12 studies were included. The mean operative
time, volume of intraoperative blood loss, and length of hospital stay
were 225 mins (181–269), 134 ml (85–184), and 7 days (5–9),
respectively. The pooled risks of need for intraoperative transfusion
was 2% (0–5%), conversion to open surgery was 3% (1–6%), need for
intra-abdominal drain was 6% (0–19%), postoperative mortality was
1% (0–3%), biliary leakage was 2% (0–4%), intra-abdominal abscess was
2% (0–4%), biliary stenosis was 1% (0–4%), postoperative bleeding was
1% (0–3%), pancreatic fistula was 1% (0–4%), pulmonary complications
was 2% (1–5%), paralytic ileus was 1% (0–4%), and need for reoperation
was 1% (0–4%).
Conclusions: Evidence from case series suggests that laparoscopic
approach may be safe, feasible and promising for resection of lesions
located in caudate lobe of liver. The findings of current study can be
used for hypothesis synthesis in future studies and can be used to
inform surgeons and patients about the estimated risks of
perioperative complications until a higher level of evidence is available.
Abstract citation ID: znac248.104
WE2.7 Meta-analysis of interrupted versus continuous
suturing for Roux-en-Y hepaticojejunostomy and duct-to-duct
choledochocholedochostomy
Shahin Hajibandeh1, Shahab Hajibandeh2, Ishaan Patel1
1
Hepatobiliary and Pancreatic Surgery and Liver Transplant Unit, Queen
Elizabeth Hospital Birmingham, Birmingham, UK
2 1
Department of General Surgery, Royal Glamorgan Hospital, Cwm Taf University
Health Board, Pontyclun, UK
Aims: To compare outcomes of interrupted (IS) and continuous (CS)
suturing techniques for Roux-en-Y hepaticojejunostomy and duct-to-
duct choledochocholedochostomy.
Method: s. A systematic search of electronic information sources and
bibliographic reference lists were conducted. A combination of free
text and controlled vocabulary search adapted to thesaurus headings,
search operators and limits in each of the above databases was
applied. Overall biliary complications, bile leak, biliary stricture,
Abstracts | v65
cholangitis, liver abscess, and anastomosis time were the evaluated
outcome parameters.
Results: Nine comparative studies were included which reported 1061
patients of whom 630 patients underwent Roux-en-Y
hepaticojejunostomy (IS:281, CS:309) and the remaining 431 patients
underwent duct-to-duct choledochocholedochostomy (IS:168, CS:263).
Although use of IS for hepaticojejunostomy was associated with
significantly longer anastomosis time (MD:9.82 minutes, p<0.00001)
compared to CS, there was no significant difference in overall biliary
complications (OR:1.34, p=0.19), bile leak (OR:1.73, p=0.26), biliary
stricture (OR:0.77, p=0.64), cholangitis (OR:1.54, p=0.35), or liver
abscess (OR:0.58, p=0.40) between two groups. Similarly, use of IS for
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choledochocholedochostomy was associated with no significant
difference in risk of overall biliary complications (OR:0.92, p=0.90), bile
leak (OR:1.70, p=0.28) or biliary stricture (OR:1.07, p=0.92) compared to
CS.
Conclusions: Interrupted and continuous suturing techniques for
Roux-en-Y hepaticojejunostomy or duct-to-duct choledochocholedo-
chostomy seem to have comparable outcomes although the former
may be associated with a longer anastomosis time. The available
evidence may be subject to confounding by indication with respect to
diameter of bile duct. Future high quality research is encouraged to
report the outcomes with respect to duct diameter and suture material.
WE2.8 Improving Management for Acute Cholecystitis and
Biliary Pancreatitis – the ‘Hot Gallbladder Pathway’
Cheuk Tung Kam, Kirolos Abdelsaid, Balaji Jayasankar,
Dinesh Balasubramaniam, Yasser Abdulaal
Maidstone and Tunbridge Wells NHS Trust
Aim: There is a wide variation between National Health Service (NHS)
hospitals in the management of patients with acute cholecystitis and
biliary pancreatitis. 20–33% of patients will make repeat visits to
hospital with gallstone-related symptoms before any surgical
intervention performed. We established a ‘Hot Gallbladder Pathway’
with the aim for improving outcome and decreasing complications of
these patients. The aim of this quality improvement project was to
assess if a district general hospital (DGH) could provide a safe and
effective ‘hot gallbladder’ service with a clear pathway.
Method: Quality improvement methods were used to integrate the ‘hot
gallbladder pathway’ to manage patients with acute calculous
cholecystitis and biliary pancreatitis. A prospective observational
study with strict inclusion/ exclusion criteria and secure online data
was conducted during a 13-month period. The data were then
compared against existing National Institute for Health and Clinical
Excellence (NICE) guidelines and further changes were recommended.
Results: We achieved almost 70% of the patients undergoing emergency
laparoscopic cholecystectomy in both group of patients who met the
pathway criteria within the expected time frame, compared with the
pre-implementation result of 23% and national average of only 16% in
England. None of the patients suffered from intraoperative
complications or 30-day mortality.
Conclusion: A clear ‘hot gall bladder pathway’ is effective at improving
care for patients requiring emergency laparoscopic cholecystectomy
and potentially useful for other acute Trusts which their standard is
below the NICE guideline.
Abstract citation ID: znac248.106
WE2.9 Quality of ultrasound report in patients with biliary
symptoms in the context of surgical diseases
Daniela Ioana Mateescu1, Abdul Hakeem2, Youssef Chedid2,
Dipankar Chattopadhyay2
Darent Valley Hospital
2
Bedford Hospital, South Wing
Aim: The diagnosis of surgical pathology in patients presenting with
biliary symptoms is highly reliant on a good quality ultrasound report,
our aim was to identify if there are any deficiencies in reports of
ultrasound which are important diagnostic parameters of upper GI
abnormalities.
Methods: Patients presenting to our hospital with biliary symptoms
who require an ultrasound of biliary diseases were included, 8
parameters from the guidelines of Society and College of
v66 | Abstracts
Radiographers were taken and analysed, means of missing data was
calculated, CBD diameter was considered as a significant parameter.
Quality of report for CBD was further scrutinized with patients who
required 2nd investigations like MRCP and CTAP using crosstabs.
Results: A total of 278 patients were included in the study, 97.9% were
due to gallstone diseases and 2.1% were for post-cholecystectomy.
89.7% had mentioned the normality of CBD while only 21.1%
mentioned the actual value of CBD. 93% reports mentioned flow of
portal vein, 7% did not mention portal vein flow. Interestingly 2.1% of
ultrasounds were for post cholecystectomy but during scans, 4.6% of
patients had absent gallbladder. 98 (34.5%) patients had one or more
secondary investigations. 22.9% of normally reported CBD on
ultrasound had positive CBD findings on MRCP.
Conclusions: This audit demonstrates the importance of a good quality
ultrasound report. A good quality ultrasound can aid in clinical
diagnosis and guidance of further investigations. Important factors to
consider are the value of CBD Diameter, portal vein flow and quality of
biliary stone/sludge.
Abstract citation ID: znac248.107
WE2.10 Regional vessels wrapping following
pancreaticoduodenectomy reduce the risk of post-operative
extra-luminal bleeding. A systematic review
Hussameldin M Nour1, Shehram Shafique2, Dimitra V Peristeri1,
Mansoor KhanProf1, Krishna K Singh1, Muhammad S Sajid1
1
University Hospital Sussex NHS foundation Trust
2
Warwick School of Medicine, University of Warwick
Aim: Post-pancreatectomy bleeding which may be a potentially fatal
complication, usually resulting from the erosion of the regional visceral
arteries mainly the hepatic artery and stump of the gastro-duodenal
artery, caused by a leak or fistula from the pancreatic anastomosis. The
objective of this article is to assess whether regional vessels wrapping
omentum or falciform/teres ligament following pancreaticoduoden-
ectomy reduce the risk of post-operative extra-luminal bleeding.
Method: Standard medical electronic databases were searched with the
help of local librarian and relevant published randomized controlled
trial (RCT) and any type of comparative trials were shortlisted
according to the inclusion criteria. Summated outcome of post-
operative extra-luminal bleeding in patients undergoing
pancreaticoduodenectomy was evaluated using the principles of
meta-analysis on RevMan 5 statistical software.
Result: One RCT and 6 retrospective trials on 4100 patients undergoing
pancreaticoduodenectomy for any indication were found suitable for
this met-analysis. There were 1404 patients in the wrap-group (WG)
group and 2696 patients in the no-wrap group (NWG). In the random
effects model analysis, the incidence of extra-luminal hemorrhage
rate was statistically lower in WG [odd ratio 0.51, 95%, CI (0.31, 0.85),
Z=2.59, P=0.01]. There was moderate heterogeneity between the
studies; however it was not statistically significant.
Conclusion: The wrapping of regional vessels (using omentum, falciform
ligament or ligamentum teres following pancreaticoduodenectomy
seems to reduce the risk of post-operative extra-luminal bleeding.
However, more RCTs of robust quality recruiting higher number of
patients are required to validate these findings because current study
presented combined data of one RCT and 6 retrospective studies.
Abstract citation ID: znac248.108
WE2.11 Optimal Utilisation of Cross-Sectional Imaging in
Patients with Painful Jaundice Undergoing Bile Duct
Exploration or Conservative Management for Suspected Bile
Duct Stones on a Specialist Unit
Basil Ibrahim, Sophie Tait, Ahmad Nassar
Biliary Surgery Unit, University Hospital Monklands, Lanarkshire, Scotland
Aim: Laparoscopic management of bile duct stones relies on
intraoperative cholangiography, optimising utilisation of
preopertative imaging. This study aims to determine whether such a
policy is justifiable in jaundiced patients over 50 years of age with no
risk factors for malignancy.
Methods: Prospectively collected data of patients presenting with gall
stones and painful jaundice undergoing biliary surgery or treated
conservatively was analysed. The presentation, preoperative imaging,
cholangiography/ choledochoscopy findings and postoperative
outcomes were recorded. Patients with risk factors for malignancy
were excluded.
Results: 1220 jaundiced patients over 50 years were referred over 24
years.
684 underwent surgery having had CT in 15.3%, MRCP 10% and ERCP
2.5%. 536 unfit patients were managed conservatively (CT 15.7%, MRCP
27.8% and ERCP 29.5%). Most had these investigations under the care
of other departments prior to referral.
21/684 (3%) presenting with painful jaundice associated with acute
cholecystitis or bile duct stones and no risk factors for malignancy
were diagnosed with malignancy on IOC and choledochoscopy. 7
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patients had preoperative cross sectional imaging, one with ERCP
showing no evidence of malignancy. The remaining 14 patients
underwent postoperative imaging; 7 had radiologically undetectable
disease, 6 had advanced disease and only one was suitable for a
“curative resection”. 21/536 (3.9%) cancers were diagnosed in patients
who were treated conservatively.
Conclusion: Based on the little diagnostic yield of curable biliary
malignancies, a policy of no cross sectional imaging in patients with
obstructive jaundice and no risk of malignancy is justifiable in units
adopting single session management of bile duct stones.
Abstract citation ID: znac248.109
WE2.12 Prognostic Factors and Predictive Models in Hot
Gallbladder Surgery. Results of a High-Volume Tertiary Centre
Amanda Shabana1, Benjamin Samra1, Alan Chetwynd2,
Michaela Nixon2, Giovanni Tebala2, Giles Bond-Smith3,
Oxford SEU Juniors4
1
John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust
2
University of Oxford, School of Medicine
3
Oxford University Hospitals NHS Foundation Trust
4
Oxford University Hospitals, Surgical Emergency Unit
Introduction: Gallstone disease is a significant worldwide problem
constituting almost one third of emergency general surgery admissions.
This study aimed identify the prognostic factors and create statistical
models to predict the outcomes of having an emergency laparoscopic
cholecystectomy (LC) during the acute symptomatic phase.
Methods: A prospective, cohort study was conducted on all patients that
underwent a LC for a hot gallbladder between January 2019 to August
2020. Patients were divided on prognostic variables such as: age,
comorbidities and time to operation. The primary outcome measured
was suboptimal treatment, defined by: abandoned procedure,
conversion to open and subtotal cholecystectomy. Secondary
outcomes measured were biliary leak, postoperative morbidity,
readmission rate, and length of postoperative stay.
Results: A total of 466 patients were included. A multivariate analysis
using a backward stepwise linear regression was used to conduct
predictive models based on the significant prognostic factors from a
univariant analysis. Approximately 10% of patients had suboptimal
treatment predicted by age (p<0.0001) and low albumin (p=0.0034).
17.2% of patients had post-operative morbidity predicted by age
(p=0.0201), admission day (p=0.0238), and male gender (p=0.0481).
20.8% of patients were re-admitted, predicted by an ASA >3
(p=0.0096), thin-walled gallbladder (p=0.0491) and greater admission
to operation time (p=0.0351). Post-operative length of stay was
predicted by age (p=0.0048), low albumin (p=0.0048) and greater
admission to operation time (p=0.0169).
Conclusion: Several predictive prognostic factors were found to be
related to poor emergency LC outcomes which can be used to inform
patients of risks pre-operatively and select patients suitable for a
delayed cholecystectomy.
Abstract citation ID: znac248.110
WE3.1 Compliance of Prescription of Intravenous Fluid
Resuscitation in Surgical Patients According to NICE
Guidelines
Hesham Morsy, Michael Li, Chris Davidson, Dharti Patel, Maryam Ali,
James Hollingshead, Kat Gu
West Hertfordshire NHS Hospitals Trust

Aim: Assess compliance of prescription of for intravenous resuscitation
fluids in accordance with NICE Guidelines in the acute surgical
admissions population.
Method: We collected data prospectively for surgical patients admitted
between 25/02/21–18/03/21 (first cycle) & 12/09/2021–4/10/2021 (2nd
cycle). Maximum of 5 patients daily randomly selected. Data collected
on wards after clerking on Day 1 of admission. Surgical Proforma was
used to identify time of admission, presenting history and co-
morbidities of patients. NEWS Charts used to identify observations of
patients on admission. Drug charts used to assess volume and types
of intravenous fluids prescribed. Admissions by audit authors were
excluded to prevent selection bias.
Intervention: Posters in Emergency Assessment Unit and Wards,
Teaching to junior doctors, Regular reminder messages to on-call teams.
Results: 72 patients included in audit. Prescription of Intravenous
resuscitation fluids in Acute Surgical Patients in compliance with NICE
guidelines rose from 49% to 69% between cycle 1 and 2, respectively.
Correct prescriptions in volume and type of fluid rose from 2% (cycle
1) to 44% (cycle 2).
Conclusions: Almost one third of acute admissions met the criteria for
resuscitation IV fluids. In indicated patients, nearly one half of patients
were correctly prescribed resuscitation fluids in accordance with guidelines.
Abstract citation ID: znac248.111
WE3.2 Analgesia Prescription in Surgical Patients
Hesham Morsy, Miraj Patel, Matthew Zimmerman, Madhav Kukreja,
Sharaf Salsabil, Vernon Sivarajah
West Hertfordshire NHS Hospitals Trust
Aim: We objectively re-assessed prescribing of analgesia for surgical
admissions at Watford General Hospital, in accordance with Trust
Guidelines
Method: Total of 117 Patients. We collected data prospectively in the 1st
Cycle 21/09/2021 – 04/10/2021 and in the 2nd Cycle 04/01/2022 – 17/01/2022.
Intervention was through virtual poster and daily reminders to on-call
team
Results & Conclusions: When patients were prescribed analgesia,
compliance to Analgesia Trust guidelines vastly improved from 50% to
79%. Most non-compliant prescriptions were prescribed more strong
opioids excessively.
Action Plan: We plan to disseminate audit findings to clinical staff in acute
services and provide Junior doctors a teaching session on guidelines
Abstract citation ID: znac248.112
WE3.3 Discharge delay-A pitfall for NHS; Can we improve?
Ashrafun Nessa1,2, Mudassar Ghazanfar1, Karola Pawlay1,
Ramandeep Purewal1, Kajenthiny Ganeshmoorthy1, Oluwasegun Tayo1
1
Aberdeen Royal Infirmary
2
University of Aberdeen
Aim: Identify reasons for discharge delays from hospital and areas of
improvement and any scope for trainees to make a difference –
Trainee lead intervention.
Method: All inpatients including Elective and Emergency admissions
were included from all 3 teams over 1 week. Data were collected on
Microsoft Excel and analysis done with SPSS.
Result: Total 102 patients were included (Purple 44, Yellow 40, Red 18).
Mean age was 60.5 years. 54 (52.9%) patients were Female. 57.4% data
were missed for clinical frailty score (CSF). 46.5%patients had
polypharmacy. 61 patients did not have any Expected date of
Discharge (EDD). Mean Length of Hospital stay (LOS) is 18.01 days and
median 10 (1–161) days. Total 27 patients were delayed. 1 stayed for
161 days awaiting rehab bed. Mean Duration of delay was 4.93 days
and Median 1 day (1–42).4 patients were waiting beds outside of
hospital for 3, 6,10, >30 days;6 patients were delayed for Stoma nurse
review for average 1 day. Delayed discharges do not seem to be
affected by polypharmacy (p=0.067), DNACPR (p=0.926), frailty score
(p=0.761) or gender (p=0.518), or which team they were on (p=0.801).
Discharges are however affected by age(p=0.037).
Conclusions: Our recommendations were to Identify patient at risk of
discharge delay by trainees on admission by CSF, early identification
of care requirements with OT/PT, regular EDD review, pre-emptive
discharge letter preparation. We also recommended increased
Abstracts | v67
resources like training of senior nurses to assess stoma training,
phlebotomists/ new clinical support worker to collect early morning
bloods, increased Surgical bed capacity.
Abstract citation ID: znac248.113
WE3.4 Nutrition in the Surgical Patient: Evaluation of the
Current Knowledge and Practice in a Tertiary Centre
Alice Procter, Jodie Murdoch, Shaneel Shah, Finlay Curran
Manchester University NHS Foundation Trust
Aims:
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• To assess the current level of knowledge regarding nutritional
support amongst surgical teams
• To evaluate the current practice against NICE guidelines
• To improve clinical knowledge, improve patient outcomes and reduce
incidents regarding parenteral nutrition
Methods: We performed a multi-cycle assessment using the PDSA
format. To establish current knowledge a quiz was designed in
consultation with local dietitians.
The following domains were evaluated against NICE guidelines:
• identifying malnutrition,
• identifying patients at risk of refeeding syndrome,
• monitoring and prevention of refeeding syndrome,
• identifying appropriate feeding methods,
• safety and complications associated with parenteral nutrition.
A pass mark of 80% was established to aid data collection.
Cohort 1 consisted of 47 foundation year 1 doctors undertaking surgical
rotations.
With the analysis of results from the first cohort a teaching session was
designed. Following delivery of the teaching session, the cohort re-
attempted the quiz.
Results:
Cohort 1
• Cycle one – 46 failed, 1 pass (2.1% pass, 97.9% fail)
• Cycle two – 35 passed, 1 failed, 11 did not participate (97.2% pass, 2.8%
fail)
Conclusions:
• Malnourished patients have increased vulnerability to illness and
higher rates of clinical complications
• We identified a gap in the knowledge of fundamental principles of
nutritional support amongst junior doctors working on surgical wards
• Delivering a short, targeted teaching session is an effective tool for
improving clinical knowledge
Abstract citation ID: znac248.114
WE3.5 Audit of Operative Note Standard: A Retrospective Case
Series Over Two Cycles
Yazan Qaoud, Kate Beattie, Andrew Dorovenis, Orla Williams,
Safari Aketch, Amenah Dhannoon, Arnold Hill
Royal College of Surgeons in Ireland
Aims: Clear, legible, and comprehensive operative notes allow for safe
transfer of patient information and form important documentation in
medical-legal cases. Compliance with criteria identified by the RCSG
for the appropriate documentation of operative notes is variable and
often poor. We aimed to audit the operative notes within the breast
surgical department in a Dublin hospital.
Methods: A retrospective review of randomly selected operative notes,
between December 2020 and September 2021, was conducted.
Compliance with RCSG criteria was recorded. A poster and an
educational program were delivered to surgical registrars.
Results: A total of 49 op notes were analyzed, majority of which were of
elective procedures. There was at least 90% compliance in 10/20 of the
RCSG criteria. Presence of signature, name of assistant, name of
anesthetist, and operative diagnosis were assessed as 82%, 80%, 71% and
61% compliant, respectively. 88% of Op notes contained the start time
only, whereas 51% contained both start and finishing times. Among the
criteria with poorest compliance were presence of problems/
v68 | Abstracts

complications (4%), any extra procedures performed (4%), details of any
prosthesis used (2%), elective or emergency procedure (0%) and
anticipated blood loss (0%). Additional criteria were assessed including
legibility (88% compliance) and use of a diagram (65% compliance).
Conclusion: Our results are consistent with previous similar published
work, highlighting the potential for variability in appropriate
documentation of surgical procedures. Impact of an educational
intervention as well as inclusion of more emergency procedures will
be further explored in second cycle of this audit.
Abstract citation ID: znac248.115
WE3.6 The effect of the Covid pandemic on operative
Melisa Kenber, Stephanie Cheetham, Alice Doughty, Eloise Smellie,
Arin Saha
Huddersfield Royal Infirmary
Aims: The Covid-19 pandemic has led to many changes in the delivery
of surgical services; perhaps the greatest of these, for the long-term
sustainability of surgery at least, is that on training. This study aimed
to describe the effect of these changes on operative experience of
laparoscopic appendicectomy
Methods: All patients who had surgery for suspected appendicitis
from 2016 to 2021 were identified from a prospectively maintained
database of surgeries. Data for 2020 and 2021 were compared with
preceding years.

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experience of laparoscopic appendicectomy Results:

Table 1 Details of patients who had surgery for appendicitis. Statistically significant differences highlighted in bold

2016 2017 2018 2019 2020 2021 p

N 322 319 311 341 291 299 0.021

Age (median, range [years]) 32,4–93 33,5–92 33,6–86 34,6–88 34,5–85 32,4–88 0.681
Diagnostic laparoscopy 36(11%) 32(10%) 30(9%) 31(9%) 13(5%) 27(9%) 0.019
Laparoscopic Appendicectomy 286 287 296 324 278 272 0.024
Operating time (mean, minutes) 62 64 61 60 50 59 <0.001
- Consultant as primary surgeon (%) 5 4 7 5 19 7 0.014
- Registrar as primary surgeon (%) 80 78 77 72 76 70 0.359
- CST/FY2 as primary surgeon (%) 15 18 16 23 5 23 0.031

Conclusions: In 2020, there were fewer operations performed for
appendicitis and markedly reduced opportunities for trainees. This
may reflect a fall in acute admissions, greater reliance on pre-
operative imaging and reployment of surgical juniors. With a focus on
returning to ‘normal’ in 2021 and a commitment to preserving surgical
services, training opportunities have returned for laparoscopic
appendicectomy despite the impact of Covid.
Abstract citation ID: znac248.116
WE3.7 Cognitive computing in minimally invasive surgical
training
Sierra Schaffer1, Justine JS Lo2
1
St. Georges University of London
2
University of Edinburgh
Aims: Research on Cognitive Computing (CC) in surgery is exponentially
developing, however is only just starting to be investigated in minimally
invasive surgical skills training. The technology is being underutilized,
especially when compared with technical skills training in other
industries. This review aimed to establish how CC is currently being
used in minimally invasive surgical training and evaluate how this is
projected to evolve.
Methods: A literature review was done of Pubmed, MedlineOvid, and
PapersWithCode using the MeSH search terms CC (including machine
learning, artificial intelligence, and neural networks), and minimally
invasive surgical training and education.
Results: AI and NN were the most common CC technologies applied to
minimally invasive surgical training. Basic laparoscopic training
followed by general surgery robotics procedures were the most
common skill sets studied.
The majority of studies focused on the assessment of skills and rating of
participants after the training was complete. Overall CC was found to be
effective and accurate at this task.
Few studies evaluated CC use for real-time feedback in order to improve
participants’ training. Those that did found the technology capable of
image tracking within 1–5 seconds. They were only used to provide
feedback on one quality within the skill, most commonly economy of
movement.
Conclusions: The application of CC to minimally invasive surgical
training has only just started to be explored. Further interdisciplinary
research with a focus on database development is needed in order to
accelerate the wider utilization of CC within minimally invasive
surgical training.
Abstract citation ID: znac248.117
WE3.8 Surgical Escape Rooms: A Novel Approach for teaching
surgical skills
Rudrik Thakkar, Olivia Wharf, Mark Hanson, Tom Badenoch, Ian Hunter
Somerset NHS Foundation Trust
Aim: Escape rooms are a novel form of a practical teaching and
simulation demonstrated to be effective in medical education. We
compared the effectiveness of the traditional didactic teaching
compared to a novel escape room style teaching of basic surgical skills
Method: A crossover study was delivered to two groups of third year
medical students. Each group received either the classroom based
teaching or the escape room teaching first, were assessed, then
received the remaining style. Each student was asked to complete a
questionnaire before the session, then after each teaching session.
Teaching covered interrupted suturing, simple wound management
and administration of local anaesthesia. Assessment was undertaken
with confidence scoring with Likert scales, a 10 questions quiz and 5
minute suturing assessment after each teaching session.
Results: 24 third year medical students attended. 100% either agreed or
strongly agreed the classroom teaching was useful, compared to 75% for
the escape room. 79% either agree or strongly agree that escape room
style teaching is a useful adjunct to the traditional teaching. 21%
either strongly agree or agree they felt confident about suturing before
the session compared to 88%. The average number of correctly
answered questions were 8 post teaching sessions, compared to 5 post
escape rooms. The mean number of correctly applied sutures were 3
post teaching sessions compared to 2 post escape rooms.
Conclusion: Traditional practical teaching is still the preferred method
of teaching and effective form of teaching. Although escape room
teaching is a useful adjunct to the traditional classroom based surgical
teaching.
Abstract citation ID: znac248.118
WE3.9 Operative competence should be assessed on a
procedure-specific basis: analysis of submitted Supervised
Structured Assessments of Operative Performance (SSAOPs) by
Core Surgical Trainees in Ireland using Generalisability Theory
Conor Toale1, Marie Morris1, Dara O’Keeffe1, Donncha M Ryan1,
Fiona Boland2, Dara O Kavanagh1
1
Department of Surgical Affairs, Royal College of Surgeons in Ireland
2
Data Science Centre, Royal College of Surgeons in Ireland

Introduction: Competency-based training programmes require reliable
summative assessment methods. The aim of this study is to assess the
reliability of the Supervised Structured Assessment of Operative
Performance (SSAOP) tool in determining the operative competence of
core surgical trainees in Ireland.
Methods: SSAOP scores from April 2016 - February 2021 were analysed.
Reliability analyses for assessment of laparoscopic appendicectomy
were compared to those across all submitted procedural assessments.
Generalizability and decision studies determined the number of
assessments and observers needed to achieve a reliability coefficient
(G) of ≥0.7 and ≥0.8 (appropriate for low- and high-stakes assessment
respectively).
Results: 2,294 SSAOPs were analysed; 85 were completed for
laparoscopic appendicectomy. G ≥0.70 is achieved using a single
assessor observing a minimum of 3 laparoscopic appendicectomy
cases, though G ≥0.70 cannot be achieved for assessments across a
wider group of procedures without large numbers of assessors and
cases. G ≥0.80 can be achieved with a minimum of two random
assessors each observing 3 cases using the Overall Performance rating,
or by two assessors and 6 assessments using the ‘Total Checklist’
score. Reliable assessment of a trainee’s skill across all procedures,
regardless of sub-specialty, could only be achieved using 89 cases and
7 assessors using the Overall Performance rater, or 67 cases and 9
assessors using the Total Checklist.
Conclusion: Operative competence should be assessed on a
procedure-specific basis. Assessing overall competence across
procedures is not feasible in practice. Trainers and trainees should
focus on repeated assessments observing index procedures suitable
for a given trainee’s stage of training.
Abstract citation ID: znac248.119
WE3.10 The Impact of Simulation Training on Junior Doctors
Managing Surgical Emergencies
Liyang Wang, Jonathan Morton, Michael Powar, Justin Davies,
Nicola Fearnhead, James Wheeler, Ioanna Panagiotopoulou
Addenbrooke’s Hospital, Cambridge, UK
Aim: The use of simulation for the training of junior doctors in surgery
usually involves either practicing technical skills or exercising
communication skills. We have identified a gap in crisis resource
management training of junior surgical trainees with scenario-based
simulation. We have developed a one-day simulation course on
general surgical emergencies and evaluated its impact.
Methods: The course included a human factors presentation and
several scenarios of acute surgical emergencies. It was aimed at core
surgical trainees, but other junior doctors were invited. High fidelity
human simulator (SimMan®) was used and controlled by faculty.
Surgical scenarios were selected in order to provide insight for the
appropriate resuscitation for acute surgical patients. The impact of
the course was evaluated with a post course questionnaire.
Results: Ten courses were completed between 2015 and 2021. A total of 58
doctors attended, 45 were core surgical trainees. All 51 participants who
responded to the questionnaire rated the course “Good (4/5)” or
“Excellent (5/5)”. Following the course, of 51 participants, 50 felt better
prepared and 51 were confident in recognising unwell surgical patients;
42 felt better prepared and 50 confident in providing resuscitation; 46 felt
better prepared and 51 confident in escalating care. During debriefs and
on free text feedback, participants frequently reported the course helped
develop their non-technical skills.
Conclusion: The General Surgical Emergencies simulation courses were
rated useful by the learners. The course has positively impacted on the
preparedness and confidence of junior surgical trainees in recognising
unwell surgical patients, providing initial resuscitation and escalating care.
Abstract citation ID: znac248.120
WE3.11 Inguinal hernia repair operation; review of the consent
and the supported decision-making in the out-patient
department
Malaz Abbakar1, Salma Ahmed2, Stevan Stojkovic1
1 this. For the second cycle a similar questionnaire was distributed to
York and Scarborough Teaching Hospitals Foundation Trust
2 observe whether the changes have been sustained and the impacts
Wirral University Teaching Hospitals Trust
Introduction: In 2015, the ruling of the UK Supreme Court in Scotland in
the case of Montgomery v Lanarkshire fundamentally changed the
Abstracts | v69
practice of consent. According to the Judges, doctors are no longer the
sole arbiter of determining what risks are material to their patients. In
this study, the RCS CONSENT: SUPPORTED DECISION-MAKING guide
was used to evaluate our practice in regards to consent taking for
inguinal hernia repair.
Methods: OPD letters to GPs were reviewed between 01/01/2019 to 30/12/
2019. For risks with its percentages, alternative management
exploration with the patient and whether information leaflets
supplied to the patients.
Results: There were 63 patients. 19/63 letters had different options of
treatment documented. 37/63 letters showed risks and complications
documented and only 4/63 letters had percentages of the risks
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written. 25/63 patients signed consents in OPD. 0/63 letters indicated a
signed consent copy was given to patients. Only 10 patients had been
given an information leaflet.
Conclusion: Overall quality of letters was: 36/63 were poor, 21/63 were
average and 5/63 were good. Therefore, to improve our practice
leaflets shall be made easily accessible in all clinics. A prompt
notification, if consent has been signed when booking a patient.
workshops with feedback for middle grades.
Abstract citation ID: znac248.121
WE3.12 A Closed Loop Clinical Audit on The Implementation of
WHO Surgical Safety Checklist at a Tertiary Level Hospital in
India: Where do we stand?
Akatya Vidushi Sinha, Sameer Kadam
MGM Medical College & Hospital, India
Aim: To complete an audit on the level of compliance to the WHO
surgical safety checklist in surgical operating theatres at a Tertiary
level hospital in India.
Method: A total of 40 general surgeries were observed at the operating
theatres at a tertiary level hospital in India to confirm the practice of
the WHO surgical safety checklist. The study was conducted for a
period of 2 months starting from July to August 2021. The results were
compared with standard guidelines and further analyzed.
Interventions were carried out by a series of rigorous departmental
meetings and discussions with the medical and nursing staff. A
re-audit was conducted after 2 weeks.
Results: Of all the operations audited, 45% Sign-In and only 1%
Sign-Out were performed in the first cycle. After the re-audit, a
significant change was reported as the Sign-In improved to 80% and
a 55% Sign-Out was conducted. The Time-Out was observed to
increase from 15% to 65%.
Conclusion: Though in the first cycle of our audit the compliance to the
SSCL was found to be suboptimal, significant improvement was
demonstrated in the second cycle after rigorous awareness programs
and training sessions. Compliance was seen to be greater in major
surgeries than in minor surgeries. Compliance with all items in the
checklist and active participation by all medical and nursing staff is
mandatory for successful implementation of the Surgical safety
checklist.
Abstract citation ID: znac248.122
WE3.13 Friday Handover Flow
Aneka Jhass, Mohammed Abu Kamal Nahid, Anthonia Efiannayi,
Ashish K Shrestha, Roland Fernandes, Kusum Asnani
William Harvey Hospital, East Kent Hospitals University Foundation Trust
Aims: Handover between teams is a requirement between colleagues to
ensure patient safety. An electronic weekend handover Friday noon
with the whole surgical team was implemented in 2017. This is the
second cycle to close the loop.
Methods: The implementation of ‘Careflow’ software had all been
initiated in 2017 to modernise handover from paper to e-handover.
Anonymised questionnaires were sent to all surgical doctors 6 months
following the initial intervention. An additional intervention of a
Friday afternoon handover prior to the weekend was started following
beneficial.
Results: From the first cycle 97% felt e-handover was better than
paper handover. Comparing first and second cycles; 97% vs 80%
v70 | Abstracts
reported adequate handover time, 97% vs 57.1reported handover
incorporated into the working day, 42% vs 97.2% reported handover
usually consultant led, 41% vs 48.6% were aware of RCS handover
guidelines 81% vs 85.7% reported ‘Caredlow’ as having a positive
impact. Overall 91.1% of staff were more than 60% satisfied with
Friday midday weekend handover, and 100% wanted the practice to
continue.
Conclusions: A prioritised handover, dedicated room, adequate time
and senior presence are all required for an effective handover. To
modernise and improve continuity of care, an electronic handover
system is a positive, effective tool. In addition a Friday noon handover
prior to the weekend enables the modern NHS to provide the best and
safest practice for our patients.
Abstract citation ID: znac248.123
WE4.1 A Prospective Observational Study on Quality of Life Pre
and Post Gastrojejunostomy for Benign Disease
Rebecca Black1, Angus McCance1, Ellen Ainger1, Mr Fernandes2
1
William Harvey Hospital, Foundation Year 1 Doctor
2
William Harvey Hospital, Consultant Surgeon
Background: Benign disease leading to gastric outlet obstruction
is a major cause for morbidity and malnutrition. Surgery in the
form of a gastrojejunostomy is aimed at improving quality of life
by bypassing the obstructing lesion and restoring adequate oral
nutrition.
Methods: Patients undergoing an open gastrojejunostomy for benign
disease at a district general hospital operated by the same surgeon
over a 3 year period were recruited. Based on the HRQoL SF-12
questionnaire, the pre-operative physical component summary (PCS)
score were recorded together with pre-operative albumin levels and
weight. The post operative PCS score, post-operative albumin and
post-operative weight were recorded at 90 days. Differences were
investigated using univariate comparisons.
Results: The mean ± SD pre-operative PCS score were 33.9 ± 8.1,
postoperative score were 42.7 ± 7.8 9 (p= 0.003) in 6 patients. Mean ±
SD pre-operative serum albumin levels were 27 ± 4 and postoperative
levels were 32 ± 3 (p=0.04). There was a 3.7 ± 1.2 kg increase in weight
over the 90 day period (p=0.03). There were no complications nor
returns to theatre. The mean length of stay was 6 ± 3 days.
Conclusions: Gastrojejunostomy for benign disease causing gastric
outlet obstruction has been shown to improve quality of life, serum
albumin and weight over a 90 day period. It can therefore be
concluded that beneficial patient outcomes can be achieved in a
relatively short time span post-surgery.
Abstract citation ID: znac248.124
WE4.2 Audit of pre-operative blood tests for Elective General
Surgery at Northampton General Hospital
Naren Kumaran, Muhammad Saad Bin Tariq, Faaraan Bangash,
Helai Habib
Northampton General Hospital
Aim: Annually 9.9 million people undergo elective surgery in the
NHS. The National Institute of Health and Care Excellence (NICE)
published guidelines on ‘Routine pre-operative tests in elective
surgery’ in 2016. It aimed to reduce unnecessary testing by taking
into account patient comorbidities and the complexity of surgery.
Excessive testing can cause significant anxiety in patients, delays in
treatment and exposure to COVID caused by unnecessary hospital
visits. Additionally, unnecessary blood tests can exacerbate blood
bottle shortages.
We are auditing the compliance of NICE guidelines when requesting
blood tests for elective general surgical patients in pre-operative
assessment clinics at Northampton General Hospital (NGH)
Method: The audit team at NGH provided details of the first 64 patients
undergoing elective general surgery (categorised into 22 Minor, 23
Intermediate, 19 Major procedures), from May to July 2021. Electronic
records were used to determine patient ASA grades and blood tests
requested at pre-operative assessment clinics. These were checked
against NICE (2016) guidelines.
Results:
Blood test ordered Number of Compliance with
appropriately NICE guidelines
ordered test (%)
Full Blood Count (FBC) 34/64 46%
Urea and electrolytes (U&Es) 19/64 70%
Coagulation 16/64 25%
Total cost of inappropriate blood tests: £382
Conclusion: There is poor compliance with NICE guidelines. NGH
Anaesthetic team have implemented changes in November 2021, as
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part of MyPreOP online app, to ensure these guidelines are followed.
We will re-audit in February 2022 and consider implementing changes
across all surgical specialties.
Abstract citation ID: znac248.125
WE4.3 Complete versus partial excision of an infected mesh
following abdominal wall hernia repair: A systematic review
and meta-analysis
Komal Bodkhe1, Mohammed Kaif Qayum2, Irfan Kar2,
Shahab Hajibandeh3, Shahin Hajibandeh4
1
Birmingham Heartlands Hospital, Birmingham, UK
2
Department of General Surgery, Hereford County Hospital, Wye Valley NHS
Trust, Hereford, UK
3
Department of General Surgery, Royal Glamorgan Hospital, Cwm Taf University
Health Board, Pontyclun, UK
4
Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital,
Birmingham, UK
Aims: We aimed to evaluate comparative outcomes of complete and
partial excision of infected mesh following abdominal wall hernia repair.
Methods: A systematic search of electronic databases and bibliographic
reference lists with application of a combination of free text and
controlled vocabulary search adapted to thesaurus headings, search
operators and limits was conducted. Surgical site infection (SSI),
chronic sinus formation, recurrent hernia and need for reoperation
were the evaluated outcome measures.
Results: Six comparative observational studies were identified,
reporting a total of 317 patients of whom 193 underwent complete
mesh excision and the remaining 123 patients underwent partial
mesh excision for an infected mesh following abdominal wall hernia
repair. The complete mesh excision was associated with significantly
lower rates of SSIs (OR: 0.36; 95% CI, 0.16–0.81, p=0.01), chronic sinus
formation (OR: 0.11; 95% CI, 0.02–0.71, p=0.02), and reoperation (OR:
0.10; 95% CI, 0.03–0.33, p=0.0001) compared to the partial mesh
excision. There was no significant difference in hernia recurrence rate
(OR: 3.96.16, 95% CI 0.62–25.44, p=0.15) between two groups.
Conclusions: Our meta-analysis demonstrated that complete mesh
excision may be associated with lower SSI, chronic sinus formation
and need for reoperation when compared to the partial mesh excision
in an infected mesh event. However, the available evidence has failed
to report the outcomes with respect to the main confounding factors
which, together with other important outcomes such as fistula
formation, should be considered by future high quality research.
Abstract citation ID: znac248.126
WE4.4 Robotic versus laparoscopic splenectomy in
management of non-traumatic splenic pathologies: a
systematic review and meta-analysis
Shahin Hajibandeh1, Shahab Hajibandeh2, Pratik Bhattacharya3,
Liam Phelan4, Ishaan Patel1
1
Hepatobiliary and Pancreatic Surgery and Liver Transplant Unit, Queen
Elizabeth Hospital Birmingham, Birmingham, UK
2
Department of General Surgery, Royal Glamorgan Hospital, Cwm Taf University
Health Board, Pontyclun, UK
3
Department of General Surgery, Sandwell and West Birmingham Hospitals NHS
Trust, Birmingham, UK
4
Department of General Surgery, Birmingham Heartlands Hospital, University
Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
Aims: We aimed to evaluate comparative outcomes of robotic and
laparoscopic splenectomy in patients with non-traumatic splenic
pathologies.

Methods: A systematic search of electronic databases and
bibliographic reference lists were conducted and a combination of
free text and controlled vocabulary search adapted to thesaurus
headings, search operators and limits in electronic databases were
applied. Intra-operative and post-operative complications, wound
infection, haematoma, conversion to open procedure, return to
theatre, volume of blood loss, procedure time, and length of hospital
stay were the evaluated outcome parameters.
Results: Eight comparative studies reporting a total of 560 patients
comparing outcomes of robotic (n=202) and laparoscopic (n=258)
splenectomies were included. The robotic approach was associated
with significantly lower volume of blood loss (MD:-82.53 mls, 95%
CI-161.91–-3.16, p=0.04) compared to the laparoscopic approach. There
was no significant difference in intra-operative complications
(OR:0.68, 95% CI 0.21–2.01, p=0.51), post-operative complications
(OR:0.91, 95% CI 0.40–2.06, p=0.82), wound infection (RD:-0.01, 95% CI
-0.04–0.03, p=0.78), haematoma (OR:0.40, 95% CI 0.04–4.03, p=0.44),
conversion to open (OR:0.63; 95% CI, 0.24–1.70, P=0.36), return to
theatre (RD:-0.04, 95% CI -0.09–0.02, p=0.16), procedure time (MD: 3.63;
95% CI, -16.99–24.25, P=0.73) and length of hospital stay (MD:-0.21; 95%
CI, -1.17–0.75, P=0.67) between two groups.
Conclusions: Robotic and laparoscopic splenectomy seem to have
comparable perioperative outcomes with similar rate of conversion to
an open procedure, procedure time and length of hospital stay. The
former may potentially reduce the volume of intra-operative blood
loss. Future higher level research is required to evaluate the
cost-effectiveness and clinical outcomes
Abstract citation ID: znac248.127
WE4.5 Meta-analysis of the outcomes of Trans Rectus Sheath
Extra-Peritoneal Procedure (TREPP) for inguinal hernia
Amal Azhar Anwer1, Shahab Hajibandeh1, Shahin Hajibandeh2,
Louis Evans1, Nader Naeem Naguib1, Tim Havard1,
Ahmed Hazem Helmy1
1 Mid Yorkshire Hospitals NHS Trust
Department of General Surgery, Royal Glamorgan Hospital, Cwm Taf University
Health Board, Pontyclun, UK
2
Hepatobiliary and Pancreatic Surgery and Liver transplant Unit, Queen Elizabeth
Hospital, Birmingham, UK
Aims: To evaluate the outcomes of Trans Rectus Sheath Extra-Peritoneal
Procedure (TREPP) in patients undergoing elective inguinal hernia repair
Methods: In compliance with PRISMA statement standards, electronic
databases were searched to identify all studies reporting the outcomes
of TREPP in patients undergoing elective inguinal hernia repair. The
outcomes of interest included recurrence, chronic pain, haematoma,
and wound infection. Proportion meta-analysis model was
constructed to quantify the risk of postoperative complications and
direct comparison meta-analysis model was constructed to compare
the outcomes of TREPP and other open techniques. Random-effects
modelling was applied to calculate pooled outcome data.
Results: Seven studies enrolling 1891 patients undergoing TREPP were
included. Pooled analyses showed that TREPP was associated with
3.00% (95% CI 1.00–6.00%) risk of recurrence, 3.00% (95% CI 2.00–6.00%)
risk of chronic pain, 8.00% (95% CI 0.00–20.00%) risk of haematoma,
and 3.00% (95% CI 0.00–6.00%) risk of wound infection. The results
remained consistent through subgroup analysis of patients with
primary hernias and those with recurrent hernias. Analysis of a
limited number of comparative studies showed no difference between
TREPP and Lichtenstein technique in terms of recurrence (OR: 1.57,
P=0.26) and chronic pain (OR: 1.16, P=0.59).
Conclusions: The best available evidence suggests that TREPP may be a
promising technique for elective repair of inguinal hernias as indicated
by low risks of recurrence, chronic pain, haematoma, and wound
infection. Moreover, there is a lack of comparative evidence on
outcomes of TREPP versus other techniques highlighting a need for
high quality randomised controlled trials for definite conclusions.
Abstract citation ID: znac248.128
WE4.6 Postoperative muscle atrophy: an overlooked cause
of morbidity
Edward Hardy1,2, Jacob Hatt1,2, Brett Doleman2, Beth Phillips2,
Jon Lund1,2
1
Department of General Surgery, Royal Derby Hospital
2 1
Centre Of Metabolism, Ageing and Physiology, University of Nottingham
Abstracts | v71
Aims: A significant proportion of patients never fully recover baseline
activity levels following major abdominal surgery. Postoperative
muscle atrophy may be a major contributing factor to this, but is often
overlooked. This study aimed to quantify the degree of muscle loss in
patients undergoing routine recovery following major abdominal
surgery and in patients admitted to critical care.
Methods: Fifteen patients undergoing major open colorectal resection
were recruited. Cross surface area (CSA) and muscle thickness (MT) of
a quadriceps muscle, Vastus Lateralis (VL) were measured
pre-operatively and on post-operative day (POD) 5 using ultrasound.
Knee extension strength was also measured pre-operatively and on
POD5 using a handheld dynamometer. A systematic literature review
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was performed to identify studies reporting muscle loss in patients
admitted to an intensive treatment unit (ITU), with pooled means of
changes in quadriceps muscle CSA calculated.
Results: By POD 5 VL CSA had decreased by 9.16% (± 2.0), and MT had
decreased by 8.14% (± 5.93). Associated with this, knee extensor
strength decreased by 19.69% (± 12.91). Systematic review identified 4
studies reporting muscle loss in ITU patients, including a total of 126
patients. Pooled mean of quadriceps CSA in patient admitted to ITU
decreased by 13.9% (-12.5% -20.75%) by POD7.
Conclusions: Major abdominal surgery is associated with a significant
loss of muscle mass and function. Losses are larger in patients
requiring ITU admission. This may have a significant impact on
patients’ full recovery to baseline function and further work is
required to investigate this.
Abstract citation ID: znac248.129
WE4.7 Is Routine Histopathological Examination Required for
all Surgically Resected Gallbladders?
Stacey Jones, Youhana Mikhael, Mohammad Altabari, Boules Bahgat,
Alexandra Parrott, Hossam Shaaban
Aims: The aim of this study was to identify both pre- and intra-operative
factors in individuals diagnosed with incidental gallbladder malignancy
on histopathology following a cholecystectomy for symptomatic
gallstone disease.
Methods: Retrospective records were analysed from October 2018 to
December 2020 of all individuals who underwent a cholecystectomy in
a single surgical unit. Demographic data (age, gender), presenting
complaint, pre-operative imaging (USS/CT/MRCP/ERCP),pre-operative
blood results, type of surgery (laparoscopic/open), intra-operative
finding (macroscopic appearance of gallbladder) and histopathological
findings were noted.
Results: 829 individuals underwent cholecystectomy for symptomatic
gallstone disease within the study period. 73.5% were female. Mean
age of patients was 51.2 years. Commonest presenting complaint was
pain in all cases followed by nausea (33.5%) and vomiting (26.9%).
Chronic cholecystitis was found to be the most common
histopathological finding (84.4%), followed by cholelithiasis (31.8%)
and cholesterolosis (10.3%.) Gallbladder carcinoma was incidentally
found in 3 cases (0.4%), of which 2 were female with a mean age of
75.3 years. A thickened gallbladder was found in all cases on
pre-operative imaging and macroscopic abnormalities were noted in
all cases intra-operatively with each individual having T2 disease on
TNM staging. No individual with normal macroscopic appearance had
gallbladder malignancy.
Conclusion: Pre- and peri-operative findings play a key role in
determining incidental findings of gallbladder malignancy and we
advocate a more selective approach in the gallbladders that are
sent for histopathological examination based on pre-operative
imaging, intra-operative macroscopic appearance and age of
individual thereby, reducing both cost and the workload of the
pathologist.
Abstract citation ID: znac248.130
WE4.9 Complete versus partial excision of an infected mesh
following abdominal wall hernia repair: A systematic review
and meta-analysis
Komal Bodkhe1, Mohammed Kaif Qayum2, Irfan Kar2,
Shahab Hajibandeh3, Shahin Hajibandeh4
Birmingham Heartlands Hospital, Birmingham, UK
v72 | Abstracts
2
Department of General Surgery, Hereford County Hospital, Wye Valley NHS
Trust, Hereford, UK
3
Department of General Surgery, Royal Glamorgan Hospital, Cwm Taf University
Health Board, Pontyclun, UK
4
Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital,
Birmingham, UK
Aims: We aimed to evaluate comparative outcomes of complete and
partial excision of infected mesh following abdominal wall hernia repair.
Method: A systematic search of electronic databases and bibliographic
reference lists with application of a combination of free text and
controlled vocabulary search adapted to thesaurus headings, search
operators and limits was conducted. Surgical site infection (SSI),
chronic sinus formation, recurrent hernia and need for reoperation
were the evaluated outcome measures.
Results: Six comparative observational studies were identified,
reporting a total of 317 patients of whom 193 underwent complete
mesh excision and the remaining 123 patients underwent partial
mesh excision for an infected mesh following abdominal wall hernia
repair. The complete mesh excision was associated with significantly
lower rates of SSIs (OR: 0.36; 95% CI, 0.16–0.81, p=0.01), chronic sinus
formation (OR: 0.11; 95% CI, 0.02–0.71, p=0.02), and reoperation (OR:
0.10; 95% CI, 0.03–0.33, p=0.0001) compared to the partial mesh
excision. There was no significant difference in hernia recurrence rate
(OR: 3.96.16, 95% CI 0.62–25.44, p=0.15) between two groups.
Conclusions: Our meta-analysis demonstrated that complete mesh
excision may be associated with lower SSI, chronic sinus formation
and need for reoperation when compared to the partial mesh excision
in an infected mesh event. However, the available evidence has failed
to report the outcomes with respect to the main confounding factors
which, together with other important outcomes such as fistula
formation, should be considered by future high quality research.
Abstract citation ID: znac248.131
WE5.1 Review of acute referrals to Surgical SDEC at a DGH
Rajesh Chidambranath, Pradeep Thomas, Janette Flatt
Queens Hospital Burton, University Hospital of Derby and Burton
Aim: We intend to interpret the pathway that patients attending
Surgical SDEC followed in this journey, at first contact point, their
experience at each stage of contact with emergency services and
reasons for taking the final pathway.
Method: We formed an anonymised questionnaire for patient pathway
to SDEC, filled on arrival at SDEC. First 53 patients were included from 1
week data. This included the reason for their visit, duration of their
presenting problem and whom they called before attending or being
directed to SDEC and patient experience with each provider such as
111, 999 and GP in brief. Finally, we observed who they contacted and
how urgent they thought their problem was.
Result: There were 53 patients, 50 responding for themselves. 51 of 53,
agreed that they would contact GP or 111 for non-urgent queries. 41/53
77.35% approached their GP initially and we found that 58.5% were
referred to SDEC. Of the 32 (37.7%) patients seen by GP, 24 (58.5%) were
referred to SDEC. 20% thought they were too urgent for GP. We found
that GPs were managing most urgent referrals (38%) and the majority
of these were referred to SDEC as in the case of 111 responders.
Conclusion: Changes introduced by the Long Term Plan were well
received by patients with majority of patients being seen in SDEC. The
first patient contacts also resulted in SDEC referrals from the
community and it would be appropriate for such referrals to be sent
directly to SDEC by GPs and 111.
Abstract citation ID: znac248.132
WE5.2 Safety of in-hospital delay to appendicectomy in acute
appendicitis: a retrospective study
Oliver Claydon1, Billy Down2, Sidharth Kumar3
1 Introduction: The NELA requirements of data collection is known to be
Norfolk and Norwich University Hospital NHS Foundation Trust
2 mandatory. Our DGH had three years of non compliance. We present an
Milton Keynes University Hospital NHS Foundation Trust
3 executed plan in the collection of retrospective and prospective process
Shrewsbury and Telford Hospital NHS Trust
Aims: In many hospitals the availability of operating theatres and
access to senior surgical and anaesthetic support diminishes during
night hours. Therefore urgent surgery is sometimes postponed until
the following morning rather than performed overnight, if judged to
be safe. We aim to determine if a delay to laparoscopic
appendicectomy in cases of acute appendicitis of over 12 hours,
analogous to an overnight delay, is correlated to worse patient
outcomes. Our primary outcome was delayed discharge from hospital.
Our secondary outcomes were appendicitis severity, conversion, and
post-operative complications.
Methods: We undertook a retrospective review of the medical records of
patients who underwent laparoscopic appendicectomy at a UK district
general hospital between 01/01/2018 and 30/08/2019. For each patient
clinical and demographic information; and times of hospital
admission, surgery, and discharge; were collected. Delayed discharged
was defined as ‘time to discharge’ >24 hours.
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Results: 506 patients were included. In 144 patients (28.5%) ‘time to
surgery’ was under 12 hours; in 362 patients (71.5%) ’time to surgery’
was over 12 hours. 362 patients (71.5%) had a delayed discharge. 303
patients (59.9%) had simple appendicitis; 143 patients had severe
appendicitis (28.3%); 60 patients had a macroscopically normal
appendix (11.9%). No statistically significant association between ‘time
to surgery’ and delayed discharge, appendicitis severity, conversion or
30 day re-presentations was observed.
Conclusions: Time from admission to start of appendicectomy did not
affect patient outcomes. Short in-hospital delays to appendicectomy,
for example an overnight delay, may be safe in certain patients, taking
account of clinical judgement.
Abstract citation ID: znac248.133
WE5.3 Emergency laparoscopic “hybrid” IPOM+ repair of
incarcerated umbilical hernia in patient with BMI 62 and small
bowel obstruction; a case study
Danielle Clyde, Andrew Healey, Dimitris Damaskos
Royal Infirmary of Edinburgh
Background: Large abdominal incisions in obese patients are associated
with considerable rates of systemic and wound complications. Recently
published European Hernia Society guidelines recommend laparoscopic
intraperitoneal on-lay mesh (IPOM) repair for large hernia defects and
patients at higher risk of wound morbidity, ideally with closure of the
defect and a 5 cm overlap.
Case Presentation: We report on a 69-year-old, morbidly obese (BMI 62),
comorbid woman who presented as an emergency with a 5-day history
of vomiting and abdominal pain. A pre-operative computed tomography
(CT) scan confirmed small bowel obstruction secondary to a ventral
abdominal wall hernia. Operative findings confirmed an obstructed
paraumbilical hernia containing small bowel and omentum. A
laparoscopic “hybrid” IPOM+ repair was performed, with a generous
overlap. She recovered uneventfully with no surgical complications.
Discussion: Minimally-invasive surgical techniques are preferred for obese
patients with evidence suggesting lower perioperative complications and
recurrence rates compared with open repair. However, additional
challenges must be taken into consideration including; surgeon expertise,
timing of operation, surgeon ergonomics, distortion of surface anatomical
landmarks, need for higher pneumoperitoneum pressures and the
physiological effects of this on the patient.
Conclusion: With preoperative planning, our case study demonstrates
that IPOM ventral hernia repair remains a viable option for severely
obese patients even in emergency presentations. The closure of the
defect is recommended whenever feasible. Addition of the hybrid
approach (excision of the sac with a limited incision after the
laparoscopic closure) reduces the risk of postoperative seromas.
Abstract citation ID: znac248.134
WE5.4 The Successful Resurrection of NELA in a District
General Hospital
Bhavesh Gohil, Varun Sarodaya, Alastair White, Arti Garg
Newham General Hospital
to achieve national standard.
Method: A new structural setup with anaesthetic and surgical teams
was formalised.
A recruitment of 13 foundation doctors was made and each were
induced to NELA with a teaching session. Allocation of 15–20 hospital

numbers with a primary deadline of seven days to achieve full entry was
expected. A formal NELA certificate and recognition for taking part from
the divisional director was issued.
A prospective strategy was initiated with patient ownership from the
joint anaesthetic and surgical team involved. A NELA login with local
access was setup, plus paper format readily available for rare access
situations. A two email reminder system with further escalation
process was introduced if entry was incomplete. The escalation being
contact from the clinical lead / divisional director. This information
was highlighted at a local meeting plus a familiarity of the NELA
database was ensured.
Results: A large proportion of the retrospective data has been collected
over a short time period due to a clear incentivised scheme.
Prospectively there has not been any escalation emails needed since
the new setup.
Conclusion: Areas of problems were identified with a wide range of
solutions being put forward.
A multi collaborative approach was needed plus positive cooperation
from the clinical lead, clinical director and the divisional director to
ensure the successful new era.
Abstract citation ID: znac248.135
WE5.5 Does use of laparoscopy in emergency surgery improve
mortality rates? A single centre experience
Louise Gurowich, Rebecca Dru, Marianne Hollyman
Musgrove Park Hospital, Taunton
Aims: With the progression of minimally invasive surgery across
surgical specialties in the elective setting, we aimed to assess the
translation of laparoscopic surgery into emergency surgery in our
district general hospital. The National Emergency Laparotomy Audit
(NELA) provides us with an excellent database to review our
single-centre’s experience over time.
Methods: Using data collected as part of the NELA, we reviewed
available operations between 2013 and 2021 at our centre, and
compared outcomes between open, laparoscopic,
laparoscopic-assisted (LA), and laparoscopic-converted-to-open
(LCTO) operations. The primary outcome was mortality. Our
secondary outcomes were variables that guided decision to operate
laparoscopically versus laparotomy.
Results: 1236 operations were identified; 205 (17%) were either
laparoscopic, LA, or LCTO. 60-day mortality in all laparoscopic groups
was significantly lower at 4.4% compared with 10.0% in the open
group (p-value 0.008). This finding was lost when variables of age, ASA
grade, or pre-operative P-possum mortality were adjusted for.
Conclusion: Laparoscopic surgery was performed on a small, selected
group. It is a safe and valuable choice for many patients, particularly
with upper-GI pathology and may contribute to improved mortality.
However, whilst at first glance laparoscopic approaches to the
emergency surgical abdomen appear to improve mortality, this likely
represents a well-known clinician-led process of selecting patients
with greater fitness and lower predicted pre-operative mortality,
therefore muddying the significance of this apparent benefit. This is
comparable with national data.
Abstract citation ID: znac248.136
WE5.6 Hajibandeh index is more accurate than NELA score in
predicting mortality following emergency laparotomy in
patients aged over 80
Amal Azhar Anwer1, Shahab Hajibandeh2,1, Shahin Hajibandeh3,
Jennifer Waterman1, Bethany Miller1, Louis Evans1, Andrew Maw4
1 2
Department of General Surgery, Royal Glamorgan Hospital, Cwm Taf University
Health Board, Pontyclun, UK
2
General Surgery, Wales Deanery, Health Education and Improvement Wales, UK
3
Hepatobiliary and Pancreatic Surgery and Liver transplant Unit, Queen Elizabeth
Hospital, Birmingham, UK
4
Department of General Surgery, Glan Clwyd Hospital, Betsi Cadwaladr
University Health Board, Rhyl, UK
Aims: To compare performance of the Hajibandeh Index (HI) and
National Emergency Laparotomy Audit (NELA) score in predicting
mortality following emergency laparotomy (EL).
Methods: In compliance with STROCSS guidelines for observational
studies a cohort study was conducted. All patients who underwent EL
Abstracts | v73
between January 2014 and January 2021 in our centre were included.
The performance of HI and NELA score in predicting 30-day and
90-day postoperative mortality were compared. The discrimination of
each test was evaluated using ROC curve analysis, classification using
classification table and calibration using a plotted diagram of the
expected versus observed mortality rates.
Results: Analysis of 700 patients showed that the predictive
performance of the HI and NELA models were comparable (AUC: 0.86
vs 0.87, P=0.557). HI was significantly better than the NELA model in
predicting postoperative mortality in patients aged over 80 (AUC: 0.85
vs 0.72, P=0.0174). The performances of both tools were comparable in
patients with ASA status above 3 (AUC: 0.82 vs 0.82, P=0.9775),
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patients with intraperitoneal contamination (AUC: 0.77 vs 0.85,
P=0.0728) and patients who needed a bowel resection (AUC: 0.85 vs
0.88, P=0.2749). Both tools were comparable in terms of classification
and calibration.
Conclusions: Hajibandeh index is better than the NELA score in
predicting mortality following EL in patients aged over 80. Its
performance is comparable to NELA for all patients, patients with ASA
status above 3, patients with intraperitoneal contamination or
patients who need a bowel resection. We encourage other researchers
to validate HI in predicting mortality following EL.
Abstract citation ID: znac248.137
WE5.7 A Comparison of Small and Large Bites Closure of Fascia
in Midline Laparotomy Wounds: Experience in a District
General Hospital
Rachel Heard, Elmahdi Darbi, Coreen Soh, Jonathan Barker
Blackpool Victoria Hospital
Aims: Small bites (SBC) laparotomy closure (5mm fascial bites, 5mm
apart) is thought to decrease incisional hernia rates compared to large
bites (LBC) closure (1cm bites, 1cm apart). A colorectal surgeon in our
centre changed practice following the STITCH trial. We aimed to
assess whether this change affected outcomes.
Methods: All midline laparotomy patients immediately before and after
the change in practice in 2017 were considered for inclusion. Data on
demographics, co-morbidities, operation details, length of stay (LoS),
complications and outcome were gathered from operation notes and
electronic patient records. Follow up was censored at 12 months to
make groups comparable.
Results: 80 patients were included (38 SBC; 42 LBC), undergoing
laparotomy from August 2014-December 2020. Age, gender and ASA
grade were comparable between groups. 58% SBC; 71% LBC were
emergency cases. LoS was 7 days (range 3–166) for SBC; 11 (5–369) LBC.
Overall wound complication rates were similar (23.7% SBC; 19% LBC,
p=0.61). There were 4 (10.5%) burst abdomens following SBC and 2
(4.8%) following LBC (p=0.21). 1 (2.6%) SBC and 3 (7.1%) LBC developed
incisional hernia at 12 months.
Conclusions: SBC did not result in decreased wound complications:
although incisional hernia rate and LoS were reduced, there was a
(non-significant) higher rate of burst abdomens in SBC. The latter may
reflect a learning curve effect of a new technique. This study suggests
SBC is feasible in a DGH, but long-term outcomes of SBC are yet to
become apparent, which may have affected results in this cohort.
Abstract citation ID: znac248.138
WE5.8 Length of stay in Emergency General Surgery – Time for
a Comprehensive Look at Our Elderly Population
Emma Howie1,2, Michael Helley2, Emma Box2, David Watt2
1
University of Edinburgh
University Hospital Crosshouse, Department of General Surgery, Kilmarnock,
Scotland
Aims: Patients’ Length of stay (LoS) has increased due to increasing age
and co-morbidities. The British Geriatric Society 2020 Position
statement states patients >65 being considered for laparotomy should
have a documented Clinical Frailty Scale (CFS) within 72hrs of
admission and, if >5, should receive Geriatrician lead Comprehensive
Geriatric Assessment (CGA) which improves patient outcomes.
We sought to quantify CFS documentation in Emergency General
Surgery (EGS) patients in a District General Hospital before
implementing a new CGA to improve elderly EGS patient care.
Methods:
v74 | Abstracts
Planning: Business intelligence records of all adult EGS admissions over
1-year were retrospectively interrogated – comparing LoS between age
groups, comorbidity number, discharge destination and whether a
procedure was undertaken.
EGS admissions were prospectively reviewed over 1-month, noting
patients >65 and CFS documentation.
Results: Retrospective: 3962 patients >16 were admitted
January-December 2019. 1317 patients (33%) were >65. Average LoS
was 3.9 days, overall highest LoS was ages 75–84 (8.5 days). Highest
average LoS were >75yr olds requiring supported care at home (15.5
days). LoS varied directly with number of diagnosis codes and
increased if undergoing a procedure.
Prospective: There were 130 EGS admissions in 1 month, 53 (40%)
patients were >65. No patients >65 had a CFS documented.
Conclusions: Increased LoS in EGS is associated with increasing age and
comorbidities - particularly patients > 75 awaiting home-care. BGS
statement concordance to establish prompt frailty assessment is
imperative to improve patient outcomes. Staff education and
surgery-specific CGA note-stickers may improve concordance.
Subsequent analysis to evaluate effectiveness in patient and
economic outcomes is paramount.
Abstract citation ID: znac248.139
WE5.9 Management of acute abdominal pain in children at
District General Hospital (DGH)
Uzma Jalali, Imran Alam, Mazyar Fani
Royal Albert Edward infirmary
Introduction: Children with acute abdominal pain are frequently seen in
paediatric A&E at DGH. Acute appendicitis is the most common surgical
cause of acute abdominal pain in children. Diagnosis and management
can be a problem in the absence of paediatric surgical unit
Methods: A retrospective study was conducted at a busy DGH where
general surgical department is routinely involved in the management
of acute abdominal pain in children. 6 months data was collected
from 01/06/21 to 30/11/21.
Results: 381 patients (5–16 years) attended paediatric emergency with
complaint of abdominal pain. 24% referred to surgeons (females 53%,
mean age 10.9 years). All Presented with pain in RIF, migratory pain
was in 42%. Nausea and vomiting were reported in 38%, loose stools in
10.8% and loss of appetite in 21.7%. Duration of pain vary between 24
hours to 3 weeks. WCC was raised in 32% patients, US was performed
in 21.7%, CT scan in 5.4%, MRI 1%, and 1% had both Ultrasound and MRI.
46.7% did not have any radiological investigations. Appendectomy was
performed in 21% (19) patients including laparoscopic in two. Duration of
stay range from less than 24 hours to 5 days. 46.7% were discharged
within 24 hrs of review, 21.7% stayed for one and only 2% stayed for five
days. 1 patient was readmitted following a post operative collection that
was managed conservatively. 2 referred to tertiary paediatric unit for
complicated appendicitis.
Conclusion: This data proves that paediatric patients with suspected
appendicitis can be safely managed in a surgical unit at DGH.
Abstract citation ID: znac248.140
WE5.10 Death in the early post-operative period: recognising
the concept of non-beneficiality in emergency laparotomy and
modelling its predictors
1 1 2 stress, a lower HRV indicating increased stress. We aim to evaluate the
Hannah Javanmard-Emamghissi , Brett Doleman , Sarah Hare ,
Jon N. Lund1, Gillian M. Tierney3, Susan J. Moug4
1 appendicectomy to determine which step of an operation is most
University of Nottingham
2 stressful and any attributing factors to trainee stress.
Medway Maritime Hospital, Kent
3
Royal Derby Hospital, Derby
4
Royal Alexandra Hospital, Paisley
Background: The publication of data from the National Emergency
Laparotomy Audit (NELA) has resulted in overall improvement in
post-operative mortality rates. However, little is known about the
characteristics of patients that die in the immediate post-operative
period. These patients may represent a missed opportunity for the
consideration of palliation. We describe this specific group of patients
where death occurred within three days of emergency laparotomy,
and investigate predictors of early mortality.
Methods: All patients enrolled in the NELA database from December
2013–2020 were included. Early post-operative death was defined as
all-cause mortality within three days of emergency laparotomy.
Multi-level logistic regression was carried out with potentially
clinically important predictors defined a priori. Frailty was modelled
separately due to missing data.
Results: Four per cent of patients (7,442/180,987) died in the early
post-operative period and 85% were admitted to critical care
post-operatively. Median NELA risk score was 32.4% compared to 3.8%
in the rest of the cohort (p<0.001). One in four patients were
commenced on an end-of-life pathway following laparotomy.
Significant predictors on multivariate analysis included female sex,
increasing age, higher ASA, surgery for intestinal ischaemia or
perforation, hypotension, reduced GCS, urgency of surgery, cardiac
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and respiratory signs (n=178,442). The addition of frailty (n=52,766)
was also predictive (OR 1.37; 95% CI 1.22–1.55) when added to the model.
Conclusion: Early post-operative mortality is associated with
quantifiable predictable factors in addition to the NELA risk score.
This finding has significant implications for the multi-disciplinary
team having shared decision-making discussions with extremely
high-risk patients.
Abstract citation ID: znac248.141
WE5.11 Intra-abdominal actinomycosis - an indolent
masquerader of malignancy
Balaji Jayasankar, Kirolos Abdelsaid, Yasser Abdul Aal,
Andreas Papadopoulos
Maidstone and Tunbridge Wells NHS
Introduction: A 54 years old lady who presented with constitutional
symptoms of lethargy, weight loss and asthenia. She had been
extensively evaluated for a possible gynaecological malignancy but
with no definitive outcome. The symptoms were persistent and a
decision had to be made towards surgery in the present climate of the
covid19 pandemic.
Method: Following oncology multi disciplinary meeting outcome she
was taken up for a total abdominal hysterectomy and bilateral
salpingo-oophrectomy. She was noted to have an incidental finding of
an extensive tumour infiltrating the liver, colon, anterior abdominal
wall and the urinary bladder. A surgical resection with ileostomy was
performed on suspicion of an underlying malignancy.
Results: The histopathological diagnosis revealed a picture of
actinomycosis which had evaded us previously. Following this she
was treated with prolonged course of antibiotics and has recovered
well, thus altering our entire management plan.
Conclusion: Actinomycosis albeit rare is an interesting mimic of
tumours. This case also delves into the on-table decision making
when in doubt about cancer.
Abstract citation ID: znac248.142
WE5.12 Stress During Laparoscopic Appendicectomy: A Study
into the Measurement of Surgeon’s Heart Rate During The
Critical Steps of A Laparoscopic Appendicectomy
James Kersey, Caterina Clements, Sabrina Bezzaa, Karim Jamal,
Dhiren Nehra, Trystan Lewis
Epsom & St Helier University Hospitals
Aims: Heart rate variability (HRV) is a validated marker of physiological
HRV of an on call surgical registrar during a laparoscopic
Methods: An observational study was performed using a commercially
available chest strap to measure HRV. HRV was recorded on different
surgical registrars performing laparoscopic appendicectomy at a DGH.
HRV was analysed during four critical steps: insertion of ports,
dissection of mesoappendix, endoloop placement and ligation of
appendix. Impact of registrar grade and consultant presence were also
evaluated.
Results: 15 recordings from seven different registrar’s (ST3 – ST8) were
obtained. Average heart rate was 74–130bpm. HRV was observed to be
less during port insertion (9.22) and mesoappendix dissection (8.42)
compared to the rest of the operation (9.86) indicating a higher level of
stress. Ligation of the appendix showed an increased HRV indicating
less stress (9.34). A significant difference was observed between ST3/4

and ST5+ grade for mesoappendix dissection (7.39 and 9.46
respectively), the step associated with most stress (p<0.05 using
paired T-test)
Conclusions: HRV is highest during mesoappendix dissection compared
to that of the whole operation. HRV increases after this step showing
that trainees experience increased stress up to and including this step
of the operation. The ST3/4 group showed a significantly lower HRV
during this step compared to the ST5+ group. Consultant presence did
not significantly affect HRV.
Abstract citation ID: znac248.143
WE5.13 Improving Pre-operative Risk Score Assessment In
Patients Undergoing Emergency Laparotomy
Maitreyi Patel, Joel Joy Thomas, Haschmatullah Sarwary
Department of General Surgery, Barking, Havering and Redbridge University
Hospitals NHS Trust
Aim: This audit was conducted with the aim to assess the compliance of
recording of risk (P-POSSUM) scores in patients undergoing emergency
laparotomy, with the objectives being to establish how many patients
required ITU/HDU admission, documentation of P-POSSUM in patients
requiring post-operative critical care admission and, pre operative
P-POSSUM documentation in elderly patients aged >70 years.
Methods: Data of all emergency laparotomies at a DGH were obtained
from electronic theatre records. The first cycle was from 14/02/2021 to
07/03/2021. The results were presented in the Divisional Audit
meeting. Following this, audit cycle was completed with data from 20/
06/2021 to 15/08/2021. Patient notes and theatre booking forms were
reviewed to assess if P-POSSUM score was recorded and analyzed with
Microsoft Excel.
Results: Twenty- three emergency laparotomies were performed
between 14th February 2021 and 7th March 2021. Of these, P-POSSUM
scores were recorded in 21.7% (5 of 23 patients). During the second
cycle, 50 patients underwent emergency laparotomy. Following the
presentation of our audit the compliance to recording P-POSSUM
increased to 64% (32 of 50 patients). Of those patients requiring critical
care admissions, there was a significant increase in the pre-operative
recording of risk scores from 13.33% (2 of 15 patients) to 51.61% (16 to
31 patients).
Conclusion: Our compliance with documentation of risk score pre
operatively in patients undergoing emergency laparotomy has
improved over time. However, there remains a room for
improvement. We recommend encouragement to record P Possum
Scores compulsorily as standard prior to Laparotomies and to
standardize the location of recording scores.
Abstract citation ID: znac248.144
WE6.1 A Sustainable Appendicectomy
Katie Boag1, Timothy Ho2, Aaron Quyn1, Adam Peckham-Cooper1
1
Leeds Teaching Hospitals Trust
2
University of Leeds Medical School
Background and Aim: Equipment consumption is the third largest
contributor to the carbon footprint of surgery. Laparoscopic surgery is
particularly resource intensive. The aim of this quality improvement
project is to reduce the carbon footprint of laparoscopic
appendicectomies performed at this high volume trust.
Methods: The laparoscopic appendicectomy was process-mapped and
carbon footprint calculations performed. Three areas of change were
identified: elimination of single use gowns and drapes, elimination of
peri-operative catheterisation, and rationalisation of the equipment
tray from 119 to 49 items. A staff survey was used to identify practices
and gain feedback on the proposed changes. Changes were
implemented from January 2022. Surgeons are able to ask for a
‘sustainable appendicectomy pathway’ at team brief. Procedures were
monitored for one week.
Results: Survey feedback indicated 100% (n=19) supported the proposed
changes. The interventions save an estimated 7.48kgCO2e and £25.1 per
procedure. No extra equipment was required during the procedures
monitored.
Conclusions: The interventions are predicted to save annually 3.9TCO2e
and £13,081 in the approximately 500 appendicectomies performed in
this trust, and can be extrapolated to many types of procedures.
Support from all members of the operating department is vital to
Abstracts | v75
sustaining the momentum of interventions. Following initial positive
results, changes were extended to only use reusable gowns in one of
the CEPOD theatres which perform around 2400 procedures/year. This
will lead to a saving of at least 6386 disposable gowns/year (1.43T of
waste). Further plans within this trust are to make the ‘sustainable
appendicectomy pathway’ an opt-out decision.
Abstract citation ID: znac248.145
WE6.2 The true cost of pre-operative investigations
Farzan Dholoo1,2, Amanda Shabana1,3, Abigail Burrows1,
Jonathon Horsnell1
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1
Royal Surrey Hospital
2
St Peter’s Hospital
3
John Radcliffe Hospital
Introduction: Pre-Operative Assessment (POA) is an integral part of
surgery. It is essential for pre-operative investigations including
bloods and COVID-19 swabbing. There was concern within the
Breast-Unit that patients may be having unnecessary blood-tests as
part of their POA. This was likely due to POA not having one unified
resource to refer to. Guidance suggests POA uses the patient’s
American Association of Anaesthesiologist’s (ASA) grade, type of
surgery they are undergoing and additional conditions for
determining pre-operative investigations.
Methods: This QIP consisted of 2 cycles. During cycle-1 data was audited
against national guidance to see which blood tests were performed
unnecessarily. After developing a universal-guidance poster and
teaching sessions, a second cycle was performed. Cycle-2 assessed
whether there was a reduction in unnecessary blood tests being
performed.
Results: During cycle-1, 216 pre-operative blood tests were undertaken.
Of these only 99 were required. Therefore 54% of the tests were
unnecessary. This equates to £690.77 over 2-months and if
extrapolated £4144.62 spent, unnecessarily per-year. This represents a
significant cost to the trust and puts needless pressure onto the
laboratory. During cycle-2, after our intervention, there were 57 fewer
tests and 40 fewer, incorrect blood tests. Our intervention therefore
resulted in a £183.46 saving, which over a year equates to £1110.76
saved.
Conclusion: The potential benefits of improving POA include financial
savings, patient autonomy, increased appointment availability and
reduced pressure on the laboratory. In these unprecedented times,
trying to tackle the COVID-19 backlog; we advise all departments to
ensure that clear guidance exists.
Abstract citation ID: znac248.146
WE6.3 This isn’t going to hurt - an ambulatory model of
management of patients with subcutaneous abscesses
reduces use of general anaesthetic and bed days
Rebecca Dru, Asem Ermiah, Bassem Amr, Jessica Barton, Lian Williams,
Marianne Hollyman
Somerset NHS Foundation Trust
Aim: Management of patients with subcutaneous abscesses is
challenging. Once in hospital, the majority require incision and
drainage (I&D), often under general anaesthetic (GA). Patients placed
on emergency lists are frequently superseded, due to being
systemically well, often staying overnight in hospital.
We assessed how the establishment of a nurse-led, ambulatory service
for I&D of abscesses reduced the need for GA, and impacted inpatient
stay.
Method: Multiple digital sources were used to retrospectively
collect data for all patients attending our centre for I&D of
subcutaneous abscess during two time periods: August-October
2019 (prior to establishment of the ambulatory service) and
August-October 2021 (a year after implementation of the service).
Location I&D performed, mode of anaesthesia and length of stay
were collected.
Results: In 2019, 102 patients underwent I&D; 87(85%) were drained
under GA. In 2021, 73 patients were managed with I&D, but only
41(56%, p<0.001) required GA; 6(15%) cases were accommodated on a
day surgery list.
In 2019, 37(36%) patients were managed without overnight stay; in 2021
this rose to 46(63%, p<0.001).
v76 | Abstracts
Extrapolating if an average of one patient requiring I&D attended each
day, estimated bed days used per year dropped from 440 in 2019, to
215 in 2021.
Conclusion: Establishment of a nurse-led ambulatory pathway for I&D
of skin abscesses safely and effectively reduces the number of general
anaesthetics and inpatient bed days, potentially by half. Patients
requiring anaesthetic support should be accommodated on planned
day case lists where possible.
Abstract citation ID: znac248.147
WE6.4 Antimicrobial Stewardship in General Surgery
Christopher Leiberman1,2, Georgis Kizis1
1
Forth Valley Royal Hospital
2
Queen Elizabeth University Hospital
Aims: National guidance states that prolonged treatment of gentamicin
must be discussed with an infection specialist or microbiology if it is to
continue beyond 3 to 4 days. This project aimed to audit gentamicin
prescribing in a General Surgical ward, against national guidelines and
improve prescribing practice.
Methods: Data was collected prospectively over the course of seven
days. General surgical admissions were analysed for any gentamicin
therapy received, how many days of treatment were received, and if
discussion with a specialist occurred if they received prolonged
treatment.
A novel sticker was introduced in patient notes to notify clinicians to
review gentamicin therapy where appropriate. Data was re-audited 6
weeks later after interventions were introduced.
Results: Initially, 12 patients were identified as receiving gentamicin. Of
these, 5 patients received prolonged treatment, 0 of whom had any
formal discussion with a specialist documented.
After interventions were introduced, 12 patients were again identified
as receiving gentamicin. Of these, 2 received prolonged treatment,
100% of whom were discussed with a specialist and the decision was
made for prolonged treatment in the absence of alternatives.
Conclusions: This small audit identified an area of improvement with
regards to the prolonged treatment of gentamicin. A simple
intervention proved to be effective and managed to improve
prescribing practice by 100%.
Abstract citation ID: znac248.148
WE6.5 Back to the future: Does increasing the proportion of
local anaesthetic inguinal hernia repairs help achieve a
#NetZeroNHS?
Henry Robb1,2, Jonathan Gan1, Jasmine Winter-Beatty1,2,
Simon Dryden1, Patricia Ortega2, Sanjay Purkayastha1,2
1 2
Department of Surgery & Cancer, Imperial College London, London, UK
2
Imperial College Healthcare NHS Trust, London, UK
Aim: To investigate whether increasing the proportion of local
anaesthetic (LA) inguinal hernia repairs (IHR) provides benefit across
the sustainability ‘triple bottom line’ of environmental, financial, and
social improvement.
Methods: After establishing suitability criteria for LA IHR, the IHR
waiting list was screened and 20 patients were deemed suitable for LA
repair. Data was collated on clinical outcomes, surgical timings,
medical equipment usage and patient satisfaction. Trust data on our
pre-pandemic (2019) practises was analysed to provide environmental
and financial estimates.
Extensive carbon footprinting was performed of the resources used in
LA and general anaesthetic (GA) cases.
Results: Of the 20 cases identified, 10 IHRs were performed under LA and
10 under GA. LA IHR had a 53.2% shorter length of stay (LOS) and a 40%
reduced complication rate. Analysis of our 2019 data mirrored this with
the LA IHR patients having a 4.75-hour shorter LOS. In 2019, only 27.7%
of cases were performed under LA, far below that in published literature
(Sanjay 2007) of 64%.
LA IHR saved 10.2kgCO2e/case. If we increased our annual LA rate to
64%, we would save 2005.12kg/CO2e/year. Financially, our trust would
save £15, 984.54/year. Our patient surveys did not identify a difference
in quality-of-life outcomes, however our improved clinical outcomes
support the superiority of LA IHR for patients.
Conclusion: Increasing the number of LA IHRs would provide
significant benefits across the triple bottom line. Our carbon
emission savings alone is equivalent to driving from London to
Edinburgh 12.5 times.
Abstract citation ID: znac248.149
WE6.6 Does Nexobrid improve healing outcomes in treatment
in adults with partial thickness burn compared to standard of
care? A meta-analysis
Anja Imsirovic1, Ceri Butler1, Paul Drake2
1
Brighton and Sussex Medical School
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2
Queen Victoria Hospital NHS Trust
Aims: Burns are usually associated with significant morbidity and mortality
due to dysfunction and disfigurement. Non-fatal burns usually contribute to
morbidity via burn wound infection, systemic sepsis, multiple organ failure,
pneumonia etc. leading to prolonged hospitalization. The objective of this
study is to present a systematic review of the role of enzymatic
debridement in healing outcomes compared to standard of care
(debridement and skin grafting) in adult patients with burns.
Methods: A systematic review of randomized controlled and
case-control studies reporting and comparing healing outcomes of
Nexobrid with the standard of care, published on Embase, Medline,
PubMed, Google Scholar and Cochrane databases in the period from
1946 until August 2021 was performed. Relevant studies were
extracted and analysed with the help of Review Manager.
Results: The database search identified thirteen articles that met
inclusion criteria. A combined number of 441 patients were included.
Nexobrid application average time was one day. The combined mean
of total body treated mean surface was 6.5%. Studies investigating
Nexobrid mention the combine average success of debridement of
82.8%. The forest plots favour the current evidence of Nexobrid
shortens time from injury to intervention, reducing the need for
surgery, hence shortening the length of hospital stay.
Conclusions: This systematic review provides the current results of
Nexobrid usage for enzymatic debridement of partial thickness to
deep dermal burns. Further randomized controlled trials or feasibility
studies are warranted to open new horizons for this modality of burns
treatment.
Abstract citation ID: znac248.150
WE6.7 Abdominal X-rays in Emergency Department:
Assessing compliance with RCR iRefer guidelines in a Tertiary
Hospital’s Emergency Department
Oscar Nolan1, Robert Anderson1, Lewis Gall1, Khurram Khan1,2
1
Glasgow Royal Infirmary
University of Glasgow
Aims: Attendance of adult patients to the Emergency Department (ED)
with acute abdominal symptoms is common. Abdominal X-ray (AXR)
is commonly the first line of imaging preformed. Our aim was to audit
the indication(s) of AXR against Royal College of Radiologists (RCR)
iRefer guidelines.
Methods: A retrospective cohort study of consecutive adult patients
who had AXR in the ED of a busy tertiary hospital. The study period
was from 1st October 2021 to 30th November 2021. Paediatric patients
(< 16 years) and AXR performed out with the ED were excluded from
the study. Patient’s demographics and the indication for AXR were
analysed. The indications were audited against the RCR iRefer AXR
guidelines (8th edition, 2017).
Results: A total of 295 patients were included in the study. 171 (58.0%)
were female and median age was 64 years (16–96). 170 (57.6%) were
performed out of hours. Median time delay from request to AXR
preformed was 31 minutes.
The indications for AXR were: perforation/obstruction 78.3%; renal colic/
foreign body 6.8%; constipation 4.7%; acute exacerbation of IBD 1.6% and
palpable mass 1.0%. Overall, 92.9% of AXR requests were compliant with
iRefer guidelines.
Conclusions: The compliance with RCR iRefer guideline is high in ED.
However, there is room for improvement and ongoing education for
junior doctors and dissemination of the latest RCR iRefer guideline
will ensure that high standards are achieved and maintained.

Abstract citation ID: znac248.151
WE6.8 An audit to look at the current practice of treating
ureteric stones and compare it to NICE/ BAUS guidelines
Avneet Minhas, Basil Moss
Chesterfield Royal Hospital
Aim: An audit to look at the current practice of treating ureteric stones
and compare it to NICE/ BAUS guidelines.
Methods: A retrospective audit looking at treatments given to patients
presenting to the emergency department with renal colic. We looked
at the time it took for patients to get a CT scan from the time of
admission, the treatments provided to them as an inpatient, the
subsequent outpatient follow-up, and the timescale within which
these were provided.
Results: A total of 50 patients were included. The average time it took for
patients to get a CT scan from the time of admission was 16hours and 31
mins. Only 6% (3) of patients received definitive surgical treatment
during their inpatient admission. 62% (31) of patients were treated
conservatively, 26% (13) were treated with a ureteric stent, and 4% (2)
with a nephrostomy. At follow-up, in patients managed
conservatively, stone had passed spontaneously in 58% and remained
in 35.5% of patients. Patients treated with interim measures like stent
or nephrostomy had to wait approximately 7 weeks on average after
their inpatient treatment for definitive management.
Conclusion: Majority of patients were able to get a CT scan within the
24-hour target. Reasons for delayed definitive management could be
not having access to suitable operating theatres or lack of trained staff
to use the laser or assist with emergency stone treatments.
Overcoming these obstacles could potentially lead to substantial cost
savings on a population level and avoid subjecting patients to
unnecessary second procedures and longer waiting periods.
Abstract citation ID: znac248.152
WE6.9 Enoxaparin venous thromboembolism prophylaxis in
bariatric surgery: A best evidence topic update
Bavin Pathmaraj1, Chetan Parmar2, Pratik Sufi2
1 Data was collected on wound morbidity, if an MRI was required and if
Division of Surgery and Interventional Sciences, University College of London
2 patients required clip removal.
Whittington Hospital, London, UK
Aim: To examine the literature and identify the best dosing regimen of
enoxaparin for perioperative venous thromboembolism (VTE)
prophylaxis in patients undergoing bariatric surgery. This
presentation reviewed publications from 2015 to 2021 to determine
whether previous recommendations based on a similar examination
of evidence conducted in 2015 needed to be updated, considering new
evidence.
Method: A literature search was conducted in accordance with a
structured format. One hundred and one papers were identified using
a standardised literature search from 2015 to 2021 on Medline and
EMBASE using the same search terms “bariatric surgery” AND “venous
thromboembolism” AND “enoxaparin”. The author, date and country
of publication, patient groups and VTE prophylaxis strategy, level of
evidence, outcomes, key results and study weaknesses were tabulated.
Results: Three studies were selected as the best available evidence to
answer the question. All three articles were non-randomised cohort
studies analysing VTE and major bleeding rates following different
bariatric thromboprophylaxis regimens. There was still no level 1
evidence available to answer this question.
Conclusion: Enoxaparin 40mg/day starting 12 hours after the operation,
continuing for at least one week post-discharge may be the best
enoxaparin dosing regimen for VTE prophylaxis in bariatric surgery
patients based on the best evidence available to 2021. New evidence
suggests that the previously recommended 40mg enoxaparin twice
daily for in-hospital patients may increase major bleeding risk. A
Randomised Controlled Trial would probably require 3500 patients in
each arm to identify the best enoxaparin dosing regimen.
Abstract citation ID: znac248.153
WE6.10 Gender Balance at Surgical Meetings in Ireland
Martin Safari Aketch, Ryan Leon, Yazan Qaoud, Andrew McGuire,
Arnold D.K. Hill
Beaumont Hospital, Dublin 9
Abstracts | v77
Aim: To assess the genders of lead authors and primary investigators in
major surgical research meetings over a 10-year period in Ireland.
Method: We gathered data from the 3 main surgical conferences in
Ireland. We looked at the abstracts of each of the plenary sessions
over the last 10 year. We used the Irish Medical Council, previous
published research from these authors and ResearchGate to help
identify the gender of the author. We complied and analysed the data
using Excel.
Results: We analysed 306 papers over the last 10 years. We found that
the primary investigator was male in 78% of the papers and female in
20%. The primary author was male in 52% and was female in 46% of
the papers. There has been little change over each 5-year interval for
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who was the primary investigator. In 2010–2015, it was 77% male and
23% female while from 2016–2020, it was 82% male and 18% female.
Furthermore, in relation to the primary author, it has shifted from being
relatively equal to becoming more male dominant. In 2010–2015, it was
52% female and 48% female while from 2016–2020, it was 57% male and
43% female.
Conclusion: The gender gap has appeared to have widened at the
non-consultant hospital doctor level and it is very apparent that there
is a large inequality at consultant level regarding surgical research in
Ireland.
Abstract citation ID: znac248.154
WE7.1 Getting it right first time: a standardised approach to
closure of trauma laparotomy
Jennifer Allan, Etain McGuinness, Susan Yoong
Royal Victoria Hospital, Belfast Health and Social Care Trust
Aims: Surgical site infection (SSI) has been reported between 12–14%
following trauma laparotomy. It became apparent in a regional
trauma center that 25% of trauma patients required an MRI within 10
days of admission and point of potential trauma laparotomy leading
to the morbidity of non-MRI compatible clip removal and reclosure of
the wound. The aim was to ensure all trauma laparotomies
underwent closure with MRI compatible clips.
Methods: A retrospective data collection was performed of patients
undergoing trauma laparotomies between July and December 2021.
Results: 16 patients underwent trauma laparotomy between
July-December 2021. 25% of these patients had an MRI performed
within 10 days of their laparotomy, (median 3days), 3 of these
required removal of clips. 1 of these patients developed a SSI requiring
negative pressure therapy.
Conclusion: This QI project led to the introduction of a unit approved
damage control laparotomy trolley with all potential essential
equipment to allow instant availability including only MRI compatible
clips. The project also led to a qualitative improvement of improved
team morale due to teaching sessions for theatre nursing staff on
importance and use of all these instruments. Outcome measure data
is currently being collected to ensure compliance with trolley usage
and MRI compatible clips negating the morbidity of reclosure of
wound as well as the process measure of staff satisfaction of
equipment knowledge and availability during a trauma laparotomy.
Abstract citation ID: znac248.155
WE7.2 The development of a rib fracture pathway in a district
general hospital to improve patient care
Justin Collis, Barnaby Farquharson, Richard Dickson-Lowe, Shirley Chan
Medway Maritime Hospital
Our aim was to evaluate the management of rib fractures under the
general surgical team over a 1-year period. To compare our practice
against a standard we reviewed rib fracture pathways from several
NHS teaching hospitals. In doing so develop a rib fracture pathway
that addressed the needs of our hospital.
A retrospective review of paper notes and electronic databases of
patients with a recorded diagnosis of ‘rib fractures’. We collected data
points on; mechanism of injury, analgesia strategy, pain team review,
dietician review, whether a nerve block was used and baseline
characteristics. Our project used the rib fracture STUMBL to determine
prognosis and collected the relevant data for this score.
A total of 42 were included in our statistical analysis. Of the patients
v78 | Abstracts
analysed 44% were older than 65 years old. The average length of stay for
each patient was 5 days. For analgesia 89% received regular
paracetamol, 41% received regular NSAIDS and 69% received regular
opioids. Advanced analgesia such as PCA and nerve blocks were
poorly used, for instance a PCA was used in only 13% of cases. Only
6% of patient received daily pain team review and 44% of patients
were seen by physiotherapist within the first 24hours. Additionally
93% of patients that were admitted under general surgery had a
STUMBL score >11.
We attributed areas of poor compliance to certain areas of best practice
as a lack of awareness on how to access resources within our hospital.
As a result we developed a pathway outlined best practice.
Abstract citation ID: znac248.156
WE7.3 Splenic abscess formation following selective splenic
embolisation for a traumatic splenic injury and its subsequent
conservative management
Justin Collis, Barnaby Farquharson, Oreolow Bajomo, Simon Lascelles
Medway Maritime Hospital
Splenic injuries are the most commonly injured organ following blunt
abdominal trauma1. Current standard of care for a haemodynamically
stable patient is non operative management (NOM). Although selective
arterial embolization (SAE) is a useful adjunct in NOM, the
complications from this intervention and subsequent management are
poorly detailed in the literature4. This report describes the development
of a splenic abscess post SAE for a traumatic splenic injury. A
50-year-old haemodynamically stable blunt trauma patient with a grade
IV splenic laceration and concomitant rib fractures was treated
conservatively with SAE. Post embolization the patient’s haemoglobin
and inflammatory markers remained stable and he self-discharged on
day 5. He returned 3 days later with abdominal pain, a repeat CT
demonstrated a left sided pleural effusion and his subcapsular
haematoma had increased in size, but inflammatory markers and
haemoglobin remained stable. He was admitted for monitoring. During
admission he reported increasing abdominal pain and his inflammatory
markers had drastically worsened, CRP 340 (60) and WBC 14 (7). A repeat
CT demonstrated a splenic abscess and worsening of his pleural
effusion. He was taken for IR drainage, which led to an immediate
improvement of his pain and resolution of his pleural effusion after
2-weeks. This case report of a post SAE abscess following a splenic
injury is unique because the patient did not demonstrate typical signs
of infection. It was serial monitoring of bloods and early repeat cross
sectional imaging that facilitated a timely diagnosis, allowing us to
avoid a splenectomy, thus preserving splenic function.
Abstract citation ID: znac248.157
WE7.4 A Systematic Review of Splenic Viability Following
Arterial Embolisation in Trauma
Ketan Dhital
Barnsley Hospital
The spleen is the most commonly injured organ in blunt abdominal
trauma. Patients with these injuries are increasingly being managed
nonoperatively, with use of Splenic Artery Embolisation (SAE). Many
of these patients receive lifelong prophylactic antibiotics as though
they were asplenic.
The aim is to seek robust evidence of splenic vascular integrity and
immunocompetence following SAE, and consider whether lifelong
antibiotic prophylaxis is necessary for trauma patients managed in
this way.
2 separate literature reviews were carried out using the Medline
database. One to assess literature pertaining to splenic tissue viability
following embolisation, the other to find literature reviewing splenic
immune function after embolisation.
In the vascular viability arm, 21 articles were reviewed. 12 studies
observed no splenic infarcts at all. 18 of the studies noted <10%
splenic infarcts in their populations. Distal embolisation resulted in
more infarcted areas of splenic tissue than proximal. 9 studies
performed follow-up imaging and confirmed splenic tissue viability
post-procedure.
For the review of immunocompetence, the literature search resulted in
13 full text articles. There was no consistency of the immunologic
marker used to test splenic immunocompetence post-SAE, but 11 of
13 studies confirmed preserved immunocompetence by their
respective markers.
The data do suggest preserved tissue viability and immunocompetence.
Agreement is yet to be reached as to which immune marker definitively
assesses immunocompetence, and the length of follow-up needed to
investigate it. More research is required to confirm the suggestion
from these data that lifelong antibiotic prophylaxis is unnecessary for
trauma patients treated with SAE.
Abstract citation ID: znac248.158
WE7.5 Hand trauma Tetanus Immunisation: a tertiary trauma
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centre experience
Amir Labib, Nga Nguyen, Jamie Banks, Jamil Moledina
St. George’s University Hospitals NHS Trust
Aims: To evaluate adherence of hand trauma service at a tertiary
trauma centre to Public Health of England guidance on tetanus
immunisation.
Methods: Prospective data collection of all adult hand trauma injuries
between March and June 2021. The first cycle was conducted within
the first two weeks of March followed by the introduction of a tetanus
immunisation booster flowchart based on the Public Health England
guidance. The second cycle was conducted within the first two weeks
of June.
Results: Of 435 cases reviewed, 380 patients met the inclusion criteria.
69% of cases were male with a mean age of 40 years. Laceration via a
sharp object was the most common mechanism of injury followed by
machine-related injury representing 44% and 21% respectively. Soft
tissue lacerations were by far the most common injury representing
46% of cases. This is the percentage of unnecessary prescription of
tetanus booster doses in patients presented with clean wounds falls
from 80% in the first cycle to 17% in the second cycle. This reflected in
saving the trust £693 within just the period of the first two weeks of June.
Conclusions: The use of an easy-to-follow chart for tetanus
immunisation when dealing with hand trauma patients led to a
significant reduction of unnecessary prescriptions and costs.
Abstract citation ID: znac248.159
WE7.6 Failure of intensive monitoring in high grade blunt
splenic injury: an important consideration beyond NOM failure
Sheah Lin Lee1,2, Joe Long2, George Rizkallah2, Sachin Modi2,
Hassan Elberm2
1
University of Southampton
2
University Hospital Southampton
Aims: Non-operative management (NOM), including intensive
monitoring (IM) and angioembolisation (AE), is the standard of care for
haemodynamically stable patients with blunt splenic injury to
preserve spleen and it’s function. Internal review of local Level 1
Trauma Center revealed a NOM failure rate of 4.4%, but an IM failure
rate of 16.2% in high grade blunt splenic injury (HGBSI). Age, Injury
Severity Score (ISS) and moderate to severe injuries are predictors for
NOM failure. However, predictors of IM failure, which can be
successfully treated with AE, is not well understood, motivating the
current study.
Methods: Patients with BSI are identified from Trauma Audit and
Research Network (TARN) databse from 2015–2020. Clinical,
biochemical and radiological data were collated from TARN database
and electronic medical records. HGBSI is defined as AAST grade III to V.
Results: Sixty-eight patients with HGBSI were identified. Seventy-eight
percent (n=53) were initially managed with IM, with 21% (n=11)
requiring subsequent interventions. Majority who failed IM were
involved in road traffic accident compared to other causes
(p-value=0.035). In addition, a higher proportion had systole blood
pressure<90mmHg (p-value=0.033) and pH<7.2 (p-value=0.038) at
presentation. AAST grade, ISS or age did not influence requirement for
further intervention. Nine of the eleven patients were treated
successfully with AE.
Conclusion: Understanding predictors of IM failure will enable better
selection of patients for AE at initial presentation, leading to potential
reduction in duration of IM, length of stay and blood transfusion.
Preliminary work using machine learning algorithm to predict IM
failure with larger dataset is on-going.

Abstract citation ID: znac248.160
WE7.7 Bone transport using the Monorail External Fixator over
an Intramedullary Nail for Post-Traumatic Femoral Defects
Victor Lu1, James Zhang1, Andrew Zhou1, Matija Krkovic2
1
University of Cambridge
2
Addenbrooke’s Hospital, Cambridge
Aim: The management of limb-length discrepancy secondary to
traumatic bone loss poses an unique challenge for surgeons. The
Ilizarov technique is popular, but is associated with long external
fixator time and many complications. This retrospective study
assessed outcomes of post-traumatic femoral defects managed by
monorail external fixation over an intramedullary nail.
Method: Eight patients were included from over a four-year period with
post-traumatic femoral defects, that underwent treatment with
monorail fixator-assisted intramedullary nailing. Mean follow-up time
was 232.83 weeks. Five were open fractures (Gustilo-Anderson type
3A:n=4, 3B:n=1), one had closed fracture. Average bone defect size
was 8cm. Primary outcomes were lengthening index, consolidation
time and index, external fixator index. Secondary outcomes were time
to full weight bearing (FWB), time to union, complications. Patient
reported outcome measures including EQ-5D-5L, SF-36, Oxford knee
scores (OKS), Oxford hip scores (OHS) were recorded after recovery.
Results: Average consolidation time and index were 11.35months and
1.24months/cm, respectively. Mean lengthening and external fixator
index were 20.2days/cm and 23.88days/cm, respectively. On average,
patients achieved FWB and bone union 56.25 weeks and 68.83 weeks
after bone transport initiation, respectively. Two patients had docking
site non-union, treated by reamed intramedullary exchange nailing.
Two patients had osteomyelitis. EQ-5D-5L and EQ-VAS scores were
compared to UK population norms (p=0.104, p=0.238, respectively).
Average OKS was 32.17 and OHS was 34.00.
Conclusions: Monorail external fixation over an intramedullary nail is
an effective option for post-traumatic femoral defects, reducing
external fixator time, lowering complication rate, returning patients’
quality of life to a level comparable with the normal population.
Abstract citation ID: znac248.161
WE7.8 Neck of Femur Fractures with Co-existent History of
Malignancy: Do Full-length Femur X-Rays Change Fixation
Method?
Thomas MacKinnon, Mosab Ahmed, Sophia Hashim, Raj Bhattacharya
Imperial College London NHS Trust
Introduction: In neck of femur (NOF) patients presenting with
co-existent history of malignancy, it is regarded as good practice to
obtain pre-operative full-length femur X-Rays (FLF-XRs) to identify
metastatic disease distal to the fracture site and aid operative
planning. Whether the availability of pre-operative FLF-XRs in the
trauma meeting influences the surgeon’s choice of fixation method
between intramedullary nail (IMN) or dynamic hip screw (DHS), is
unclear.
Methods: We performed a retrospective analysis of all NOFs that
underwent surgical fixation at a major London hospital over a
3-year period (2018–20), and collected data on history of any
malignancy, FLF-XR status and fixation method (IMN vs DHS). Our
results showed that of the 308 extracapsular NOFs during this time
period, 23% had a history of malignancy, and of these, 55% had
undergone FLF-XRs. NOFs with co-existent history of Ca who had
undergone FLF-XR were more likely to undergo IMN fixation than
DHS to a statistically significant degree (p<0.05) than those who did
not, despite only 3% of these radiographs demonstrating distal
femoral metastases.
Results: The findings of this preliminary audit raise questions around
the value of FLF-XRs in NOFs with co-existent malignancy,
particularly if IMN fixation is opted for in the majority of cases
despite normal radiographs. The next phase of this study is to
establish whether IMN/DHS fixation, with or without pre-operative
FLF-XRs, amongst this cohort correlate to better or worse
complication rates.
Abstracts | v79
Abstract citation ID: znac248.162
WE7.9 Triage in Terror-Related Major Incidents
Nabeela Malik1,2, Yuanwei Xu3,1, Saisakul Chernbumroong4,2,
Douglas Bowley5,1, Timothy Hodgetts6, Georgios Gkoutos3,1
1
NIHR Surgical Reconstruction and Microbiological Research Centre, University
Hospitals Birmingham NHS Trust
2
Institute of Inflammation and Ageing, University of Birmingham
3
Institute of Cancer and Genomic Sciences, University of Birmingham
4
NIHR Surgical Reconstruction and Microbiological Research Centre, University
Hospitals NHS Trust
5
Academic Department of Military Surgery & Trauma, Royal Centre for Defence
Medicine
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6
Academic Department of Military Emergency Medicine, Royal Centre for Defence
Medicine
Introduction: Recent major incidents (MI) in the UK have involved
intentional explosions or indiscriminate attacks by perpetrators with
bladed weapons. At a MI, on-scene triage vitally identifies those needing
time-critical surgery and/or resuscitation (Priority 1, or P1, casualties),
facilitating urgent transfer to specialist care. Currently, the National
Ambulance Resilience Unit (NARU) Triage Sieve is used. We interrogated
the Trauma Audit and Research Network (TARN) registry to compare
performance of MI triage tools in predicting P1 status amongst adults.
Methods: TARN patients aged ≥16 years with penetrating and blast
injury (January 2008-December 2017) were assigned triage categories
(P1, P2, P3, Expectant or Dead) using pre-defined, intervention-based
criteria. Ten MI triage tools were applied to patients’ first pre-hospital
observations. Tool-predicted and intervention-based P1 assignments
were compared.
Results: Of 5,660 patients, 5,635 (92%) suffered penetrating injuries, 25
(0.4%) sustained blast injuries. Mortality was 3.1% (n=171); median
Injury Severity Score was 9 (IQR 9–16). 2,639 (46.6%) patients fulfilled
P1 criteria: 1,170 (44.3%) required life-saving and 209 (7.9%) required
limb-salvage surgery within 4 hours. The NARU Triage Sieve
demonstrated sensitivity of 32.2%, over-triage 40.3% and AUC 0.566
(95%CI 0.555–0.578). The tool best-able to identify P1 casualties was
the Battlefield Casualty Drills (BCD) Triage Sieve (sensitivity 68.0%,
over-triage 47.3%, AUC 0.573 [95%CI 0.561–0.586]).
Conclusions: Terrorist attacks characteristically yield a high proportion
of patients requiring urgent surgery. The current UK MI triage tool in
use, the NARU Triage Sieve, exhibits unacceptably low detection of P1
casualties; we recommend it is superseded by the BCD Triage Sieve.
Abstract citation ID: znac248.163
WE7.10 Traumatic abdominal wall hernia and CT missed
severe intra-abdominal injuries
Mariana Rita Afonso Matias, Leslie Hunt
Sheffield Teaching Hospitals, NHS Foundation Trust
Despite traumatic abdominal wall hernia (TAWH) being a rare entity,
the incidence of associated intra-abdominal injuries is extremely
common. With only few cases published, TAWH remains a diagnostic
as well as a therapeutic challenge.
We present an obese 47-year-old female, front seat passenger, that was
transferred to our hospital from a neighbouring DGH with a diagnosis of
TAWH after a 30mph road traffic collision. On arrival, she was
haemodynamically stable, abdominal examination showed a large
hernia, extensive bruising but the abdomen was otherwise
unremarkable. The CT performed before transfer showed a large hernia
but no obvious other injury, no free fluid or gas was identified. Hernia
repair was planned for the following day. Overnight there was a transient
period of hypotension responsive to transfusion of multiple RBC units.
The surgical approach was over the hernia site. Within the sac a
transected end of small bowel was found and so laparotomy was
undertaken, which demonstrated a bucket handle mesenteric tear of
terminal ileal mesentery with infarction of 20 cm of small bowel and a
complete transverse tear of mid sigmoid colon and its mesentery.
Remarkably there was no intraperitoneal contamination from either injury.
Our clinical case highlights that although the CT scan is the
gold standard for initial diagnosis of intra-abdominal injuries in
v80 | Abstracts
TAWH, these can still be missed. To note that failure to make a
timely diagnosis can result in delayed complications with
significant morbidity and mortality. Therefore, a high clinical
suspicion, despite of negative imaging, is crucial to provide
appropriate management.
Abstract citation ID: znac248.164
WE7.11 Robotic-assisted versus conventional total knee
arthroplasty: A Systematic Review and Meta-analysis
Kaif Qayum, Irfan Kar, Ghulam Nawaz
Hereford County Hospital
Aim: To compare robotic-assisted total knee arthroplasty (TKA) and
conventional TKA on both long-term and short-term follow-up.
Methods: For conducting this study, we searched four electronic
databases. The outcomes were pooled as mean difference (MD) or risk
ratio (RR), and 95% confidence interval. We used RevMan for
performing the analysis.
Results: We included nine studies. The data showed a significant
favoring of robotic-assisted TKA than the conventional one in
mechanical alignment, Western Ontario and McMaster Universities
Osteoarthritis Index (WOMAC), and femoral coronal outliers (MD=
-1.10, 95% CI [-1.51, -0.69], p<0.00001), (MD= -1.19, 95% CI [-2.35, -0.03],
p=0.04), and (RR= 0.49, 95% CI [0.30, 0.80], p=0.004) respectively. On the
other hand, the conventional TKA was better in range of
motion-flexion (long-term) than the robotic-assisted one (MD= -3.02,
95% CI [-3.68, -2.37], p<0.00001). However, there were no significant
differences between them in knee society score-knee score, knee
society score-function score, change in hospital for special surgery,
and change in range of motion-extension (MD= -0.36, 95% CI [-2.43,
1.70], p=0.73), (MD= -0.34, 95% CI [-2.36, 1.68], p=0.74), (MD=0.78, 95%
CI [-0.84, 2.40], p=0.34), and (MD=0.16, 95% [-1.32, 1.64], p=0.83)
respectively.
Conclusion: Robotic-assisted TKA had better outcomes than
conventional TKA regarding mechanical alignment and WOMAC.
However, the conventional approach showed a better range of
motion-flexion in the long term. More data is needed for the
long-term outcomes.
Abstract citation ID: znac248.165
WE7.12 The changing management of penetrating liver
trauma at a tertiary referral centre in the North West of
England over a 20-year period
Harriet Reader1,2, Raimundas Lunevicius1
1 1
Department of General Surgery, Liverpool University Hospitals NHS Foundation
Trust, Cheshire and Mersey Major Trauma Centre Collaborative, Aintree
University Hospital, Lower Lane, Liverpool, UK
2
North West Schools of Surgery, Health Education England, Regatta Place,
Summers Road, Brunswick Business Park, Liverpool, UK
Background: In the context of penetrating liver trauma (PLT), the liver is
the second most commonly injured intra-abdominal organ. Our
institution has served as a regional Major Trauma Centre (MTC) since
2012. This study aims to review trends in PLT presenting to our
institution and how management has changed over time.
Methods: This was a single-centre, retrospective cohort study using
data obtained from the Trauma Audit and Research Network (TARN)
database across a 20-year period (2000–2020).
Results: 77 patients presented with PLT; 21 prior to MTC status in
2012 and 56 after. Median age was 26.8, M:F ratio was 6.9:1 and
median Injury severity score (ISS) was 14. Stabbing was the most
common mechanism of injury (n=53, 68.8%), followed by shooting
(n=22, 28.6%). 24 patients were managed conservatively (31.2%) and
5 patients underwent angioembolisation. Prior to becoming an MTC
in 2012, 19% of patients (4/21) were managed non-operatively and
this increased to 50% (28/56) when the MTC was established (P <
0.05). Understandably, there was a significant increase in injury
severity in the post-MTC era (mean ISS 11.75 with SD=2.8 vs 17.9
with SD=2.1). The mortality in the conservative group was 20.7%
(n=6) vs 8.3% in the operative group. Overall mortality from PLT
was 11.7%.
Conclusion: There was a statistically significant increase in
non-operative management of PLT since the MTC was established,
there has been no observed increase in mortality during this period.
Abstract citation ID: znac248.166
WE7.13 Blunt Hepatic Trauma at a Major Trauma Centre in the
North West of England between 2000 and 2020
Harriet Reader1,2, Raimundas Lunevicius3
1
1Department of General Surgery, Liverpool University Hospitals NHS
Foundation Trust, Cheshire and Mersey Major Trauma Centre Collaborative,
Aintree University Hospital, Lower Lane, Liverpool, UK
2
North West Schools of Surgery, Health Education England, Regatta Place,
Summers Road, Brunswick Business Park, Liverpool, UK
3
Department of General Surgery, Liverpool University Hospitals NHS Foundation
Trust, Cheshire and Mersey Major Trauma Centre Collaborative, Aintree
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University Hospital, Lower Lane, Liverpool, UK
Background: Our institution became a Major Trauma Centre (MTC) in
2012, currently serving a population of 2.3 million. This study aims to
evaluate the trends in blunt hepatic trauma (BHT) and the changes in
management strategy over time (pre- and post- MTC era).
Methods: This was a single-centre, retrospective cohort study. Data
were obtained from the Trauma Audit and Research Network (TARN)
database across a 20-year period (2000–2020).
Results: 209 patients presented with BHT: 31 in 2000–2011 and 178 in
2012–2020. The median age was 35.6 and M:F ratio was 2.8:1. Road
traffic accidents (RTAs) were the most common mechanism (n=124,
59.3%), followed by fall from height (n=44, 21.1%). Patients had a
median ISS of 25 (range 4–75). 109 patients were managed
conservatively (52.5%), with 10 of these patients having
angioembolisation. Although 100 patients (47.8%) underwent
operative management, only 7 patients underwent liver surgeries
such as liver laceration repair (n=7, 3.3%) or resection (n=2, 1%).
Mortality rate was 13.8% (n=44) in the conservative group and 21% in
the operative group. The overall mortality was 16.7% (n=35). The
subgroups analyses revealed no significant difference in mortality for
patients managed non-operatively.
Conclusions: BHT patients frequently present as a polytrauma. Only
3.3% required a laparotomy and intervention to the liver parenchyma.
The establishment of the MTC was associated with a significant
increase in BHT presentations. The proportion of conservatively
managed patients was similar pre- and post-MTC eras. The mortality
rates were not significantly different.
Abstract citation ID: znac248.167
WE7.14 Penthrox is effective but is it patient approved?
Ana Dias1, Ziad Zeidan1,2, Matthew Copp1,2, Frances Eslabra1,2,
Rawan Hassan1, Rory Middleton1
Royal Cornwall Hospital Trust
2
University of Exeter, College of Medicine & Health
Background: Penthrox® is a handheld inhaler that administers
methoxyflurane, approved for analgesia in moderate-to-severe
trauma-related pain in adults in the emergency department (ED). The
literature currently lacks methodologically robust qualitative data on
the individual patient experience. Using a structured qualitative
study, this project set out to address this shortcoming.
Methods: A focus group of five patients was initially contacted to
identify key themes deemed integral to incorporate into the study
questionnaire. All uses of Penthrox® in ED from March to August 2021
were retrospectively identified. Qualitative data was gathered using
the Trickett short interview method with responses grouped into
positive and negative descriptors. In addition, quantitative data using
a 5-point-Lickert scale was also gathered.
Results: The focus group felt that side effects and overall satisfaction
with Penthrox® should be explored. Thus far, 77 respondents have
completed the survey. 91% reported an overall satisfaction ‘≥ Good’,
while 95% reported ease-of-use as ‘≥ Good’. The analgesic
effectiveness of the device was rated as ‘Excellent’ by 52% of
respondents and ‘≥ Good’ by 88%. The most reported side effects were
drowsiness (14%) and nausea (18%); however, most patients (71%)
reported no side effects. Furthermore, 94% of respondents reported
they would use Penthrox again. An NVIVO word cloud was created
visually confirming an overall positive experience.
Conclusions: This study highlights that Penthrox® is a well-tolerated
and user-friendly method of managing acute trauma pain in ED.
Furthermore, it highlights the importance of considering
the individual patient journey alongside robust evidence-based

data on safety and efficacy for the development of a holistic
treatment.
Abstract citation ID: znac248.168
WE8.1 Index admission cholecystectomy with or without
single session bile duct exploration for emergency gall stone
complications neutralised the adverse effects of COVID
Sophie M Tait, Tarek Z Katbeh, Basil Ibrahim, Ahmad H M Nassar
Biliary Surgery Unit, University Hospital Monklands, Lanarkshire, Scotland
Aims: The COVID-19 pandemic impacted surgical practice globally. We
aim to study the effects this had on the presentations, practice and
results of biliary surgery on a unit adopting index admission
laparoscopic cholecystectomy (LC) and single session management of
bile duct stones for emergency presentations.
Methods: Prospectively collected data of biliary surgery over a period of
12 months pre-COVID (PRE) and 12 months post-COVID (POST) was
analysed. The presentation, type of admission, type of operating list
and operative and postoperative data were compared.
Results: 257 LCs were done PRE and 270 POST. All emergency
presentations increased; acute cholecystitis 8.5% to 25.9%, acute
pancreatitis 6.2% to 11.8% and jaundice 22.5% to 27.7%. Elective LC
decreased from 53% to 20%. With an increase in patients with
previous admissions (13.6% PRE vs 20.7% POST), 87% of PRE vs 80%
POST had index admission LC, utilising 192 emergency theatre
sessions and 29 CEPOD lists. In spite of increased LC difficulty grades
(grades 4 and 5 from 20.2% to 30.5%), bile duct explorations (34%),
operating time and median total hospital stay the morbidity,
mortality and median presentation to resolution intervals were not
affected.
Conclusions: Covid-19 caused an increase in all acute biliary
presentations requiring emergency admissions, almost certainly the
result of a significant decline in elective LC. However, similar numbers
of LC PRE and POST were maintained due to a policy of index
admission surgery and bile duct exploration, utilising emergency
theatre scheduling, optimised clinical outcomes in spite of some
logistical parameters being affected.
Abstract citation ID: znac248.169
WE8.2 Has the change in emphasis to conservative
management of appendicitis during the first wave of COVID-
19 had a longer lasting affect on assessment and management
of patients
Rudrik Thakkar, Tom Badnenoch, Angeliki Kosti, Asef Rakin,
Marianne Hollyman
Somerset NHS Foundation Trust
Aims: During the first wave of the COVID-19 pandemic (March-June 2020),
surgeons were advised where possible to avoid operating on appendicitis
due to the perioperative risk for patients and theatre staff. This resulted
in an increase in conservative management and a decreased negative
appendicectomy rate (NAR) (COVID:HAREM). We sought to assess if the
experience in 2020 had changed practice a year on.
Methods: Data collection was undertaken of patients presenting acutely
with appendicitis or clinical appendicitis requiring diagnostic
laparoscopy, using the electronic records. Data was collected over the
same three-month period in 2019, 2020 and 2021. Patient’s electronic
records were reviewed.
Results: In total 174 patients were identified over the three-year period
(59, 46 and 69). Mean age was 42 and 55% were female. The number of
patients undergoing US scans dropped during the pandemic (36%, 26%
and 41%) whereas CT use increased (37%, 63% and 46%). In 2021,
conservative management of patients had not returned to
pre-pandemic levels (5%, 46% and 19%). NAR were 12%, 0% and 5%.
Mean length of stay was unchanged (3.3, 3.9 and 3.5days).
Conclusions: This study demonstrates the change of practice during
and following the first wave of pandemic. In 2020, more patients
were undergoing a diagnostic imaging and fewer patients were
undergoing an operation compared to 2019, demonstrated
improvement in the NAR in 2020. Although these changes have
dampened in 2021, the trend is still present; there is an improved
NAR in 2021 compared to 2019, possibly due to more patients
undergoing CT.
Abstracts | v81
Abstract citation ID: znac248.170
WE8.3 Pandemic Priorities: The Impact of COVID 19 Pandemic
on Ethical Leadership in the Healthcare Profession
Holly Wright, Aya Musbahi
Royal Victoria Infirmary, Newcastle
Leadership priorities within the healthcare setting have been brought
into sharp focus by the Covid 19 pandemic, coinciding with the Black
Lives Matter movement, Me Too movement, PPE shortages and
staffing crises. Appropriately championing the rights of such staff is
imperative. The pandemic necessitates a period of rigorous
self-analysis, recognising past failures, oversights and
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discriminations. Utilising a modified ethical leadership questionnaire,
comparing pre- and post-pandemic views of healthcare leaders on
their own ethical leadership values, this study demonstrates a novel
research into the effects of the pandemic on this topic. Our study has
found significant changes in attitudes of healthcare leaders with
regards to the ethics of justice; fewer leaders were likely to hold
formal investigations and more leaders would follow unwritten rules
relating to an ethical dilemma. They also would pay more attention to
individuals. In addition, in terms of critique, leaders were more likely
post-pandemic to speak out against injustice and unfair practices
although whether this is due to the pandemic solely, or social
movements such as Black Lives Matter and Me Too is yet unknown.
Abstract citation ID: znac248.171
WE8.4 Acute Pancreatitis during COVID-19 Pandemic: An
Overview of Patient Demographics, Disease Severity,
Management and Outcomes in Western Health and Social Care
Trust (Altnagelvin Area Hospital)
Bakhat Yawar, Ahmed Marzouk, Heba Ali, Ayeisha Asim, Tamer Ghorab,
Zahid Bahli, Asim Asim
Altnagelvin Area Hospital
Background: Acute pancreatitis is a common disease requiring
admissions under surgical and critical care units. The two most
common causes are alcohol and gallstones. COVID-19 pandemic had a
significant impact on service delivery and patient management
throughout all surgical specialties. In this study, primary aim was to
ascertain incidence of COVID-19 in acute pancreatitis patients.
Methods: A retrospective observational review of all patients admitted
under General Surgical team from March 2020 till September 2020 was
performed. Information regarding demographics, severity of acute
pancreatitis (using Glasgow score, Atlanta classification and CT
severity index score), ICU admission and organ support, treatment
modalities and follow-up data for outcomes was collected.
Results: Forty four (44) patients were admitted with acute pancreatitis.
Only one patient (2.3%) was diagnosed with COVID-19 at time of
pancreatitis. Aetiology of pancreatitis was found comparable to
aetiology reported by large scale studies (2). Mortality was 7% (3
patients). Five patients (11%) needed ICU admission due to organ
dysfunction. Three patients (7%) developed ARDS.
Conclusions: The overall incidence of COVID-19 in pancreatitis in our
population of study was low. Therefore, results were compared to
patients who were COVID-19 negative in COVID-PAN study. Patients
with acute pancreatitis in our target population were mostly elderly,
about one in five had moderate to severe or severe pancreatitis and in
16.3% the aetiology could not be identified. As has been observed in
other centres globally, urgent for gallstone pancreatitis faced
significant delays with no patients being offered index
cholecystectomy and only 4/19 patients having undergone interval
cholecystectomy.
Abstract citation ID: znac248.172
WE8.5 Can self-estimated BMI be used for pre-operative
planning in elective general surgery?
Charlotte Burford, Ellen Ainger, Ashim Chowdhury, Roland Fernandes
East Kent Hospitals University NHS Foundation Trust
Aims: Telemedicine is being increasingly used in outpatient settings
following the COVID-19 pandemic. This study aimed to determine if
self-estimated body mass index (BMI), from telephone consultation,
was accurate and useful for planning prior to elective general surgery.
v82 | Abstracts
Methods: Age, gender and estimated BMI were collected from
consecutive patients attending a pre-operative telephone clinic under
a single surgeon at a district general hospital in the South of England
between April and October 2021. Actual BMI was measured on the day
of surgery and compared.
Results: 124 patients were included (median age 59 years, 49.2% male).
BMI was accurately estimated by 38, under-estimated by 33 and
over-estimated by 53 participants. Overall, there was a significant
difference in the pre-operative and post-operative BMI (p = 0.003). This
was significant for females (median change 0.1, IQR 0.0–0.7, p = 0.002)
but not for males (median change 0.0, IQR -0.1, 0.2, p = 0.479). Those
with an actual BMI >29.9 had a significantly higher median change (0.2
(0.0, 1.1) compared to those with BMI ≤29.9 (0.0 (-0.2, 0.1); p <0.001).
Only 2 patients could have required a change in surgeon on the day of
the procedure (p = 0.500).
Conclusions: Self-estimated BMI is a suitable method for assessing
patients for planning in elective general surgical procedures,
particularly for males. However, it is important to be aware of those
with higher BMIs, particularly females, who may underestimate their
BMI.
Abstract citation ID: znac248.173
WE8.6 Paediatric inflammatory multisystem syndrome
presenting as acute appendicitis: a case report and literature
review
Sabina Catana, Charlotte Burford, Anang Pangemi, Ashish Shrestha
East Kent Hospitals University NHS Foundation Trust
Aims: Paediatric inflammatory multisystem syndrome– temporally
associated with SARS-CoV-2 (PIMS-TS) is a novel hyperinflammatory
condition that most commonly presents with an acute abdomen. Here
we present a case of PIMS-TS mimicking appendicitis and a review of
the literature with a proposed protocol for managing abdominal pain
in patients with recent SARS-CoV-2 infection.
Results: An 8-year old girl presented with suspected appendicitis. She
underwent a day case open appendicectomy with normal appendix
confirmed on histology. Unfortunately, she re-presented the following
day with persistently high fever and was investigated for
post-appendicectomy complication. She was started on intravenous
antibiotics. MRI of abdomen and pelvis showed no collection but
evidence of lymphadenopathy. On post-operative day four she was
transferred to the tertiary centre PICU for specialist management of
suspected severe PIMS-TS.
Common abdominal radiological findings in PIMS-TS include ascites,
bowel wall thickening and mesenteric inflammation. In addition, CRP
and ferritin have been found to be significantly higher in PIMS-TS.
White cells may be raised with neutrophilia and lymphopaenia. In
addition, highly deranged inflammatory markers in the context of a
normal abdominal imaging are more consistent with PIMS-TS than
appendicitis. We propose anyone with these findings is considered as
having PIMS-TS and requires urgent imaging including combined
senior surgical and paediatrician review.
Conclusion: PIMS-TS may present mimicking acute appendicitis and
given the severe cardiac compromise that can develop in patients
with PIMS-TS is it important to avoid unnecessary general anaesthetic
and abdominal surgery where possible. Our proposed protocol could
help reduce unnecessary abdominal surgery in these patients.
Abstract citation ID: znac248.174
WE8.7 Are Virtual Clinics for General Surgery Here to Stay? – A
Single Centre Analysis
Charlotte Leigh, Rita Deb, Hemant Sheth, Durgesh Raje, Naresh Pore,
Fiammetta Soggiu
London North West University Healthcare NHS Trusts
Aim: Virtual clinics were rapidly established during the COVID-19
pandemic to maintain outpatient surgical care.
To evaluate their use, we analysed telephone clinic outcomes and their
compliance with the NHS Referral to Treatment (RTT) guidelines.
Method: Data was collected for patients booked into Upper GI Surgery
clinics between September – December 2020 (n = 622). This included
details of referral, appointments (first to most recent), patient
attendance, and clinic outcomes (active monitoring, offered surgery,
discharge, other). We compared first appointment management
decisions between telephone and face-to-face clinics.
Results: 317 patients had their first appointment via telephone; 179
patients were seen initially face-to-face.
For first appointments, non-attendance rate was 9.8% (31/317) in
telephone clinics versus 3.9% (7/181) in face-to-face clinics.
At first appointment, 8.5% (27/317) of patients consulted via telephone
were offered surgery compared to 20.1% (36/179) seen face-to-face.
22.4% (71/317) of telephone clinic patients were started on active
monitoring at first appointment, compared to 31.3% (56/179) of
patients assessed face-to-face.
31.3% (155/496) of all patients analysed were compliant with RTT
guidelines – 57.4% initiated on active monitoring; 11.6% underwent
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surgery.
Conclusion: Patients are less likely to be listed for surgery after their first
assessment if this was via telephone appointment compared to
face-to-face. Delays in physical examination, and clinician and/or
patient hesitancy may contribute to this; higher non-attendance rates
would further postpone outcomes. However, telemedicine does allow
effective active monitoring.
To better evaluate telemedicine’s efficacy in sustaining timely patient
care, comparison of compliance with the RTT guidelines for cases
managed solely face-to-face pre-COVID-19 is warranted.
Abstract citation ID: znac248.175
WE8.8 Analgesia prescribing in a Surgical Assessment Unit
Roxane Stienstra, Zack Slevin, Elizabeth Cannings
Forth Valley Royal Hospital, Larbert
Aim: Efficient analgesia administration is paramount to delivering good
patient care and is an important factor in the safe assessment of
patients. The aim of this audit was to assess analgesia prescribing and
administration in the local Surgical Assessment Unit (SAU) and
compare it with the standard of care set out by the Royal College of
Emergency Medicine guidelines.
Methods: A retrospective audit was performed. Paper and electronic
notes, including electronic prescribing data via HEPMA and pain
scores were analysed for all patients referred with abdominal pain to
SAU by GP’s between the 21st of October and the 30th of October 2021.
Data was compared with the RCEM best practice guidelines.
Results: A total of 33 patients were included. 39% of patients had a
documented first pain score within 15 minutes of arrival, with a
median time of 20 minutes. Of all patients presenting with moderate
to severe pain, none received analgesia within 20 minutes. Earliest
analgesia administration for this group was 1 hour 42 minutes. Overall
median time to first analgesia prescription was 2 hours and 4 minutes
and median time to administration was 4 hours and 8 minutes.
Conclusion: Since the COVID pandemic, NHS hospital staff- and bed
shortages have put increased pressure on the delivery of safe
patient care. This audit has found significant delays in both
prescribing and administering analgesia for patients presenting to
SAU. An electronic prescribing protocol was developed to increase
efficiency in prescribing and another audit will be conducted to
assess impact.
Abstract citation ID: znac248.176
WE8.9 Do Telephone Clinics Lead to Greater Patient
Satisfaction in General Surgical Outpatients?
Angus McCance, Ellen Ainger, Rebecca Black, Roland Fernandes
East Kent Hospitals University NHS Foundation Trust
Aims: To limit exposure risk in view of the current COVID-19 pandemic,
telephone clinics have become the mainstay of outpatient assessment.
Although there is data from primary care, there is little evidence for the
suitability of telemedicine within General Surgery. The lack of clinical
examination can be dissatisfying for both patient and surgeon. The
aim of this study was to explore patient satisfaction from telephone
clinics in a General Surgery setting.
Methods: Data was collected prospectively from general surgery clinic
appointments by a single surgeon in a District General Hospital from
September 2021. Demographic data was obtained in addition to a
short questionnaire at the end of their consultation. Patients were
asked to score their experience out of 5 (5 being most favourable) and
their preference in comparison to face to face appointments.

Results: 156 patients were included in the study, of which 95% of
patients were contactable. 98% of patients gave the experience a
satisfaction score of 3 or more out of 5. The median satisfaction score
was 5. 97% expressed a preference over a Face-to-Face appointment.
7% of patients required a further Face-to-Face consultation and this
group were more likely to have a lower patient satisfaction score.
Conclusion: Telephone clinics within general surgery achieve excellent
satisfaction for the majority of patients. The patient experience could be
further optimised by careful selection of patient suitability for the service.
The data provides supportive evidence to the NHS Long Term Plan to
reduce Face-to Face outpatient appointments by one third before 2024.
Abstract citation ID: znac248.177
WE8.10 Management and outcomes of gallstone disease
during the SARS-COV-2 Coronavirus pandemic
Maitreyi Patel, Dita Chaloupkova, Xavier Aguayo, Princely Sivapragasm,
Joel Joy Thomas, Haschmatullah Sarwary
Department of General Surgery, Barking, Havering and Redbridge University
Hospitals NHS Trust
Aims: The aim of this study was to compare the patient demographics
and management of acute manifestations of gallstone disease during
the COVID-19 pandemic with an equivalent period in 2019 and assess
the differences in recurrence patterns over the period of first and
second wave of the pandemic.
Methods: A retrospective cohort study of all adult patients aged >16
years presenting to the emergency department at a large District
General Hospital with symptoms related to gallstones was conducted.
Data was obtained from electronic patient records. Primary outcome
assessed were incidence and management of gallstone disease while
secondary outcome studied included length of Stay, re-admission rate
and recurrence. Data was tabulated and analyzed using Excel
(Microsoft, 2016 version). Chi square, t-test and One way ANOVA tests
were used.
Results: 51 patients presented during the period of first wave and 105
patients during second wave as compared to 71 patients in the study
period during 2019. The median age of patients during the first wave
of COVID was significantly higher than pre COVID and that in second
wave. During both the waves of the pandemic, there was a no
significant difference in patients presenting with cholecystitis
compared with 2019 (47 and 94 versus 60; p value 0.39). There was no
significant increase in use of cholecystostomy. There was no
significant difference in recurrence and readmissions. Majority of the
patients still await surgery.
Conclusion: During the pandemic, older patients with higher
comorbidity presented with acute gallstone disease. Conservative
management was effective in the management of these patients.
Abstract citation ID: znac248.178
WE8.11 How has the management of acute biliary pathology
changed as a result of the SARS CoV2 pandemic?
Arnab Mukherjee, Sarah Robertson, Claire Carden
NHS Tayside
Aims: Gallbladder pathology is a common cause of emergency
admission under general surgery - however management had to be
drastically changed given the unexpected pressures of the
SARS-CoV-2 pandemic. This study aimed to compare management
strategies in patients presenting with biliary pathology pre and
intra-SARS-CoV-2 pandemic in one NHS trust.
Methods: A database of patients admitted to the acute surgical
admissions ward in the months of November 2019 and 2021 was
accessed, patients with biliary presentations were isolated and
information about these admissions analysed.
Results: In 2019 4 of 57 (8.7%) of patients admitted with biliary pathology
had a laparoscopic cholecystectomy during that acute admission,
compared to 8 of 65 (12.3%) in 2021. For all interventions (including ERCP
and cholecystostomy) these values were 14 of 57 (25%) in 2019 and 24 of
65 (37%) in 2021. Of 54 patients in 2019 who did not have laparoscopic
cholecystectomy on index admission, 9 were readmitted (16.7%).
The median duration of admission for all biliary patients on index
admission was 4 days in 2019 compared to 5.9 days in 2021.
Conclusions: SARS CoV2 has precipitated a change in management of
acute biliary patients. There is now an increased rate of intervention
Abstracts | v83
during the index admission and subsequent increase in admission
duration. This is seen as an improvement in the pathway for patients
in the long term, reducing the burden on the elective waiting list and
reducing re-admission which will offset the modest increase in length
of stay on the index admission.
Abstract citation ID: znac248.179
WE8.12 Improvement of the Laparoscopic Cholecystectomy
Service at a District General Hospital During the COVID-19
Pandemic
Shivam Patel1, Richard Dickson-Lowe2, Nabeel Qureshi2,
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Simon Lascelles2
1
GKT School of Medical Education, King’s College London
2
Medway NHS Foundation Trust
Background: British Association of Day Surgery and Royal College of
Anaesthetists guidelines specify that 75% of elective surgery should be
done as a day-case. Our Trust reported a laparoscopic
cholecystectomy day-case rate of 25% pre-pandemic. Following the
first wave of the pandemic our waiting list increased significantly.
Therefore, to address this, we aimed to improve the day-case rate by
developing the booking pathway, such as introducing the
Cholecystectomy As A Day-case (CAAD) score.
Methods: Retrospective data for laparoscopic cholecystectomy were
reviewed between 19th March and 9th July 2021. Specific documents
reviewed were the operation booking forms, hospital-specific
‘boarding cards’ for booking and CAAD score completion, and a
day-case rate was calculated.
Results: A total of 86 procedures were performed. There was an overall
day-case rate of 54.7%. Of those booked to be day-cases (n=39), 61.5%
remained day-case post-operatively and 28.2% were discharged the
next day. Of the patients that were not discharged the same day
(n=39), 18 cases had no documented reason for the additional stay.
Incomplete booking forms (n=42) demonstrated a day-case rate of 50%
versus 60.5% with complete forms (n=38).
Conclusions: Overall, the day-case rate has improved. We believe this is
from adhering to the boarding card and introduction of the CAAD score
to guide appropriate booking. However, for further improvement we are
going to revise the booking form and create a Standard Operating
Procedure (SOP) for the booking of these operations. Together with
CAAD scoring, this should improve day-case rates further to reach the
nationally accepted standard.
Abstract citation ID: znac248.180
WE8.13 Hospital consultant remote consultations during
COVID 19 - experiences at a large NHS trust
Humairaa Ahmed1, Georgette Oni2
1
University Of Nottingham
2
Nottingham University Hospitals NHS Trust
Aim: COVID-19 has intensified the need for the NHS to almost
overnight utilise remote consulting technology, with clinicians
under increasing pressure to provide virtual services preferentially,
in line with the NHS digital ideals. This study explores the clinician
experience of virtual working during the pandemic in a large acute
NHS Teaching Trust, and to identify the facilitators and barriers to
remote consultations (RC).
Method: A multi-format online questionnaire was constructed and
emailed to all 816 consultants across the trust. The survey was open
for one month and during that time two reminders were sent. The
data was tabulated and analysed using Microsoft excel.
Results: 270 consultants responded to the questionnaire, giving a
response rate of 33%, with 208 (77%) performing RCs. 92.8% of these
(N=193) have increased the number of RC during the pandemic. 45.9%
did not have their own office (N=124), with over half of those (N=63)
sharing an office with 3 or more people. The majority of remote
consultations were over telephone (82%) with only 54.4% feeling they
had the right equipment for video consultations. The biggest barriers
were patient related issues (technical, poor environment or not
available at scheduled time).
Conclusion: The main challenges facing consultants, in the provision
of virtual services were: lack of appropriate hardware, an absence of a
suitable environment, the prevalence of technical complications,
and difficulties experienced by their patients. It is therefore,
v84 | Abstracts
important to recognise, both at an organisational level, and
nationally, that virtual consultations may play a role in the
worsening of health inequalities.
Abstract citation ID: znac248.181
TH1.1 Self Directed Aftercare is a Safe, Efficient and well
tolerated way to follow up Breast Cancer Patients
Hannah Anderson, Justin Ong, Samantha Sloan, Peter Mallon,
Stuart McIntosh, Gareth Irwin
Belfast City Hospital
Aims: Self Directed Aftercare (SDA) was introduced in the Belfast Trust
in August 2012. It offered breast cancer patients treated with curative
intent an opportunity to self-manage their 5 year follow up, including
their annual mammograms. We reviewed the enrolment and
outcomes for the first cohort reaching 5 years (diagnosed 2013).
Methods: The prospective SDA database identified patients on the
pathway. Additional outcome data was collated through NIECR.
Patient feedback was obtained at several points along the pathway.
Results: 342 patients underwent surgery for newly diagnosed breast
cancer in 2013. 37.7% (129 patients) were enrolled in SDA. Of these,
62.8% (81 patients), remained on the pathway throughout their follow
up. 33 patients (25.6%) required no further review, having had yearly
mammograms and were discharged after 5 years. The remaining
patients received reviews via rapid access or recalled through
screening. Feedback was largely positive.
Conclusions: In its first full year of SDA implementation, the Belfast
Trust achieved its target by enrolling 37.7% of patients. 25.6% of
patients did not require any additional appointment thereby
reducing waiting lists for outpatient surgical review. Of those with a
concern, 100% were able to enter back in to the system. 85% of
patients entered into SDA attended remote surveillance
mammography appropriately. Patients report high levels of
satisfaction with the pathway.
Abstract citation ID: znac248.182
TH1.2 Referral of patients with breast pain to breast clinic: a
retrospective analysis
Marcus Dyer, Tim Gate, Thomas Ward
Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, North
Wales
Aims: Previous literature provides evidence that in patients with breast
pain and a normal breast examination, the incidence of ipsilateral
breast cancer is approximately equivalent to the screening incidence.
Isolated breast pain is not an indication for a suspected cancer
pathway referral as per NICE guidance. We assessed all breast clinic
referrals in one month for use of the appropriate referral pathway for
patients with isolated breast pain, and correct primary care
management of breast pain.
Methods: GP referral letters and breast clinic letters were analysed
retrospectively using an electronic clinical data system for all 173
patients referred to breast clinic in September 2021, of which, 47
patients satisfied eligibility criteria. Letters were assessed for urgency
of referral and documentation of GP interventions for breast pain (bra
fitting advice, simple oral analgesics and topical NSAIDs).
Results: 62% of patients presenting with isolated breast pain were
referred under a USC or urgent referral pathway to breast clinic. Only
one patient with breast pain as a symptom, had documented evidence
of GP interventions for breast pain.
Conclusions: The majority of patients presenting with isolated breast
pain were inappropriately referred under urgent pathways, potentially
impeding capacity in breast clinic for patients that satisfied USC
criteria. There was little evidence of GP interventions for breast pain
which could negate need for a clinic appointment or alleviate
symptoms in the interim. Further GP education could reduce
inappropriate urgent referrals of patients with isolated breast pain
and improve breast pain management.
Abstract citation ID: znac248.183
TH1.3 Initial experience - Magseed for impalpable breast
lesion localisation
Grant Harris, Tamer Saafan, Katie Quigley, Gary Bristow,
Alice Townend, Magdi Youssef
Northumbria Healthcare NHS Foundation Trust
Aims: Impalpable breast lesions can be localised intraoperatively with
Magseed and the Sentimag probe. Advantages over traditional wire
localisation include reduced displacement, flexible insertion
timescales, reduced patient anxiety and no requirement for radiation
governance compared with radio-iodine seeds. We assess outcomes
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following introduction of Magseed localisation for impalpable breast
lesions.
Methods: The first consecutive Magseeds inserted into breast lesions
were identified from radiology records in a UK non-screening breast
unit from July 2020 to March 2021. Indication for seed, intra-operative
complications, margin involvement and re-excision rates were
ascertained from electronic patient records. Caldicott / audit
department approval was obtained.
Results: 63 Magseeds were inserted in 59 patients. Indications for seed
localisation were invasive disease 81% (51/63), DCIS 8% (5/63) and B3
lesions 11% (7/63). 21% (10/47) of patients with invasive disease had
received neoadjuvant chemotherapy. The median seed insertion to
surgery time was 13 days. All patients underwent standard wide local
excision or therapeutic mammoplasty. The lesion localisation rate and
seed retrieval rate was 100%, however 2 magseeds (3%) were displaced
during dissection. The margin re-excision rate was 15.3% (8/52) in
patients with invasive and preinvasive disease. The upgrade rate for
B3 lesions was 16.6% (1/6).
Conclusions: Magseed can be used to accurately localise impalpable
breast lesions with acceptable margin re-excision rates. These
findings during the learning curve would imply that this technique is
easy to adopt. Insertion of seeds within 2 weeks of the operation is
feasible and should improve radiologist’s efficiency by avoiding on the
day wire insertion.
Abstract citation ID: znac248.184
TH1.4 Indication for clinical biopsy in symptomatic breast
disease- A closed loop audit
Rachel Xue Ning Lee1, Avinesh John1, Christiana Fabelurin1,
Zoe Ying Zheng Chia2, Amit Goyal1
1
University Hospitals of Derby and Burton NHS Foundation Trust
2
Nottingham University Hospitals NHS Trust
Aims: Royal College of Radiologists states core biopsy is indicated where
imaging is normal, but clinical assessment is P3 and above. However,
many clinicians opt for clinical biopsy following normal imaging
results despite clinical assessment under P3. We recommended:
reserving clinical biopsies following normal imaging for women >50
year; performing ultrasound and mammogram in women <40 years
with clinically (P3-P5) or ultrasonically (U3-U5) findings. Here we look
at the impact of our recommendations on clinical practice and patient
diagnosis.
Methods: All patients who had clinical biopsies were analysed within a
six-month time period in 2019 and 2020. 43 patients were included in
2019. 78 patients were identified in 2020. 14 were excluded as they had
history of breast malignancy, or a biopsy diagnosis of non-breast
malignancy.
Results: 64 patients were included in our analysis. Improvements in the
2020 audit cycle compared to 2019 included: Lesser women <40 years
with P3/U3 not getting MMG prior to clinical breast biopsy (15.4%
compared to 80.0%); higher rates of both MMG and targeted US were
performed in women 340 years with score 3U3 (86.8% compared to
41.9%). Only 6 (9.4%) patients returned with malignant biopsy results.
No patients (compared to 1) who underwent clinical biopsy for
symptomatic breast disease following normal imaging showed
malignant biopsy results.
 Abstracts | v85

Conclusion: Our findings indicate a low test positivity rate for clinical
Malignant Tumour (4) Reoperation
biopsies performed following normal imaging. Being prudent and
selective in the type of patients clinical biopsies are carried out have a WLE (2) No
positive impact on clinical practice and patient diagnosis. Excision Biopsy (2) Yes

Abstract citation ID: znac248.185

TH1.5 A Novel Method Breast Lesions Localisation: Using Margin positive (19) Number of patients Reoperation
Scout System Benign 12 1
Rebecca Lefroy, Jaspreet Kaur, Athanasios Karategos, Natasha Bowen, Borderline 5 4
Sircar Tapan, Vidya Raghavan Malignant 2 2
Royal Wolverhampton Trust

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Aims: The advent of screening along with increased patient awareness Recurrence Number of patients
means that approximately 30–50% of breast lesions are impalpable at
diagnosis. SAVI SCOUT is a reflector guided system using an Benign 2 (B3) after 1 year and 3 year
implanted device within the breast to guide excision. A probe is then Borderline 1 (B3) after 9 years
used, in a similar fashion to sentinel node localisation, to target and
excise the lesion. As it lacks an external component, it can be placed Conclusions:
days prior to surgery, one of a number of advantages it has over our
current standard; wire guided excision. • 87% occurs in patients less than 50 years
Methods: Our unit aimed to review the implementation of the SAVI • Post menopausal phyllodes carry higher risk of borderline or
SCOUT system into our practice, looking at the excision and malignant potential
re-excision rates as well as evaluating the advantages or drawbacks • 60% are left sided tumours and 40% are right sided tumours
we found during our learning curve with this device. • Initial core biopsy among the phyllodes tumour were B3 and above
Results: 18 patients underwent 19 SCOUT guided excisions, over a nine • 66% had Excision biopsy, 27% had WLE
month period. Average age was 62 (range 50–81) and modal length of • Recurrence occurred more than 1 year
hospital stay was 0 days (range 0–1). All 18 patients were female and
79% (n-15) underwent wide local excision with 21% (n-4) undergoing Recommendations:
quadrantectomy with mammoplasty. 100% of patients (n-19) had the • Excision Biopsy is preferred surgery for suspected Phyllodes tumour
lesion successfully removed. 10% (n-2) of patient underwent (reoperation is required in borderline and malignant phyllodes with
re-excision due to close or positive margins. margin positivity)
Conclusion: Our study has small numbers so far but represents • No follow up required at 6 months (as evident, no recurrence in less
successful use of this technology with good outcomes. We have than 1 year)
also found its use acceptable to both surgeons and radiographers.
In our experience we have found that diathermy can prevent the Abstract citation ID: znac248.187
reflector from sending or receiving signals if used too close to the TH1.7 Patterns of care of male breast cancer in clinical practice:
device. A five-year single institution experience

Abstract citation ID: znac248.186 Amanda Troy1, Alisha Jaffer2,1, Barbara Julius1, Shona Tormey1
1
University of Limerick Hospitals Group
TH1.6 Management of Phyllodes Tumour - a 10 years 2
University of Limerick
experience
Aims: Only 1% of all diagnosed breast cancers are in male patients.
Sangara Narayanasamy, Brenda Muntean, Amit Goyal
Overwhelmingly, current literature addresses breast cancer in female
University Hospitals of Derby and Burton
patients. This study aims to analyse the investigation and
Introduction: Phyllodes tumors are rare fibroepithelial neoplasm of the management of male breast cancers in a busy Symptomatic Breast Unit.
breast (phyllodes -leaf like pattern). The three main types of phyllodes Methods: We conducted a single-centre review of male breast cancers
tumour are benign, intermediate and malignant. diagnosed in our institution between January 2016 and December
Current Guidelines: Follow up: 2020. Initial presenting symptoms, imaging findings, histology and
follow-up data were collected via a prospectively maintained database.
• Clinical breast examination within 4 to 6 months, mammogram and Results: The most common presenting symptom was a palpable breast
ultrasound 6 months after treatment, lump (69%). Other symptoms included nipple bleeding/discharge (15%)
• Breast MRI if needed. CT (computerized tomography) scans of the and skin ulceration (8%). 62% of cases were located centrally behind, or
chest and abdomen for 2 to 5 years. involved, the nipple. The most common pathology was invasive ductal
• For breast-conserving surgery, mammogram on both breasts. For carcinoma (77%). One patient was diagnosed with invasive papillary
mastectomy, with or without reconstruction, mammogram on the carcinoma, while two patients were diagnosed with different cancers
other breast. (spindle cell sarcoma and metastasis of medullary carcinoma of the
thyroid). 77% of patients were managed operatively, with all undergoing
a simple mastectomy. A sentinel lymph node biopsy or axillary
Results of Audit: clearance was performed in 62% and 8% of cases respectively. Several
patients underwent adjuvant radiotherapy (62%) and chemotherapy
(54%). 77% of patients were ER/PR positive, with 15% HER2+ positive.
Primary Surgery Number of patients (48) 100% of these patients received appropriate endocrine therapy.
Conclusions: Although female breast cancer commonly presents in the
Wide Local Excision 13
upper outer quadrant of the breast this study found that more male
Excision Biopsy 32
breast cancers occur centrally and involved the nipple. As breast
VAE/Mammotome 3
cancer in male patients is rare, larger cohorts are required to confirm
the findings of this study.

Abstract citation ID: znac248.188

Types Number of patients (48)
TH1.8 Changes In the Operative Management of Breast Cancer
Benign 35 During The COVID Pandemic -- Single Institution Experience
Borderline 8
Malignant 4 James Chean Khun Ng1, Nazli Muhibullah2, Giulio Cuffolo3,
Fibroadenoma 1 Lisa Whisker1
1
Nottingham Breast Institute
v86 | Abstracts
2
University Hospitals of Derby and Burton NHS Foundation Trust
3
Royal Berkshire NHS Foundation Trust
Aims: COVID has had a wide ranging impact on surgical practice;
including staffing issues, procedural prioritisation and changes to
perioperative practice. We aim to compare the operative management
of breast cancer before and during year 1 of the pandemic.
Methods: A retrospective review of primary breast cancer surgery in
women between 23/3/2020–23/3/2021 with sub-analysis looking at
wave 1 of COVID (23/3/2020–23/7/2020), compared to pre-COVID (1/1/
2018–31/12/2018). Data collected include type and complexity of
surgery, re-operations and complications.
Results: Pre-COVID, 606 cancers were included, with 217 (35.8%) simple
BCS, 241(39.8%) oncoplastic BCS, 88 (14.5%) simple mastectomies and 60
(9.9%) mastectomies with immediate reconstruction. During COVID
study period, a total of 398 cancers were included, with operative
number (percentages) being 104(26.1%), 176(44.2%), 83(20.9%) and
35(8.8%) respectively. During wave 1, 47 cancers were diagnosed and
operated on. The operative numbers (percentages) during initial wave
COVID pandemic were 9 (19.1%), 25(53.2%), 12(25.5%) and 1(2.1%)
respectively.
Conclusions: In our unit COVID led to a shift of breast cancer operative
management to more BCS and simple mastectomies. As a unit, we were
able to maintain good oncoplastic BCS service, however, reconstruction
options were limited.
Abstract citation ID: znac248.189
TH1.9 Clinical relevance of postoperative elevated
thyroglobulin antibodies in patients with differentiated
thyroid cancer
Hannah Anderson1, Sadaf Gull1, Kah Lim1, Raluca Oprean2,
Kirsty Spence3, Titus Cvasciuc1
1
Royal Victoria Hospital, Endocrine Surgery Department
2
Royal Victoria Hospital, Department of Endocrinology and Diabetes
3
Royal Victoria Hospital. Endocrinology Laboratory
Aims: 20%–25% of patients with differentiated thyroid cancer (DTC) can
have elevated thyroglobulin antibodies (TgAb). The study aimed to find
any prognostic significance of elevated TgAb during follow-up.
Methods: 10-year retrospective study from a tertiary centre including 79
patients with raised TgAb after total/staged thyroidectomy for DTC. We
identified patients with stable (7.6%), increasing (15%) and decreasing
levels of TgAb (77.2%); groups 1, 2 and 3 respectively. During follow-up
we analysed TgAb in subcategories by TgAb trend (>50% increase,
<50% increase, >50% decrease, <50% decrease, positive to negative,
negative to positive and stable levels), gender, age, surgery,
autoimmune disease, histology, RAI uptake, distant metastasis, and
recurrence.
Results: The incidence of raised TgAb levels was 33.2%, with female
predominance. No connection was identified regarding other
parameters; 11.4% had distant metastasis. The highest mean level of
TgAb was in group 2 (1918.75IU/mL) and the lowest in group 3
(412.70IU/mL). The recurrence rate changed significantly between the
3 groups: 50% in group 1, 75% in group 2, and 25% in group 3 (p=0.002).
Recurrence rates decreased to 15% in the subcategory where TgAb
become undetectable from positive (p=00001). In patients with
negative to positive trend or >50% increase, recurrence rates were
100% (p=0.041) and 70% (p=0.012) respectively.
Conclusions: Patients with increasing TgAb levels during follow up have
a higher rate of recurrence distinctly for those with negative to positive
and >50% increase. These categories of patients need closer follow-up.
Abstract citation ID: znac248.190
TH1.10 Antithyroid peroxidase antibodies and
histopathological outcomes in Egyptian patients subjected to
total thyroidectomy for nonmalignant nodular goiter.
Retrospective study
Khaled Noureldin1, Mohamed Salman2, Mohamed Issa3,
Marwa Badawi4, Goerge Bisheet1, Sally Maryosh3
1
Cairo University Hospitals, Egypt
2
Cairo University Hospital, Egypt
3
Prince Charles Hospital, Merthyr Tydfil
4
Conquest Hospital, Hasting
Introduction: Thyroid is an endocrine gland. It produce T3 and T4
hormones through a series of enzymatic actions. These hormones
regulate body metabolism and physiology. Immune disorders in this
gland can cause hypo/hyperthyroidism.
Objective: The study aimed to assess antithyroid antibodies in patients
with benign thyroid masses and the effect of total thyroidectomy on the
antibodies titres.
Patients and Methods: This is a retrospective work of 112 cases
managed with total thyroidectomy who have positive antithyroid
peroxidase antibodies (TPO-Ab), antithyroglobulin antibodies (Tg-Ab),
or both. All patients were euthyroid before surgery. Thyroid function
tests and thyroid antibodies levels were measured before and 6 and 12
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months after surgery.
Results: Histopathological evaluation revealed Hashimoto thyroiditis
(47.3%), colloid nodules (22.3%), and lymphocytic thyroiditis (30.4%).
All patients were TPO-Ab positive, while 96 patients (85.7%) were
Tg-Ab positive before surgery. There was no considerable change in
TPO-Ab and Tg-Ab after surgery (p = 0.817, and p=0.560, respectively).
Also, there was no significant difference between the three
histopathological diagnoses in the levels of TPO-Ab (p = 0.086) or
Tg-Ab (p = 0.673).
Conclusions: Antithyroid antibodies are not valuable markers for
diagnosis or prognosis of benign thyroid diseases subjected to total
thyroidectomy. We do not recommend their use beyond being a
supportive evidence of the possibility of autoimmune nature of the
disease if other criteria are confirmed.
Abstract citation ID: znac248.191
TH1.11 Outcomes of Sublay Mesh repair in Ventral Abdominal
hernia; retrospective study
Khaled Noureldin1, Mohamed Issa2, Marwa Badawi3, Mariam Darwish4,
Ayyat Abdelaziz5, Mahmoud Makram1
1
Cairo University Hospitals
2
Prince Charles Hospital, Merthyr Tydfil
3
Conquest Hospital, Hasting
4
University Hospital of Wales, Cardiff
5
Menia University Hospital, Egypt
Introduction: Ventral hernia repair is one of the challenging surgical
operations over time. It is suggested that sublay mesh repair has the
lowest recurrence and surgical site infection in open anterior
abdominal hernia repair. This study aimed to analyse the pros and
cons of sublay mesh in ventral hernia repair to evaluate the
significance of this technique as a treatment modality. Hospital stay,
acute postoperative complications, and the recurrence rate were the
main areas of investigation.
Methods: A retrospective study on 79 Patients with ventral hernias were
operated on (electively) with sublay mesh repair over 3 years. Fit
patients with first-time ventral hernias (primary and incisional) were
included. Recurrent hernia, associated decompensated
cardiopulmonary disorders, and bleeding disorders were excluded.
The project Performa includes; patient’s demographics, operative
details, length of stay, postoperative complications, and follow-up, up
to 12 months.
Results: All patients underwent open mesh repair using the sublay
technique. Ventral hernia was five times more common in females
than males. Mean age of presentation was at 44.8 years old. Mean
operating time was 67 minutes and a 1-day hospital stay.
Para-umbilical and incisional hernias represented the majority of
cases. Component separation approach was added in three cases
(3.7%). Simultaneous cholecystectomy was performed in 2 cases
(2.5%). Only 6 cases (6.3%) developed wound-related complications,
while 2 cases (2.5%) had a recurrence.
Conclusion: Sublay mesh repair is favourable for ventral abdominal
hernia reconstruction. It is associated with a smooth and short
hospital stay and the least incidence of complications and recurrence.
Abstract citation ID: znac248.192
TH1.12 Merkel Cell Carcinoma in the Breast: A rare Case
Presentation
Emad Rezkallah, Wael Elsaify
South Tees NHS Foundation Trust

Background: Merkel cell carcinoma (MCC) is a rare neuroendocrine
tumor of the skin. The annual incidence is 0.13–1.6 per 100.000. MCC
arise from Merkel cells in the basal layer of the epidermis and hair
follicles. It is characterized by poor prognosis and rapid progress with
a mortality rate about 30%. Most patients are over 65 years. We
represent a rare case of MCC in the breast and axilla.
Case presentation: A 71-years old lady initially presented with loss of
weight. A CT scan reported a 45.97 mm malignant mass in the right
axilla with no identified primary origin. No obvious tumors were
detected in the breast on mammogram and ultrasound scans. Core
biopsy eventually confirmed a metastatic Merkel cell tumor. The
patient had neo-adjuvant chemotherapy followed by right axillary
nodal dissection (level III). Post-operative radiotherapy was given. Six
months later, the patient represented with two tumor foci in the right
breast. The patient underwent right mastectomy. Two foci of Merkel
cell carcinoma, 28 mm and 10 mm, were found.
Discussion: MCC is a rare highly aggressive cutaneous neoplasm. It
affects primarily the sun exposed areas of the skin. 5-year survival in
patient with MCC is 50–68%. Treatment options vary according to the
disease stage. Surgical excision provides the best treatment for
localized diseases. Radiotherapy and chemotherapy are provided for
high stage MCC and/or lymph node involvement.
Conclusion: Treatment of MCC should be multidisciplinary. Early
diagnosis and proper surgical resection provide the best management
option. Long term follow-up is recommended.
Abstract citation ID: znac248.193
TH1.13 The Role of Metanephrines in the Diagnosis of
Pheochromocytoma
Emad Rezkallah, Wael Elsaify
South Tees NHS Foundation Trust
Introduction: Pheochromocytomas are rare neuroendocrine
catecholamine-producing tumors that arise from either the adrenal
medulla (PHEO) or extra-adrenal paraganglionic tissues
(paraganglioma/PGLs). PHEO is responsible for about 0.01–0.1% of the
cases of hypertension. Assessment of the plasma/urinary levels of
metanephrines (catecholamines metabolites) is now considered the
gold standard for the diagnosis of PHEOs.
In this study, we aimed to investigate the role of the plasma and 24-hour
urinary metanephrines levels in the diagnosis of PHEO/PGLs.
Patients and Methods: Retrospective review of 26 patients diagnosed
with PHEO/PGLs. We measured the plasma/ 24-h urinary
metanephrines. The data were compared with another set of 26
patients with other adrenal pathologies. The correlation coefficient
between the tumor sizes and the plasma/24-hour urinary
metanephrines levels was calculated.
Results: The mean tumor size was 4.88 ± 1.99 cm. The sensitivity and
specificity of the plasma metanephrines were about 95.8% and 98%,
respectively, while for 24-hour urinary metanephrines were about
83.3% and 98%, respectively. We found a strong positive relationship
(r = 0.472, P = 0.05) between the tumor size and the summed plasma
concentrations of metanephrines. The relation between the tumor
diameter and summed 24-hour urinary metanephrine was potentially
strong (r = 0.354, P = 0. 083).
Conclusion: Plasma/24-hour urinary metanephrines are of great value
in the diagnosis PHEOs/ PGLs as they are continuously produced by
the tumor. There are strong relations between the size of these
tumors and the plasma and urinary concentration of these
metabolites, which can help to predict the size of the tumor even
before imaging.
Abstract citation ID: znac248.194
TH1.14 Major limb amputation during the Covid-19 pandemic
– Have we seen a change in practice?
Kinza Fatima1, Thomas Trinder1, Chloe Rodger1, Feldheim McGivney2,
Douglas Orr2, Keith Hussey2
1
Glasgow University Medical School, Glasgow, Scotland
2
Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow,
Scotland
Introduction: There have been significant changes in the delivery of
health care as a consequence of the Covid-19 pandemic. Standard
operating procedures have been re-defined to minimise harm from
Abstracts | v87
the reduction in access to services, whilst at the same time protecting
hospitals (and in particular critical care units) from admissions.
We have explored major limb amputation (MLA) practice and compared
this with a historical series.
Methods: Retrospective review of major limb amputations (March 2019
to October 2021). Historical datasets have also been scrutinised (2008–
2010). Specific variables of interest included the annual number of
major limb amputations, primary versus secondary amputation and
ratio of transtibial (TTA) to transfemoral (TFA) amputations.
Results: A complete dataset was available for 282 patients during the
Covid period. Patient demographics were as anticipated - 206 (73%)
male, mean age 63-years (range 23 to 90-years). Peripheral arterial
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disease (190) and diabetes mellitus (149) were common. These
demographics were comparable to the historical data. The annual
number of MLA has not changed over the Covid period. The ratio of
primary to secondary MLA was 1:1.3 in the historical series and 1:1
during the Covid period. The ratio of TTA to TFA was 3:1.8 in the
historical series and 2:1 during the Covid period.
Conclusion: The trends suggest that practice has not changed
significantly during the Covid period. There has been a slight change
in the ratio of transtibial to transfemoral amputation, which may
reflect patients presenting with later stage disease.
Abstract citation ID: znac248.195
TH2.1 Antibiotics during Pancreatitis… Is it “NICE”??
Anil Rai1, Rhea Singh2, Omar Mehana1, Shantata Kudchadkar1,
Ahsan Mahmood1, Aruna Munasinghe1
1
Luton and Dunstable University Hospital
2
Kharkiv National Medical University
Aim: National Institute for Health and Care Excellence (NICE), British
Society of Gastroenterology, the American College of Gastroenterology
and the trust guidelines do not recommend prophylactic antibiotics in
patients with uncomplicated acute pancreatitis. Our three-cycle study
was focused on finding out adherence to these guidelines.
Method: Three cycles of the study were conducted over a span of 2 years
with 87, 78 and 121 patients with the peak age range of 20–40 in the first,
41–60 in the others respectively. Unspecified acute pancreatitis and
gallstone pancreatitis were the most common diagnosis in the second
and third cycles respectively. Majority of patients were prescribed
antibiotics on 1–2 days after admission in the first and second cycle
and on the day of admission in the third cycle.
Results: 44.8%, 39.7%, 35.5% of the patients admitted with pancreatitis
were prescribed antibiotics in the three cycles respectively.
Interestingly, in the first cycle 74.3% patients were prescribed
antibiotics without any clear indication. However, we saw an
improvement in the trend of prescribing antibiotics without indication
from 45% in the second cycle to 37.2% in the last cycle. The maximum
number of patients had a hospital stay of 2–4 days in all the cycles.
Co-amoxiclav was the most prescribed antibiotic in the first and the
third cycle. In the second cycle, the order was Metronidazole followed
by Amoxicillin.
Conclusion: The prescription of empirical antibiotics in acute
pancreatitis doesn’t improve the duration or outcome of the disease.
Therefore, antibiotics must be used judiciously in this era of
ever-increasing antibiotic- resistant microbes.
Abstract citation ID: znac248.196
TH2.2 Optimum Timing of Emergency Cholecystectomy for
Acute Cholecystitis - A Single Sited Retrospective Cohort Study
Prabhu Ravi1,2, Najam Husain1, Himaz Marzook1, Zbigniew Muras1,
Pradeep Thomas1
1
University hospital of Derby and Burton
2
Hamshire Hospital Foundation Trust
Aim: To evaluate timing of emergency cholecystectomy performed at
one of the hospital in West Midlands.
Methods: This is a retrospective single centre study conducted from
September 2019 to August 2020. The patients were divided into two
groups with those operated within 1 week as emergency group (EG)
and those operated after a week but within 6 weeks as delayed
group(DG). The outcome is to evaluate post-operative complications,
conversion to open, re-admissions, hospital stay, intra-operative blood
loss, surgery duration and level of surgeons.
v88 | Abstracts
Results: Among 176 patients, only 88 patients underwent LC. Only 40.9%
(36) underwent LC within 1 week of index admission and 12.5% (11)
underwent LC after 1 week but within 6 weeks of admission. The
remaining 46.5% (41) underwent delayed LC after 6 weeks. 10.6% (5)
developed post op complications. Among which only one developed
complication in EG and 8.5% (4) developed in DG. Total number of
readmissions after LC in both group was 5.5% (5) and 10.2% (9)
respectively. Median Length of hospital stay in days (4.03 versus 8.72
days respectively), Duration of surgery was 81(23–153) mins versus 69
(28–122) mins respectively), Intra operative blood loss (64 ml versus
166 ml respectively). Level of surgeon by consultant and Registrar in
both groups were 21:6 and 15:5 respectively. None of the patients were
converted to open surgery in both group.
Conclusion: Early LC within 1 week can be performed safely in most
patients with AC to minimise the intra-operative blood loss, total
hospital stay, post-op complication and readmissions rate.
Abstract citation ID: znac248.197
TH2.3 Elective versus emergency management of gallstone
disease at a tertiary referral centre amidst the COVID-19
pandemic - should the protocol be altered?
Maxwell Renna, Aaditya Sinha, Kevin Pinto, Caitlin Roe, Chloe Koh,
Katie Cheung
Guy’s & St. Thomas’ NHS Foundation Trust
Background: Gallstones are a common pathology affecting
approximately 15% of the population in UK, 20% of which are
symptomatic. It is suggested symptomatic patients undergo
cholecystectomies. Guidelines recommend this is performed within
one week of initial emergency presentation or 52 weeks for elective
case. Surgical capacity to manage emergency cholecystectomies was
limited due to the COVID pandemic. We assessed wait time
discrepancy between elective and emergency cholecystectomies.
Methods: A retrospective review of all patients undergoing
cholecystectomies between January and November 2021 in a major
tertiary referral centre in London was undertaken. Initial pathology at
the time of presentation, elective vs emergency presentation,
pre-surgical biliary complications along and wait times were reviewed.
Results: 219 (74 elective, 145 emergency) patients underwent surgery,
mean age 48 years (23% Male and 77% Female). Average wait times for
elective cholecystectomies were 69.7 days (min 0, max 246) in
comparison to 68.9 days (min 1, max 253) for emergency surgery. 22
(15%) of the patients of initial emergency presentation re-attended
hospital and 6 (4%) had adverse events such as gallbladder perforation
or pancreatitis due to delayed treatment. Comparatively, 9 (12%)
elective patients attended A&E due to pain, with no adverse outcomes.
Conclusions: Overall wait time of emergency vs elective
cholecystectomies were similar. This review indicates emergency
cases require prioritisation over elective cholecystectomies due to the
higher number of re-attendance and adverse events. Emergency cases
need to be prioritised to meet guidelines, which could also reduce
complication rates whilst awaiting surgery and lead to fewer adverse
outcomes.
Abstract citation ID: znac248.198
TH2.4 Systematic Review on Surgical Management of Difficult
Common Bile Duct stones
Zi Hao Sam1,2, Silje Welsh1,2, ChiaYew Kong2, Paul Glen2
1
University of Edinburgh
2
NHS Greater Glasgow & Clyde
Aims: 85–95% of common bile duct stones (CBDS) are successfully
managed with endoscopic treatment, but a small proportion of CBDS
are difficult to remove. These lead to high morbidity secondary to
complications of biliary obstruction. This study aims to appraise
existing management options for difficult to retrieve CBDS through
systematic review of existing published data.
Methods: Systematic literature search was performed on search
engines including MEDLINE, EMBASE, Cochrane library and
ClinicalTrials.gov using pre-defined search strategy and pre-registered
in International Prospective Register of Systematic Review
(PROSPERO). All studies regarding management options, efficacies
and/or complications of difficult CBDS managements were included.
Definition of difficult to clear CBDS were outlined. Results were
independently reviewed, assessed for bias, analysed and reported
using Preferred Reporting Items of Systematic Reviews and
Meta-Analyses (PRISMA) guidelines.
Results: 59 studies were included through database search. Various
difficult stone characteristics, surgical interventions and study designs
were reported. Common bile duct exploration was shown to be the
preferred management approach with good stone clearance. Stone
clearance rate on CBD exploration and biliary enteric anastomoses
were found to be overall above 83% among reviewed studies.
Adjunctive strategies, particularly laser lithotripsy, were of additional
beneficial value in clearing difficult stones. Overall complication rates
were found to be low, and majority did not require significant
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intervention. However, included data were heterogenous and of high
risk of biases.
Conclusion: Current evidence suggests good outcomes from surgical
management of difficult choledocholithiasis, but evidence is of
heterogenous quality. Further randomised controlled trials are
warranted to explore preferable management options.
Abstract citation ID: znac248.199
TH2.5 Evaluation of Radiological and Multimodal Prognostic
Models in Discriminating Patients by Overall Survival in a
Large Single Centre Cohort of Peri-Hilar Cholangiocarcinoma
Patients
Nicholas Bird1, Nichola Manu1, Zak Shehata2, Stephen Fenwick1,
Robert Jones1, Hassan Malik1
1
Liverpool Foundation Trust, Liverpool, UK
2
Royal Preston Hospital, Preston, UK
Aims: Several putative prognostic models have been developed to
stratify patients with peri-hilar cholangiocarcinoma (PHC) by Overall
Survival (OS). The objective of this study was to evaluate the utility of
these models in determining prognosis for all patients presenting to a
tertiary referral centre with PHC.
Methods: Three hundred and two patients diagnosed with PHC referred
to a regional tertiary referral centre between 2008 and 2019 had their
demographic and survival data retrospectively analysed from a
prospectively held database linked to Hospital Episode Statistics and
Somerset Cancer Registry data. Univariate and multivariate modelling
was utilised to determine significant prognostic variables.
Concordance indices were constructed for the prognostic models to
determine internal validity within the cohort.
Results: Multivariate analysis demonstrated that: pre-interventional
ECOG status (p 0.02); bilirubin levels (p 0.001); resectional status (p
0.001) and Mayo Clinic (MC) model (p 0.003) were significant predictors
of OS. MC staging system demonstrated utility in stratifying patients
by OS in pre-interventional patients with peri-hilar
cholangiocarcinoma in all comers (p 0.001) and patients who did not
progress to resection (p=0.021). There was strongly significant
concordance between pre-intervention MC staging and OS in all
comers in this cohort (C-index 0.59).
Conclusions: This study has validated the use of the MC model in a
pre-interventional clinic setting. Bilirubin, a standardised easily
obtainable serological biomarker, should be considered for
incorporation into the MC model to refine patient stratification by OS.
Abstract citation ID: znac248.200
TH2.6 Evaulation of the prognostic utility for hENT 1
transmembranous protein in resected hilar
cholangiocarcinoma patients
Nicholas Bird1, Nichola Manu1, Zak Shehata2, Stephen Fenwick1,
Robert Jones1, Hassan Malik1
1
Liverpool Foundation Trust, Liverpool, UK
2
Royal Preston Hospital, Preston, UK
Aims: Human equilibriative nucleoside transporter protein 1 (hENT1)
facilitates nucleoside transport into the cell.
Immunohistochemically-detected hENT1 is increased in
cholangiocarcinoma tumour cells and in highly metabolising cells.
The Mackey 10D7G2 hybridoma has demonstrated prognostic utility in
Pancreatic Ductal Adenocarcinoma. The Proteintech Polyclonal hENT1
antibody’s prognostic utility has not been assessed. Cellular Ki67
expression is linked to tumour proliferation. This study aims to assess

the antibodies’ prognostic utility for resectable hilar
cholangiocarcinoma.
Methods: Between 2009–2016, 54 patients underwent resection for
peri-hilar cholangiocarcinoma. Formalin-Fixed Paraffin Embedded
blocks from 44 specimens were retrieved. A Tissue-Matched Array
was constructed and stained for each antibody. H-scores were utilised
to determine expression intensity. Correlation of expression was
determined by Pearson correlation co-efficient and Chi-squared.
Silencing RNA for transfected HepG2 cell-lines was used to determine
accurate hENT1 staining by the Proteintech antibody. Demographic
and survival characteristics were acquired from a prospectively held
database, and were calculated with global log-rank calculations.
Results: There was significant correlation between the Mackey and
Proteintech antibodies (p<0.001), and between the Proteintech
antibody and Ki67 expression (p= 0.02). Knockdown of hENT1 with
silencing RNA transfected HepG2 cells was confirmed by Western blot.
The antibodies (Mackey; Proteintech; Ki67) showed no significance for
predicting OS (p= 0.75; 0.63; 0.22 respectively). Nodal stage (p= 0.03)
and tumour differentiation (p= 0.02) showed prognostic utility.
Conclusion: While the Proteintech antibody demonstrates concordance
with the 10D7G2 antibody in determining hENT1 expression, they didn’t
demonstrate significant prognostic ability. Standard histopathological
co-variates retain prognostic utility within the cohort.
Abstract citation ID: znac248.201
TH2.7 Pancreatitis and Cancer. An evaluation of clinical
practice with focus on links to the development of pancreatic
cancer
Gautam Singh, Ashwini Ghorpade, Aleksis Martindale, Hannah Maroof,
Henry De’Ath, Darmarajah Veeramootoo
Frimley Park Hospital
Aim: Pancreatitis is a common surgical pathology that burdens all
healthcare systems. Acute or chronic presentations require dedicated
resources and evidence-based management. Literature suggests
increased risk of cancer is two-fold with acute and up to 8-fold with
chronic pancreatitis. Our study aims: 1. Assess current practice
against NCEPOD 2016 guidelines, 2. Explore the incidence of cancer.
Method: Prospectively collected electronic records and clinical systems
were interrogated from Jan 2015 to Feb 2018. Data was collected on
patient demographics, analytics, clinical outcomes and follow up. All
patients and hospital episodes’ data were included.
Results: Over the 3 years, 337 patients presented with a male: female
ratio of 1:1. Median age was 61.2 (IQR 51.3–74.4). Diagnosis was acute
pancreatitis 82% and chronic 18%. Aetiology was biliary 63%,
alcohol-related 20% and idiopathic 10%. Ca19–9 was performed in 10%
overall; and IgG4 in 10% of unknown aetiology. Ultrasound scan
within 24 hours performed in 62% (improved to 79% on re-audit after
an educational campaign). Within the study period, 120 patients
completed 5 years follow up. 4 patients developed cancer: 3 (1.1%) in
acute group and 1 (1.6%) in chronic pancreatitis group. All had Ca19–9
levels done at initial presentation with values of 6310, 19, 14 and 239u/
ml respectively.
Conclusions: Compliance with guidelines is improved through
awareness and clinical focus, to the benefit of patients. Pancreatitis
can be an early marker of cancer, and Ca 19–9 (best validated serum
tumour marker) may help clinical suspicion. Larger multi-centred
collaborations may further the knowledge base.
Abstract citation ID: znac248.202
TH2.8 Continuing fast-track (Expedited)
pancreaticoduodenectomy service during the Covid-19
pandemic: Experience from an established pancreatic surgical
centre
Dharmadev Trivedi1,2, Sheah Lin Lee1, Arjun Takhar1,
Thomas Armstrong1, John Primrose1, Ali Arshad1
1 health information for patients. This information has been shown to
University Hospitals Southampton NHS Foundation Trust
2 be generally of poor quality. The purpose of this study was to identify
South Warwickshire NHS Foundation Trust
Aim: Avoiding preoperative biliary drainage (PBD) can facilitate early
curative surgery for patients with periampullary tumours. However,
the evidence over PBD is conflicting. This prospective re-audit aimed
to assess compliance to NICE guidelines (NG85) and surgical outcomes
Abstracts | v89
at a well-established HPB surgery unit after achieving additional
theatre sessions following prior audit.
Methods: Prospective data collection and analysis for all patients
undergoing pancreaticoduodenectomy with curative intent was
performed as re-audit at a tertiary pancreatic centre between
September 2020 to August 2021.
Results: 64 or 71 patients received curative pancreaticoduodenectomy
(43 Kausch-Whipple & 23 pylorus-preserving pancreaticoduo-
denectomy, 7 inoperable). Of 29 patients without PBD, 10 were
jaundiced with median bilirubin levels of 138 Micromole/L (range
27–357 Mmol/L). Median time (range) from diagnostic imaging to
surgery with curative intent was 21 days (3–42) for patients without
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PBD compared to 62 days (22–305) for those with PBD (p=0.00028). No
statistically significant difference in median HDU/ITU stay (4 Vs
3 days, p=0.849), postoperative complications (C-D>2) (30% Vs 27.8%,
p=0.755), R0 resection rates (42.8% Vs 75%, p=0.364), and median
hospital stay (17 Vs 10 days, p=0.076) was observed for patients
without or with PBD respectively. Interestingly, inoperable patients
had shorter time delay from diagnostic imaging to surgery (29 Vs 49
days, p=0.010)
Conclusion: Fast-track (expedited) pancreaticoduodenectomy is
feasible and safe for selected group of jaundiced patients without PBD.
The constraints and challenges posed by Covid-19 pandemic are likely
reflected in higher number of patients receiving PBD (42/ 71) despite
clear referral pathway established following prior work at our institute.
Abstract citation ID: znac248.203
TH2.9 The Incidence and Outcomes of Delayed Laparoscopic
Cholecystectomy and Bile Duct Exploration on a Unit Adopting
Index Admission Surgery for all comers. A Review of 5750
patients
Silje Welsh, Ahmad Nassar, Mahmour Sallam
University Hospital Monklands
Background: The timing of laparoscopic cholecystectomy (LC) for
emergency biliary admissions remains inconsistent with national and
international guidelines. The perception that LC is difficult in acute
cholecystitis and the popularity of the two-session approach to
pancreatitis and suspected choledocholithiasis result in delayed
management.
Methods: Analysis of prospectively maintained data in a unit adopting
“intention to treat” during the index admission. The aim was to study
the incidence of previous biliary admissions and compare the
operative difficulty, complications and postoperative outcomes with
index admission LC.
Results: Of 5750 LC performed 20.8% had previous biliary admissions;
one in 93% and two or more in 7%. Most presented with biliary colic
(39.6%) and acute cholecystitis (27.6%). A previous biliary history was
associated with increased operative difficulty (p<0.001), longer
operating times (86.9 v 68.1 minutes, p<0.001), more post-operative
complications (7.5% v 5.2%, p=0.002) and longer hospital stay (8.1 v 5.5
days, p<0.001). However, conversion and mortality rates showed no
significant differences.
Conclusion: Index admission LC is superior to interval cholecystectomy
and should be offered to all patients fit for general anaesthesia
regardless of presenting complaints. Subspecialisation should be
encouraged as a major factor in optimising resource utilisation and
post-operative outcomes of biliary emergencies.
Abstract citation ID: znac248.204
TH2.10 YouTube videos as a source of patient information for
gallstone disease
Kealan Westby, Evan Mannion
Galway Clinic, Galway, Ireland
Aim: YouTube is a widely accessible platform & a popular source of
and assess the quality of YouTube videos as a source of information
for patients with gallstone disease.
Methods: A cross-sectional study was carried out with the keyword
“Gallstones” used to search the YouTube database. Only videos In
English were included. Duplicated videos, advertisements and those
v90 | Abstracts
videos in other language than English were excluded. Videos were listed
by relevance and the first 50 videos identified were evaluated. Recorded
video features included likes, dislikes, length and source. DISCERN +
JAMA benchmark criteria were used for quality analysis
Results: 50 videos were analysed, the majority of which were uploaded
by healthcare professionals (60%). Mean DISCERN and JAMA scores were
40.5 and 2.5. Overall quality of the videos were low. The correlation
between length of video and DISCERN and JAMA scores was positive.
Conclusions: There are a number of videos on YouTube concerning
gallstone disease that are frequently viewed but unfortunately are of
low quality. Health professionals should be aware of this and caution
patients on their unreliable nature.
Abstract citation ID: znac248.205
TH2.11 The influence of sarcopenia and systemic
inflammation on survival in resected pancreatic cancer
Adam Bryce1,2, Stephan Dreyer1,2, David Chang1,2
1
University of Glasgow
2 Marcus Quinn1, Annie Reilly1, Emma Niewdach2, Sam Rodgers2,
Glasgow Royal Infirmary
Aims: Sarcopenia, cachexia and systemic inflammation are early
hallmarks of pancreatic cancer. The impact of these processes on
survival has been demonstrated in other cancer types using
image-based body composition analysis. We sought to determine the
impact of sarcopenia and systemic inflammation on survival in
pancreatic cancer.
Methods: A database of patients with pancreatic cancer undergoing
resection with curative intent was maintained. Single-slice (L3)
skeletal muscle index from pre-operative CT was used to define
sarcopenia. Pre-operative systemic inflammation measures were
curated (modified Glasgow Prognostic Score and
neutrophil-lymphocyte ratio).
Results: 176 patients underwent resection. Median post-operative
survival was 26.3 months and 95 were sarcopenic (54%). Sarcopenia
was not associated with worse survival versus non-sarcopenia
(median 24.2 months vs 27.4 months, p = 0.558). mGPS was raised in
52 patients (30%) however this was not associated with worse survival
versus normal mGPS (median 26.2 months vs 26.6 months, p = 0.193).
Raised NLR did not significantly influence survival.
Conclusions: Pancreatic cancer represents a complex biological process
with survival likely influenced by tumour biology and the relationship
between tumour epithelium and tumour microenvironment. Survival
has previously been shown to be influenced by sarcopenia in all
patients with pancreatic cancer, suggesting selection of “fitter”
patients for resection in our cohort. Further understanding of tumour
biology is needed to determine the relationship between tumour
epithelium, tumour microenvironment, cachexia and systemic
inflammation. Analysis of this relationship is ongoing and we
envisage presenting results of this research in conjunction with this
abstract if selected for presentation.
Abstract citation ID: znac248.206
TH2.12 Difficulties in managing acute gallstone disease at a
Tertiary Referral Centre admist COVID-19
Kevin Pinto, Caitlin Roe, Chloe Koh, Katie Cheung, Aaditya Sinha,
Husam Ebied, Maxwell Renna
Guy’s and St Thomas’ NHS Foundation Trust
Background: Acute biliary disease, a surgical emergency, is
predominantly treated conservatively initially. Specialist units aim to
follow guidelines set by the Royal College of Surgeons and NICE to
provide a cholecystectomy within a set time. Clinical practice at St
Thomas’ Hospital was reviewed along with the difficulties during the
COVID-19 pandemic.
Aims: Reassess practice at a specialist unit failing to meet guidelines
during the start of COVID-19. Prospective data collection, on patients
booked for a laparoscopic cholecystectomy (LC) after emergency
attendances.
Method: Initial retrospective data analysis, reviewing pre-COVID (PC19)
practice (03/19–02/20), initial COVID-19 (IC19) management (03/20–12/
20). Prospective data (01/21–11/21) after implementing changes (AC19).
Identifying demographics, pathology, length of stay during acute
admission, average wait for surgery and readmission rate prior to
surgery. Patients receiving surgery within 6 weeks, which has been set
by our trust as an acceptable standard.
Results: Patients with acute presentation (acute cholecystitis, gallstone
pancreatitis, cholangitis) 162 (PC19), 80 (IC19), 145 (AC19). Gender Ratio
M:F 1:2 for all groups. Average wait to surgery 93 (PC19), 44 (IC19), 69
(AC19) days. Patients receiving surgery within 6 weeks 24.7% (PC19),
32.5% (IC19), 51.7% (AC19). Patients who were still awaiting surgery at
the end of each time frame 49% (PC19), 51% (IC19), 48% (AC19). Mean
length of surgical stay 1.75 (AC19) days.
Conclusions: Further changes are required, as guidelines are still not
being met, with average wait times significantly above the
recommended wait to undergo laparoscopic cholecystectomy.
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Abstract citation ID: znac248.207
TH3.1 Implementation of a home finger-prick CEA test for
follow-up of colorectal cancer - a pilot study of patient
perspectives
Anne Pullyblank1
1
North Bristol NHS Trust, Bristol
2
Medichecks Ltd, Nottingham
Aim: NICE guidance advocates 6 monthly CEA blood testing following
curative colorectal resection. This usually takes place through face to
face appointments with a phlebotomist, with associated monetary
and resource cost to local services, as well as impacting on patient
lives. This project piloted use of self-taken finger-prick blood tests in
this patient population, to assess feasibility, patient perspectives and
preferences.
Methods: During colorectal outpatient clinics, patients undergoing face
to face CEA surveillance in primary care were offered postal finger-prick
assessment. Recruitment stopped once 50 patients had been recruited.
Recruited patients were sent finger-prick blood testing kits with
pre-paid return packaging. Follow-up questionnaires were undertaken
to assess patient perspectives and future preferences.
Results: 67.6% (50/74) of eligible patients agreed to participate. 76.0% (38/
50) of patients successfully completed finger-prick CEA assessment.
46.8% (22/47) of patients felt they would prefer finger-prick rather than
phlebotomy for future CEA testing, whilst 19.1% (9/47) had no
preference. 38.3% (18/47) patients felt finger-prick testing was worse
than their previous experience. No significant differences in
preference existed between patients aged <65 and 65+. Qualitative
data showed difficulties with pain, discomfort and sample collection.
Patients felt that finger-prick samples were convenient and easier to
fit in with their lives.
Conclusions: Whilst some patients prefer finger-prick CEA assessment,
there are significant numbers for whom it is challenging, unnecessary or
less preferable. Finger-prick CEA testing may represent a future strategy
for reducing burden of follow-up blood tests on resources, but this
would currently be acceptable only to limited patient groups.
Abstract citation ID: znac248.208
TH3.2 Audit of acute lower GI bleed admissions - outcomes and
management
Sharukh Sami1, Niroshini A Hemadasa1, Cheryl Loh2, Antony DeCruz2,
Muhammad Mirza1
1
NHS Dumfries & Galloway
2
University of Glasgow
Background: Lower GI bleeding (LGIB) is a common surgical emergency.
The British Society of Gastroenterology (BSG) in 2019 developed a UK
national guideline on the management of LGIB. Our aim is to audit the
current practice and standards for patients admitted with LGIB.
Methods: This retrospective audit identified patients presenting to the
Emergency department and Surgical assessment unit between
September 2020 to February 2021 with LGIB. The shock index and
Oakland score (OS) at first presentation were calculated.
Results: A total of 27 patients satisfied the inclusion criteria. Average age
of patients was 64.7 years. Three patients had an OS of ≤8 with 1 patient
being hospitalised. 21 patients had an OS of >8 and 7 out of the 21
patients were discharged instead. 14 patients (51.8%) were on
anticoagulants/antiplatelets of which 1 was on dual antiplatelet

therapy. 10 patients had their drugs suspended appropriately and 2 did
not. Eight patients were referred for OP endoscopy.
Conclusion: We found that improvements can be made with respect to
suspension of anticoagulant and antiplatelet drugs and duration to
colonoscopy. A more pragmatic approach to both intervention and
interval to endoscopy may have to be applied due to service constraints.
A checklist has been developed based upon the guidelines to
• Triage patients as stable or unstable bleed at admission
• Recommend admission or discharge
• Guide decisions regarding suspension and re-commencement of
antiplatelet and anticoagulants
• We plan to re-audit the parameters prospectively after 3 months from
the roll-out of the checklist.
Abstract citation ID: znac248.209
TH3.3 “Closing the loop”: what is the delay in Reversal of
Hartmann’s procedure?
Victoria Roberts1, Vinay Mandagere1, George Crisp1, Sarah Biggs2,
Jamshed Shabbir1
1
University Hospitals Bristol NHS Foundation Trust
2
North Bristol NHS Trust
Reversal of Hartmann’s procedure is performed to restore intestinal
continuity. There is conflicting literature on the best time for reversal,
with little evidence suggesting waiting longer than a year is beneficial.
We assessed the experience of our patients.
Patients were identified from the local Enhanced Recovery After Surgery
(ERAS) database over a 9-year period (2012–2021) at a University
Hospital. Data was collected from digitalised hospital notes on patient
demographics; timings to reversal of Hartmann’s; defunctioning
stoma; reasons for delay; length of stay; and complications.
Forty-three patients underwent reversal of Hartmann’s procedure.
Median age was 57 (38–83) years; 19 (44%) of patients were female.
Surgery was performed laparoscopically in 18 (42%); laparoscopic
converted to open 6 (14%); open in 19 (44%) patients. Average length of
stay was 6 days. Indications for primary Hartmann’s procedure were
diverticular disease (67%), malignancy (21%), and other causes (14%).
Median time from the index operation to reversal of Hartmann’s was
85.2 weeks (range 19.9–312.4 weeks). Only 9 (21%) patients underwent
reversal Hartmann’s within 1 year of primary surgery. Of the reasons
known for the delay in reversal; 15 (35%) were due to patient
complications, 6 (14%) were due to administrative reasons, 2 (5%) were
due to COVID-19 associated delays and 1 (2%) patient choice.
This retrospective analysis highlights the varied patient experience
within just one centre, further research incorporating detailed patient
experience is needed. It also highlights a paucity of national
evidence-based consensus on optimal timing for challenging
revisional surgery.
Abstract citation ID: znac248.210
TH3.4 Perineal reconstruction following standard and
extralevator abdominoperineal excision: results of a national
practice questionnaire
Rushabh Shah1, Rituja Kamble2, Mohammad Herieka3, Milind Dalal3
1
Manchester University NHS Foundation Trust
2
University Hospitals Plymouth NHS Trust
3
Lancashire Teaching Hospitals NHS Foundation Trust
Aims: Challenging perineal defects resulting from extralevator (ELAPE)
and standard abdominoperineal excision (APE) have resulted in a
growing multidisciplinary approach between colorectal and plastic
surgery colleagues. Currently there is a paucity of evidence on best
practice in this emerging field. This study aims to define and describe
current national practice within the United Kingdom (UK) in perineal
reconstruction following APE/ELAPE.
Methods: A national practice questionnaire was designed using ‘Google
Forms’ and circulated via email to 41 units across the UK performing
perineal reconstruction following APE/ELAPE.
Results: Complete responses were received from 23 units (response rate
56%), representing 12 regions across the UK. All units had a dedicated
APE/ELAPE service. 70% had a standardised approach to
Abstracts | v91
reconstruction, with the Inferior Gluteal Artery Perforator (IGAP) flap
being the most common approach (n = 11). Significant variation was
observed in the reconstructive approach with regards to flap choice
and routine use of pelvic acellular dermal matrix or mesh. Similar
differences were observed in the perceived importance of various
surgical factors that guide the reconstructive decision making
process.
Conclusions: Our national practice questionnaire responses report
nationally well established local networks between colorectal and
plastic surgeons. However, the variation in results reflects a lack of
national consensus on the optimal reconstructive method after APE/
ELAPE. Our study highlight the need for the development of
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collaborative evidence based national guidance on best practice.
Abstract citation ID: znac248.211
TH3.5 Completeness of operative reports for rectal cancer
surgery
Inmook Bae, William Spinks, Balakrisanan Saravanan, Andrei Moscalu
James Paget University Hospital
Introduction and Objectives: Synoptic operative reporting has been
shown to improve completeness and consistency in surgical
documentation, which ultimate improves quality of care. We set out
to assess whether post-operative reports, made at the JPUH, include
the primary components recommended by the National Accreditation
Program for Rectal Cancer. The JPUH does not currently use synoptic
templates to guide post operative note making.
Methods and materials: We retrospectively looked at the post-operative
reports for 71 patients who had undergone surgery for rectal cancer
from March 2018 to October 2020 at the James Paget University
Hospital. These reports were evaluated to establish how many of the
primary components were included.
Results: Of the 71 reports assessed, none included all 23 components.
The areas well documented included the nature of the operation
(100%), completeness of resection (93%), the type of reconstruction
(85%) and anastomosis testing method (97%). The areas that were
poorly documented included en bloc resection (8%), metastectomy
(0%), intra-operative complications (0%) and blood transfusion (0%).
Overall there was 53% completeness of documentation.
Conclusion: Rectal cancer post-operative note making at the JPUH does
not meet the standard expected by the NAPRC. Some points were
documented well and others were infrequently documented. Plans are
in place to introduce accessible templates to guide note making and
re-audit will be completed.
Abstract citation ID: znac248.212
TH3.6 Comparison Between Preoperative MRI and
Postoperative Histopathological Staging in Rectal Cancer
Surgery (RCS)
Masood Rehman, A Gendia, M T Nasir, J Ahmed, Nishil Gupta
Northampton General Hospital
Aim: To evaluate diagnostic values of preoperative MRI imaging staging
in comparison to postoperative histopathological staging (HPS) in rectal
cancer surgery.
Methods: A retrospective chart auditing was performed on all RCS
patients from 2019 till 2021. Data collected included patient
demographic, preoperative MRI imaging and postoperative
histopathological analysis.
Results: A total number of 83 rectal surgeries were performed during
the given period, mean age was 67(±11) and 60% were males. 62.7%
(52) of patients underwent anterior resection (low AR 27.7%). APR
and Hartmann’s procedure were performed in 27.7% and 6% of
patients. Complete resection was achieved in 95.2% with average
LN harvest of 20.5 (±5.8) nodes. The most common Tumour (T)
burdens on preoperative MRI and postoperative HPS were T2
(45.6%) and T3 (44.5%) respectively with MRI diagnostic accuracy of
47%. Lymph nodes analysis showed diagnostic preoperative
predictive values of 56.6%. Extramural vascular invasion (EMVI)
was accounted in 68 Pre-MRI with diagnostic accuracy of 50.6%.
Pre-MRI evaluated 69 CRM and accurately commented in 73.5%.
Although Pre-MRI staging had tendency to over-stage tumour
burden, lymph nodes analysis and EMVI in around 30% of reported
v92 | Abstracts
cases. It showed accuracy in diagnostic values in CRM prediction
with around 73%.
Conclusion: Preoperative MRI diagnostic values showed differences
when compared with postoperative histopathological analysis.
Pre-MRI showed a tendency to over-staging in tumour size, LNs and
EMVI. However, Pre-MRI showed favourable values in accurately
describing CRM which is the main factor affecting the outcome of
surgery and the ongoing treatment.
Abstract citation ID: znac248.213
TH3.7 Is There a Benefit for Routine Doughnuts
Histopathological Examination After Anterior Resection (AR) in
Colorectal Cancer Surgery?
Masood Rehman, A Gendia, M T Nasir, J Ahmed
Northampton General Hospital
Aim: To evaluate the oncological benefits and cost-effectiveness of
routine histological examination of the doughnuts from stapled
anastomoses in patients undergoing colorectal cancer surgery.
Methods: A retrospective chart auditing was performed on all
consecutive rectal cancer surgery (RCAS) patients performed in NGH
from January 2019 till August 2021. Data collected included patients’
demographic, procedure performed and postoperative
histopathological analysis including doughnuts examination.
Results: Fifty-two patients underwent AR during the given period. 37
(71%) patients had doughnuts histopathological examination. median
age was 68.59 (±11) years old and 62.1% were male. The
histopathology of all resected specimens was adenocarcinoma. 48.6%
and 51.4% underwent low anterior resection and high anterior
resection respectively. Proximal doughnuts sent in 70.2% patients
whereas distal doughnuts were sent in all resections. Mean distal
resection margin from tumour was 21.7 mm and the shortest distance
from the tumour to resection margin was 6 mm. All the doughnuts as
well as resection margin were negative for any malignancy.
Additionally, each doughnut costs our pathology laboratory around
150 pounds with total preparation time of 72hours and around 10
mins of microscopic examination. This makes total costs and time of
examining all specimens of around 9,300 pound and 4,470 hours in
resources.
Conclusion: There was no additional oncological benefit in sending
routine examination of doughnuts. It should only be sent in those
deemed of a higher risk of a positive margin. This will result in
significant reduction in cost and time burdens on our resources.
Abstract citation ID: znac248.214
TH3.8 Retrospective study on the use of colonic stents in
malignancy; a bridge to surgery or the end of the line?
N Williams, N Reeves, S Chandler, H Jones
Aneurin Bevan University Healthboard
Aim: Colonic stenting is a management option for obstructed left sided
colorectal malignancy in the emergency and elective setting. Stenting
can provide a bridge to curative surgery or to adjuvant treatment. The
aim of this study was to assess the role of colonic stenting in
management of obstructed colorectal cancer.
Methods: This retrospective cohort study analyses prospectively
collected data from two centres within one Health Board in Wales.
Patients were recorded in a cancer database, who underwent colonic
stenting for left sided colonic malignancy between January 2008 and
December 2021. Patient demographics, treatment pathways, length of
admission, stoma formation rates and morbidity were recorded.
Results: In total, 98 patients, with a mean age of 73.5 years (range 37–97)
underwent a colonic stent. The majority were elective 55% (n=54). The
sigmoid colon was the commonest site of tumour in 33 patients, with
metastatic disease in 82% (n=80). The study found 86% (n=84) of
patients were successfully stented. The mean length of admission was
13 days. The complication rate was 23% (n=23), most commonly stent
obstruction (n=6). Stenting was a bridge to curative surgery for 3
patients, and 47% (n=46) received adjuvant treatment. Five-year
survival was 19.3% (n=19). The overall stoma rate was 10.2% (10
patients).
Conclusion: This study shows colonic stenting is a viable alternative in
surgical management for advanced obstructing colorectal malignancy
but not as a bridge to surgery. The majority of this cohort returned
home following stenting, had a low overall stoma rate and 19%
survival at 5 years.
Abstract citation ID: znac248.215
TH3.9 Cleft closure is an effective procedure for the treatment
of pilonidal disease with low recurrence rate
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Ambeur Ali, Francesco Di Fabio, Caroline Yao,
Arcot Venkatasubramaniam, Steve Arnold, Mahesh Daniel
Basingstoke and North Hampshire Hospital
Aims: The surgical treatment of pilonidal sinus disease has evolved
over time, with reported time to healing, post-operative
complications and disease recurrence rates still significant. The
modified Karydakis procedure such as the Bascom’s cleft lift
operation or “cleft closure” flattens the cleft and has shown
promising results. The purpose of this single-centre study is to
analyse outcomes of this technique.
Method: This is a retrospective study of 192 patients undergoing cleft
closure as a day case over 10 years. The technique involves an
off-midline cleft closure with an advancement flap and primary
closure. Outcome measures were postoperative complications, time to
healing and recurrence requiring surgery.
Results: The median age at surgery was 25 years (IQR 21–33), with males
representing 76%. Overall, 91 (47%) were smokers. 141(73%) patients had
previous emergency treatment. The median numbers of pits/sinuses
were 3 and in 71% of patients were localized in the midline. The
median time to wound healing was 3 weeks (IQR 2–6). Twenty-five
(13%) patients had postoperative complications including infection
(n=21) and hematoma (n=4). Disease recurrence requiring surgery
occurred in 7 (3.6%) patients. Median time to recurrence was 9 months
(IQR 5–15).
Conclusion: Cleft closure is an effective procedure for the treatment of
pilonidal disease, with a low rate of postoperative complications and
recurrence.
Abstract citation ID: znac248.216
TH3.10 An audit assessing factors contributing to the 5-year
disease recurrence rate after curative resection of rectal cancer
Nadia Youssef, Ishani Sinha, Gethin Williams
Aneurin Bevan University Health Board
Aim: To study the 5-year recurrence rate of rectal adenocarcinomas
following curative surgery in a cohort of patients from a single Health
Board, and to identify statistically significant risk factors of disease
recurrence.
Method: This audit included a total of 95 patients who underwent elective
resections of primary rectal cancer between January 2014 and January 2016
at a single health board. The 5-year disease recurrence rate was
documented. Medical records were accessed via the Clinical Workstation
system and a number of factors were recorded and statistically analysed
on Microsoft Excel using z-score for two populations portions. A p-value
of <0.025 was considered statistically significant.
Results: Of the 92 patients included in this audit, 23 suffered
disease recurrence. Younger age at diagnosis, tumour perforation,
positive lymph nodes, tumour involvement of circumferential
resection margin, and extramural vascular invasion were all
associated with significantly increased risk of disease recurrence and
poorer prognosis. Postoperative complications were observed in 26%
of the cohort and it was significantly (p=0.009) associated with disease
recurrence. Although more patients who developed disease
recurrence received chemoradiation as part of their initial disease
management, the number was not statistically significant.
Conclusion: The audit supports lowering the age of bowel cancer
screening. Strategies are required to minimise the risk of
postoperative complications in patients undergoing elective rectal

cancer resections. Reasons must be identified as to why patients with a
higher risk of recurrence, undergoing curative surgical resection of
tumours, do not have higher uptake of adjuvant and neoadjuvant
chemoradiation.
Abstract citation ID: znac248.217
TH3.11 Standardised Follow-up for Patients with Acute
Diverticulitis – Quality Improvement Project
Ana Gavrila, Chaitanya Mehta, Najaf Nawaz Siddiqi
Poole General Hospital
Aims: Historical guidelines recommended routine colonoscopy some
weeks after an episode of acute diverticulitis. Our project aimed to
analyse outpatient follow up in our unit for patients with a clinical
diagnosis of uncomplicated diverticulitis who did not require any
inpatient investigations or intervention. Following on from this we
proposed a pathway to standardise follow up care in this group of
patients.
Methods: A retrospective audit was undertaken of outpatient follow up
received by all patients coded with a primary clinical diagnosis of
diverticulosis or uncomplicated diverticulitis in 2015, 2017 and 2019.
Follow up investigations included a colonoscopy, flexible
sigmoidoscopy, CT colonogram (CTC) or none of the above due to
frailty or recent endoscopic investigation within the previous 2 years.
Results: Overall 118 patients were included in the audit. There was a
reduction in patients who had a clinical diagnosis of uncomplicated
diverticulitis in the second and third cycle of the audit from 67 to 22
and 29 respectively. This overall led to less outpatient endoscopic
evaluation.
Conclusion: Departmental consensus guided the formation of a
standardised pathway whereby appropriate patients without any
colonic investigation within the last 24 months were investigated with
an outpatient CTC six weeks after discharge. This led to a significant
reduction in outpatient colonoscopy numbers.
Abstract citation ID: znac248.218
TH4.1 Systematic review of preoperative magnetic resonance
angiography, computed tomography angiography and duplex
ultrasonography for diagnosis and planning of surgical,
endovascular or hybrid procedures for lower limb
revascularisation
Daisy Edgerley1, Asad Rahi2
1
University of Manchester
2
Regional Vascular Centre, Royal Preston Hospital
Aims: This systematic review assessed literature concerning
preoperative magnetic resonance angiography (MRA), computed
tomography angiography (CTA), and duplex ultrasonography to
determine the sensitivity and specificity at detecting lower limb
arterial stenosis and/or occlusion, with digital subtraction
angiography (DSA) as the reference standard. The aim was to see if
any, or a combination of, methods could replace DSA in peripheral
arterial disease diagnosis and treatment planning.
Methods: 10 databases were searched on Ovid for studies involving
MRA, CTA and/or duplex ultrasonography of the lower limb arteries.
The period of interest was 1995-April 2021. The papers were assessed
for their relevance to the review against the exclusion criteria.
Results: 41 studies were included. For detecting ≥50% stenosis or
occlusion, multi-detector CTA had the highest median sensitivity of
93.9% and specificity of 93.4%. Contrast-enhanced MRA and duplex
ultrasonography reported median sensitivities and specificities of
91.1% and 91.9%, and 82.7% and 90.6%, respectively. For detecting
occlusions, duplex ultrasonography had the best median sensitivity of
92.3% and specificity of 99.5%. Contrast-enhanced MRA and
multi-detector CTA had median sensitivities and specificities 92.0%
and 96.5%, and 88.6% and 98.3%, respectively.
Conclusion: Contrast-enhanced MRA had the best overall diagnostic
accuracy. Multi-detector CTA detected ≥50% stenosis or occlusion
well, but the sensitivity for occlusions was lower than MRA and
duplex ultrasonography. Though duplex ultrasonography detected
occlusions better than MRA and CTA, it was less sensitive and specific
at detecting ≥50% stenosis or occlusion. Consequently,
contrast-enhanced MRA could be used as an alternative to DSA.
Abstracts | v93
Abstract citation ID: znac248.219
TH4.2 To do or not to do, Branch ligation of a non-maturing
arterio-venous fistula for haemodialysis
Abdallah Abdelwahed, Fatima de Figueiredo,
Raghvinder Pal Singh Gambhir
King’s College Hospital NHS Foundation Trust
Aim: Up to 20% of arterio-venous fistulas (AVFs) may fail to mature to
become usable for renal access in patients on Haemodialysis (HD).
There is no consensus on benefit of branch ligation. This study aimed
to assess the outcomes of branch ligation on maturation of these AVFs.
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Methods: Electronic patient records and Renalware were accessed to
obtain data of branch ligation procedures done at secondary care
centre from 2016 till 2021.
Results: With a prevalent dialysis population of over 771 patients and
incident dialysis population of 147 in 2021, we as a centre perform
250–300 access procedures annually.
A total of 23 ligation procedure were done in the above-mentioned
period. Less than 50% of patients had a large branch documented on
Duplex scan report to be draining a significant and measurable flow
away from the AVF. The other procedures were done based on clinical
judgement. All procedures were done under Duplex guidance and
under Local or Regional anaesthesia. About two thirds of the fistulas
that required branch ligation were Radio-Cephalic AVFs, the rest
Brachio-Cephalic AVFs. No complications were reported though one
patient needed a fistuloplasty due to vein pinch.
In 16 out of the 23(69.5%) patients there was clinical and sonological
improvement in flow, and or vein diameter after the branch ligation
making them usable for HD.
Conclusion: Branch ligation of non- maturing fistula in selected cases
can help maturation and make these arteriovenous fistulas usable.
Abstract citation ID: znac248.220
TH4.3 Walk the extra mile!!
Aimee Griffiths, James Archer, Raghvinder Pal Singh Gambhir
King’s College Hospital NHS Foundation Trust
Aim: Limb salvage and mortality remain high in patients with critical
limb ischaemia. The present study looks at outcomes of a
multimodality 24x7 service at a major diabetic foot centre.
Methods: We retrospectively reviewed surgical outcomes of bypass
procedures done to identify patients that needed to go have further
procedures within the same admission for limb salvage. Electronic
patient records were reviewed and data analysed to assess the
outcomes of overall limb salvage rates and mortality.
Results: 68 patients underwent bypasses in the study period. 38 (55%) of
patients who had procedures performed in the study period needed to
have an additional intervention after the index procedure. 9 needed
redo surgery (thromebctomy and further extension of graft with jump
grafts), 27 needed angioplasties and 2 patients needed both. Majority
of the intervention were done within 24–72 hours. Among those grafts
which failed one of the causes identified was prolonged hypotensive
episodes in perioperative period. All these additional interventions
delayed discharge, prolonged hospital stay but were essential for limb
salvage.
64 patients (94%) had intact limbs at discharge, 4 required a major
amputation - 1 below knee and 3 above knee. At 1 year follow up 56
patients (82%) were alive.
Conclusion: If the patients have to retain the ability to walk we have to
be prepared for some extra effort. Additional procedures planned or
unplanned are sometimes necessary to save the limb. A
multimodality 24x7 service willing to go the extra mile goes a long
way in preventing major amputations.
Abstract citation ID: znac248.221
TH4.4 Real-world mid to long term mortality after Abdominal
Aortic aneurysm (AAA) repair
Ananya Muthukumar1, Meghna Nair1, Raghvinder Pal Singh Gambhir2
1
King’s College London
2
King’s College Hospital NHS Foundation Trust
v94 | Abstracts
Aim: Centralisation of vascular services has decreased 30-day AAA
mortality from 7% to 3% across UK, but does it have an effect on their
long term survival?
Methods: Electronic patient records for 264 patients with AAA repair
between 2009–2018 submitted to national vascular registry (NVR) from
a single centre were analysed.
Results: 231 of 264 patients (88%) had endovascular aneurysm repair
(EVAR) while 19 (12%) had open repair (OR). Male to Female ratio 8:1;
Mean age 76.5 years at time of surgery (TOS). 251 elective, 13 were
emergency repairs. 192 (72%) of patients have died since surgery- a
median survival of 4 years (IQR 2–7) post-surgery. Of these, 171 were
male, with a median survival of 4 years (IQR 2–7); 21 were female, with
median survival 3 years (IQR 1–5). Cause of death could be ascertained
only in 27 & 23 were attributable to non-aortic reasons. Median
survival post-surgery in 70–80 years age group (n-89) and 80+ (n-82),
was 5 years (2–7) and 3 years (1.25–5), respectively. Cohorts of patients
who lived either greater or less than median survival years were aged
similarly at TOS; 79.7 and 80.4 years, Mean survival post-EVAR was 4.5
years, while post-OR was 2.3 years.
Conclusion: With a median and mean survival post surgery of about 4
years, is it time we had mandatory involvement of Geriatric
physicians/older person assessment units like POPS (Perioperative
medicine for Older People Undergoing Surgery) in patient risk
assessment preoperatively especially in those that require costly
customised stent grafts.
Abstract citation ID: znac248.222
TH4.5 The introduction of a custom made endograft service for
patients with complex thoracoabdominal aneurysm
Nicola Duncan1, Antony Pilkington1, Larissa Dearie2, Martin Hennessy3,
Keith Hussey2
1
Glasgow University Medical School, Glasgow, Scotland
2
Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow,
Scotland
3
Department of Interventional Radiology, Queen Elizabeth University Hospital,
Glasgow, Scotland
Introduction: Custom made endografts represents a technological
advance that has been widely adopted across vascular centres in the
United Kingdom. The most recent National Vascular Registry report
describes in-hospital mortality for complex as 2.3%. We have reviewed
the outcome associated with the introduction of a custom made
endograft program in a single Scottish Health Board.
Methods: Index cases were identified from a prospective radiology
database with cases identified from 2008 to 2021. We collected patient
demographics, pre-operative assessment, peri-operative and
procedure related details and information on surveillance and
re-intervention.
Results: There have been 49 cases performed. Most patients were males
over the age of 70-years with significant medical co-morbidity. The
mean AAA size was 5.8cm. Most of the procedures have been
performed under general anaesthesia with percutaneous common
femoral access. Procedural complications have included inability to
stent target arteries (coeliac axis twice and right renal artery twice).
Other complications have included limb ischaemia and haemorrhagic
complications from access. Two critical care bed days have been used.
The mean duration of hospital stay is 9-days. There have been no
deaths on the index admission. During the follow-up period there
have been 6 deaths. One of these deaths was from rupture of
abdominal aortic aneurysm (secondary to Type III endoleak).
Conclusion: These data suggest that the case selection for custom made
endografts is good. The cost of the device may be off set by a reduction in
critical care utilization/hospital bed stay.
Abstract citation ID: znac248.223
TH4.6 Is major limb amputation the most appropriate means
of palliation for patients with non-reconstructable arterial
disease?
Thomas Trinder1, Chloe Rodger1, Kinza Fatima1, Larissa Dearie2,
Keith Hussey2, Douglas Orr2
1
Glasgow University Medical School, Glasgow, Scotland
2
Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow
Introduction: Major limb amputation (MLA) is the highest risk lower
limb surgical procedure performed in the United Kingdom with
reported in hospital mortality 9.1%. For patients with
non-reconstructable arterial disease it offers palliation of symptoms.
The primary aim of the current work was to define if surgical
palliation with major limb amputation is being offered to patients
who may have been best managed medically
Methods: Retrospective review of major limb amputations (March 2019
to October 2021). Historical datasets have also been scrutinised (2008–
2010). Specific variables of interest included the annual number of
major limb amputations, mortality on the index admission and place
of discharge.
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Results: A complete dataset was available for 282 patients during the
Covid period. Patient demographics were as anticipated - 206 (73%)
male, mean age 63-years (range 23 to 90-years). Peripheral arterial
disease (190) and diabetes mellitus (149) were common. The number
of major limb amputations was comparable with the historical series.
In-hospital mortality was 7% (n=20). The median duration of
admission for patients who survived was 26-days and 38% of patients
were limb-fitted (which was also comparable with historical data).
Most patients (71%) were discharged to their own home.
Conclusion: The outcomes described are better than the comparable
local historical and national data both in terms of in-hospital
mortality and place of discharge. These data imply that we make the
correct decision about MLA more often than we don’t.
Abstract citation ID: znac248.224
TH4.7 Seventeen years experience of surgical management of
Thoracic Outlet Syndrome at a District General Hospital
Sadia Jaskani, Barnaby JMc Farquharson, Justin Collis, Brian Andrews
Medway Maritime Hospital
Aims: To evaluate the outcomes of patients who underwent first rib
resection (FRR) for Thoracic Outlet Syndrome (TOS) over a period of 17
years at a single District General Hospital (DGH).
Methods: Retrospective review of patient notes of individuals treated
with FRR from August 2004 to August 2021.
Results: Sixty patients underwent 65 subclavian approach FRR for
indications neurogenic (n=45 (69%)), venous (n=6 (9%)), arterial (n=14
(22%)) TOS. Forty-four female patients underwent FRR (68%) and mean
age at time of surgery 34 years (range 27 to 64 years). Five patients (7.6%)
had bilateral FRR and seven patients (10.6%) diagnosed with cervical rib.
Mean length of time from initial symptoms to diagnosis 24 months
(range 2 to 60 months). Forty patients (62%) underwent a failed trial of
conservative management with physiotherapy before proceeding to
surgical management. Fifty-two patients (80%) reported complete
resolution of symptoms at follow up. Complications included wound
infections 2(3%), pneumothorax 4(6%), haemothorax 1(1.5%), phrenic
nerve complications 3(4.6%) and chronic pain 1(1.5%). One patient with
phrenic nerve injury underwent diaphragmatic plication procedure with
resultant resolution of symptoms. Mean length of stay 1.6 days.
Conclusions: This series presents the difficulty of diagnosis and
management of TOS with the majority of patients enduring symptoms
for a prolonged period of time before referral and definitive
management. Phrenic nerve complications are an underreported
complication of subclavian approach FRR, it is essential to counsel
patients accordingly before proceeding to surgery. FRR for TOS can be
performed safely and effectively in a DGH environment.
Abstract citation ID: znac248.225
TH4.8 Antiplatelet therapy used in vascular patients post CEA
Yasmin Zolfaghari, Raghvinder Gambhir
Kings College Hospital
Aims: To review antiplatelet therapy of vascular patients who had
undergone CEA post TIA over a 1-year period and to compare their
antiplatelet therapy to European Society of Vascular Surgery (ESVS)
guidelines for atherosclerotic carotid disease.
Methods: We reviewed all patients admitted under the vascular team
who underwent elective CEA from 1/1/20 to 1/1/21 (n=65). We
reviewed the antiplatelet therapy that were prescribed on discharge
summaries, and compared to current ESVS guidance. According to
ESVS guidance, it is stated that dual antiplatelet therapy (DAPT) is not

recommended in patients undergoing carotid endarterectomy unless
indicated for cardiac reasons.
Results: Out of the 65 patients who were discharged over one year, 55%
were discharged on DAPT, with the remaining 45% prescribed either
aspirin or clopidogrel alone. Additionally, there was heterogeneity in
the treatment duration for antiplatelet therapy across patients.
However, on 3 month follow up appointments, 100% of patients were
advised to continue on SAPT long-term in accordance to guidance.
Conclusions: Given the heterogeneity in treatment plans for CEA
patients over the studied time period, we believe there is value in
introducing weekly teaching sessions for MDT members of all grades,
to keep all members up to date on current guidance. Additionally, use
of posters incorporating up to date antiplatelet therapy guidance may
also serve as a useful tool for doctors discharging post CEA patients.
Despite the heterogeneity noted on discharge summaries, 100% of
patients were advised to continue on SAPT long term in follow up
clinic appointments.
Abstract citation ID: znac248.226
TH4.9 Patient Reported Outcome Measures (PROMs) – A Key to
Understanding Laparoscopic Cholecystectomy Outcomes?
Conor Melly1,2, Gearoid McGeehan1,2, Niall O’Connor1, Claire Donohoe3,
Magda Bucholc4, Michael Sugrue5,6
1
Department of Surgery, Letterkenny University Hospital and Donegal Clinical
Research Academy Ireland
2
University of Limerick School of Medicine, University of Limerick, Limerick,
Ireland
3
Department of Surgery, Trinity College Dublin, St James’ Hospital, Dublin,
Ireland
4
Intelligent Systems Research Centre, School of Computing, Engineering and
Intelligent Systems, Ulster University, Magee campus, Northern Ireland, UK.
(European Union Interreg VA funded)
5
Department of Surgery, Letterkenny University Hospital and Donegal Clinical
Research Academy Ireland
6
EU INTERREG Centre for Personalized Medicine, Intelligent Systems Research
Centre, School of Computing, Engineering and Intelligent Systems. Ulster
University, Magee Campus, Derry-Londonderry, Northern Ireland
Aims: Healthcare requires patient feedback to improve outcomes and
experience. This study undertook a systematic review of the depth,
variability, and digital suitability of current patient reported outcome
measures PROMS in laparoscopic cholecystectomy.
Methods: A PROSPERO registered (ID: CRD42021261707) systematic
review was undertaken of English language articles, published from
January 1st, 2011 to June 2nd, 2021, and underwent MINORS grading,
using PubMed version of Medline, Scopus, and Web of Science
electronic databases in June 2021. The search used Boolean operators
and wildcards including key words: laparoscopic cholecystectomy
AND patient outcome OR patient reported outcome OR patient
reported outcome measure OR PRO OR PROM.
Results: A total of 4960 individual articles were reviewed, 44 were found
to evaluate PROMs in patients undergoing laparoscopic
cholecystectomy. 21 articles spanning 19 countries and 4 continents
were included in the qualitative data synthesis. There was significant
heterogeneity in PROMs, with eight different PROM tools used in 21
studies. Wide variation in the time points at which PROMs were
recorded. Fourteen of twenty-one studies recorded PROMs pre- and
post-operatively, seven of twenty-one recorded PROMs
post-operatively only. Follow up periods ranged from 3 days to 2 years
post-operatively. All PROMs detected changes in quality-of-life over
time.
Conclusions: This study identified that while post laparoscopic
cholecystectomy PROMs are infrequently measured currently, tools
are widely available to achieve this in clinical practice. PROMs may
not capture all the outcomes but should be incorporated into future
cholecystectomy outcome research. EuroQOL EQ-5D provides a simple
platform for the modern digital era.
Abstract citation ID: znac248.227
TH4.10 Prophylactic cholecystectomy offers best outcomes
following ERCP Clearance of Common Bile Duct stones
Gearoid Mc Geehan1, Conor Melly1, Niall O’Connor1, Gary Bass2,
Magda Bucholc3, Michael Sugrue1,4
Abstracts | v95
1
Donegal Clinical Research Academy. Letterkenny University Hospital, Donegal,
Ireland
2
Division of Traumatology, Emergency Surgery and Surgical Critical Care,
University of Pennsylvania, Philadelphia, United States
3
Intelligent Systems Research Centre, School of Computing, Engineering and
Intelligent Systems, Ulster University, Magee campus, Northern Ireland, UK.
(European Union Interreg VA funded)
4
Department of Surgery, Letterkenny University Hospital, Letterkenny, Co
Donegal, Ireland
Aims: Clearance of choledocholithiasis reduces recurrent cholangitis,
but following clearance of the CBD, cholecystectomy is required. This
meta-analysis evaluated outcomes in patients undergoing ERCP with
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or without sphincterotomy to determine if cholecystectomy post ERCP
clearance offers more favourable outcomes than a wait-and-see
approach.
Methods: A Prospero-registered meta-analysis of the literature using
PRISMA guidelines incorporating articles relating to ERCP,
choledocholithiasis, cholangitis and cholecystectomy was undertaken
for papers published between 1st January 1991 and 31st May 2021.
Existing research demonstrating outcomes of ERCP with no
cholecystectomy versus ERCP and cholecystectomy was reviewed to
determine key events, complications, and mortality. Odds Ratios (OR)
were calculated using Review Manager Version 5.4 and meta-analyses
using OR with either fixed- or random-effect models, depending on
heterogeneity of studies.
Results: 13 studies (n=2,598), published between 2002 and 2019 were
included in this meta-analysis: six retrospective studies, two
retrospective propensity score matched studies, three prospective
studies and two randomised control trials from a total of 11 countries.
There were 1,433 in the no cholecystectomy cohort (55.2%) and 1,165
in the prophylactic cholecystectomy cohort (44.8%). Cholecystectomy
resulted in a decreased risk of cholecystitis (OR= 0.15; CI, 0.07–0.36;
p<0.0001), cholangitis (OR= 0.51; CI; 0.26–1.00; p=0.05) and mortality
(OR= 0.38; CI; 0.16–0.9; p=0.03). In addition, prophylactic
cholecystectomy resulted in a significant reduction in biliary events,
biliary pain and pancreatitis.
Conclusions: In patients undergoing CBD clearance consideration
should be given to performing prophylactic cholecystectomy to
optimise outcomes.
Abstract citation ID: znac248.228
TH5.1 The compliance and utility of Abdominal X-ray in acute
general surgical admissions
Oscar Nolan1, Robert Anderson1, Lewis Gall1, Khurram Khan1,2
1
Glasgow Royal Infirmary
2
University of Glasgow
Aims: Most acute surgical admissions have abdominal symptoms, with
many having an Abdominal X-ray (AXR) performed. Primary aim was to
audit the indication(s) of AXR against Royal College of Radiologists (RCR)
iRefer guidelines. Secondary aim was to analyse the proportion of
patients who had further imaging.
Methods: A retrospective cohort study of consecutive adult patients
with acute surgical admission who had AXR in a busy tertiary
hospital. The study period was from 1st October 2021 to 30th
November 2021. Patient’s demographics, indication for AXR and
further imaging within 7 days were analysed. The indications were
audited against the RCR iRefer guidelines (8th edition, 2017).
Results: 456 patients were included; 252 (55.3%) were female and
median age was 63 years (16–96). 200 (43.9%) were performed out of
hours. The indications for AXR were: perforation/obstruction 70.0%;
renal stone/foreign body 17.9%, constipation 5.9%, acute exacerbation
of IBD 1.3% and palpable mass 0.7%. Overall, 95.2% AXR requests were
compliant with iRefer guidelines.
196 (43.0%) patients had further imaging within 7 days of admission: 164
(36.0%) had CT scan, 35 (7.7%) had abdominal and/or pelvic ultrasound
and 12 (2.6%) had MRI.
Conclusions: The compliance with RCR iRefer guideline is very high.
However, a large proportion of patients had further imaging, with
over one third of patients subsequently undergoing a CT scan. We
suggest that in cases where further cross sectional imaging is
likely, clinicians should consider omitting AXR. This will prevent
delays, reduce radiation exposure and maximise the utility of
resources.
v96 | Abstracts
Abstract citation ID: znac248.229
TH5.2 Gender differences in patients undergoing emergency
appendicectomy
Khurram Khan1,2, Lewis Gall1, Gillian Miller1, Yassir Al-Azzawi1,
Andrew Macdonald1
1
Glasgow Royal Infirmary
2
University of Glasgow
Aims: Although appendicectomy is common, there exists minimal
published literature exploring whether there are differences between
adult males and females undergoing appendicectomy. This study
aimed to investigate the demographics, pre-operative investigation,
intra-operative findings and clinical outcomes between both genders
having an emergency appendicectomy (EA).
Methods: A multicentre retrospective observational study was carried
out across four hospitals who had an EA between August 2018 and
November 2020. Patients were identified through pathology records.
Data was extracted from electronic records for demographics,
pre-operative (peak) blood results, pre and post-operative imaging,
operative details, and the clinical outcomes. Patients were
dichotomised by gender and results compared. Data was analysed
using unpaired Student t test or Chi-squared test as appropriate with
p < 0.05 considered statistically significant.
Results: 1,128 emergency appendicectomies (57.5% male) were
included. Males undergoing EA were younger (median age: 34 vs 40
years, p<0.001). There was no difference in peak pre-operative white
cell or neutrophil count; however, C-reactive protein was lower in
male patients (median 72 vs 97, p<0.001). Pre-operative imaging was
performed more often in females: ultrasound (20.7 vs 1.5%, p<0.001)
and CT scan (61.8 vs 54.9%, p=0.020). Male patients underwent more
open surgery (14.0 vs 6.5%, p<0.001). There was no difference in the
severity of appendicitis, rate of negative appendicectomy, median
total hospital stay, post-operative complication or 30-day readmission
rates.
Conclusions: This study demonstrates that differences exist between
males and females who have EA in terms of age, use of pre-operative
imaging and operative approach, however, clinical outcomes are
similar.
Abstract citation ID: znac248.230
TH5.3 Improving the Quality of Surgical Discharge Summaries
Using a Discharge Summary Checklist- A Prospective Closed
Loop Audit
Melody Lee, Ju Lyn Lim, James Chean Khun Ng, Abeed Chowdury
Nottingham University Hospitals NHS Trusts
Aim: Discharge summaries (DS) form the mainstay of communication
between primary and secondary care following inpatient episodes.
Poor quality DS often leads to poor continuity of care. We aim to audit
the quality of DS following admission under general surgery and
improve DS by implementing a DS checklist.
Methodology: A prospective audit was conducted for 100 DS across 4
surgical wards (emergency and elective) between 1/1/2021 to 1/3/
2021. Data collection included the clinical summary, operation
details, significant investigation results and follow up plans. A DS
checklist was created and introduced at junior doctor induction. A
re-audit was conducted prospectively on 100 DS produced from 1/
8/2021 to 1/10/2021.
Results: A general improvement in quality of DS is seen across different
domains. In particular, operation date (76.1% vs 90.1%, p=0.019),
abnormal blood test results (89% vs 97%, p=0.323), outpatient
investigations (72% vs 85%, p=0.025) and their urgency (39.6% vs
43.3%, p=0.741), GP plans and actions (73% vs 81%, p=0.178) and
outpatient appointments (85% vs 93%, p=0.037). Interestingly, details
of clinical summary (98% vs 94%, p=0.149) and duration of venous
thromboembolism (VTE) prophylaxis (99% vs 90%, p=0.005) were
worse on reauditing.
Conclusion: The introduction of DS checklist has significantly improved
the quality of documentation and instructions for primary care for most
domains. This was not seen for the domain of duration of VTE
prophylaxis.
Abstract citation ID: znac248.231
TH5.4 Robustness of morbidity and mortality documentation
before emergency laparotomies
Charlotte Muehlschlegel, Chantal Rees, Pia Borgas, Muhesh Taheem,
Nader Bedwani, Venugopala Kalidindi, Kunal Bhanot
North Middlesex University Hospital
Introduction/Aims: Participation in the National Emergency
Laparotomy Audit (NELA) is a national requirement, highlighting areas
for improvement in patient care and service provision . When
consenting for emergency laparotomy, NELA Morbidity and Morality
scores (NMMS) should be clearly documented, informing the consent
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process and guiding surgical intervention.
Aims:
1) Calculate the incidence of clear NMMS documentation
2) Compare incidence to national standards
3) Provide education regarding national standards and importance of
NMMS documentation
4) Introduce a consent form supplement, prompting NMMS
documentation
5) Ascertain intervention success
Method: A retrospective (C1) (13/02/21–06/07/2021) and ongoing
prospective (C2) (24/10/2021-present) analysis of emergency
laparotomies in our local hospital was performed before and after
implementation of interventions respectively. Laparotomies were
categorised by operation time, NMMS documentation time, patient
age and gender. Results were presented locally. Interventions included
departmental education and a bright orange supplementary sticker
placed on consent forms, providing fields for NMMS documentation.
Fischer’s exact t-test was used to calculate p values.
Results: 30 and 21 patients were included in C1 and C2 respectively.
More patients had clear NMMS documentation in C2 (10/30 vs 16/21;
p<0.005). Within C2, sticker use was associated with more frequent
NMMS documentation (7/7 vs 8/13; p=0.1107).
Conclusion: Use of NMMS informs consent, guides surgical decision
making and improves accountability. Whilst important for both legal
and governance reasons, utilisation and documentation of clinical
decision-making tools whilst managing unwell patients can be
onerous. We found combining both education and a visual adjunct has
improved compliance with the NMMS documentation NELA standards.
Abstract citation ID: znac248.232
TH5.6 Communication not technology: How an electronic
patient referral process affects patient care in acute general
surgery
Simone Magnisio, Annabel Howitt, Sonia Louise Lockwood
Bradford Teaching Hospitals NHS Foundation Trust
Introduction: The Royal College of Surgeons (RCS) high-risk general
surgical patient guidelines recommend that a patient who needs
emergency surgical assessment must be seen within 30 minutes in
the case of a life-threatening emergency, and within 60 minutes for a
routine emergency referral. The aim of this audit was to assess the
efficiency of a new electronic referral system in expediting surgical
assessment compared with direct referrals to the surgical oncall team.
Methods: The study assessed the referral process and time to surgical
review over two weeks. We included patients assessed in SAU and
excluded patients reviewed in the emergency department (ED).
Referrals were received from ED, general practitioners (GP) or surgical
outpatient clinics.
Results: A total of 214 patients were included, 54% (116) referred from
ED, 32% (69) from GP, 12% (26) from outpatients clinic, 1% (3) self
-presenting. The median waiting time was 108 minutes. Direct
referrals had a median waiting time of 84 minutes (RR 0–347). Patients
allocated to the electronic transfer list waited for a median of 120
minutes (RR 6–720).
Conclusion: All patients waited longer for review than recommended by
RCS guidelines. The electronic transfer system failed to expedite

surgical review and may have contributed to delays in some cases.
Communication between colleagues, not technology, is imperative to
ensure timely assessment of the acute surgical patient.
Abstract citation ID: znac248.233
TH5.7 Spontaneous pneumomediastinum case series: Lessons
learnt in assessment and management
Bhagat Manku, Ashwin Krishnamoorthy, Luke Thomson,
Euan McLaughlin
Department of Upper Gastrointestinal Surgery, University Hospital Coventry &
Warwickshire
Aims: Spontaneous pneumomediastinum (SPM) is usually a
self-limiting condition in clinically stable patients with no obvious
causative factor. SPM can be difficult to distinguish from important
secondary causes such as tracheobronchial injury or oesophageal
perforation. Therefore, thorough clinical history and examination is of
paramount importance. We aim to highlight lessons learnt from our
experience to improve rapid diagnosis and clinical management of
these patients.
Methods: Patients were identified through hospital records between
October 2019 – December 2021. Data was collected on clinical
presentation, precipitating events, radiological confirmation of SPM
and compared with current reported literature.
Results: 11 patients were identified, 8 males (72.7%), 3 females (27.3%)
with a mean age of 29 ± 17 years. The most frequent symptom was
retrosternal chest pain 27.3%; and vomiting the most common
precipitating event (54.5%). Mean white cell count was 14×109/l on
admission. All patients underwent plain film chest radiography, and
subsequent computerised tomography of thorax, abdomen and pelvis.
Patients underwent gastroscopy selectively, showing no acute
pathology. Mean length of stay was 4.6 days. No patients required
operative intervention or any other intervention beyond antibiotics.
No complications or recurrence were found in patients at follow up.
Conclusion: SPM is a self-limiting condition with low morbidity and
mortality. If life-threatening causes have been excluded, SPM can
safely be managed expectantly at a local level, without the need of
transfer to tertiary centres and prolonged hospital admission. We
propose a structured approach to aid in the management of SPM and
help address these challenges.
Abstract citation ID: znac248.234
TH5.8 Use of Botulinum Toxin A infiltration in conjunction
with negative pressure wound dressing and mesh-mediated
traction in the management of the ‘open abdomen’
Imran Mohamed, Christian Egeler, Simon Ford, Thomas White,
Dean Harris, Rhiannon Harries
Swansea Bay UHB
Aims: Botulinum Toxin A (BTA) is widely used in complex abdominal
wall reconstruction (CAWR). It temporarily paralyses the oblique
muscles allowing medialisation of the rectus sheath and decreases
tension on the closure. This analysis presents the use of BTA in
management of the ‘open abdomen’ (OA).
Methods: Retrospective series of patients with OA where BTA was used
in conjunction with AbtheraTM negative pressure wound therapy
(NPWT) and polypropylene mesh-mediated traction (MMT) to attempt
fascial closure. BTA was performed by Anaesthetists with experience
of BTA use in CAWR using Dysport® 600 IU.
Results: We include 5 patients since 2020. Median age at index operation
was 55 years (range 39–81); four were male. Index operations were
intra-abdominal catastrophe where fascia closure impossible (n=2),
dehiscence after Vertical Rectus Abdominis Myocutaneous (VRAM)
flap for pelvic malignancy (n=2) and colectomy for obstructing
colorectal cancer complicated by rectus sheath necrotising fasciitis
(n=1). There were no immediate complications from BTA infiltration.
All patients achieved primary fascial closure with a median of five
re-looks (range 3–7). There were no full-thickness dehiscences after
final closure. One patient died within 1 month from unrelated cause.
One patient had no clinically palpable incisional hernia at six months
and a further two had no incisional hernia at six and 12 months,
respectively, on cancer surveillance CT.
Conclusion: BTA in the setting of the OA in conjunction with NPWT and
MMT appears safe and effective in achieving fascial closure, and can
Abstracts | v97
potentially reduce the risk of incisional hernia. Further studies are
welcomed.
Abstract citation ID: znac248.235
TH5.9 Role of Ultrasound in Management of Acute
Appendicitis
Hesham Morsy, Mohamed Elkorety, Samuel Massias, Sharaf Salsabil,
Anas Owera
West Hertfordshire NHS Hospitals Trust
Aim: Assess the outcomes of suspected appendicitis patients who had
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an abdo-pelvic ultrasound, and whether the scan made a difference to
their management.
Method: Cycle 1: we collected data retrospectively for confirmed
appendicitis patients admitted for the period betweeen 03/06/2021–01/
09/2021. Clinical coding department supplied a database of EAU
admissions diagnised with appendicitis based on histology. Cycle 2:
we collected data retrospectively for all surgical patients with acute
abdominal pain during the period between 1/11/2021–30/11/2021.
Ultrasounds requested were provided by the Radiology department.
Admission summaries were used to assess patients’ management.
Intervention: Presentation of Audit results in departmental teaching,
Teaching to junior doctors on the NICE guidelines for management of
Appendicitis.
Results: Cycle 1: Out of 60 patients, only 10 were included as most
patients had CT scan. 25% of which suggested appendicitis and 25%
suggested different pathology. The appendix couldn’t be visualised in
75%. Cycle 2: Out of 83 patients, 23 patients were included as
suspected appendicitis. Confirmed cases were 4.34%, not visualized
were 86.96% and NAD 8.70% (their final diagnosis on discharge:
Appendicitis). Other suspected pathologies of biliary, gynaecological
and post-op collections were mostly correctly confirmed/denied.
Conclusions: Ultrasound was very informative in Biliary pathology,
Gynae Pathology, Other pathology like Hematoma, post-op collection.
However, in terms of suspected appendicitis, it was only informative
in a rare occurrence. Of the patients who were diagnosed as
Appendicitis in the final diagnosis, only an eighth were confirmed by
US. Ultrasound didn’t change the management plan in majority of
patients with suspected appendicitis.
Abstract citation ID: znac248.236
TH5.10 Results of a pilot programme of Care of the Elderly
inreach in Emergency General Surgery patients
Nandu Nair, Vasileios Kalatzis, Anne Gaunt, Julian Dawson, Vittal Rao,
Marilyn Browne
Royal Stoke University Hospital
Introduction: Due to adverse outcomes in patients age >65years who
undergo emergency laparotomy NELA suggests surgical units engage
with care of the elderly inreach services. This twelve week pilot
programme ran during the summer of 2021.
Aim: To assess the feasibility and benefits of elderly care review of acute
general surgical patients aged >65 years.
Methods: Surgical team identified elderly patients requiring medical
input which were reviewed by the elderly care team. Outputs of
consultations were recorded and standard proforma developed.
Results: 129 reviews (male- 63, female- 66) of 121 patients, aged 65–94,
were seen between 1st June and 31st August 2021. There were 13
patients more than 90 years old. 54 patients had undergone an
emergency operation and 36 had bilio-pancreatic disease. 23 patients
needed modification of medications for management of heart failure,
fluid balance and Parkinson’s disease. Further medical investigations
for pre-existing medical conditions were arranged and acted upon.
There was significant help in managing patients with delirium and in
organizing follow up in memory clinic. SNPs were trained in
comprehensive review of elderly patients including clinical frailty
score and delirium wheel app to aid in assessment.
Conclusion: There was evidence that review by the elderly care team
helped in preventing call out to the on call medical team and in
optimisation of medical comorbidities in complex older patients.
Referral criteria to elderly care around medical optimisation and
polypharmacy for complex pre-existing disease, management of
delirium, discharge planning and end of life care have been developed.
v98 | Abstracts

Abstract citation ID: znac248.237 • Age> 60 (High Risk)

TH5.11 Quality Improvement Project-NELA Assessment of • Antibiotics < 1 hour
factors influencing the mortality of emergency laparotomy • ASA 3 and more (High Risk)
• Theatre <6 hours, since the decision to operate
patients
Sangara Narayanasamy, Zwe Naing, Najam Husain, James Eccersley, Recommendations:
Pradeep Thomas
University Hospitals of Derby and Burton NHS Foundation Trust • NELA score >15 should be considered for MDT decision involving
Surgeon, Anaesthetist and ICU. (From National guidelines and Local
Aim: NELA aims to enable the improvement of the quality of care for
Audit 2019)
patients undergoing emergency laparotomy, through the provision of
high quality comparative data from all providers of emergency
Abstract citation ID: znac248.238
laparotomy

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Methods: TH5.12 Impact of Nurse Specialist to Clinical Outcomes after
Emergency Laparotomy
• Retrospective analysis of patients data registered under NELA Hwei Jene Ng1, Maggie Clark, Susan Moug
• Duration: Jan 2020- Dec 2020 1
Royal Alexandra Hospital, NHS Greater Glasgow and Clyde
• Total number of patients: 79 2
Royal Alexandra Paisley, NHS Greater Glasgow and Clyde
• Number of mortality: 23
Aims: The role of the Emergency Laparotomy nurse specialist
Table 1 Distribution of ASA among emergency laparotomy (EmLapNS) is under-researched. In addition to data collection for
patients ELLSA (Emergency Laparoscopic and Laparotomy Scottish Audit), the
EmLapNS may provide: education; ERAS principles (daily chest
ASA GRADE Number exercises and early mobilisation); advocacy; multidisciplinary
meetings; emotional support. We report on clinical outcomes before
1 0
and after the appointment of an EmLapNS.
2 1
Methods: Retrospective analysis was performed on data collected from
3 13
one site as part of ELLSA. The data were compared between 6 months of
4 7
2017 (pre-EmLapNS) and 6 months of 2021 (post-EmLapNS). The role of
5 2
ELLSA nurse was explored using key ELLSA clinical outcome markers.
Results: 95 patients underwent EmLap in 2017 and 68 in 2021.
Table 2 Clinical Fraility Score among emergency laparotomy Comparing pre-EmLapNS vs post-EmLapNS, the median age was 66 vs
patients 61 years, 52.6% vs 45.6% were females and 63.2% vs 60.3% were ASA
≥3. Post-operative chest physiotherapy post op day 1–3 was performed
Score Number in 8.8% pre-EmLapNS versus 48.4% post-EmLapNS (p<0.05); 30-day
morbidity was 52.6% vs 33.8% (p<0.05) and length of stay was 11 days
(1–3) - Not frail 4 vs 8 days. 30-day mortality and rates of readmission were unchanged
4 - Vulnerable (11.6% vs 8.8% and 10.5% vs 11.8% respectively).
5 - Mildly frail 3 Conclusions: The introduction of EmLapNS has significantly improved
6 - Moderately frail 14 morbidity and perioperative care. These clinical improvements are
7 - Severely frail - completely dependent for personal 1 likely to be complemented by other aspects of this patient-centred
care role which require further analysis.
8 - Very severely frail
9 - Terminally ill 1
Abstract citation ID: znac248.239
NELA Score = Physiology Severity Score (PSS)+ Operative Severity Score(OSS) TH5.13 Stoma reversal post emergency laparotomy

Table 3 Physiology Severity Score Hwei Jene Ng, Maggie Clark, Ala Eldin Alhoweris, Serene Teo,
Mark McGuigan, Susan Moug
Score Pre-op Post-op Royal Alexandra Hospital, NHS Greater Glasgow and Clyde

<10 0 0 Aims: Approximately a fifth of stomas have to be sited in emergency

11–20 4 4 setting and the National Bowel Cancer Audit found almost one third
21–30 10 10 of patients undergoing anterior resection do not have reversal of their
31–40 5 5 stoma within 18 months following surgery. We aim to explore the
41–50 1 1 reversal rate of stoma post emergency laparotomy (EmLap).
51–60 1 1 Methods: Retrospective analysis was performed on all patients
61–70 2 2 undergoing EmLap over 12 months (2018) from one site using the local
ELLSA (Emergency Laparoscopic and Laparotomy Scottish Audit)
database. Demographic, indication for surgery, stoma formation/ type,
30-days morbidity and mortality were collected. Follow-up and stoma
Table 4 Operative Severity Score
reversal data were evaluated at 12 months postoperative.
Score Pre-op Post-op Results: 205 patients underwent EmLap (52.5% female, median age 66
years). 42% (n=85) had emergency stoma formation: 58% ileostomy,
<10 0 0 42% colostomy.
11–20 17 16 Of those who had stoma formed (51% female, median age 67 years), 45%
21–30 5 7 presented with bowel obstruction and 24% had new colorectal cancer
31–40 0 0 diagnosis. Of those alive at follow-up (89%), 19% had stoma reversed (1:1
ileostomy:colostomy; mean reversal time 11 months). Of the 81% not
reversed: 28% declined, 12% were unfit, 4% technically not feasible, 4%
on waiting list, 11% had 30-day mortality. The remaining 22% had no
• Average death of patients for 2020: 29.1% (2019 Death- 18%) documented stoma reversal discussion (5%) or no follow-up (17%).
• Average PSS: 32% Conclusions: Compared to the elective setting, the stoma reversal rate
• Average OSS: 19.3% post-EmLap is significantly lower (reversal of ileostomy 9.5% in this
• Average NELA score: 24.3% study vs 85% in Close-IT study). Although this may reflect a higher
risk surgical population, post-EmLap pathways should consider
Conclusions: Factors analyzed are routine follow up to ensure shared decision making.

Abstract citation ID: znac248.240
TH5.14 Surgical Telephone Virtual Clinic: A Safe and Effective
Alternative to Hot Clinics for Semi-Urgent, Ambulatory Patients
Oluwafemi Osunlusi1, Sima Patel1, Apurva Ashok1, Stephen Stonelake2
1
Walsall NHS Trust
2
Birmingham Women’s and Children’s NHS Foundation Trust
Introduction: Many ‘Hot Clinics’ deal with ambulatory patients only
requiring semi-urgent investigation and treatment, potentially
avoiding hospital admission. These clinics often use the same staff
and resources being utilised for acute surgical admission and
treatment. We present data showing that “Virtual Clinics” (VC) are
safe alternatives to this system, improving patient service and
relieving a significant burden on the acute surgical units.
Method: 78 patients who came through the established VC between 23/
12/2020 and 19/01/2021 (4 weeks), were assessed for delays in scan date,
call-backs, diagnosis, referral patterns, readmission rates and eventual
outcomes for those who needed surgical interventions.
Results: 83% of patients had their scans within the set-out time of 72
hours. 89.7% of scans were reported on the same day. Only 18% of the
patients had a surgical diagnosis. 51% had no diagnosis at all and
were discharged safely from the clinic. 16.7% were still symptomatic
at the time of the VC with 3.8% of these having a surgical pathology.
22% were referred to other specialities. 2 patients were referred to MDT.
In total, 6 patients were re-admitted to the hospital (7.6%). 4 patients
were listed for surgery following the VC.
Conclusion: The VC proves to be a safe and effective system for
semi-urgent, ambulatory patients. Re-admission rates are low,
justifying the discharge of these patients from the acute surgical
assessment unit to a virtual follow up environment.
Abstract citation ID: znac248.241
TH6.1 Fasting times and medication administration in ‘nil by
mouth’ emergency surgery patients
Catherine Oxley1, Gita Lingam2, Matthew Metcalfe2
1
University of Cambridge School of Clinical Medicine, Hills Road, Cambridge, UK
2
Department of Surgery, East and North Hertfordshire NHS Trust, Stevenage,
Hertfordshire, UK
Aims: 1) To determine whether ‘nil by mouth’ (NBM) emergency surgery
patients are fasted for longer than the recommended 6 hours for food
and 2 hours for clear fluids. 2) To establish whether oral medications
are being correctly administered/omitted in these patients.
Methods: Fasting and medication administration data were collected
prospectively on patients who received emergency surgery over a 2-
week period. Drug administration decisions were categorised as
‘correct’ or ‘incorrect’ by comparison with local guidelines.
Results: A total of 65 patients were identified with the average
preoperative fasting times being 24 hours for food and 14 hours for
clear fluids. However, the range of fasting times exceeded 110 hours.
Notably, only 16 (25%) patients had a drink while they were NBM and
29 (45%) patients were incorrectly administered medications,
including several instances of omission of critical drugs.
Conclusions: Further work is needed to establish the cause of prolonged
fasting periods. However, likely factors include; operation scheduling
difficulties, lack of understanding of NBM guidelines, inadequate
communication with patients, and patient choice. This is resulting in
poor preoperative optimisation of patients (e.g. dehydration of
patients), as well as a significant risk to patient safety with critical
medications being omitted.
In order to rectify the severe lack of adherence to the guidelines, we are
introducing further NBM training for medical professionals in our trust,
in addition to updating the current trust guideline to reflect a wider
range of medications and keep up to date with current national
guidance.
Abstract citation ID: znac248.242
TH6.2 Day Case Laparoscopic Appendicectomy for Acute
Appendicitis In Adults: A Retrospective Case Series Study
Dimitra Peristeri, Shameen Jaunoo
Surgery Department, Brighton and Sussex University Hospitals NHS
Trust-Esophagogastric Research Group
Abstracts | v99
Aims: Laparoscopic appendectomy (LA) is nowadays considered the
standard of care as it is associated with shorter hospital stay and
fewer complications. The purpose of this study was to assess the
safety of same-day discharge after laparoscopic appendectomy for
acute appendicitis at a tertiary Care Center.
Methods: A retrospective chart review was performed for patients
>18 years old who underwent LA for acute appendicitis in 2021.
Patients were categorized into 2 groups: discharge in <24h or
admission for >24-h. Demographic data, postoperative length of stay,
histology report, complications and readmission rates were abstracted
from patient medical records.
Results: A total of 303 laparoscopic appendicectomies were included. Of
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these, 71 patients had Length Of Stay (LOS) less than 24 hours.
Pathology, comorbidities, and readmission were recorded. Average
LOS for all patients was 7 hours with a minimum stay of 4 hours and a
maximum stay of 23 hours. For patients discharged in less than 24
hours, there was no readmission and 58 (19.1%) of these patients had
simple appendicitis on pathology. A total of 26 patients (8.58%) were
discharged in less than 7 hours (from the recovery room). There was
no significant difference in complications or readmission between
patients discharged in less than 24 hours and those who stayed longer.
Conclusion: Day case LA is a safe and effective practice for treating
selected patients with non-perforated appendicitis, as it decreases the
length of stay and hospital charges.
Abstract citation ID: znac248.243
TH6.3 Establishing a sexually transmitted infection (STI)
testing programme in an ambulatory surgical clinic for female
patients aged 18–44 years presenting with abdominal pain
Helen Please1, Ciara Mahon1, Michael Hughes1, Michael Ewans2,
Anna Hartley2, Adam Peckham-Cooper1
1
Leeds Institute of Emergency General Surgery, Saint James’ University Teaching
Hospitals Trust, Leeds, UK
2
Genito-Urinary Medicine Department, Saint James’ University Teaching
Hospitals Trust, Leeds, UK
Introduction: Young females presenting to hospital with acute
abdominal pain (AP) are often discharged without clear diagnoses.
Gynaecological causes including chlamydia and gonorrhoea (C&G) are
increasing, however STI testing remains underutilised. This study
aims to:
1. Establish robust STI testing in an ambulatory surgical clinic (ASC),
utilising collaborative pathways between GUM and EGS services.
2. Identify barriers.
Methods: This pilot ran from October to December 2021. GUM-led
training for all ASC staff was delivered. All females (18–44yrs)
presenting to ASC with AP were offered vulvo-vaginal self-swabs
(VVS) and a patient information leaflet. Positive results were referred
to GUM for treatment and contact tracing. Following the pilot, a focus
group was facilitated to identify barriers and potential improvements.
Results: Twelve eligible patients (mean 28yrs) consented to testing. All
results were negative for C&G. Fifteen patients declined (mean 33yrs).
The remaining eligible population were not approached. Barriers
identified included: nursing staff concerns that offering VVS could
make patients feel judged regarding sexual promiscuity; male staff
being uncomfortable discussing VVS; concerns regarding other
patients overhearing; and a single toilet being inadequate for testing.
Conclusions: The pilot confirmed a robust STI testing programme can
be delivered within ASC, which we believe is the first in the country.
Strong collaborative working between EGS & GUM teams delivered
clear mutually beneficial pathways. However, low numbers of patients
undertook testing, accounting for the lack of positive results. Clear
barriers were identified which are being addressed prior to delivery of
a second pilot period and pathway rollout.
Abstract citation ID: znac248.244
TH6.4 Clinical Audit on the Assessment and Management of
Lower Gastrointestinal Bleeding: A Single Centre Experience
Sharmaine Yen Ling Quake, Charles Johnson, Alastair Coulson,
Michael Courtney
Sunderland Royal Hospital
v100 | Abstracts
Aim: To audit our local practice in the management of patients with
lower gastrointestinal bleeding (LGIB) against the 2018 British Society
of Gastroenterology (BSG) acute LGIB guideline
Method: Patients aged ≥18 years presenting with LGIB at our local trust
between January 2020 – May 2020 were included. Data were collected via
electronic documentation to identify the following: shock index (SI),
whether patients with high-risk Oakland score (>8) were admitted and
inpatient investigations received including CT angiogram (CTA), OGD
and colonoscopy. Data were analysed according to two patient groups:
unstable bleed (SI <1) and stable major bleed (SI>1 with Oakland score
>8).
Results:
• 50 patients were included in the study with median age being 70
years.
• 6 patients (12%) had unstable LGIB; in this subset, only 4 patients had
CTA, 2 underwent urgent OGD and none received inpatient
colonoscopy. Only one patient underwent surgical intervention -
subtotal colectomy for acute flare of inflammatory bowel disease.
• 44 patients (88%) had stable LGIB. In this group, 86% of patients had
high-risk Oakland score (>8); 68% were appropriately admitted. 14%
had low risk Oakland score and 50% were appropriately discharged.
The practice of utilising Oakland risk stratification score remained
low at time of clinical assessment.
• Of all patients who were admitted, CTA (14.2%), OGD (5.7%),
colonoscopy (8.6%) and flexible sigmoidoscopy (2.9%) were
performed as initial investigation. The 30-day mortality in inpatient
is zero.
Conclusion: There are potential barriers to implementation of the BSG
LGIB guideline, such as reduced awareness of the BSG
recommendations, resource availability and economic implications.
Abstract citation ID: znac248.245
TH6.5 Perioperative group and save testing are not routinely
indicated for emergency laparoscopic appendicectomy and
laparoscopic hernia repairs
Ieuan Reece1, Ealaff Shakweh2, Clemency Britton2, Jun Yu Chen2,
Norman Zafar2, Jasim Al-Musawi2
1
The Hillingdon Hospitals NHS Trust
2
London North West University Healthcare NHS Trust
Introduction: Major haemorrhage is a rare complication of laparoscopic
hernia repair and laparoscopic appendicectomy. It is common practice
for patients undergoing these procedures to have 2 valid group and
saves preoperatively, however perioperative blood transfusions for
these patients is seldom required. Obtaining valid samples is not only
financially burdensome but frequently leads to delays in theatre lists
and patient care. Our unit therefore performed a retrospective cohort
analysis to investigate blood transfusions performed perioperatively
and within 28 days of laparoscopic appendicectomy and laparoscopic
hernia repairs.
Method: We used our electronic records system to collect data of all
laparoscopic appendectomies and laparoscopic hernia repairs
between March 2017-March 2021. Patients of any age undergoing
laparoscopic appendicectomy or laparoscopic hernia repair were
included. Patients requiring concomitant intra-abdominal surgery or
had incomplete medical records were excluded.
Results: 1893 patients were included in the study of which 1464(77.3%)
had a laparoscopic appendicectomy vs 429(22.7%) laparoscopic hernia
repair. In total 3511 group and saves were taken costing £47,398.50.
Only 1 patient (0.068%) required an emergency blood transfusion (4
units of red cells) secondary to major haemorrhage and 2 patients
(0.11%) required pre-operative transfusions for anaemia.
Conclusion: Our findings demonstrate that the incidence of
perioperative blood transfusions for laparoscopic appendicectomy and
laparoscopic hernia repairs is low, challenging the indication for
routine preoperative group and saves. Considering our findings, the
burden of cost, patient discomfort and theatre delays; we advocate a
more nuanced approach to preoperative group and saves, reserving
these for patients stratified as high risk.
Abstract citation ID: znac248.246
TH6.6 Characteristics of Cervical Lymph Node Involvement in
Papillary Thyroid Carcinoma
Emad Rezkallah, Wael Elsaify
South Tees NHS Foundation Trust
Background: Papillary thyroid carcinoma (PTC) accounts for 80–85% of
all thyroid carcinoma. The SR reaches over 90% over a 10-year of
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follow-up. The frequency of cervical lymph node metastasis ranges
from 40–90%.
We analyzed the data of 37 PTC patients who underwent thyroidectomy
and neck dissection to illustrate the pattern of cervical lymph node
metastasis in PTC.
Methods: Retrospective review of 37 patients who underwent
thyroidectomy with neck dissection for PTC. Preoperative assessment
included FNAC, US +/- CT/MRI scans.
Results: The patients’ average age was 44± 19.5 years. Female to male
ratio was 1.5:1. The incidences of lymph node metastasis according to
the neck level were; 40.5% (15) at level II, 67.6% (25) at level III, 45.9% ()
at level IV, 16.2% (6) at level V, 54% (20) at level VI, while no metastasis
was found at level I. 29 cases (78.4%) had multiple levels involvement,
while 6 patients had single level metastasis; 5 at level VI and one at
level II. Two patients had no metastatic lymph nodes.
Conclusion: Selective neck dissection has proven to reduce the
potential morbidity associated with more extensive neck dissection
without affecting the oncological outcomes. Levels III and IV are
commonly involved, and usually dissected in continuity. Level II
dissection is recommended whenever there is extensive involvement
of levels III/IV. Level VI is usually dissected, even as a prophylactic
procedure due to the high frequency of microscopic metastases.
Level V dissection is usually not recommended unless involved.
Involvement of Level I is rare.
Abstract citation ID: znac248.247
TH6.7 Direct Streaming of Acute Surgical Patients to an
Advanced Nurse Practitioner-led Service: A Prospective Audit
of a Pilot Service to Improve Patient Flow
Anna Riley1,2, Aileen Aherne1, Joe Box1, Natalie Grady1, Jashmin Maria1,
Anthony Chan1
1
Manchester University Hospitals NHS Foundation Trust
2
Health Sciences School, University of Sheffield
Aims: The ongoing uncertainty of the COVID-19 pandemic and recovery
to re-establish elective services presents a major challenge to the NHS.
Patient flow and bed capacity is now a priority for acute hospitals. We
have implemented a new service model aimed at improving patient
flow from A&E, where acute surgical patients are triaged and referred
directly to the Advanced Nurse Practitioner (ANP) team for
assessment and management. A criterion based on the presenting
complaint and clinical observations was developed to identify suitable
patients. The utilisation of this service was audited for its safety and
impact on the Emergency General Surgical provision.
Methods: The setting is a busy University Teaching Hospital with a
diverse catchment population of 75,000. A prospective audit identified
the number of patients utilising the new care pathway and details of
any adverse events or delays in treatment identified. All patients
presenting with a General Surgical condition were included.
Results: Between August and December 2021, 361 patients were referred
directly from A&E (81% within first 2 hours of presentation) to the
surgical ANP team for assessment. Of these, 85 (24%) were admitted
for emergency treatment and 276 (76%) were discharged the same day
for either ambulatory or outpatient follow-up, or back to Primary Care.
There were no adverse events identified during the audit period.
Conclusion: Direct streaming of acute surgical patients within a defined
criteria to an ANP-led service is safe and effective in helping to improve
patient flow and experience within an acute care model.

Abstract citation ID: znac248.248
TH6.8 The Utility and Impact of Advanced Nurse Practitioners
in Unplanned Surgical Admissions: A Review of the Literature
Anna Riley1,2, Angela Tod1, Rachel King1, Anthony Chan2,
Steve Robertson1
1 Introduction: Roux En Y gastric bypass [RYGB] remains the most
Health Sciences School, University of Sheffield
2 effective bariatric surgical option to date. Unfortunately, the anatomic
Manchester University Hospitals NHS Foundation Trust
Aims: Advanced Nurse Practitioners (ANP) are well established within
acute medical and Critical Care environments. The evolution of
surgical ANPs have tended towards preoperative roles, such as
anaesthesia or scrub, with few clinical roles involving the assessment
of acute patients or inpatient care. The Royal College of Surgeons of
England have recently recognised, by professional membership, the
roles of non-medical members of the surgical team, such as ANPs and
physician associates. This review explores the areas of impact of ANPs
on the emergency General Surgery service provision to help develop
the role of the modern surgical ANP.
Methods: A scoping literature review was performed to identify themes
of ANP function and outcome. Search terms such as “Advanced Nurse
Practitioners”, “Surgical Assessment Units” and “outcomes” were
combined with Boolean operators to query PubMed, BNI, CINAHL,
Google Scholar and HMIC databases. Studies in the last decade were
included.
Results: We identified and screened 54 unique articles. 40 articles were
reviewed for eligibility and 21 were included in this review. A thematic
analysis identified the impact of ANPs on the process of care (such as
assessment and treatment waiting times and patient satisfaction) and
outcomes of care (readmission rates, length of stay and cost-effectiveness).
Conclusion: Research into the impact of ANPs are largely focused on
objective outcome measures and within non-surgical specialties.
Whilst this review demonstrates the positive aspects of ANP care on
emergency care, we identify a paucity of evidence on patient-focused
outcomes and the impact of ANPs on the patient journey within surgery.
Abstract citation ID: znac248.249
TH6.9 Does the management of right iliac fossa pain vary
between men and women?
Eloise Smellie, Alice Doughty, Stephanie Cheetham, Melisa Kenber,
Arin Saha
Huddersfield Royal Infirmary
Aims: Recent studies have suggested that women are more likely to
suffer a bad outcome after surgery compared to men with similar
findings in healthcare areas including pain management and
diagnosis. This study aimed to assess the management of female
patients with right iliac fossa (RIF) pain.
Methods: Patients who presented to a DGH general surgical unit with RIF
pain from March to October 2020 were identified from a prospectively
maintained database of admissions. Clinical parameters, management
and final diagnosis were recorded. Minimum follow-up was 12 months
(October 2021) to identify re-admissions and morbidity.
Results: There were 417 patients; 274 (66%) were women. Women were
more likely to have an ultrasound (39% vs. 4%, P<0.001) and less likely to
have a CT (60% vs. 67%, P=0.250), though they had the same proportion
of normal CT imaging (33% vs. 34%). Men were more likely to undergo
surgery (49% vs. 29%, P<0.001) but, despite this, women were more
likely to have a diagnostic laparoscopy alone or a normal appendix
after appendicectomy (15% vs. 4%). The proportion of women without
a definitive diagnosis was greater (39% vs. 32%, P=0.024) and only 4
women were referred on for further investigations leading to a greater
proportion of re-admissions with ongoing pain amongst women.
Conclusions: More women than men with RIF pain did not have a
diagnosis and women were more likely to have ‘unnecessary’ surgery.
Closer attention to gynaecological past medical history or symptoms
may improve diagnostic yield and management of women with RIF pain.
Abstract citation ID: znac248.250
TH6.10 Rare case of concurrent caecal volvulus and internal
herniation through the mesenteric defect following a Roux en
Y gastric bypass - Case report and review of the literature
Lasitha Bhagya SamarakoonFRCSEd1, Lucy Hopkisson2,
Annang PangeniMRCS3, Roland FernandesFRCS4
Abstracts | v101
1
Specialist grade doctor, William Harvey Hospital, Ashford, Kent, UK
2
F2, William Harvey Hospital, Ashford, Kent, UK
3
Registrar in Surgery, William Harvey Hospital, Ashford, Kent, UK
4
Consultant Emergency and UGI surgeon, William Harvey Hospital, Ashford,
Kent, UK
alterations caused by the surgery can predispose towards the very
rare occurrence of internal herniation through the mesocolic defect
created if a retro colic approach is used.
Case presentation: We report a patient who underwent laparoscopic
roux en y gastric bypass 3 years ago who presented to our surgical
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unit with acute abdominal pain and obstipation. On exploratory
laparotomy, we noted internal herniation of the entire small bowel
and caecum through the mesenteric defect with concomitant volvulus
of the caecum around its axis. Fortunately, the bowel was viable after
detorsion and after reduction, the mesenteric defect was repaired.
Conclusion: Although internal herniation of the small bowel through
the trans mesenteric defect following RYGB has been reported, we
believe ours is the first report of caecal and ascending colonic
herniation. Secondly, we believe our case is unique in that there was
concomitant caecal volvulus in addition to herniation through the
trans mesenteric defect. A careful search of the literature did not
reveal any similar cases with concurrent internal herniation and
volvulus of the right colon following RYGB.
Internal herniation and volvulus of the right colon may rarely occur
following RYGB. Symptoms may be nonspecific and classic features of
small bowel obstruction such as vomiting and abdominal distension
may not be seen. Imaging may be nonspecific. A high index of suspicion
and early intervention is essential to prevent morbidity and mortality.
Abstract citation ID: znac248.251
TH6.11 Successful Relaunching of NELA at an inner City
District General Hospital: Need for Multidisciplinary Approach
Varun Sarodaya, Bhavesh Gohil, Alastair White, Arti Garg
Barts Health NHS Trust
Introduction: The national case ascertainment rate for National
Emergency Laparotomy Audit (NELA) over 179 hospitals is 84.5%. Our
hospital is one of the few hospitals despite being eligible, had not
submitted any data to the NELA for the past three years.
Methods: We retrospectively collected data for all the patients that
underwent laparotomy for a period of 2 years. The mean age of
patients was 58 years. We found 83 patients who fit the NELA
inclusion criteria from January 2020 to November 2021.
Results: The 83 patients were divided into low risk (<5%) and high risk
(>5%) and further analysed. The results of the high risk group are
illustrated in Table 1.
Table 1 Comparison of the National rate with local rates at DGH
(District General Hospital)
Domains Rate
National (%) DGH (%)
Pre-op Risk Assessment 84 48
Geriatrics involvement 24.7 14.6
Surgical Consultant 96.9 96.3
Anaesthetic Consultant 93.9 88.9
Both Consultants 88.5 85.1
ICU Admission 85 81.4
Mortality rate 9.3 24
Discussion: There were various factors which resulted in a low
compliance rate. These included a lack of surgical / anaesthetic
trainees, a poor understanding of NELA and an overall reluctance to
engage in data collection. By re-engaging with NELA data collection,
we have facilitated discussion and education regarding laparotomy
care at NUH on a multidisciplinary level. We hope to demonstrate
improvements in care with subsequent re-audit.
Conclusion: NELA is a useful audit for the comparison of national care. It
allows for reflective practice at local level with aim to deliver a uniform
standard of care.
v102 | Abstracts
Abstract citation ID: znac248.252
TH6.12 Predicting Mortality and Morbidity in Oesophageal
perforation: A Review of Current Tools
Mohamed Alasmar, Zak Shehata, Mohammad Altarawni, Patrick Casey,
Rachel Melhado, Javed Sultan
Salford Royal NHS Foundation Trust, Salford, UK
Aim: Oesophageal perforation is a challenging condition associated
with high mortality and morbidity. There is a lack of consensus
regarding the optimal treatment strategy, when and whom to
operate on.
The aim of this study is to identify the optimal morbidity and mortality
risk prediction tool for patients with oesophageal perforation.
Methods: We compared and validated commonly used risk prediction
models, including the Pittsburgh Severity Score (PSS), the National
Emergency Laparotomy Audit score (NELA score), the Portsmouth
Physiological and Operative Severity Score for the enumeration of
Mortality (P-POSSUM), and the Surgical Outcome Risk Tool (SORT)
using a dataset of 83 patients ranging from 2009 to 2021. The ability to
predict morbidity was assessed using the comprehensive
complication index (CCI). The CCI was calculated for both operative
and non-operative cohorts.
Results: Of the scores assessed, NELA showed the most robust
predictive value for in-hospital mortality, 30-day mortality, and 90
mortality (AUROC 0.812, 0.8602, 0.8302, respectively). The PSS also
showed significant predictive value for in-hospital mortality, 30-day
mortality, and 90 mortality (AUROC 0.792, 0.856, 0.813 respectively).
Furthermore, NELA had the strongest correlation between score and
CCI (rs 0.644 p<0.001).
Conclusion: Despite not being validated for oesophageal pathology,
NELA appears to be the optimum scoring model to predict mortality
and morbidity for this patient population. This is the first study to
compare the efficacy of different risk prediction models in
oesophageal perforations and could be used to inform shared decision
making and peri-operative outcomes. Further large-scale validation of
risk prediction tools is required to corroborate these findings.
Abstract citation ID: znac248.253
TH6.13 Post-Operative Pain Management Following
Emergency Laparotomy
Thomas Shepherd, James Butterworth, Rafiza Islam, Kirsty Asante,
Olatokunbo Oke
Lewisham & Greenwich NHS Trust
Aims: Post-operative pain is a common yet challenging presentation.
Although an expected part of the acute recovery phase, uncontrolled
pain is associated with poorer patient experience, delayed functional
recovery and increased morbidity. Up to 40% of patients report severe
pain that negatively impacts on their post-operative recovery. We
aimed to determine whether post-operative complications and length
of hospital admission were associated with choice of analgesic agents.
Methods: We conducted a retrospective observational study of 42
patients who underwent a laparotomy between March – May 2021.
Data was extracted from patients electronic medical records and
summarised in Microsoft Excel. Statistical analysis was performed
using the Chi-Squared and Mann-Whitney U tests.
Results: 22 patients (52.4%) experienced post-operative complications
whilst 20 (47.6%) did not. In those without post-operative
complications, a greater proportion received Patient Controlled
Analgesia (PCA) compared to those with post-operative complications
(17, 85% vs 11, 50%, p = 0.02). We also observed a trend towards
greater use of Oxycodone (11, 55% vs 6, 27%) and Meptazinol (11, 55%
vs 7, 32%) in those without post-operative complications (p= 0.07 and
p = 0.13 respectively). The length of hospital admission was
significantly shorter for patients who received PCA (median = 11 days)
compared to those who did not (median = 15 days) (U = 111.5, p = 0.04).
Conclusions: This study emphasises the importance of effective
post-operative analgesia in reducing post-operative complications and
improving speed of recovery. We suggest that the use of PCA should
be encouraged for post-operative analgesia following emergency
laparotomies.
Abstract citation ID: znac248.254
TH7.1 Patient Reported Outcomes and Experiences Following
Emergency Laparotomy: A Mixed-Methods Patient Survey
Louise Silva1,2, Sarah Mohammed Abbas1, Tessa Watts2,
Jared Torkington1, Julie Cornish1
1
University Hospital of Wales, Cardiff
2
Cardiff University
Aims: Emergency laparotomy (EmLap) is a “life-saving” procedure, but
little is known about how “life-changing” it can be.
This study aims to establish the impact of EmLap using PROMs and
PREMs.
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Methods: All surviving patients who had an EmLap from 2016–2019
were included. Eligible patients were invited to complete a postal
questionnaire. Responses underwent qualitative and logistical
regression analysis.
Results: Response rate was 42.6% (n=310). 11.3% reported that they had
not resumed intimacy post-op. Patients were less likely to resume
intimacy if they were >80 years (OR 10.500, p0.003), had a return to
theatre (OR 5.111, p0.017), IBD diagnosis (OR 5.00, p0.009) or stoma (OR
4.906, p0.003). Patients were more likely to change employment if
female (OR 2.858, p0.009), more comorbid (ASA3 OR 5.000, p0.024), had
a stoma (OR 4.006, p<0.001), or incisional hernia (OR 4.228, p<0.001).
Qualitative analysis revealed deconditioning, lack of employer support,
and delays to reconstructive surgery were the main reasons for not
returning to work.
Qualitative analysis of experience exposed a number of unmet needs:
surgical “debrief” and “what to expect” (33.6%), surgical aftercare
(25.2%), mental-health support (22.6%), and timely restorative surgery
(11.7%). 88.1% felt a specialist nurse would have improved their
experience. Patients were more likely to have reported a negative
experience if they had benign disease (p0.010).
Conclusion: This is the first study to describe PROMS and PREMS
following EmLap, and also to identify patients at risk of poor outcome.
It advocates the need for an EmLap specialist nurse to facilitate
holistic aftercare.
Abstract citation ID: znac248.255
TH7.2 The EXTEND trial: EXTENDed antibiotics to improve
outcomes in patients with complicated Intra-Abdominal
Infection (cIAI)
Olivia O’Connor1, Shadia Ahmed2, Dermot Burke3, Andrew Kirby2,
Thomas Pinkney4, Tamas Szakmany5
1
Chesterfield Royal Hospital, Chesterfield, UK
2
Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
3
Leeds Institute of Medical Research, University of Leeds, Leeds, UK
4
Institute of Applied Health Research, University of Birmingham, Birmingham,
UK
5
Critical Care Directorate, Royal Gwent Hospital, Newport, UK
Introduction: Complicated intra-abdominal infections (cIAI) pose a
major challenge in surgical patients. Despite the heterogenous
aetiology they have a common disease process, which is bacterial
infection of the peritoneal space. Hence, all cIAIs are managed with
source control, plus antibiotic therapy. However, there is uncertainty
regarding the optimal antibiotic treatment strategy in order to prevent
relapse or extra-abdominal spread of infection. Presently, there is no
UK guidance on the management of cIAIs. For other serious infections
outside the abdomen microbiologists often advise at least 28-days of
antibiotics. Currently the effectiveness of extended duration
antibiotics in patients with cIAI is unknown. This trial aims to
compare the clinical and cost effectiveness of 28-day duration
antibiotics with standard care with respect to rate of treatment failure
in patients with cIAIs. Secondary outcomes include complications and
quality of life.
Method: A multicentre, open label, two-arm, parallel group, pragmatic,
randomised controlled trial with internal pilot. A total of 1166
consenting adult patients with cIAI will be recruited over 3 years and
randomised on a 1:1 basis between 28-days antibiotics and standard
care antibiotics. Patients will be recruited from ICUs and hospital
in-patient wards across 30 sites.

Trial management and funding: EXTEND is sponsored by University of
Leeds and hosted by York Trials Unit. It is funded by the NIHR. The Trial
Management Group will oversee design and running of the trial. Each
site will have a Principal Investigator (PI) with local responsibility. The
NIHR Associate PI scheme will be adopted to enable trainees to
participate in the trial.
Abstract citation ID: znac248.256
TH7.3 Is CT a valid tool for diagnosing acute appendicitis in
patients aged 40 or older?
Thomas Stockdale, Angela Lam, Kumaran Thiruppathy
Royal Berkshire NHS Foundation Trust
To establish whether computerised tomography abdomen and pelvis
(CTAP) with contrast is a necessary tool in the diagnosis of acute
appendicitis in those aged 40 years or older compared to clinical
assessment alone.
The study was performed in a district general hospital in England. A
retrospective analysis included 314 patients aged 40 years or older
who presented between 3rd October 2020 and 31st October 2021 and
received a CTAP with contrast where the request queried appendicitis.
An Alvarado score was calculated for each patient as a measure of
clinical likelihood of appendicitis based on documentation from their
initial assessment by a General Surgeon.
CTAP demonstrated evidence of acute appendicitis in 46.1% of patients.
CTAP diagnosed alternative pathologies in 41.1% of patients. These
included diverticulitis (10.5%), gynaecological pathology (4.5%),
urological pathology (3.2%), malignancy (2.9%) and others (19.4%).
11.8% demonstrated no cause for symptoms. Furthermore, those with
an Alvarado score of 9 or more, 94.9% had a CTAP reporting
appendicitis. With scores of 3–8, only 49.4% had a CT finding of
appendicitis and this dropped to 5.0% with scores of 0–2.
This study supports using CTAP to aid in diagnosing appendicitis in
patients aged 40 years or older with Alvarado scores of 8 or less.
However, patients scoring 9 or more had a 94.4% positive finding of
acute appendicitis on CTAP, thus potentially negating the need for a
CTAP scan pre-operatively. Alvarado scores of 2 or less suggest an
alternative diagnosis is more likely, however CTAP may still be a valid
investigation.
Abstract citation ID: znac248.257
TH7.4 Improving quality of message taking for on-call
surgeons unable to answer calls during emergent operating
Anna Walters1, Katie Sanders1, Robyn Marsh1, Mariam Malik1,
Stephen Stonelake1,2
1
Walsall Manor Hospital
2
Queen Elizabeth Hospital, Birmingham
Aims: Responding appropriately to messages taken by theatre staff
whilst the on-call surgeon is performing emergency operations is an
important aspect of emergency care. As part of a quality improvement
project we produced a standardised proforma aiming to ensure
messages had sufficient information to enable the on-call surgeon to
prioritise referrals according to clinical urgency
Methods: Written messages from emergency theatre were collected
from February to December 2021. A new proforma for message taking
was introduced in May 2021. This consisted of a pre-printed A5 sheet
with space for eight specified informatics to be recorded alongside the
free-text message; namely, patient name, DOB, PID, location, name
and role of caller and time of message. Additionally, the urgency and
early warning score could be recorded. The presence or absence of the
above 8 key pieces of information was examined and the score was
recorded pre and post intervention.
Results: There was 60% (32/53) uptake of the new proforma following its
introduction. The mean quality of information score for 60 messages
pre-intervention was 2.6/8 (range 1–6) compared with 3.9/8 (range 1–8)
in 53 messages collected post-intervention (P = < 0.01). One out of 60
(2%) versus 11/53 (21%) had the level of urgency stated in the
pre-intervention and post-intervention group respectively. Three of
the 11 urgent messages additionally included patient’s observations
and early warning score.
Conclusions: This simple and reproducible proforma produced a
quantifiable improvement in the quality of messages received,
Abstracts | v103
enabling the on-call surgeon to better prioritise care for emergency
surgery patients.
Abstract citation ID: znac248.258
TH7.5 De Garengeot hernia: a combination of niche
presentation, diagnostic, and anatomical factors
Rochelle Sylvester, Gautam Singh, Ali Haque
Frimley Health NHS Foundation Trust
Background: De Garengeot hernias occur in almost 1% of femoral
hernias and are diagnosed when the appendix is also present within.
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They are more commonly observed in post-menopausal women, but
their pathogenesis remains controversial. Theories involve
abnormalities in bowel rotation during embryological growth, caecum
mobility or size, and increased abdominal pressure. Most are
diagnosed intra-operatively and are otherwise incidentally discovered
on imaging. An advised surgical technique has not been determined
due to its rarity; however, most literature suggests laparoscopic
hernioplasty and appendicectomy in absence of infection.
Case report: A 77-year-old female presented with a three-day history of
a painless, right groin mass. Blood results were within normal range,
and sonography identified a De Garengeot hernia suggesting
appendiceal inflammation. She underwent emergency laparoscopic
surgery that discovered a strangulated appendiceal tip within an
incarcerated femoral hernia, which then unexpectedly divided during
manipulation. Additional findings included a broad mesoappendix
and lack of appendicitis. The team proceeded with a hernioplasty and
appendicectomy, and the patient was discharged two days later
without complications.
Conclusion: This case report highlights a few niche aspects of De
Garengeot hernias. Firstly, it is unusual our patient’s diagnosis
occurred preoperatively via ultrasound; secondly, the ischaemic
tip of the appendix unexpectedly self-detached upon mobilisation;
and thirdly, the widened mesoappendix likely contributed towards
her predisposition to De Garengeot hernias. Overall, our case
represents laparoscopic surgery being optimal in treating De
Garengeot hernias that are diagnosed preoperatively, and that they
should remain a differential diagnosis for non-specific groin lumps,
regardless of pain.
Abstract citation ID: znac248.259
TH7.6 Recurrent Gallstone Ileus: A Case Report
Annabelle White, Joanna Shepherd, Basim Al-Robaie
Conquest Hospital
Introduction: Gallstone Ileus (GSI) is a rare cause of mechanical bowel
obstruction secondary to impaction of an ectopic gallstone within the
bowel lumen. Recurrent GSI is rare, accounting for less than 3% of
SBO. The main risk factors for recurrence include a large
choleduodenal fistula, an active fistula or faceted gallstones.
There is currently no mainstay approach to managing GSI, with
“single-stage” and “two-stage” options advocated.
Case: A 73-year-old lady presented with epigastric pain and vomiting,
and was shown to have an obstructing gallstone in the distal ileum.
She underwent a laparotomy and enterolithotomy and initially made
a good recovery. However, she represented three months later with
similar symptoms and was found to have a jejunal gallstone causing
proximal small bowel obstruction. She underwent a second
enterolithotomy, and is planned for an interval cholecystectomy.
Discussion: The management of recurrent GSI include one of three
options: enterolithotomy alone, “single-stage” (enterolithotomy,
cholecystectomy and fistula repair) or “two-stage” approach
(enterolithotomy and interval cholecystectomy). The optimal
approach in management is still debated. The traditionally taught
two-stage approach demonstrates a lower mortality and recurrence
rate and shorter index procedure in the unstable patient, requiring a
skillset common to most general surgeons. However, with increasing
reports of recurrent GSI, a single-stage approach during the index
procedure has been advocated, citing decreased risk of cholecystitis,
cholangitis and repeat laparotomy in the event of recurrence. Our
patient underwent emergency enterolithotomy on both presentations,
however there may support for a “single-step” approach in certain
patient cohorts.
v104 | Abstracts
Abstract citation ID: znac248.260
TH7.7 Pre-operative Coagulation Screening in General Surgery
Esther Yomi-Orungbe1,2, Noureen Fazili3
1
London Northwest University Healthcare Trust
2
Northwick Park Hospital
3
Royal London Hospital
Aim: Routine preoperative coagulation screening is considered
standard practice to predict peri-operative bleeding. However,
according to British Society of Haematology, indiscriminate
coagulation screening is not recommended as it may to inappropriate
delay of surgery, lead to further unnecessary tests and is also
associated with significant costs. Instead, they recommend detailed
bleeding history, including family history and use of medications.
Methodology: A retrospective audit of 148 post-operative patients in
Northwick Park Hospital admitted under the General Surgical who
presented to Surgical Assessment Unit between 01.04.2021 to
14.05.2021 at the initial audit and between 20.09.2021 to 07.10.2021 at
the re-audit.
Results: The initial audit was done over a 6 week period with 98 cases
selected. 19% of them had appropriate requests with 81% of the tests
done being inappropriate. There was significant improvement by the
re-audit with appropriate requests increasing to 56% and
inappropriate tests dropping at 44%. The criteria for appropriate were:
a) Not requested as no significant medical history. b) Requested as
clinically indicated. With each coagulation screening costing an
average of £29.42, an overall estimate of £2971.42 was expended in
inappropriate requests
Conclusion: All patients had relevant blood requests and PMH were
documented but many inappropriate requests were made. It was
recommended that instead of indiscriminate coagulation testing, a
thorough history was advised to determine appropriate testing. There
was a marked improvement at the re-audit with more appropriate
requests being made.
Recommendations:
• Further meetings with the Anaesthesiologists to ensure a joint effort
in achieving the target goal
Abstract citation ID: znac248.261
TH7.8 Delayed Diagnosis of Duodenal Injury in Blunt
Abdominal Trauma following a normal initial Computed
Tomography scan: A Systematic Review
1 2 2 2
Robyn Westerman , Panos Stathakis , Paul Goldsmith , Stella Smith ,
Christian Macutkiewicz2, Anthony Chan2
1
University of Manchester
2 1
Manchester University NHS Foundation Trust
Aims: Isolated duodenal injury and perforation can result from blunt
abdominal trauma (BAT) in approximately 5% of patients with
intrabdominal injuries. Modern major trauma pathways mandate
computed tomography (CT) as part of the primary assessment. The
evolution of a duodenal injury to a perforation can be delayed. The
aim of this review is to ascertain the proportion of false negative CTs
for duodenal perforation in BAT.
Methods: A systematic review of the literature was conducted using
PubMed, Embase and OvidSP databases to include search terms “blunt
abdo*”, “duoden*”, “trauma”, and “computed tomography” combined
with Boolean operators. Data were extracted from studies that report
data on patients following BAT with a normal initial CT who
subsequently develop a perforation. Studies were limited to the last 10
years.
Results: There were 315 articles identified, which after excluding
duplicates and screening, 18 articles were reviewed in detail and 6
articles (3 case studies and 3 retrospective cohort studies) included in
the final review. Across the 6 studies, a total of 159 patients suffered
BAT with 29 patients (18%) having a normal CT on admission. The
majority of patients underwent a repeat CT within 24 hours which
then subsequently revealed radiological signs of a duodenal injury/
perforation.
Conclusion: Patients who present with following BAT should be closely
observed for delayed clinical signs of visceral perforation. CT (preferably
with oral contrast) should be performed if there is any clinical suspicion
of perforation, even if the timeframe is within 24 hours of the initial CT
scan.
Abstract citation ID: znac248.262
TH7.9 A retrospective audit of the investigation and
management of acute pancreatitis (AP) in a tertiary referral
hospital in Ireland
Sarita Ankatiah, Barbara Julius, Juliana Falusi, Chwanrow Baban,
Anne Merrigan, Shona Tormey
University Hospital Limerick
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Aims: This audit aims to determine if standards of best practice
according to NICE guideline pancreatitis (September 2018) are being
met.
Methods: Using the Hospital In-Patient Enquiry (HIPE) system, 129
admissions with AP during 2020 were retrospectively identified. Audit
targets included adequate fluid resuscitation and nutritional support,
frequency of radiological investigations, emergency cholecystectomy,
lifestyle advice and appropriate follow up.
Results: Aetiologies identified were biliary (33.3%), alcohol (33.3%),
idiopathic (7.8%), hypertriglyceridemia (3.8%), autoimmune (1.6%),
medication (0.8%), anatomical variant (0.8%) and the remainder
(18.6%) were unidentified since not fully investigated (NFI). 47.3%
(n=61) had ultrasound while 61.2% (n=79) had computed tomography
of abdomen and pelvis (CTAP) during hospital-stay. Out of 33.3%
(n=43) with biliary aetiology, 25.6% (n=11) had successful ERCP and
41.9% (n=18) were referred for outpatient clinic or already awaiting
outpatient laparoscopic cholecystectomy. No emergency
cholecystectomies were performed. Out of 28 readmissions, biliary
pathology accounted for 35.7% (n=10), alcohol 25% (n=7) and NFI 17.9%
(n=5). 37.2% (16) of alcoholic pancreatitis admissions had documented
cessation advice either as in-patient or on discharge. There was no
documentation for HbA1C in 6 months or DEXA scan in 2 years’ time,
or a yearly fecal elastase for chronic pancreatitis patients.
Conclusion: Audit of current practice identified areas for improvement,
including bettering access to emergency theatre, increased focus on
encouraging lifestyle modification and monitoring pancreatic
endocrine and exocrine function. We aim to create an institutional
standard operating procedure for investigating and managing
pancreatitis, and re-audit next year to discern if management has
moved closer to the established standard.
Abstract citation ID: znac248.263
TH7.10 Extraction site hernias following Laparoscopic Right
Hemicolectomy: Does location matter?
Laurie Smith1, Joseph Filby2, Harriet Coxon1, Julie Cornish1,
Jared Torkington1
Department of Colorectal Surgery, University Hospital of Wales, Cardiff
2
Department of Radiology, University Hospital of Wales, Cardiff
Introduction: Laparoscopic colorectal surgery is the gold standard
treatment for patients requiring colorectal resection, however the
need to exteriorise the specimen and perform extracorporeal
anastomosis leads to a risk of incisional hernia. Robotic surgery may
facilitate intracorporeal anastomosis which could potentially negate
the need for an umbilical extraction site. This study compares current
practice of transverse versus midline extraction sites for laparoscopic
right hemicolectomy and the incidence of incisional hernia.
Methods: A retrospective collection of all patients undergoing
laparoscopic right hemicolectomy between 2018 and 2020 was
performed using OPCS theatre codes. Only those undergoing
laparoscopic right hemicolectomy, who had cross-sectional imaging
post-operatively were included. Operation notes were scrutinised to
identify extraction site and closure method. Post-operative CT scans
were reviewed by a radiologist to identify presence of incisional hernia.
Results: Of 103 patients, 50 met the inclusion criteria. 25 were male. The
mean age was 67 (Range = 21–85). 31 patients had midline extraction
sites, with 19 having transverse. The average time from operation to
CT was 662 days (314–1094) and 34% (n=17) had incisional hernia
identified on a CT scan post-operatively. Midline extraction sites were
associated with a significantly higher rate of incisional hernia when
compared to transverse sites (n=16/31, 1/19; p<0.01).
Conclusion: Transverse extraction sites are associated with a lower risk
of incisional hernia after laparoscopic right hemicolectomy and should

be preferred to midline incisions where possible. As intracorporeal
anastomosis becomes a more established technique, further work is
needed to determine optimum extraction site to further reduce the
risk of incisional hernias.
Abstract citation ID: znac248.264
TH7.11 Developing a new TAMIS service at a district general
hospital. A dual consultant experience
Ian Lord1, Nicholas Ward1, Ami Mishra2
1 Aims: The vertical rectus abdominis myocutaneous (VRAM) flap is
West Suffolk Hospital
2 commonly used to reconstruct perineal defects for low rectal and anal
Norfolk and Norwich University Hospital
Aim: To evaluate the development of a Transanal Minimal Access
Surgery (TAMIS) service at a district general hospital.
Method: In 2017, a TAMIS service was set up at our hospital by 2
consultants trained in single port laparoscopic and transanal
endoscopic techniques. Benign rectal polyps and early cancer cases
were performed as dual consultant procedures. All cases were
reviewed in the colorectal MDT pre-operatively. Data was collected
prospectively for patient demographics, co-morbidity, length of stay,
complications, pathology and surveillance outcomes.
Results: Between May 2017 and July 2021, 31 TAMIS procedures were
performed. The median age was 73(34–87) with 17(55%) male and 14(45%)
female patients. The indication for resection was adenomatous polyps in
20(65%) patients and adenocarcinoma in 11 (35%) patients. The median
diameter of benign polyps was 44mm(25–105mm). At a median follow up
of 8 months (0–48 months) there were no recurrent polyps.
Rectal cancers had a median size 23mm (11–32mm). Nine cancers were T1
(82%), one T2 (9%), and one T3(9%). All cancers were R0 resections. At a
median follow up of 15 months (3–43) there were no locoregional or
distant recurrences. The median length of stay was 1 day (0–2). There
was no post operative mortality. The readmission rate was 5% with two
Clavien-Dindo grade 1 complications.
Conclusions: Dual consultant operating in the early phase of this
service’s development has allowed for experience to be concentrated
and shared problem solving, resulting in encouraging early outcomes
with no local recurrence, short inpatient stay and minimal morbidity.
Abstract citation ID: znac248.265
TH7.12 Improving electronic prescribing of mechanical VTE
prophylaxis in general surgery patients
Christopher Gunn, Imran Alam
Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust
Aims: Mechanical VTE prophylaxis forms part of NICE guidance
in general surgical patients. Locally, thromboembolic deterrent
(TED) stockings are used but not available as a prescription item on
the electronic system. They are often prescribed verbally or via
noted plans but do not appear on the medication administration
record. Importantly, multiple incidents of patient harm through
pressure damage have been seen due to poorly checked TEDs. Our
aim was to audit and improve safe mechanical VTE prophylaxis
prescribing.
Methods: At each cycle, we retrospectively collected data from two
weeks of admissions. Data relating to VTE assessment completion,
VTE score, TEDs in use, TEDs prescription and LMWH prescription was
collected. Our initial intervention consisted of departmental education
regarding a work around enabling TEDs to be prescribed as a freehand
extra-formulary item. This was reaudited at 12 months.
Results: All patients in both cycles had VTE assessments completed.
TED stocking use increased significantly from 5.1% to 26.4% and
prescription of TEDs, when used, increased from 0% to 61.1%.
However, documentation regarding daily checks was non-existent.
Conclusions: Our QIP showed a significant improvement in TEDs use
and prescription. However, the intervention is difficult and time
consuming. Subsequently from this project, a TEDs stocking item is in
the final approval phase for integration into the online prescribing
system and will come with associated safety checks built into the
nursing medication administration system. Once this is live, we will
complete a third cycle to assess uptake and again at 6 months to
assess for lasting change.
Abstracts | v105
Abstract citation ID: znac248.266
TH8.1 Radiological incidence of donor-site incisional hernia
and parastomal hernia after Vertical Rectus Abdominus
Myocutaneous Flap-based reconstruction following colorectal
surgery
Alethea Tang, Naomi Spencer, Kristie Parkins, Victoria Bevan,
Peter Drew, Rhiannon Harries
Swansea Bay University Health Board
cancer. The incidence of midline incisional hernias after VRAM
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reconstruction varies from 3.6% when detected clinically to up to 50%
when detected radiologically. The aims of this study is to accurately
determine the radiological incidence of donor-site incisional and
parastomal hernia following VRAM reconstruction.
Methods: Retrospective cohort study of patients undergoing
colorectal surgery requiring VRAM reconstruction over 10 years.
Data were collected on patient demographics, indication for
surgery and surgical procedure including details of any hernia
repair. Images from surveillance CTs were reviewed for presence
and size of midline incisional and/or parastomal hernias.
Parastomal hernias were classified based on the European Hernia
Society (EHS) classification.
Results: 173 patients were included in the analysis. The median age was
67 years (range 29 – 88 years) and median length of follow up was 49
months (IQR 24.3 – 71.0 months). The overall radiological incidence of
incisional hernia was 27.6%. The radiological incidence of donor-site
incisional hernia after VRAM at 1, 2 and 5 years was 16.8%, 25.2% and
18.5%. The parastomal hernia incidence at 1, 2 and 5 years was 37.9%,
44.1% and 29.8% (48.6% overall).
Conclusions: The majority of patients who develop donor-site
incisional hernia and parastomal herniation following VRAM tend to
do so within the first two years. Although the use of CT imaging
improves the diagnosis of donor-site incisional and parastomal
hernias, the clinical significance of this is unknown.
Abstract citation ID: znac248.267
TH8.2 Trans-umbilical versus peri-umbilical incision for
general laparoscopic surgery
Stacey Jones1, Mohamed Sheredi2
1
Airedale NHS Trust
2
Mid Yorkshire NHS Trust
Aims: The aim of this study was to determine whether a trans-umbilical
or peri-umbilical incision is a better route for the initial umbilical trocar
in general laparoscopic surgery in terms of post-operative pain, risk of
surgical site infection (SSI), post-operative complications and scar
cosmesis.
Methods: This was a prospective study of 128 patients who underwent a
trans-umbilical incision and 97 patients who had a peri-umbilical
incision during general laparoscopic surgery between January 2020
and July 2021. Demographic data and type of surgery were obtained
from the operation note. Following the procedure each patient was
contacted via telephone and asked questions regarding,
post-operative pain, SSI, post-operative complications and cosmetic
satisfaction.
Results: Of the 128 patients within the trans-umbilical group, 57.8%
were female with a mean age of 44.4 years and a BMI of 26.6 kg/m2.
Whereas, in the peri-umbilical group 62.9% were female with a mean
age of 50 years and a BMI of 29.8 Kg/m2. The most common operation
performed was laparoscopic cholecystectomy in both groups. The
trans-umbilical group experienced less post-operative pain than
expected p=0.03, less post-operative complications p=0.009 and better
scar cosmesis satisfaction p=0.001. There was no statistically
significant difference in the rate of SSI p=0.73.
Conclusion: The trans-umbilical incision for initial peritoneal access
in general laparoscopic surgery is recommended due to the lower
than expected post-operative pain, reduced post-operative
complication rates and increased patient satisfaction with regards
to scar cosmesis.
v106 | Abstracts
Abstract citation ID: znac248.268
TH8.3 Single incision laparoscopic cholecystectomy versus
conventional laparoscopic cholecystectomy- A rural center
experience
Sharanya Ravindran1, Shruthi Venkat2
1
Pinderfields Hospital West Yorkshire
2
Saveetha Medical College Chennai India
Aim: Single Incision Laparoscopic Surgery (SILS) is a new technique of
minimally invasive surgery using a single incision to minimize all
ports to one site for a perceived scar less abdomen compared to
conventional laparoscopic surgery in terms of complications and
patient satisfaction.
Materials & Methods: We report our study conducted in southern India
from September 2015 to October 2016, evaluating the possible
advantages of SILS versus CLC through a randomized controlled trial.
The study population includes patients diagnosed as cholelithiasis. A
total of 50 patients underwent cholecystectomy, Patients were
randomly assigned to either SILS cholecystectomy or conventional
cholecystectomy in 1:1 ratio. Primary end points were operative time,
postoperative pain quantified using visual analogue scale, post
operative hospital stay and patient satisfaction.
Results: The pain scores measured at 48 hours were significantly lower
in SILS (1.3) group than CLC group (2.03). Patients had significant
satisfaction score in terms of cosmesis in SILS group (4.25) than Lap
cholecystectomy group (3.08) measured at 6 weeks after
cholecystectomy. However the post operative stay was similar in both
the groups. There was no conversion to open cholecystectomy in both
the groups. Patient satisfaction score in SILC (4.25) as found to be
higher than CLC (3.08). Operating time was significantly more in SILC
(85mins) and post operative stay was lower in SILC.
Conclusion: Based on this SILS offers better cosmetic outcome,
however, due to prolonged operating time and steep learning curve
CLC is considered a better procedure.
Abstract citation ID: znac248.269
TH8.4 The potential for day case total parathyroidectomy in
patients with secondary hyperparathyroidism
Sophie McDonald, Nina Al-Saadi, Jessica Chang,
Christodolous Neophytou, Andrew Houghton
Royal Shrewsbury Hospital
Aims: Hypocalcaemia is a common complication after
parathyroidectomy for secondary hyperparathyroidism (SHPT) and is
often the cause of a prolonged hospital stay post operatively.
Although there is no current guidance on targets for total
parathyroidectomy for SHPT, current guidance recommends a
day-case rate of 90% for patients undergoing surgery for primary
hyperparathyroidism.
Our centre has developed a safe protocol which allows us to perform
total parathyroidectomies as a day-case procedure in patients with
SHPT. This protocol, developed in conjunction with the renal
physicians, involves giving the patients alpha calcidol pre-operatively
for 5 days, to minimise the incidence of hypocalcaemia, and close
monitoring of the calcium levels post operatively, to permit safe
discharge.
Methods: We carried out a single centre retrospective study on all
patients who underwent a total parathyroidectomy for SHPT between
February 2005 and May 2021. All the patients received the alpha
calcidol regimen pre-operatively. Data on patient baseline
characteristics, peri-operative calcium, potassium and PTH levels,
length of hospital stay, operative procedure details, hospital
readmission and 30-day morbidity were collected.
Results: 49 patients underwent a total parathyroidectomy during the
study period. 67% of patients were discharged on day 0 or on day 1
post-operatively. Reasons for prolonged hospital stay in the remaining
patients included refractory hyperkalaemia requiring dialysis,
complications secondary to anaesthesia, as well as hypocalcaemia in
a few cases. No patients required readmission during the 30-day
post-operative period.
Conclusion: Day-case surgery for SHPT can be achieved safely with a
pre-operative regimen of alpha calcidol and close monitoring of
calcium levels post-operatively.
Abstract citation ID: znac248.270
TH8.5 VTE Pharmacological Prophylaxis in Oesophagogastric
Cancer Resection Patients: A Triple Cycle Closed Loop Audit
Against NICE Guidance NG89
Jessica Baxter, Hywel Room, Conor Parsley, Benjamin Smith,
Chalint Sechante
University Hospital Southampton
Aims: NICE NG89 Guidance introduced in 2018 recommends 28 days
extended VTE pharmacological prophylaxis in patients who have
major abdominal surgery for cancer. In 2018, our oesophagogastric
unit protocols prescribed only inpatient VTE prophylaxis. Through the
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interventions of clinician education and modified unit protocols we
improved our unit’s compliance with NICE NG89.
Methods: We conducted a three cycle hybrid audit. 50 patients who
underwent either oesophagectomy or gastrectomy were randomly
chosen from 2017–19 (Cycle 1), 2019–21 (Cycle 2) and 2021–22 (Cycle 3).
The first cycle intervention was the requirement for 14 days
postoperative VTE pharmacological prophylaxis. The second cycle
intervention increased this requirement to 28 days. All cycles
additionally had interventions of clinician education.
Results: Against the NICE NG89 recommendation for 28 days
postoperative pharmacological prophylaxis, our audit showed 14%
compliance in Cycle 1, 26% in Cycle 2 and 91% in Cycle 3. The median
duration of VTE prophylaxis prescription (combined inpatient and
outpatient) was 7 days in Cycle 1, 23 days in Cycle 2 and 28 days in
Cycle 3. The correct dose by weight for VTE prophylaxis was
prescribed in 89% of cases in Cycle 1 and 100% of cases in Cycle 2 and
3. Whilst small numbers preclude statistical analysis, there were 2
bleeding events and 1 VTE event in both Cycles 1 and 2 but none in
Cycle 3.
Conclusions: Our unit made a stepwise improvement against the NICE
NG89 recommendation for extended VTE prophylaxis in cancer
resections. Furthermore, clinician education improved correct weight
based dosage.
Abstract citation ID: znac248.271
TH8.6 Thoracic sarcoma: three-year data from a tertiary
referral centre
Sarah Saifuddin1, Solveig Hoppe2, Matthew Williams3, Thomas Cosker3,
Dionisios Stavroulias3, Francesco Di Chiara3
1
University Hospitals of North Midlands NHS Trust
2
Isle of Wight NHS Trust
3
Oxford University Hospitals NHS Foundation Trust
Aims: The rarity of thoracic sarcomas leads to challenges in their
diagnosis and evidence-based management. We aim to investigate the
management and outcomes of primary thoracic sarcoma patients
under the care of our tertiary centre Sarcoma Service over a
three-year period.
Methods: Data of all thoracic sarcoma patients discussed at the tertiary
centre multidisciplinary meetings from 2017–2019 were collected from
the local electronic database.
Results: 65 patients met the inclusion criteria. The most common
histological subtypes were chondrosarcomas and spindle cell
sarcomas. 60% of cases were high-grade sarcomas. 14 out of 19 deaths
occurred in patients with high grade sarcomas (p=0.0586). 78.3% of
patients underwent surgical resection, with 35.4% undergoing surgical
resection as their sole treatment modality. Surgical intervention was
associated with a statistically significant improvement in survival (p <
0.0001*). Clear marginal status was associated with better survival
outcomes (p = 0.026*). Local recurrence was seen in 15 cases, and
93.3% of these were in high-grade sarcomas. There was no association
between recurrence and marginal status. 8 of the 15 cases with
recurrence received surgical intervention for the recurrence. 4 of the
cases with recurrence passed away within the study time frame.
Conclusion: Primary resection should remain the gold standard for
treatment of thoracic sarcomas due to its significant improvement in
survival. Variability between outcomes and overall survival is likely
multifactorial – diversity of histological subtypes, predominance of
high-grade sarcomas, and a wide range of age at diagnosis.
Prospectively maintained databases and cross-centre collaboration
would be beneficial for future study in thoracic sarcomas.

Abstract citation ID: znac248.272
TH8.7 Impact of routine G&S in Laparoscopic Cholecystectomy
on the Trust Resources
Mariana Rita Afonso Matias, Ahmed Elnabil-Mortada,
John Money-Taylor, Emma Gill, Ben Rees, Simon Boyes
Sheffield Teaching Hospitals, NHS Foundation Trust
Background: Despite consistently low bleeding rates in laparoscopic
cholecystectomy (LC) (0.1 – 0.46%), preoperative testing of ABO group
and Rh (D) – G&S – remain common practice throughout UK hospitals.
Current NICE guidelines for routine pre-operative tests for elective
surgery don’t include routine G&S. Additionally, there have been few
recently published articles regarding elective and emergency LC
suggesting that the routine practice of G&S are unnecessary,
potentially delaying surgeries with significant financial impact. Based
on published data, if a patient undergoing LC requires perioperative
blood transfusion there is no time to cross match, therefore the major
hemorrhage protocol is activated and patient is transfused O negative.
Aim: This project aimed to assess the need for routine G&S in
laparoscopic cholecystectomy including impact on Trust resources,
national shortage of blood tubes.
Methods: Retrospective data collection regarding 448 patients that
underwent LC at Northern General Hospital, Sheffield in 2020.
Results: Between January and December 2020 401 G&S samples were
taken during the preoperative assessment, and 425 second G&S
samples taken on the day of surgery. Antibodies were identified in 8
patients, although they were not cross matched. Furthermore, none of
the 448 patients required blood transfusion during the perioperative
period.
Conclusions: Our results highlight that current compliance with NICE
guidelines/recent published data is suboptimal. Overall, collecting
G&S samples perioperatively takes up resources, time and can delay
surgery. Furthermore, Trust savings could be in excess of £8000 in one
year. Hence, we are currently reviewing our local policy.
Abstract citation ID: znac248.273
TH8.8 Retrospective study on the safety of thyroid surgery with
confirmed benign histology in a UK district general hospital
Ayodeji Adedeji, Eugene Omakobia, Frank Agada, Conor Gordon
York Teaching Hospital
Aim: With increasingly aging population, more thyroidectomies are
being performed in the elderly. These surgeries may be suspected to
be unsafe as majority of the geriatric population suffer from
comorbidities. Our local study explored the safety of thyroid surgery
with confirmed benign histology in the elderly, with the
post-operative complication rates being the primary outcome
measures.
Methods: The study group included patients over 75 years who had
thyroid surgeries with confirmed benign histology in a UK district
general hospital from January 2010 to January 2022. We then analysed
the rates of complications including temporary hypocalcemia,
permanent hypocalcemia, vocal cord palsy and haematoma.
Abstracts | v107
Results: 41 elderly patients underwent thyroid surgery with confirmed
benign histology in our facility within the period. 78% of them had
thyroid lobectomy and the commonest indication for surgery was
benign multinodular goitre. There were no haematomas, no
permanent vocal cord palsies and no cases of permanent
hypocalcemia. Only 3(7.3%) patients had transient hypocalcemia, and
2(4.9%) had vocal cord palsy which all resolved before 6 months.
Conclusions: Our study has demonstrated that it is generally safe to
perform thyroidectomy in the elderly population with low
hypocalcemia and vocal cord palsy rates as compared to the British
Association of Endocrine and Thyroid Surgeons’ report of 10.2% and
7.8% for hypocalcemia and early cord palsy rates respectively in all
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age-groups. Nevertheless, we would advocate appropriate patient
selection in terms of ASA classification. For example, 50% of those
who had post-operative vocal cord palsy in our study had an ASA of 3.
Abstract citation ID: znac248.274
TH8.9 Impact of laparoscopic sleeve gastrectomy on fibrosis
stage in patientswith child–A NASH–related cirrhosis
Mohamed Salman1, Khaled Noureldin1, Mohamed Issa2,
Mohamed Tourky3, Marwa Badawi4, Ayyat Abdelaziz5
1
Cairo University Hospital, Egypt
2
Prince Charles Hospital, South Wales
3
Great Western Hospital, NHS Foundation Trust, Swindon
4
Conquest Hospital, Hastings
5
Menia University Hospital, Egypt
Introduction: Bariatric surgery can improve non-alcoholic fatty liver
disease (NAFLD). This work endeavored to evaluate laparoscopic
sleeve gastrectomy (LSG) in cases with compensated non-alcoholic
steatohepatitis (NASH)-related cirrhosis and its impact on fibrosis stage.
Methods: A prospective work involved 132 cases with Child-A
NASH-related cirrhosis suffering from morbid obesity scheduled for
LSG. They had preoperative assessment, wedge biopsy, and
ultrasound-guided true-cut liver biopsy after 30 months. Patients with
F4 fibrosis were included. Liver condition was assessed based on
NALFD Activity Score (NAS).primary outcome measure was the impact
of LSG on fibrosis stage and its relation to weight loss.
Results: Analysis included only 71 patients who completed the
30-month follow-up period. By the end of follow-up interval, there
was a substantial weight loss with a reasonable resolution of
comorbidities. median NAS decreased from 6 (1–8) to 3 (0–6) after
surgery. Fibrosis score regressed to F2 in 19 patients (26.8%) and F3 in
29 (40.8%). Patients with improved scores had a significantly higher
amount of weight loss (p < 0.001). Improvement was more frequent in
males (p = 0.007). By 30 months after treatment, 53.8% of cases with
borderline NASH and 36.8% of those with probable NASH showed
complete resolution, and 44.7% of patients with NASH showed
improvement. Steatosis improved in 74.6% of patients.
Conclusion: Patients with NASH-related liver cirrhosis of Child class A,
LSG may be a secure approach for the management of morbid obesity. It
has a long-term benefit for both obesity and liver condition with
significant improvement of steatosis, steatohepatitis, and fibrosis.

EPosters
Abstract citation ID: znac245.001
EP-3 Quality improvement project analysing the impact on
antimicrobial prescribing in a General Surgery department
after introducing access to guidelines via a mobile phone app
Aniket Bharadwaj1,2, Neil Donald1,3
1
Peterborough City Hospital
2 EP-19 The innate aptitude’s effect on the surgical task
University College London
3
Imperial college London
Introduction: Antimicrobial prescribing forms a central pillar of
treatment in surgical admissions. This project aimed to analyse the
impact of increasing access to antimicrobial guidelines for doctors in a
general surgical department via mobile and laptop apps. Prior to this
guidelines were only available in a pdf format accessible via the trusts
intranet.
Method: An initial audit of 238 antimicrobial prescription from 109
patients in the month of October 2020 was performed. The data was
collected was compared against the antimicrobial stewardship NICE
guidelines (NG 15 1.1.2.4). This showed that only 57% of antibiotic
prescriptions were in line with the correct treatment guidelines. After
discussion with the lead microbiology consultant and lead
pharmacist, trust guidelines were introduced for the first time on the
Micro-guide, made accessible to all doctors via the mobile app and
laptops. Information was circulated within the surgical department
via educational posters and a presentation. 6 months later we closed
the audit look. We aimed to review whether increasing access via
technological means would lead to greater standards of antimicrobial
prescribing.
Results: Results following the increasing the access to guidelines
significantly improved the accuracy of antibiotic prescriptions. Some
improvement was also seen in the other parameters such as
documentation of indication and duration of antibiotic prescriptions.
Conclusion: It is evident that improving access to trust guidelines via
trusted mobile applications and trust laptops can facilitate
improvement in antimicrobial stewardship standards and help slow
the emergence of resistance in communities.
Abstract citation ID: znac245.002
EP-10 Is selective histology of cholecystectomy specimens for
benign gallbladder disease a future surgical practice?
Mariana Rita Afonso Matias1, Madara Kronberga2
1
Sheffield Teaching Hospitals, NHS Foundation Trust
2
Calderdale and Huddersfield NHS Foundation Trust
Cholelithiasis, known as gallstone disease, is highly prevalent in
developed countries population, with symptomatic cholelithiasis
being one of main indications for cholecystectomy (BMJ Best Practice,
2021). Elective or emergency laparoscopic cholecystectomy has
become a gold standard with a common practice all over the world to
proceed with routine histopathological examination of all gallbladder
specimens. The rationale behind this established practice is to
exclude the presence of incidental gallbladder malignancy (Lundgren
et al., 2018). Despite being the most common cancer of the biliary
tract, gallbladder cancer is a rare benign entity in developed countries.
It is generally associated with a poor prognosis (Lundgren et al., 2018).
Gallbladder cancer often mimics the clinical features of benign
gallbladder disease with 60 to 80% (Emmett et al., 2015) of the cancers
being diagnosed following cholecystectomy.
Different authors have reported a low incidence of GC (0.19 to 3.3%)
(Emmett et al., 2015) in cholecystostomy specimens. Therefore, recent
literature reviews (Khan et al., 2021) have challenged the surgical
community to change their clinical practice. They suggest a selective
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BJS, 2022, 109(Supplement 5) v108–v149
https://doi.org/10.1093/bjs/znac245
Abstracts
histopathology examination of gallbladder specimens based on
patients’ risk factors and thorough intraoperative macroscopic
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assessment by the surgeon as a safe and cost-effective practice
(Lundgren et al., 2018; Khan et al., 2021).
Abstract citation ID: znac245.003
performance
Michael El Boghdady1, Béatrice Marianne Ewalds-Kvist2,3
1
General Surgery Department, Kingston Hospital NHS Foundation trust, London,
UK
2
Stockholm University, Sweden
3
University of Turku, Finland
Aims: Surgery is a craft profession requiring individuals with specific
innate aptitudes for manipulative skills, visuospatial and psychomotor
abilities. The selection process of surgical trainees excludes aptitude
testing for the psychomotor and manual manipulative skills of
candidates for required abilities. We scrutinize the effect of innate
aptitudes in surgery and its skill-training by systematically reviewing its
significance on the surgical task performance.
Methods: A systematic review was performed by PRISMA guidelines. A
search on PubMed/Medline for English language articles was
performed from January 2001 to January 2021. Search terms were
‘aptitude for surgery’, ‘innate aptitude and surgical skills’,
‘manipulative abilities and surgery’ and ‘psychomotor skills and
surgery’. The quality of quantitatively researched citations was
assessed by MERSQI scores.
Results: The results yielded 1142 studies and 21 met the inclusion
criteria and 6 high-quality citations rejected our 3 null hypothesis and
all medical students cannot reach proficiency in skills necessary for a
career in surgery. Playing video games and/or musical instruments do
not promote surgery skill; yet, a valid test with predictive value for
novices aspiring for a surgical career is helpful. MERSQI mean score
was 11.07 (SD= .98; range 9.25 to 12.75).
Conclusion: Visuospatial aptitude, rate of skill acquisition and quality of
surgical performance predicted baseline surgical ability. Additionally,
visuospatial aptitude along with psychomotor skills and perceptual
talent, furthered laparoscopic simulator performance. The selection
process for candidates suitable for a career in surgery requests a
simulated surgical environment, where the candidates’ skills also in
forms of non-technical aptitudes are assessable.
Abstract citation ID: znac245.004
EP-20 Postoperative music, a non-pharmacological pain relief:
a randomized controlled trial
Nader Aghakhani1, Béatrice Marianne Ewalds-Kvist2,3,
Michael El Boghdady4
1
Urmia University, Iran
2
Stockholm University, Sweden
3
University of Turku, Finland
4
General Surgery Department, Kingston Hospital NHS Foundation Trust, London,
UK
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 <.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 < .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.
Abstract citation ID: znac245.005
EP-21 The adequacy of consent forms for post-operative
inguinal hernia complications relative surgeon’s grade of
training
Michael Quefferus, Michael El Boghdady
General Surgery Department, Croydon University Hospital, London, UK
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.
Abstract citation ID: znac245.006
EP-25 Double Gastric Outlet Obstruction Caused by an
Incarcerated Right Inguinal Hernia, a Rare Presentation
Malaz Abbakar1, Salma Ahmed2, Michael Lim1
1 exclusion of more urgent complications associated with migration is
York and Scarborough Teaching Hospitals Foundation Trust
2 necessary to avoid morbidity and mortality.
Wirral University Teaching Hospitals Foundation Trust
We report a case of an 84-year old man who presented with double
gastric outlet obstruction from an incarcerated right inguinal hernia
that contained part of the stomach, most of the small bowel,
omentum, appendix, caecum, ascending and transverse colon,
causing a double gastric outlet obstruction.
Several intra-abdominal organs have been reported in groin hernias
including the appendix, bladder, small and large bowel and ovaries.
There are approximately 60 cases of inguinal hernias containing the
stomach, the majority were before 1980. It’s believed that the emphasis
of early repair minimized the occurrence of complications and decreased
presentations of these cases. Two cases were published in the UK with a
similar condition in 2014 of which one was treated conservatively and
the other had an open inguinal hernia repair with mesh.
Abstracts | v109
He presented to the emergency department with a 1 day history of
severe abdominal pain and dark brown vomiting due to
incarceration of inguino-scrotal hernia which he had for the last 24
years with no symptoms. His abdomen was soft and non-tender
with large right inguino-scrotal hernia which was tender on
palpation and irreducible.
The diagnosis was confirmed with a CT scan. The P-Possum score was
calculated, 2.56% mortality and 49.5% morbidity. He was taken to the
theatre, after resuscitation for exploratory laparotomy, omentectomy
and inguinal hernia Lichtenstein repair with Vicryl® mesh.
At the end, it is thought that long-standing traction on the greater
omentum and its attachments may be responsible for the descent of
the stomach into the hernia sac.
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Abstract citation ID: znac245.007
EP-29 The prevalence of a small occult umbilical hernia during
the trans-umbilical approach in general laparoscopic surgery
Stacey Jones1, Mohamed Sheredi2
1
Airedale NHS Foundation Trust
2
Mid Yorkshire NHS Trust
Aims: The aim of this study was to firstly determine the prevalence of a
small occult umbilical hernia during the trans-umbilical incision
technique in general laparoscopic surgery. Secondly, to determine
patient satisfaction with post-operative pain and cosmesis.
Methods: This was a prospective study of 128 patients who underwent a
trans-umbilical incision during general laparoscopic surgery by a single
surgeon between January 2020 and July 2021. Demographic data, type of
surgery, presence of small occult umbilical hernia, time to gain access
and time of incision closure were obtained from the operation note.
Following the procedure each patient was contacted via telephone
and asked questions regarding, post-operative pain, surgical site
infection, post-operative complications and cosmetic satisfaction.
Results: Of the 128 patients within the study, 57.8% were female with a
mean age of 44.4 years and a BMI of 26.6 kg/m2. The most common
operation performed was laparoscopic cholecystectomy in 51.6% of
patients. 62.5% of patients were found to have the presence of a small
occult umbilical hernia with a mean of 1.1 minutes to gain access and
6 minutes to close incision. Approximately, 80% of patients stated that
post-operative pain experienced was as or less than expected. All
patients were satisfied with scar cosmesis.
Conclusion: Well over half of patients were found to have a naturally
occurring small umbilical hernia that could make gaining access to
the abdominal cavity via a trans-umbilical incision easier, quicker and
safer. As well as excellent patient satisfaction with regards to scar
cosmesis and lower than expected post-operative pain scores.
Abstract citation ID: znac245.008
EP-33 Migrated Esophageal Stent Causing Imminent
Perforation. A Case Report
Qurrat Al Ain Atif, Mehdi Raza, Edidiong Essiet, Kazi Ahmed
Dartford and Gravesham NHS Trust
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
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.
v110 | Abstracts
Abstract citation ID: znac245.009
EP-34 A rare cause of upper abdominal pain – left gastric artery
trapped in gastric band
Cheuk Tung Kam, Jaideep Rait
Maidstone and Tunbridge Wells NHS Trust
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.
Abstract citation ID: znac245.010
EP-42 Adherence to Guidelines of Pre-operative Antibiotics
Prophylaxis in Bahrain
Ahmed Alanzi1, Sundus Almukhodher2
1
King Hamad University Hospital
2 Abstract citation ID: znac245.012
Salmaniya Medical Complex
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.
Abstract citation ID: znac245.011
EP-43 Soup and sweet is not enough to eat: Postoperative
nutritional intake is inadequate following open colorectal
resection
Edward Hardy1,2, Anna Quinn3, Emma Bergin3, Beth Phillips2, Jon Lund1,2
1
Department of General Surgery, Royal Derby Hospital
2
Centre Of Metabolism, Ageing and Physiology, University of Nottingham
3
School of Agriculture and Food Science, University College Dublin
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
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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
Charles Carey1, Shanthi Natarajan2
1
Manchester University NHS Foundation Trust
2
Limelight Health and Wellbeing Hub
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.

Abstract citation ID: znac245.013
EP-48 Laparoscopy in Emergency Colorectal Surgery: A 7-Year
Retrospective Single Centre Cohort Study
Alexander Darbyshire, Rachel Smythe, John Richardson, Jim Khan,
Stuart Mercer
Portsmouth Hospitals University NHS Trust
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<0.001) and 30-day mortality (6.1% vs 17.9%, p<0.001)
than open surgery. Cases completed laparoscopically had a 30-day
mortality comparable to elective surgery (2.1%, p<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.
Abstract citation ID: znac245.014
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
Lasitha Bhagya Samarakoon1, Samip Chandraprakash2,
Roland Fernandes3, Pradeep Basnyat4
1 EP-53 The ambulatory care of unusual presentation of
Specialist grade doctor, William Harvey Hospital, Ashford, Kent
2 Boerhaave’s syndrome
Trust grade doctor, William Harvey Hospital, Ashford, Kent
3
Consultant Emergency and UGI Surgeon, William Harvey Hospital, Ashford
4
Consultant Emergency and colorectal Surgeon, Clinical lead, William Harvey
Hospital, Ashford.
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.
Abstracts | v111
Abstract citation ID: znac245.015
EP-51 Acute presentations of Jejejunal diverticulosis – a
literature review of the uncommon entity
Lasitha Bhagya Samarakoon1, Annang Pangeni2, Charlotte Florance3,
Venkat Satya SontenamDr4, Ashish K Shrestha5
1
Specialist Grade Doctor, William Harvey Hospital Ashford, Kent
2
Registrar in General Surgery, William Harvey Hospital Ashford, Kent
3
F2, William Harvey Hospital Ashford, Kent
4
Consultant Radiologist, William Harvey Hospital Ashford, Kent
5
Consultant General and Colorectal Surgeon, William Harvey Hospital Ashford,
Kent
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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.
Abstract citation ID: znac245.016
Santhosh Loganathan, Rahman Gul, Laura Whittaker
Airedale General Hospital, Keighley
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.
v112 | Abstracts
Abstract citation ID: znac245.017
EP-55 Subclinical Spigelian hernia: sailing with the hidden
iceberg
Aakansha Giri Goswami1, Somprakas Basu1, Vijay Kumar Shukla2
1
All India Institute of Medical Sciences, Rishikesh, India
2
Banaras Hindu University, Varanasi, India
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.
Abstract citation ID: znac245.018
EP-66 Omental infarct – A rare cause of Right iliac fossa pain in
a child
Lasitha Bhagya Samarakoon1, Samip Chandraprakash2, Veera Allu3
1
Specialist Grade Doctor in General Surgery, William Harvey Hospital, Ashford,
Kent
2
Trust Doctor in General Surgery, William Harvey Hospital, Ashford, Kent
3 Pneumomediastinum without trauma or clear secondary cause is called
Consultant Emergency and Colorectal Surgeon, William Harvey Hospital,
Ashford, Kent
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.
Abstract citation ID: znac245.019
EP-67 An Audit of extended Venous Thromboembolic
Prophylaxis for major Laparotomy in a District General
Hospital, Are We Compliance With NICE guidelines?
Tarek Elshafey, Muhammad Azam, Rajish Satchidanand
Southport and Ormskirk NHS Trust Hospitals
Aim: Development of Thrombo-embolic episode is a well-recognised
complication after major abdominal surgery in high risk patients.
studies have shown the extended VTE prophylaxis is beneficial for the
patients after a major abdominal surgery.
Aim of this study was to evaluate the administration of extended VTE
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prophylaxis after being discharged home.
We prescribed LMWH for prophylaxis postoperatively for 28 days and
patients or carers were trained to self-administer before discharge.
Method: This is a retrospective review of prospectively collected and
maintained data on major abdominal surgery (Laparotomy) in a district
general hospital for the length of VTE prophylaxis after discharge home.
and compare the result with the standard set out by NICE. we collected the
patients’ data from electronic database from January 2019 to January 2021.
Results: A total of 310 patients records were retrieved from the database
system.
Our record result showed that 189(61%) patients went home with
extended VTE prophylaxis. 121(39%) patients did not receive VTE
prophylaxis after discharged.
Out of 121 patients 2 patients developed VTE
1 patient developed DVT and PE and one patient developed DVT only.
Patient with DVT and PE was admitted for medical management.
Conclusion: Post operative DVT and PE are worrisome preventable
complications for the patients after major surgery especially the
elderly and patients with medical co morbidities. the morbid patients
with malignancy are more challenging to mobilise after the surgery.
There has been studies on extended VTE prophylaxis for such patients
after discharge and benefits are documented for those patients with
extended VTE prophylaxis.
Abstract citation ID: znac245.020
EP-68 A Case of Spontaneous Pneumomediastinum due to
Marijuana usage- A rare cause
Santhosh Loganathan, Pallavi Gungadin, Petre Ichim
Wrightington Wigan and Leigh Teaching Hospital NHS FT, UK
Spontaneous pneumomediastinum with an incidence between 0.001%-
0.014% and most commonly seen in young males. Marijuana smoking
has rarely been identified as a possible cause of spontaneous
pneumomediastinum, which is likely caused by barotrauma during
breathing manoeuvres. Fewer than 10 case reports have been reported
in the literature on Marijuana causing Spontaneous pneumomediastinum.
We present a 24year male who presented with dysphagia, swelling and
crackling under the skin of his neck for the past 12hours, half an hour
after blowing his nose. There was no chest pain or dyspnoea, and he was
hemodynamically stable with normal blood investigations. He smokes
cannabis regularly and occasionally does cocaine. On examination,
surgical emphysema was felt on both sides of the neck; the systemic
examination was unremarkable. CT thorax demonstrated extensive
pneumomediastinum and surgical emphysema from the angle of the jaw
throughout the neck and down to the right subcapsular region. No
pneumothorax was seen, and lung parenchyma was unremarkable.
However, to rule out the clinical suspicion of oesophageal rupture, he
had a CT oesophagus with oral contrast, which showed no extravasation
of contrast from the oesophagus. The patient was admitted for
observation, and the Chest X-ray after 12hours dint show pneumothorax.
He was clinically well, tolerating oral feeds, so he was discharged with
oral antibiotics as a prophylactic cover as per UGI surgeons.
The knowledge about this rare cause would help the physicians diagnose
and educate the patients on the risk involved in using Marijuana.

Abstract citation ID: znac245.021
EP-69 The use of IFAbond© tissue adhesive to reduce seroma
rates and improve breast reconstruction outcomes
Rebecca Lefroy, Senthurun Mylvaganam
Royal Wolverhampton Hospital Trust
Introduction: Tissue adhesives have had uses in surgery for over 45
years. Evidence for use in haemostasis and cavity closure is growing.
Seromas are a common (up to 85% incidence) but potentially serious
complication in implant-based breast reconstruction (IBBR). If infected
can cause implant loss and reconstruction failure. Tissue adhesives
may reduce seroma rates.
Aims and Methods: Our study considered whether IFAbond©
significantly reduces seroma formation following IBBR and as a pilot to
evaluate the optimum use and application of IFAbond©. 7 consecutive
patients undergoing pre-pectoral IBBR were recruited to the control
arm (standard closure) and a further 7 patients undergoing pre-pectoral
IBBR were recruited to the intervention arm (standard closure including
IFAbond©). Qualitative assessment of seroma formation and IBBR
objective early outcomes were assessed at 1 week, 2 weeks and 30 days.
Results: Cohorts were comparable for demographics, mastectomy
weight and implant size. No wound infection, healing concerns or
implant loss at thirty days in either cohort. No patients developed
clinically significant seroma (requiring drainage) in either arm. 4 of 7
control arm patients developed clinically noticeable seroma at 30 days
compared to none in the intervention arm.
Conclusions: IFAbond© is safe and easily applied during IBBR adding
little time to closure. This study suggests that IFAbond© can reduce
clinically evident seroma formation in IBBR compared to standard
closure. This pilot will inform a larger study to explore the statistical
significance of this intervention and with longer term follow-up
whether this correlates to lower rates of implant loss/failure.
Abstract citation ID: znac245.022
EP-70 Gangrenous appendix with an abscess in femoral hernia
cavity-a rare case of De Garengeot’s hernia
Tayyaba Syed, Ashim Chowdhury, Ashish Shrestha
East Kent Hospitals University Foundation Trust- William Harvey Hospital
Background: De Garengeot’s hernia (DGH) is a Femoral Hernia that
contains an appendix and has been named after Rene De Garengeot, a
French surgeon in 1731. It is a rare entity that is mostly identified as an
incidental finding during exploration of an incarcerated Femoral Hernia
and even rarer is the incidence of a gangrenous appendix in these cases.
Case: An 81 years-old female patient presented to Accident &
Emergency complaining of a progressively tender enlarging mass in
the right groin region, associated with local inflammation. CT scan of
abdomen and pelvis (CTAP) performed showed suspected perforated
caecum with large groin abscess. She underwent groin exploration
which confirmed femoral hernia sac containing a gangrenous
appendix with a surrounding abscess. The abscess cavity extended
from the right groin to medial aspect of thigh. Appendectomy was
performed, abscess cavity drained and washed with normal saline/
Betadine followed by suture repair of the femoral hernia defect . She
made an uneventful recovery following the surgery.
Discussion: DGH itself is rare surgical pathology with an incidence of
about 0.18% to 0.13%, however, the presentation like our case is even
rarer. Emergency surgery is the definitive treatment of DGH to avoid
any complications. During surgery, appendectomy and femoral hernia
repair are performed consecutively.
In conclusion, appendicitis within a femoral hernia often lacks a
classical presentation. CTAP can be helpful in diagnosis, however
there can be limitations. Appendectomy with mesh-free hernia repair
is an acceptable treatment for DGH.
Keywords: De Garengeot hernia, Incarcerated femoral hernia
Abstract citation ID: znac245.023
EP-82 The First International Delphi Consensus Statement on
Laparoscopic Gastrointestinal Surgery
Islam Omar1, Brijesh Madhok2, Bassem Amr3, Sjaak Pouwels4,
Yitka Graham5, Kamal Mahawar6,7
Abstracts | v113
1
Wirral University Teaching Hospital
2
University Hospital of Derby and Burton NHS Foundation Trust, Derby, East
Midlands, UK
3
University Hospitals Plymouth NHS Trust, UK
4
Department of Intensive Care Medicine, Elisabeth Tweesteden Hospital, Tilburg,
The Netherlands
5
University of Sunderland, UK
6
Bariatric Unit, South Tyneside and Sunderland NHS Trust, Sunderland, UK
7
Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland,
UK
Introduction: Laparoscopic surgery is now firmly established in the field
of gastrointestinal (GI) surgery and has replaced open surgery in many
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areas. The purpose of this exercise was to prepare a consensus
statement highlighting the important principles of laparoscopic GI
surgery.
Methods: A committee of 38 experts in laparoscopic GI surgery proposed
and voted on 149 statements in two rounds following a modified Delphi
protocol.
Results: A consensus was achieved on 133 statements after two rounds.
There was 100% consensus on informing the team of unusual complex
operations, asking for a second opinion when needed and following
the ergonomics principles.
Additionally, 94.7% advised to have multiple options for abdominal
entry, 100% agreed on tailoring the first port site to the patient, and
84.2% advised to use Veress needles with caution.
Moreover, 97.4% consensus was reached on keeping the intra-
abdominal pressure at the minimum required, and 92.1% agreed that
a pressure of 12 mm Hg is adequate for most intra-abdominal surgery.
There was a complete (100%) consensus on using cartridges of
appropriate height, checking the doughnuts after using circular
staplers, adding any foreign body inserted into the abdomen to the
operating count, ensuring the integrity of instruments on removal
from the abdomen, and avoiding handing over an operation in the
middle.
There was a 100% consensus on focusing on precision, not the speed,
and learning to use the non-dominant hand effectively.
Conclusion: A 38 experts achieved a consensus on 133 statements.
Increased awareness of these should enhance the safety of patients
undergoing laparoscopic surgery.
Abstract citation ID: znac245.024
EP-85 Abdominal hernia mesh repair in patients with
inflammatory bowel disease: A systematic review
Michael El Boghdady1, Béatrice Ewalds-Kvist2,3, Aggelos Laliotis4
1
Kingston Hospital NHS foundation trust, London, UK
2
Stockholm University, Sweden
3
University of Turku, Finland
4
Croydon University Hospital, London, UK
Aims: Postoperative hernia-repair complications are frequent in
patients with inflammatory bowel disease (IBD). This fact challenges
surgeons’ decision about hernia mesh management in these patients.
Therefore, we systematically reviewed the hernia mesh repair in IBD
patients with emphasis on risk factors for postoperative complications.
Method: A systematic review was done in compliance with the PRISMA
guidelines. A search was carried out on PubMed and ScienceDirect
databases. English language articles published from inception to
October 2021 were included in this study. By MERSQI scores quality
and evidence classifying were performed in agreement with GRADE’s
recommendations. The research protocol was registered with
PROSPERO (CRD42021247185).
Results: The present systematic search resulted in 11243 citations with
a final inclusion of 10 citations. One paper reached high and 4 moderate
quality. Patients with IBD exhibit about 27% recurrence after hernia
repair. Risk factors for overall abdominal septic morbidity in Crohn’s
disease comprised enteroprosthetic fistula, mesh withdrawals,
surgery duration, malnutrition, midline incision site of hernia,
biological mesh and digestive concomitant procedure.
Conclusion: Patients with IBD were subject, more so than controls, to
postoperative complications and hernia recurrence. The use of a
diversity of mesh types, a variety of position techniques and several
surgical choices in the citations left room for less explicit and more
implicit inferences as regards best surgical option for hernia repair in
patients with IBD.
v114 | Abstracts
Abstract citation ID: znac245.025
EP-86 Preventable errors in hand surgery: analysis of data from
NHS England
Ahmed Hafez1, Islam Omar2, Andrew Ang1, Kamal Mahawar3
1
Royal London Hospital, Barts health NHS Trust, London, UK
2 1
Wirral University Teaching Hospital, UK
3
South Tyneside and Sunderland Foundation Trust, UK
Background: Avoidable medical errors and never events represent a
significant problem with negative consequences on the patient, the
healthcare professionals, and the healthcare facilities. Hand surgery is
a unique multidisciplinary speciality in which orthopaedics, plastic
and general surgery are usually involved in the care of their patients,
which makes this speciality prone to medical errors. The study
highlights these preventable errors in hand surgery in NHS England.
Methods: We analysed hand surgery-related preventable medical errors
published by the NHS England during the last ten years from 2012 till
July 2021.
Results: Out of 3742 never events during the review period, only 50 never
events related to hand surgery were found, representing (1.3%).
The majority were under wrong-site surgery category 30 (60%), which
included 17 (57%) wrong finger or digit surgery followed by five wrong
digit or thumb injections, three wrong K wire placement, and three
scaphoid bones were mistakenly removed during trapeziectomy.
The second most common category was wrong incision 15 (30%), with 13
wrong finger incisions, two wrong carpal tunnel incisions for trigger
finger release.
Four patients had wrong procedures, including CTR rather than trigger
finger or Dequervain release or an unnecessary carpal tunnel release
in addition to one wrong hand tendon transfer. Lastly, only one
patient had a wrong injection for carpal tunnel that was intended for
another patient.
Conclusions: Hand surgery-related medical errors represent 1.3% of the
whole Never Events reported.
Awareness of these incidents will help prevent their occurrence in
the future.
Abstract citation ID: znac245.026
EP-87 Use of Harmonic Focus Shears in Plastic Surgery.
Literature review and future recommendations
Darab Bahadori1, Inez Eiben2, Paola Eiben3, PennyLouise Hever2
1
Chelsea & Westminster NHS Foundation Trust
2 Emma Smith, Sarah Zhao, Michael El-Boghdady, Serena Sabato-Ceraldi
Guy’s and St Thomas NHS Foundation Trust
3 Croydon University Hospital
Royal London NHS Foundation Trust
Introduction: Harmonic Focus Shears (HFS) (Ethicon Endo-Surgery, USA)
is an ultrasonic device specifically designed through its curved clips and
hand activated trigger system to be precise and minimise the impact on
tissues. Initially designed for head and neck dissection and proved to be
effective without increasing risk of complications in thyroidectomy
procedure it is surprisingly rarely mentioned in the field of plastic
surgery.
We performed a literature search to established current uses of
ultrasonic devices in plastic surgery and determine its effectiveness,
and future uses.
Methods: Literature search was performed in accordance to guidelines
for Preferred Reporting Items for Systemic Reviews and Metanalysis.
Discussion: Use of ultrasonic devices as harmonic prove to be a useful
tool in precise large tissue dissection surgery including pedicled flap
and free flap dissection. Described benefits embrace upgraded
operative time, blood loss, tissue discharge and morbidity.
Initially described to be superior to traditional electrocauthery in facelift
procedure, ultrasonic devices then evolved to be advantageous when
considering outcomes in breast reduction surgery, implant based
breast reconstruction and capsulectomy.
HFS as a novel and improved ultrasonic device allows for focused
forceps dissection, haemostasis and tissue coagulation without the
need to swap instruments that is safe to the surrounding tissues.
Learning curve is expected and pitfalls include additional staff
training, multiple wire device setup, single use and possible
overheating. On balance however improved timings and therefore
operative efficiency, low risks of complications and optimal patient
outcomes make this method of tissue handling a favourable tool to
introduce to common plastic surgical practice.
Abstract citation ID: znac245.027
EP-88 Plastic Surgery Venous Thromboprophylaxis for
abdominal and thigh based free flap breast reconstruction
surgery
Darab Bahadori1, Inez Eiben, Paola Eiben3
Chelsea & Westminster NHS Foundation Trust
2Guy’s and St Thomas NHS Foundation Trust
3
Royal London NHS Foundation Trust
Aims: Correct Venous Thromboprophylaxis (VTE) assessment and
prescription is at basis of patient safety when considering patient
hospital admission. Current local Guy’s and St Thomas Hospital
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guidelines are in keeping with National Institute for Health and Care
Excellence (NICE) guidelines recommending all patients to be assessed
and prescribed VTE prophylaxis within 24 hours of admission. There
are no specific local or national guidelines however that would
recommend VTE prophylaxis specific to free flap breast reconstruction
surgery.
We assessed therefore adherence to VTE prophylaxis guidelines for
patients undergoing abdominal and thigh based free flap breast
reconstruction surgery. Patient outcomes were reviewed and VTE
prophylaxis proforma was recommended.
Methods: Patients who underwent abdominal or thigh based free flap
breast reconstruction surgery between October 2017 and February
2019 were identified. Data was collected retrospectively and analysed
via SPSS Statistics (IBM, USA).
Results: 51 patients were included in the first audit cycle; 50 patients in
the re-audit. Overall improvement and 100% of patients received LMWH
on admission. The timings of correct prescription versus actual
administration of LMWH decreased however from 71% to 49%.
Discussion: There is good adherence to assessment and administration
of VTE prophylaxis across the patients. Unfortunately the prescription
of VTE prophylaxis itself is mostly incorrect. It is therefore with
gratitude to the ward staff VTE is administered correctly. Further
improvements in the communication therefore between theatre, ward
and surgical staff and implementation of VTE prophylaxis proforma
need to be considered.
Abstract citation ID: znac245.028
EP-90 Bouveret Syndrome: A challenging case of impacted
gallstone within the fourth part of the duodenum
Aims: Bouveret syndrome is a rare condition characterised by gastric
outlet obstruction secondary to a gallstone fistulating into the
proximal duodenum or pylorus. We present a case of a 68-year-old
with recurrent small bowel obstruction secondary to a large gallstone
impacted in the fourth part of the duodenum and cholecysto-
duodenal fistula. We describe our atypical approach to surgical
retrieval.
Methods: The patient presented acutely with abdominal pain and
vomiting, on a background of recent admission for gallstone ileus
managed conservatively. Initially, due to high anaesthetic risk (P
POSSUM score = 14% mortality, 60% morbidity), the patient was
managed conservatively with nasogastric drainage and total
parenteral nutrition. On day 6 of admission, emergency laparotomy
was performed after identifying radiological signs of impending
perforation and clinical deterioration. Endoscopic management was
not available locally. The stone could not be milked proximally for
retrieval via pyloroplasty. Subsequently, high-pressure water flushes
delivered via the gastrostomy expelled the stone distally. The stone
was then retrieved via a jejunotomy at the DJ flexure.
Results: The patient required a 2-day high dependency unit
admission and she was discharged 3 weeks post-operatively at her
functional baseline. She was clinically well and asymptomatic when
reviewed at the four-month post-operative surgical follow-up
appointment.
Conclusions: This is the first report to our knowledge to describe
successful surgical management of a gallstone impacted in the
fourth part of the duodenum. Enterolithotomy can be considered
safe option in patients with large, impacted stone and multiple co-
morbidities.

Abstract citation ID: znac245.029
EP-94 To see or not to see: A case of complex multidisciplinary
surgical reconstruction
Sarah Jane Afify, Jorge Leon-Villapalos, Richard Scawn, Manvi Sobti,
Naresh Joshi
Chelsea and Westminster Hospital
A 4 year-old child suffered catastrophic 60% total body surface area burn
injuries affecting head and neck, trunk and limbs following sulphuric
acid burns. He underwent limited treatment in his country consisting
of first aid and debridement and grafting in upper and lower limbs
and trunk, but no treatment to the facial and ocular areas.
He was referred for assessment and reconstruction in the United
Kingdom. Even though there were widespread burn scar contractures,
his most severe injuries involved both eyes and adnexal structures
with evidence of severe bilateral cicatricial ectropion and threat to
vision.
He required multidisciplinary plastic surgery and ophthalmic complex
bilateral eyelid reconstruction in two separate procedures to restore
anatomical and cosmetic integrity to both eyes.
The initial procedure involved examination under anaesthesia of both
eyes, release of the left upper and lower eyelids burns scar ectropion
and resurfacing of the resulting defect with full thickness grafts from
the left clavicular area. The grafts had full take with no evidence of
infection and excellent cosmesis.
A similar procedure was performed to reconstruct the right eyelids 6
weeks later. The vision of this eye was beyond salvage but the need
for cosmetic eyelid symmetry was considered as an appropriate
indication to proceed to reconstruction. This was found to be
successful with excellent graft take and parental satisfaction.
This case required coordination, expert holistic approach, complex
surgery and extra efforts from the team to ensure compliance,
communication and positive outcomes and highlights the importance
of multidisciplinary team effort.
Abstract citation ID: znac245.030
EP-95 Full Cycle Audit on Prescription and Cost Effective
Analysis of Metronidazole in Acute Surgical Unit
Li Siang Wong, Mei Ying Chin, Caroline Mcgee, Kay Mccubbin
Royal Alexandra Hospital Paisley
Aims: Oral Metronidazole has very high bioavailability, similar to that of
intravenous(IV) metronidazole. Prescribing oral Metronidazole has
many advantages such as saving drug preparation time, reducing risk
of line infection and also being more cost effective. We aim to study
the incidence of prescription or oral Metronidazole and its cost impact
in or acute surgical unit.
Methods: Retrospective analysis on the prescription and cost
effectiveness of Metronidazole usage in acute surgical setting.
Inclusion criteria for this study was acute surgical patients with viable
oral route and who were prescribed oral or IV Metronidazole. Cost
assessment was carried out using British National Formulary (BNF).
Education and awareness campaigns were held to encourage the
prescription of oral Metronidazole. A second cycle audit was done to
measure outcome of education.
Results: First audit done in 2020 found only 12.5% of patients were
prescribed oral instead of IV Metronidazole. This has improved to 61%
during second cycle audit done in 6 months time after the awareness
campaigns. Prescribing oral instead of IV Metronidazole would save
approximately £64.77 per dose resulting in reducing total cost by
£971.55 per standard course of 5 days treatment.
Conclusion: There is clear improvement in the rate of prescribing of oral
Metronidazole following equation campaigns. Further improvement
can be achieved through continued education of various members of
surgical team which will ultimately result in reduced costs, lessen
drug preparation time for nursing staff and lower risk of line infection
for patients.
Abstracts | v115
Abstract citation ID: znac245.031
EP-100 Skin Graft Versus Local Flaps in Management of
Post-Burn Elbow Contracture
Khaled Noureldin1, Mohamed Issa2,3, Marwa Badawi4,5,
Mariam Darwish6, Mahmoud Makram7,1, Ayyat Abdelazizi8
1
Cairo University Hospital, Egypt
2
Prince Charles Hospital, Merthyr Tydfil
3
Al Takwa Specialized Hospital
4
Conquest Hospital, Hasting
5
Cairo University Hospital, Egypt
6
University of Wales Hospital, Cardiff
7
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Misr international Hospital, Egypt
8
Menia University Hospital, Egypt
Introduction: Contracture is a pathological scar tissue resulting from
local skin tissue damage, secondary to different local factors. It can
restrict joint mobility, resulting in deformity and disability. This study
aimed to investigate the outcomes of skin grafts compared to local
flaps to reconstruct post-burn elbow contractures. These parameters
included regaining function, range of movement, recurrence, and local
complications.
Methodology: A retrospective study reviewed twenty-one patients for
elbow reconstruction over 12 months. Only patients with post-burn
elbow contracture were included. Other causes, including previous
corrective surgery, any resultant elbow stiffness, and patients who
opted out of postoperative physiotherapy, were excluded. Subdivision
was according to the method of coverage into three groups: graft
alone(G1), local flap(G2), or combined approach(G3).
Results: Females were three times at higher risk to suffer a burn injury,
while almost half of the cases were children. Scald injury represented
81% of burn causes. G1,2,3 were used in 47.6%, 42.9% and 9.5% of cases
retrospectively. Overall rate of infection was 28.5%. 100% graft taken
was recorded in 81.8% of cases; however, flap take was in 90%. After
12 months of follow-up,re-contracture was 60% and 22.8% in G1 and
G2; however, the satisfaction rate was 70% and 100% in both groups
retrospectively. The overall satisfaction was 85.7% in all groups.
Conclusion: Grafts and local flaps are reasonable options for post
contracture release; however, flaps are superior. Coverage selection
depends on the lost tissue area and exposure of underlying deep
structures. Physiotherapy and patient satisfaction are crucial in the
outcomes.
Abstract citation ID: znac245.032
EP-116 Family and Next of Kin (NOK) Communication - Time
for a new NELA standard?
Salma Ahmed, Karim Hassan, Malaz Abubaker, Jeremy Wilson,
Conor Magee
Department of Surgery, Wirral University Teaching Hospital NHS Foundation
Trust
Introduction: The Covid-19 pandemic highlighted the importance of
communication between patients, families, and the surgical team.
Covid left many patients bereft of personal contact with loved ones
and NOK were often left without information due to overwhelming,
challenging situations for surgical teams. These challenges may not
be unique to Covid- e.g team shift-working, late-night operating are
ongoing barriers to NOK communication following emergency
laparotomy (EmLap).
Methods: Twenty random EmLap patients during the pandemic were
identified. Qualitative data on NOK discussion were obtained
including telephone follow-up to confirm whether discussions took
place.
Results: Only 50% of patients had documented NOK discussion- of these
seven were held prior to surgery, 4 post-operatively and 5 during
admission. Communication with families was mainly carried out by
v116 | Abstracts
nurses while consultant/registrar discussions were documented on 7
occasions only.
Conclusion: Communication with the NOK of patients undergoing
emergency laparotomy needs improving. Patient-centred care must
involve the NOK. We would suggest that NOK should be informed of
surgical outcomes and prognosis by a senior surgical team member.
Notwithstanding the usual caveats of confidentiality and patient
wishes- the importance of this facet of surgical care to many patients
and their relatives cannot be understated and could be considered as
a potential NELA standard of care.
Abstract citation ID: znac245.033
EP-124 Local Recurrence after Breast Cancer Surgery – 5 year
follow up. Breast Cancer Unit University Hospital North Tees
Neill Allen, Yogesh Jain, Matei Dordea
University Hospital North Tees
Introduction: Breast conserving surgery in the form of wide local
excision with sentinel node biopsy is a common treatment option for
patients with early breast cancer.
The National Institute for Health can Care Excellence recommends that
each Breast Unit should audit their local recurrence rates.
Aim: Audit our unit’s 5 year local recurrence rate as recommend by
national guidelines
National Standard: Early and locally advanced breast cancer: diagnosis
and management NICE guideline [NG101] Published: 18 July 2018
Method: Patients who had a breast cancer operation in 2014 were
included. Histology records were checked to confirm diagnosis and
check for any histological recurrence in the following 5 years.
Data collected were Age at diagnosis, the disease free interval in months
and the site of recurrence.
Results: 531 patients were included in the study of these 22 patients had
local recurrence defined as recurrence in the ipsilateral breast, chest
wall or local axillary nodes.
The local recurrence rate was 4.14% for this cohort of patients. This is
below the recommended <5%.
The mean age at diagnosis was 62.
The mean disease free interval was 39 months.
Recommendation: Our unit are meeting the national local recurrence
rate for early and locally advanced breast cancer.
Plan for re-audit: Re-audit annually to ensure maintaining quality
clinical care. To review method of admission (breast screening vs
symptomatic clinic) and the method of detection for the recurrence.
Abstract citation ID: znac245.034
EP-125 A rare case of abdominal wall necrotizing fasciitis
caused by Actinomyces europaeus—a novel pathogen
Neill Allen, Georgina James, Yogesh Jain
University Hospital North Tees
Actinomyces europaeus is a sub-species of actinomyces first isolated in
humans in 1997. It is commensal bacteria found within the
genitourinary and gastrointestinal tract. Although it is known to cause
soft tissue infection and has been known to cause abscesses, it has
never been identified as the primary pathogen in a case of necrotizing
fasciitis. We present the case of a 59-year-old man with recurrent
groin infections, poorly controlled Type 2 diabetes and obesity who
developed necrotizing fasciitis of his lower abdominal wall secondary
to Actinomyces europaeus. We discuss the clinical course and the
value of early identification of the pathogen and specialist
microbiologist advice.
Abstract citation ID: znac245.035
EP-127 Filling in the Knowledge Gap: Designing the General
Surgery/ Orthopaedic Clinical Handbook for NHS Dumfries &
Galloway
Niroshini A Hemadasa, Chris Isles, Jeyakumar Apollos, Sharukh Sami
NHS Dumfries & Galloway
Introduction: The NHS Dumfries & Galloway Clinical Handbook was
developed to provide readily accessible and practical guidance when
assessing and managing a wide variety of medical conditions for
junior doctors. We summarise the relevant NICE and SIGN guidelines
and link to other relevant handbooks. Until now the content has been
purely medical.
Aim: To expand the Clinical handbook to include topics in General
Surgery and Orthopaedics that would be useful for junior doctors.
Methods:
• A survey was sent to the current FY1 and FY2 doctors requesting for
their input for helpful and relevant topics to be included.
• Common general surgical and orthopaedic presentations were
identified and the handbook was written to include presentation,
investigations and managements.
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• Information in the handbook was vetted by a general surgical
registrar, consultant general surgeon and consultant orthopaedic
surgeon.
Results: Initial survey sent to 15 junior doctors showed everyone stating
it would be very useful to have a general surgery and orthopaedics
section in the handbook with 80% stating they used the handbook all
the time. Free text questions included asking useful topics to be
included in the handbook with answers including management of
common surgical emergencies/ presentations, analgesia and laxatives,
anticoagulation. The handbook was written and published online and
can be accessed via https://www.nhsdghandbook.co.uk
Conclusions: The handbook was well received by the junior doctors. A
survey has been sent out to junior doctors for feedback and number of
online visitors to the site will be collected and reviewed. The
handbook will be updated to include more topics.
Abstract citation ID: znac245.036
EP-138 Pseudomyxoma peritoni induced by appendiceal
mucinous adenocarcinoma- a case report
Fatima Rauf, Fakhar Munir Sial, Muhammad Hanif,
Muhammad Naveed Malik, Huma Sabir Khan, Adam Umair Ashraf Butt
Benazir Bhutto Hospital, Rawalpindi
Introduction: Appendiceal tumours are rare and mucinous tumours
account for 58% of the malignant tumours of appendix according to
SEER data base, with remaining being carcinoid tumors. Mucinous
tumours of appendix have a potential of peritoneal spread in the form
of gelatinous material, resulting in pseudomyxoma peritoni (PMP). We
report a case of mucinous adenocarcinoma of appendix inducing
pseudomyxoma peritoni in a 37 year old male.
Case summary: A 37 year old male presented with generalised
abdominal pain for 2 months and gradually increasing abdominal
distension over a period of one month. On examination, abdomen was
tense, distended and mildly tender. Rest of systemic examination was
unremarkable. Biochemical investigations revealed normal blood
complete picture. AST was mildly raised. ALP was 330 (normal upto
130 U/L. Bilirubin, total proteins and renal function tests were within
normal limits. CECT abdomen and pelvis showed omental caking and
moderate ascites with no overt bowel mass lesion. Diagnostic
laparoscopy was done which showed extensive mucinous deposits
over peritoneum. Biopsy was taken which revealed metastatic
mucinous adenocarcinoma with appendix as primary organ of origin
on immunohistochemistry (CK 7 -/CK 20 +, CDX 2 positive). CEA levels
were done which were 220 ng/ml (normal upto 10 ng/ml). Patient was
referred to oncology centre for further management.
Discussion: PMP occurs in 7th decade of life and more common in
females with a M: F ratio of 1:4 and is almost always of appendiceal in
origin.
Conclusion: PMP is rare tumour with negligible incidence in younger
population.
Abstract citation ID: znac245.037
EP-142 Assessing the Diagnostic Sensitivity of CT and
Ultrasound in Suspected Appendicitis
Salma Ahmed, Karim Hassan, Malaz Abubaker, Jeremy Wilson,
Conor Magee
Department of Surgery, Wirral University Teaching Hospital NHS Foundation
Trust

Introduction: Acute appendicitis is the most common surgical
emergency and accounts for one-third of adult patients presenting to
A&E. CT imaging has high positive predictive value for acute
appendicitis. Ultrasound, on the other hand, is preferred as a first-line
imaging in children and women of child-bearing age. However, it is
dependent on operator experience, variation in appendiceal anatomy
and patient body habitus.
The RCR standards for the CT sensitivity should be >90% and for US it
should be >70%. We conducted this study to investigate whether the
diagnostic yield of CT and Ultrasound imaging in suspected
appendicitis meet that of published research studies.
Method: All patients who underwent CT or US for suspected
appendicitis followed by confirmed diagnosis where included. RCR
AuditLive template was used to assess the performance in our local
hospital.
Results: Sixty patients included. Of which eighteen had Ultrasound
Abdomen and pelvis, forty-six had contrast CT scan and four patients
had US followed by CT. Sensitivity for CT and US was 93% and 40%
respectively with negative appendectomy rate of nearly 2%.
Conclusion: The standards for CT have been met in our hospital,
however this is not the case for the US. This could be related to the
performing operator, group of patients referred for US or the request
itself, weather we request it to confirm the presence of appendicitis or
rather excluding other pathologies. In all cases we recommend that
we discuss these results in our next joined meeting with the
radiologists.
Abstract citation ID: znac245.038
EP-145 Prescription of antimicrobials…according to the
guidelines?!
Anil Rai1, Ahsan Mahmood1, Rhea Singh2, Shantata Kudchadkar1,
Omar Mehana1, Jayesh Sagar1
1
Luton and Dunstable University Hospital
2
Kharkiv National Medical University
Aim: The trust guidelines do not recommend prescription of Co-
amoxiclav and Metronidazole concurrently in the mentioned group of
patients. This study aims to discern and improve the adherence to
trust guidelines of antibiotics prescription in general surgery and
urology patients.
Methods: A retrospective review over a period of three months was
analyzed, wherein record sampling was done on two occasions with
584 and 490 patients respectively, with majority (280 and 254)
admitted electively. The study comprised patients admitted to general
surgery and urology departments. Data was assembled on patient
demographics and use of antibiotics.
Results: 51 patients (8.73% of 584) were prescribed both Co-Amoxiclav
and Metronidazole during the first cycle. This number fell to 34 (6.9%
of 490) during the second cycle. Prescription of antibiotics was
observed to be maximum in emergency patients admitted in A&E.
Furthermore, one patient in the first cycle was prescribed
Metronidazole despite being allergic to it. Patients reported to be
penicillin allergic were 48 and 26 in the two cycles respectively. It was
found out that majority of the patients were discharged on the same
day of admission.
Conclusion: Although, a minimal improvement (1.8%) in antibiotic (Co-
Amoxiclav & Metronidazole) prescription was observed over the
duration of the study, the trust guidelines on antimicrobials usage
was not adhered to satisfactorily. Therefore, there is a need to create
awareness among clinicians regarding the guidelines of appropriate
antibiotic prescription.
Abstract citation ID: znac245.039
EP-148 Acute appendicitis complicated by COVID-19: an
unexpected postsurgical sequela, Case Presentation
Salma Ahmed, Vasudev Zaver, Adil Shafi, Zaid Al-Hamid
Surgical Department, Blackpool Teaching Hospital
Background: This is a case in which we explore the presentation and
management of a 62-year-old gentleman, who attended a UK based
surgical unit with appendicitis and a positive COVID-19 on admission.
Following an urgent appendicectomy, he suffered a morbid and
protracted postoperative period, complicated by an upper
gastrointestinal bleed and prolonged ileus. The virus has been
Abstracts | v117
recognised to increase the risk of micro-thromboembolic events and
gastrointestinal complications. We discuss the possibility of COVID-19
causing the patient’s presentation and his post-surgical recovery. We
aim to demonstrate our experience of the relationship between acute
appendicitis and the morbidity associated with COVID-19.
Discussion: The case demonstrates a unique sequela following an
otherwise routine emergency appendicectomy. In concurrence with a
radiologically and microbiologically evident COVID-19 infection, it
raises the question of whether the appendicitis was caused or at least
complicated by the virus. This hypothesis is supported by a similar
discovery in a case series carried out in Wuhan, in which a paediatric
patient acutely presented with a perforated appendix in parallel with
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a SARSCoV-2 infection, which required urgent surgery. Contrastingly,
a case which involved a COVID-19 positive adult male with a non-
perforated and non-suppurative appendix demonstrated no
complications post-operatively.
Conclusion: It is possible to postulate that the severe presentation
outlined in our case could also have been caused by a delayed COVID-
19 presentation. However, there is currently no formal research to
support this and the approach has not been exemplified in a complex
case such as ours.
Abstract citation ID: znac245.040
EP-157 Pyocystis: A silent complication of a supravesical
urinary diversion
Baseerat Anwar, Waqas Khalil, Praveen Rao, Salaheddin Ghiblawi,
Jawad Ul Islam
Blackpool Victoria Hospital
Aim: Pyocystis is an important yet overlooked rare complication of a
non-functioning urinary bladder. It is due to collection, liquefaction
and decomposition of shed bladder epithelium, resulting in
accumulation of pus in the bladder causing sepsis. We describe a case
of Pyocystis in a patient with bilateral nephrostomies who presented
with urosepsis multiple times due to this complication.
Case Report: A 78-year-old man, known case of Ca Prostate wit bilateral
nephrostomies warranted multiple subsequent hospital admissions in
one month due to urosepsis presenting with fever, urethral discharge,
suprapubic pain and very high inflammatory markers. He underwent
a CT Abdomen & Pelvis which revealed markedly distended bladder
despite nephrostomies in place. Upon catheterization, no urine output
was observed which raised concerns. An attempt at bladder washout
displayed a large amount of thick foul-smelling pus which was
aspirated. This was sent for culture and patient was commenced on
appropriate IV antibiotics. After a thorough bladder wash out under
flexible cystoscopy, patient was eventually discharged on a long-term
catheter with regular bladder washouts in community as required.
Patient was successfully managed on conservative treatment.
Conclusion: Pyocystis can sometimes be a missed complication of
urinary diversion or a non-functioning bladder that can present
silently under sepsis and should therefore be considered as a
differential diagnosis of sepsis in patient with supravesical urinary
diversion.
We wanted to highlight this condition which if left undiagnosed will
progress to severe sepsis and possible death. Hence prompt
intervention and aggressive management is vital.
Treatment for this complication requires catheterization, bladder
irrigation and antibiotics.
Abstract citation ID: znac245.041
EP-168 A rare encounter of “Forgotten disease”
Shreya Sengupta1, Sayantan Bose2
1
Frimley Park Hospital
2
Salford Royal NHS Foundation Trust
With the advent and prompt use of antibiotics after throat infections,
the rare entity of Necrobacillosis has almost disappeared in clinical
practice. Here we present a case of a fit and well 27 year old lady who
was brought into A&E with septic shock, DIC and MODS after initial
diagnosis of a sore throat 4 days ago which was treated by oral
antibiotics. She was found to have bilateral patchy consolidations
which later became necrotic cavities, empyema thoracis, peritonitis
and abscess cavities in abdomen with evolving splenic abscess,
prolonged QT and ectopics and type 2 respiratory failure. She was
v118 | Abstracts
resuscitated, intubated and transferred to the ICU. With an isolate of
Fusobacterium necrophorum from blood culture Meropenem,
clindamycin and metronidazole were started. However, over the next
few days of treatment, lack of clinical response prompted antibiotics
changing, and surgical drainage of abscesses in chest and abdomen.
Eventually after a considerable period of abdominal abscess drainage
and about 3 weeks of metronidazole and other antibiotics followed by
Piperacillin and tazobactam for another 3 weeks the patient recovered
from sepsis and was stepped down to ward. This case though rare is a
good example of the benefits of surgical drainage and prolonged
antibiotics for septic patients with collections. A rapid weaning only
results in re-collection and clinical deterioration or recurrent
collection as happened to this patient. This is a rare case of Lemierre’s
syndrome which depicts the surgical difficulties faced due to
recurrent abscess cavities formed in this condition.
Abstract citation ID: znac245.042
EP-169 Management dilemma in an unusual presentation of
acalculous acute cholecystitis
Sayantan Bose, Mohamed Alasmar, Helen Doran
Salford Royal NHS Foundation Trust
Acute acalculous cholecystitis is a recognised but seldom encountered
entity except in immunocompromised and critically ill patients.
Epstein-Barr virus infection, on the other hand, is a common viral
illness throughout the world, mostly in the younger age groups.
However acute cholecystitis due to EBV infection is very rare to occur
and can be difficult to diagnose. Here we present a case of a middle
aged adult who presented with upper abdominal pain and non-specific
viral illness-like symptoms. LFTs were of a mixed picture and she had
marginally raised inflammatory markers. Standard imaging studies
excluded gallstones but she had thickened gallbladder wall with
pericholecystic oedema and some fat stranding, but normal intra
hepatic biliary tree and CBD. Strikingly there were sizable lymph nodes
in abdomen and thorax. Suspecting viral aetiology, a viral screen was
performed which gave a positive EBV result. However on daily clinical
examination she kept on worsening symptomatically and a decision to
operate was made following discussion with gastroenterologists and
the patient. To note, EBV result was delayed and arrived after she had
the operation. This case gives an example of a rare surgical case which
may create a diagnostic dilemma amongst clinicians. Whilst
understanding that management of acalculous cholecystitis is usually
conservative, but in a clinically deteriorating young patient like this
there may be a case for cholecystectomy or cholecystostomy. Here the
learning point should be to think of other possible diagnoses and
consider viral aetiologies earlier which may avoid a procedure on a
patient.
Abstract citation ID: znac245.043
EP-175 Two-layer Biodegradable Temporizing Matrix
Reconstruction of Abdominal Wall Dermatofibrosarcoma
Protuberans
Rushabh Shah, Ailbhe Kiely, Stuart McKirdy
Royal Preston Hospital, UK
Dermatofibrosarcoma protuberans (DFSP) is a rare, locally invasive
dermal sarcoma. The management is generally surgical, with wide
local excision (WLE) forming the mainstay of treatment. Large
abdominal wall defects are most aesthetically reconstructed using
pedicled or free flaps; however, these require tumour-free surgical
margins, and can cause donor site morbidity. We describe an
alternative, aesthetic, and low-morbidity technique for abdominal
wall reconstruction following WLE of DFSP, using 2 layers of a novel
synthetic dermal matrix (NovoSorb® BTM).
A 25-year-old women presented with a large DFSP involving the right
anterior-abdominal wall. After WLE with 3cm margins, BTM was
implanted to the large sub-fascial abdominal wall defect. At 6 weeks,
after histological confirmation of tumour-free margins, a second layer
of BTM was applied to improve the significant contour deformity of
the wound bed. After complete integration by 7 weeks, a split-
thickness skin graft was harvested from the right thigh and fixed to
the new dermis.
At 14-days postoperatively, the skin graft had fully taken, and donor site
healed. By 8 weeks, the scar had started to mature with no obvious
contour defect or contracture. Overall, the patient was satisfied with
the functional and aesthetic outcome.
To our knowledge, a two-layer reconstruction using an artificial dermal
matrix has never been described for abdominal wall reconstruction. We
found that double-layer BTM is able to restore the inherent thickness
and pliability of skin in complex abdominal wall reconstruction
following WLE of DFSP and offers improved durability and cosmesis
compared to skin grafting or indeed single layer skin substitutes alone.
Abstract citation ID: znac245.044
EP-180 Analysis of two-week wait referrals to a colorectal
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surgery department for iron deficiency anaemia in a rural DGH
Catherine Anderson, Tsitsi Chituku, Milind Rao
United Lincolnshire Healthcare Trust
Iron deficiency anaemia (IDA), defined as low haemoglobin and ferritin
levels, affects 2–5% of adults in the developed world. Asymptomatic
malignant gastrointestinal pathology must be excluded in all patients.
Patients referred on a two-week wait Colorectal pathway with IDA
between 4/1/2018–28/2/2021 were recruited (n=566). 92.4% of patients
were investigated, only 45.2% had true IDA. Although screening for
coeliac disease was a prerequisite in the referral pro forma, 63.2%
were referred without.
NICE guidance recommends upper and lower gastrointestinal
investigations in all patients with confirmed IDA. 61.6% of patients
had both investigations performed. 65.1% patients were diagnosed
with benign conditions- diverticular disease (37.6%), polyp (31%) and
hiatus hernia (28.5%). Age was the strongest predictor for pathology in
patients with IDA (p=0.001), not specifically for cancer (p=0.111).
4.4% (n=23) patients were diagnosed with colorectal cancer. Low
haemoglobin was significantly correlated with cancer (p=0.002),
however only 60.9% had low ferritin.
Guidelines suggest that only post-menopausal women should be
investigated for IDA unless symptomatic or risk factors. Although only
80% had symptoms; the entire cohort had investigations and only 60%
returned a positive test.
This study highlighted variability in investigations in addition to lack of
adherence by primary care physicians to referral guidelines resulting in
avoidable referrals and potentially inappropriate investigations in pre-
menopausal women by secondary care physicians, thus
overwhelming an exceedingly burdened two- week wait pathway.
Abstract citation ID: znac245.045
EP-182 The predictive significance of
neutrophil-to-lymphocyte ratio in cholecystitis: a systematic
review and meta-analysis
Alex Millward1, Aaron Kler1, Adnan Taib1, Shahab Hajibandeh2,
Shahin Hajibandeh3, Peter Asaad1
1
Royal Albert Edward Infirmary
2
Wrexham Maelor Hospital
3
Hereford County Hospital
Aims: The aim of this review was to examine whether neutrophil-to-
lymphocyte ratio (NLR) can predict the presence of cholecystitis and
distinguish between simple and severe cholecystitis.
Methods: A systematic literature search was performed. Risk of bias was
assessed using the Newcastle-Ottawa Scale. Random effects model was
used to calculate mean difference (MD) in two situations: (a) no
cholecystitis versus cholecystitis and (b) simple versus severe
cholecystitis. Receiver operating characteristic (ROC) curve analysis
was performed to determine cut-off values of NLR for the above
situations.
Results: Ten retrospective studies comprising of 2827 patients were
included. 327 had no cholecystitis, 2100 had simple cholecystitis and
the remaining 400 had severe cholecystitis. NLR was significantly
higher in acute cholecystitis compared to "no cholecystitis" (MD = 8.05
(95% CI 7.71–8.38), p < 0.01) and severe cholecystitis when compared
with simple cholecystitis (MD = 3.14 (95% CI 1.26–5.02), p < 0.01). For
patients with cholecystitis compared to those without cholecystitis,
an NLR cut-off value of 2.98 was identified (AUC = 0.90). Logistic
regression analysis confirmed NLR > 2.9 was an independent predictor
of cholecystitis (OR 36.0, p = 0.006). In simple versus severe
cholecystitis, an NLR cut-off value of 8.5 was identified (AUC = 0.73).

Binary logistic regression analysis suggested an NLR > 8.5 was not an
independent predictor of severe cholecystitis (OR 6.5 p = 0.090).
Conclusion: NLR is significantly higher in patients with cholecystitis of
any severity compared to patients without cholecystitis. Moreover, NLR
can predict acute cholecystitis. However, NLR cannot predict the
severity of disease due to inadequately powered studies.
Abstract citation ID: znac245.046
EP-186 Recurrent Boerhaave’s Syndrome
Santhosh Loganathan, Rahman Gul, Laura Whittaker
Airedale General Hospital, UK
Boerhaave’s syndrome is a rare clinical entity. It is caused by severe
straining, vomiting or prolonged severe coughing, affecting the distal
intrathoracic part of oesophagus. The clinical presentation is varied
and associated with high mortality if there is a delayed diagnosis.
Therefore, the mainstay of treatment is early diagnosis, drainage of
intrathoracic collection if indicated and restoration of the oesophagal
integrity. The recurrent Boerhaave’s syndrome is rare, and only a few
cases have been reported in the literature.
We present a 27-year-old female diagnosed to have Boerhaave’s a year
back which was managed conservatively, presented to hospital with
sudden onset of epigastric pain radiating to left shoulder and chest
associated with multiple episodes of vomiting. Abdominal
examination revealed a tender epigastric region with elevated white
cells and C-reactive protein. CTTAP showed a recurrent para-
oesophageal collection of fluid and gas adjacent to the distal
oesophagus at the same site, with no pneumoperitoneum. She was
managed conservatively for a week with peripheral nutrition. The
CTTAP was repeated with oral contrast, which showed partially
improved left para-oesophageal collection, and surrounding
inflammatory changes had also partly improved with no leak of
contrast. She was hemodynamically stable, clinically well, and
tolerated oral feeds, so she was discharged from the hospital.
As the recurrent presentation is rare, the treatment should be
customised for individuals as per their clinical condition. We
emphasis on recognising this condition in both acute and chronic
condition, which could be vital in preventing the mortality from this
condition.
Abstract citation ID: znac245.047
EP-190 Comparative Study of Single Clip Laparoscopic
Cholecystectomy (SCLC), Two Clips Laparoscopic
Cholecystectomy (TCLC) and Clipless Laparoscopic
Cholecystectomy (CLLC) Vs Conventional Laparoscopic
Cholecystectomy (CLC)
Bhavesh Devkaran1,2, Anshu Attri2, Upender Kumar Chandel2
1
Royal Liverpool and Broadgreen University NHS Trust, Liverpool, UK
2
Indira Gandhi Medical College, Shimla, India
Introduction: Laparoscopic cholecystectomy has been accepted as the
“gold standard” for the treatment of symptomatic gallstone disease.
Conventionally 6 titanium clips are used for laparoscopic
cholecystectomy (LC). Cost of 6 titanium clips are high and have been
associated with complications in form of migration.
Material and Methods: 200 patients of proven gallstones were randomly
divided into four groups of 50 patients each, undergoing dissection of
gall bladder by harmonic scalpel with application of one titanium clip,
two titanium clips and absorbable Vikyl suture on cystic duct in Group
1 (SCLC), 2(TCLC) and 3(CLLC) respectively before division of duct and
artery with harmonic ace. Group 4(CLC) patients underwent
conventional LC with electrocautery and application of 6 clips.
Results: Mean operative time was statistically significant when CLC was
compared with SCLC, TCLC and CLLC (CLC 43.10 ± 9.68 min vs 26.80 ±
8.44 in SCLC, 28.76 ± 8.23 IN TCLC, 37.30 ± 8.22min in CLLC group).
Approximate blood loss in the CLC group was 28.90 ± 11.71ml as
compared to 7.8 ± 3.06 in SCLC, 8.10 ± 3.18 ml in TCLC and 8.40 ± 3.70
ml in the CLLC group. Pain score was significantly better in the SCLC,
TCLC and CLLC group. Conversion to open cholecystectomy was
comparable in all the groups. Post operative hematoma formation and
overall cost was significantly high in the CLC group.
Abstracts | v119
Conclusion: SCLC, TCLC and CLLC are comparable to standard 6 clip
laparoscopic cholecystectomy in all aspects. SCLC and TCLC have a
clear advantage of decreased operative time, blood loss and low cost.
Abstract citation ID: znac245.048
EP-191 The effect of surgical case-based discussions in
confidence levels in acute kidney injury management
Jayan George1,2, Chantal Olivia Blanch Rees3
1
General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield,
UK
2
Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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3
General Surgery, North Middlesex University Hospital, London, UK
Aims:
1) Assess confidence levels of current foundation year one (FY1)
doctors in managing acute kidney injury (AKI).
2) Assess confidence levels managing AKI at the end of the rotation
between FY1 doctors who had case-based discussions (CBD), as
opposed to those who did not.
3) Document the differences between FY1 doctors who had CBD
teaching, in order to improve FY1 education in managing AKI.
Methods: FY1 doctors were surveyed throughout July 2021 and
December 2021 across two sites. Six questions used Likert scales (1 to
5: not at all confident to very confident) to assess managing AKI. Data
was initially inputted using Google Docs and analysed in Microsoft
Excel.
Results: 44 FY1 doctors completed the initial questionnaire.
19 FY1 doctors completed the questionnaire post rotation. (8 attended
teaching and 11 did not.)
Confidence levels in managing AKI were greater in FY1 doctors who had
received CBD for recalling the common classes of drugs that cause AKI,
explaining the significance of lactate and bicarbonate and managing
the surgical patient with AKI, as opposed to those who did not.
Confidence levels for managing AKI, categorising the causes of AKI and
assessing a patient’s fluid status, were similar between those who had
received CBD and those who did not.
Conclusions: Confidence levels in managing AKI were mostly higher in
those FY1 doctors who received surgical CBD teaching. Further research
is required for the use of CBD in its potential to improve FY1 doctor
education.
Abstract citation ID: znac245.049
EP-192 The effect of surgical case-based discussions in
confidence levels in surgical intravenous fluid prescribing
Chantal Olivia Blanch Rees1, Jayan George2,3
1
General Surgery, North Middlesex University Hospital, London, UK
2
General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield,
UK
3
Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
Aims:
1) Assess confidence levels of current foundation year one (FY1)
doctors in prescribing surgical intravenous (IV) fluid at the start of
the rotation.
2) Assess confidence levels in prescribing surgical IV fluid at the end of
the rotation between FY1 doctors who had case-based discussions
(CBD) as opposed to those who did not.
3) Document the differences between FY1 doctors who had CBD
teaching, in order to improve FY1 education in prescribing surgical
IV fluids.
Methods: FY1 doctors were surveyed throughout July 2021 and
December 2021 across two sites. Eight questions used Likert scales (1
to 5: not at all confident to very confident) to assess surgical IV fluid
prescribing. Data was initially inputted using Google Docs and
analysed in Microsoft Excel.
Results: 44 FY1 doctors completed the initial questionnaire.
19 FY1 doctors completed the questionnaire post rotation. (8 attended
teaching and 11 did not.)
v120 | Abstracts
Confidence levels in surgical intravenous (IV) fluid prescribing were
greater in FY1 doctors who had received CBD across 7 of the 8
questions than in those who did not.
Confidence levels were similar between those who had received CBD or
not in surgical IV fluid prescribing in diagnosing a chest infection (as
opposed to fluid overload).
Conclusions: Confidence levels in surgical IV fluid prescribing were
mostly higher in those FY1 doctors who received surgical CBD
teaching. Further research is required for the use of CBD in its
potential to improve FY1 doctor education.
Abstract citation ID: znac245.050
EP-193 The effect of surgical case-based discussions in
confidence levels managing general surgical patients
Jayan George1,2, Chantal Olivia Blanch Rees3
1
General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield,
UK
2
Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
3
General Surgery, North Middlesex University Hospital, London, UK
Aims:
1) Assess confidence levels of current foundation year one (FY1)
doctors in managing general surgical patients at the start of the
rotation.
2) Assess confidence levels when managing general surgical patients at
the end of the rotation between FY1 doctors who had case-based
discussions (CBD) as opposed to those who did not.
3) Document the differences between FY1 doctors who had CBD
teaching, in order to improve FY1 education in managing general
surgical patients.
Methods: FY1 doctors were surveyed throughout July 2021 and
December 2021 across two sites. Seven questions used Likert scales (1
to 5: not at all confident to very confident) to assess managing general
surgical patients. Data was initially inputted using Google Docs and
analysed in Microsoft Excel.
Results: 44 FY1 doctors completed the initial questionnaire.
19 FY1 doctors completed the questionnaire post rotation. (8 attended
teaching and 11 did not.)
Confidence levels in managing the unwell general surgical patient and
prescribing antiemetics was greater in FY1 doctors who had received
CBD as opposed to those who did not.
Confidence levels were similar in managing gallstone disease,
appendicitis, diverticulitis and prescribing analgesia for those who
had received CBD and those that did not.
Conclusions: Confidence levels in managing general surgical patients
were mostly higher in those FY1 doctors who received surgical CBD
teaching. Further research is required for the use of CBD in its
potential to improve FY1 education.
Abstract citation ID: znac245.051
EP-194 The effect of surgical case-based discussions in
confidence level in end of life patient management
Jayan George1,2, Chantal Olivia Blanch Rees3
1
General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield,
UK
2
Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
3
General Surgery, North Middlesex University Hospital, London, UK
Aims:
1) Assess confidence levels of current foundation year one (FY1)
doctors in end of life patient management.
2) Assess confidence levels in end of life patient management at the
end of the rotation in FY1 doctors who had case-based discussions
(CBD) as opposed to those who did not.
3) Document the differences between FY1 doctors who had CBD
teaching, in order to improve FY1 education in end of life patient
management.
Methods: FY1 doctors were surveyed throughout July 2021 and
December 2021 across two sites. Six questions used Likert scales (1 to
5: not at all confident to very confident) to assess end of life
management. Data was initially inputted using Google Docs and
analysed in Microsoft Excel.
Results: 44 FY1 doctors completed the initial questionnaire.
19 FY1 doctors completed the questionnaire post rotation. (8 attended
teaching and 11 did not.)
Confidence levels in end of life patient management were greater in FY1
doctors who had received CBD across 5 of the 6 questions as opposed to
those who did not.
Confidence levels were similar for end of life patient management for
prescribing oral morphine for breakthrough pain when a patient is on
a Fentanyl patch, for those who had received CBD and those who did not.
Conclusions: Confidence levels in end of life care management were
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mostly higher in those FY1 doctors who received surgical CBD
teaching. Further research is required for the use of CBD in its
potential to improve FY1 doctor education.
Abstract citation ID: znac245.052
EP-195 The effect of medical and surgical rotations on
confidence in managing acute kidney injury
Chantal Olivia Blanch Rees1, Jayan George2,3
1
General Surgery, North Middlesex University Hospital, London, UK
2
General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield,
UK
3
Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
Aims:
1) Assess confidence levels of current foundation year one (FY1)
doctors in managing acute kidney injury (AKI) at the start of the
first rotation.
2) Assess confidence levels of managing AKI between FY1 doctors who
have completed their first medical or surgical rotation.
3) Document the differences between medical and surgical rotations in
educating FY1 doctors in managing AKI.
Methods: FY1 doctors were surveyed throughout July – August 2021 and
December 2021 across two sites. Six questions used Likert scales (1 to 5:
not at all confident to very confident) to assess AKI management. Data
was initially inputted using Google Docs and analysed in Microsoft
Excel.
Results: 44 FY1 doctors (27 Surgery, 17 Medicine) completed the initial
questionnaire.
19 FY1 doctors (13 Surgery, 6 Medicine) completed the questionnaire
post rotation.
Confidence levels were greater for FY1 doctors in surgery than those in
medicine at recalling the five most common drugs that cause AKI and
understanding the significance of lactate and bicarbonate.
Confidence levels were greater for FY1 doctors in medicine than in
surgery at assessing a patient’s fluid status.
Confidence levels in identifying causes and management of AKI in both
surgical and medical patients were similar for FY1 doctors in either
group.
Conclusions: Confidence levels are similar post first rotation
management of AKI between medical and surgical specialties.
Confidence levels are slightly higher for surgical FY1 doctors overall.
Further research is required in this area to improve FY1 doctor
education.
Abstract citation ID: znac245.053
EP-196 The effect of medical and surgical rotations in
confidence in managing surgical patients
Jayan George1,2, Chantal Olivia Blanch Rees3
1
General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield,
UK
2
Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
3
General Surgery, North Middlesex University Hospital, London, UK
Aims:
1) Assess confidence levels of current foundation year one (FY1)
doctors in managing surgical patients at the start of the first rotation.
2) Assess confidence levels of managing surgical patients by FY1
doctors who had completed their medical or surgical rotation.

3) Document the differences between medical and surgical rotations in
educating FY1 doctors in managing surgical patients.
Methods: FY1 doctors were surveyed throughout July – August 2021 and
December 2021 across two sites. Seven questions used Likert scales (1 to
5: not at all confident to very confident) to assess general surgical patient
management. Data was initially inputted using Google Docs and
analysed in Microsoft Excel.
Results: 44 FY1 doctors (27 Surgery, 17 Medicine) completed the initial
questionnaire.
19 FY1 doctors (13 Surgery, 6 Medicine) completed the questionnaire
post rotation.
Confidence levels were greater for FY1 doctors in surgery when managing
the unwell general surgical patient and prescribing antiemetics.
Confidence levels in managing analgesia, diverticulitis, gallstone disease
and appendicitis were similar for FY1 doctors in either group.
Conclusions: Confidence levels are similar post first rotation in
managing surgical conditions between medical and surgical
specialties. Confidence levels are higher for surgical FY1 doctors.
Further research is required in this area to improve FY1 doctor
education in managing surgical patients.
Abstract citation ID: znac245.054
EP-198 Is Primary surgical treatment of anal carcinoma safe
and cost-effective in low resource settings?
Elroy Weledji
University of Buea, Cameroon
Aims: The aim of the study is to debate if primary surgical treatment
(abdominoperineal (AP) resection remains safe and effective in low
resource settings especially when considering the cost, availability,
protracted treatment and complications of radiotherapy+/-
chemotherapy.
Methods: An electronic literature search were performed to identify
original published studies on anal carcinoma and management.
Results: The oncological outcome of primary surgical treatment is
equivalent to chemoradiotherapy. The arguments for surgery as
primary treatment are (1) Surgery is the primary treatment modality
for small perianal lesions that can be locally excised, (2) a 55% 5-yr
survival after a potentially curable AP resection of early locally
advanced cancer, (3) 50% relapse after complete remission using
chemoradiation and many can be salvaged by AP resection. (4) Four
situations may require surgery after primary chemoradiotherapy (a)
residual tumour, (b) complications of treatment, (c) incontinence or
fistula after tumour resolution, (d) subsequent tumour recurrence. (5)
Only a generous biopsy will reveal if a residual ulcer contains residual
disease for which a salvage AP resection may be the only option as
further radiotherapy cannot be given. (6) Salvage AP resection carries
a high morbidity. The main arguments against surgery as primary
treatment are the increased tumour radiosensitivity in the
undisturbed pelvis with well oxygenated tissues and less small bowel
in the radiation field limiting toxicity, (2) radiation therapy will reduce
local recurrence better than after surgery (3) 20% are incurable
surgically at presentation.
Conclusions: Primary surgical treatment of anal cancer may remain
safe and cost-effective in low resource settings
Abstract citation ID: znac245.055
EP-210 Routine colonoscopy after acute
diverticulitis – appraising an age-old practice
Nada Elsaid, Benjamin Paxton, Adam Ismail, Ayo Oshowo
The Whittington Hospital
The standard of care for patients with diverticulitis is to perform a
colonoscopy following resolution of the acute episode, to exclude
occult malignancy. But how often does malignancy masquerade as
diverticulitis? Further, when deciding whether or not to investigate
these patients, there does not appear to be a consensus for those who
have had a previous colonoscopy confirming diverticulosis only. We
examined this cohort to assess the outcomes of their endoscopic
screening. Historically, tests, including barium studies, yielded a lower
sensitivity but since the advent of CT colonography, the results are
more accurate with the added benefit of reduced procedure-related
morbidity and burden on the NHS. We consider whether routine
Abstracts | v121
endoscopic colonic evaluation post diverticulitis should, to all intents
and purposes, become obsolete. A total of 34 patients (identified from
a series of 457) were coded with a diagnosis of diverticulitis between
September and December 2021. Of these, 21 underwent subsequent
endoscopic evaluation post inflammatory episode. 0 patients had
cancer. 2 patients had tubular adenomatous polyps, displaying low
grade dysplasia. Interestingly, technical difficulty and/or poor patient
tolerance meant that 4 of these patients underwent a flexible
sigmoidoscopy only. 1 patient developed diverticulitis a month after
their scope. 2 patients had repeat colonoscopies within 2 years, the
indication being diverticulitis. The authors acknowledge that the
sample used is small and robust conclusions could not be drawn thus
far. Our aim is to evoke interest in the reader with this study serving
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as a precursor to a larger project that is underway.
Abstract citation ID: znac245.056
EP-213 An Audit on the Initial Management of Acute
Cholecystitis: A Single Centre Experience
Sarah Stoll, Rachel Doherty, Tina Sedighi, Christopher Davidson,
Hemel Modi
Watford General Hospital
Aim: Acute cholecystitis (AC) accounts for up to one third of emergency
surgical admissions. The initial management of AC includes fluid
resuscitation and appropriate antibiotic therapy. The aim of this study
is to audit compliance with local microbiology guidelines for the
treatment of AC and to develop interventions that improve
compliance rates.
Method: All patients admitted from September to December 2020 with
radiologically confirmed AC were included in an initial prospective audit
(n=39 patients). Antibiotic prescriptions, patient demographics, presence
of fever (>38°C), inflammatory markers and liver function tests were
recorded. The results were disseminated, educational material produced,
and antibiotic “champions” appointed to improve adherence to antibiotic
guidelines. A prospective re-audit was conducted from May to June 2021
to establish the effectiveness of the interventions (n=49 patients).
Compliance rates before and after the interventions were compared
using a Chi-squared test. Binomial logistic regression was carried out to
establish whether any patient demographic or clinical parameters were
independent predictors of prescribing behaviour.
Results: Compliance to antibiotic guidelines for AC significantly
improved following the interventions (12.8% vs 57.1%; p<0.001). Age,
gender, temperature, inflammatory markers and liver function tests
were comparable in both groups and were not found to be
independent predictors of non-compliant antibiotic prescription.
Conclusions: Adherence to antibiotic guidelines for AC can be improved
with educational interventions and the appointment of individuals
responsible for ensuring correct prescribing behaviour. Interestingly,
patient demographics, signs of sepsis or liver function did not
influence prescribing behaviour, suggesting that divergence from
antibiotic guidelines may be due to ingrained prescribing dogma.
Abstract citation ID: znac245.057
EP-215 COVID-19: Influence on Stoma Outcomes
& Post-Operative Mortality
Mhairi Mactier, Tracey Tallo, Isobel Robertson, Angus MacDonald
University Hospital Monklands
Introduction: The COVID-19 pandemic resulted in cessation of elective
surgery and a shift towards emergency surgery, often non-curative
with stoma formation. Our hospital stoma database scores surgical
complications (retraction, prolapse, stenosis and hernia) and patient
symptoms (leakage, soiling, skin changes and odour), recorded by the
specialist nurse at varying post-operative points.
Aim: To compare stoma scores and post-operative mortality pre- and
mid-pandemic.
Methods: The stoma database (Microsoft Access) was interrogated for
two periods: 16/03/19–16/09/19 (pre-pandemic) and 16/03/20–16/09/20
(mid-pandemic). Mortality at 6 and 12 months was extracted from
electronic patient records (Clinical Portal).
Results: Pre-pandemic, 28 patients underwent stoma formation. Median
stoma score at post-operative day 3, day 10, 6 months and 12 months was
0(0–4), 0(0–4), 1(0–8) and 1(0–3) respectively. Post-operative mortality was
21% at 6 months and 36% at 12 months.
v122 | Abstracts
Mid-pandemic, 19 patients underwent stoma formation. Median stoma
score at equivalent time intervals was 0(0–2), 1(0–8), 0(0–5) and 4 (n=1
patient score recorded). There was a relative paucity of data recorded
mid-pandemic with a maximum of 9 patient scores recorded at any
one time. Post-operative mortality was 16% at 6 months and 26% at 12
months.
Conclusions: While acute surgery during the pandemic does not appear
to be associated with increased stoma complications and post-operative
mortality was less during the pandemic, limited data recording makes
true comparison of pre- and mid-pandemic stoma outcomes difficult.
Assessing the impact of the COVID-19 pandemic on surgical outcomes
may be limited by poor quality of data collected.
Abstract citation ID: znac245.058
EP-216 Case Report: A Fishy Case of Flexor Tendon Injury
Mhairi Mactier, Kerry Davies, Adam Gilmour
Glasgow Royal Infirmary
Introduction: We describe the first documented case of a flexor pollicis
longus (FPL) tendon injury occurring secondary to a fish bite.
Case Report: A 52-year-old right hand dominant male was referred with
inability to flex his right thumb following a pike bite whilst fishing in a
nearby Loch. Clinical examination revealed superficial abrasions to his
right thumb with two deeper puncture wounds over the volar pulp. He
had no active flexion of the interphalangeal joint. Radiographs
showed no fracture/foreign body. Given deep animal bite, intravenous
antibiotics and operative exploration were indicated. Intraoperative
findings revealed 100% division of the FPL tendon (zone II); this was
repaired using a modified Strickland method. The patient completed
48 hours intravenous antibiotics and was discharged with
physiotherapy-led follow up.
Discussion: Animal bites are a common presentation to the Emergency
Department however non-domesticated animals account for <5% cases.
We are not familiar with managing marine animal bites and the
literature is lacking. Only 2 cases of sting-ray injuries have been
described, both of which were associated with delayed presentation
and poor functional outcome. Aquatic injuries also contain unique
bacterial flora including Vibrio, Aeromonas and Pseudomonas which
merits consideration.
Conclusion: This case highlights the importance of managing
innocuous wounds with caution in case of underlying structural
damage. Unusual animal bites should be closely monitored with low
index for surgical exploration to avoid delayed complications.
Discussion with microbiology specialists should also be considered.
Abstract citation ID: znac245.059
EP-221 Outcome of early cholecystectomy compared to
percutaneous drainage of gallbladder and delayed
cholecystectomy for patients with acute cholecystitis:
systematic review and meta-analysis
Ahmed Nassar1,2, Ibrahim Elshahat3, Katharine Forsyth2,
Shafaque Shaikh1,2, Mudassar Ghazanfar1,2
1 has been challenging. At our tertiary referral centre, we have had to
University of Aberdeen
2 coordinate care across multiple sites in order to maintain provision of
NHS Grampian
3 services. This study looks at how this was achieved at the Nottingham
Princess Royal university hospital, King’s college, London, UK
Aim: Compare outcomes of ELC and PTGBD as an initial intervention for
AC and to compare operative outcomes of ELC and delayed laparoscopic
cholecystectomy (DLC).
Methods: English-language studies published until December 2020 were
searched. Randomised controlled trials (RCTs) and observational
studies compared EC and PTGBD with delayed cholecystectomy for
patients presented with acute cholecystitis were considered. Main
outcomes were mortality, conversion to open, complications and
length of hospital stay.
Results: Out from 1347 records,14 studies were included. 205,361(94.7%)
patients had EC and 11,565 (5.3%) patients had PTGBD as an initial
intervention for AC. Risk of mortality was considerably higher in
PTGBD compared to EC group; HR,95% CI: [3.68 (2.13, 6.38)]. In contrast,
complication rate was significantly higher in EC group (47%) vs 8.7% in
PTGBD group in patients admitted to ICU for sepsis related to AC;
P-value=0.011. ELC group had more intra-operative blood loss than
DLC group; MD (95%CI): 34.2 (4.15, 64.25) ml. There was no difference
in mortality between the two groups; HR (95% CI): 1.30 [0.60, 2.83]
Patients had ELC are at higher risk of post-operative complications
compared to DLC; RR [95% CI]: 2.88 [1.78, 4.65]. Risk of bile leak or bile
duct injury was six folds more in ELC; RR [95% CI]: 6.07 [1.67, 21.99].
Conclusion: ELC should be considered for all patients with acceptable
surgical risk admitted with AC regardless its severity. PTGBD can be
considered for patients admitted to the ICU for organ support. Future
studies needed to assess the validity of this approach.
Abstract citation ID: znac245.060
EP-235 Improving working conditions of junior surgeons
Felix Hammett, Arin Saha, Anna Hurley, Helen Fifer, Emily Moran,
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Bhavika Patel
Calderdale and Huddersfield NHS Foundation Trust
Aims: Significant exception reporting is reflective of difficult working
conditions though well-recognised barriers exist to reporting which
may reflect the culture within a unit. This study used exception
reporting data to understand and improve the working conditions of
juniors.
Methods: Junior surgeons were surveyed in December 2019 to evaluate
additional hours worked, reasons for this work and whether exception
reports were completed; where they were not, doctors were asked why.
After data analysis, rota structures and surgical teams were changed
and formal education about exception reporting given at
departmental induction. The main changes involved greater
opportunities to take leave and enhanced staffing on evenings and
weekends.
Surgical juniors were re-surveyed in September 2021.
Results: In December 2019, 49.2 additional hours were worked between
18 juniors. No exception reports were completed with the main reasons
being a personal decision to stay late (for training opportunities), lack of
understanding on how to report and cultural issues that made juniors
unsure about how exception reports would be viewed.
In September 2021, only 30 additional hours were worked between 17
respondents. Again, no exception reports were completed with over
95% of respondents citing a personal decision to stay late. Cultural
issues within the department were no longer cited and knowledge of
how to exception report was greatly increased.
Conclusions: A positive and open culture, where consultants and
surgical leaders engage with juniors about rotas and working
conditions can lead to a reduction in additional hours and improve
the understanding of exception reporting.
Abstract citation ID: znac245.061
EP-238 Challenges of delivering a tertiary breast cancer service
during the COVID-19 pandemic
Anjali Mehta1, Lisa Whisker2, Georgette Oni2
1
The University of Nottingham
2
Nottingham Breast Institute
Introduction: Delivering a breast service during the COVID-19 pandemic
Breast Institute (NBI) by a team of 6 Consultant Surgeons.
Methods: This was a retrospective review of a prospective data base
(managed by one Consultant Oncoplastic surgeon) of all patients
treated at the NBI over a period of 18 months, at the start the
pandemic from March 2020 to October 2021. Data collected included
patient demographics, hospital site, and type of surgery.
Results: Over the 18 months 1191 patients were operated on. The
average age was 57.8 years (range 17 to 86); as expected the
commonest indication was cancer (93.1%). 11.3% of those patients
(125/1109) received neoadjuvant chemotherapy. Of these 37.4% of
patients (N=446) were operated on at our usual operative base site
(NBI). 49.5% and the majority of cases (N=589) were performed across
two independent hospitals and a smaller proportion (12.9%) was
conducted at a fourth hospital which offered 23 hour stay facilities.
Conclusions: Despite the challenges of securing operative capacity,
thus far, we have been able to deliver over 1000 breast cancer
surgeries during the COVID-19 pandemic. This is due in part to
multisite working, surgeon flexibility, and oversight of all the patient
pathways collated on one database by a dedicated surgeon.

Abstract citation ID: znac245.062
EP-241 Surgical virtual clinic (VC) practice: an audit of practice
in the University Hospitals Sussex NHS Trust
Mohamed Saleem, Irtesam Tahir, Mazin Mohamed,
Christie Swaminathan, Mokthar Uheba, Muhammad Sajid
University of Sussex Hospitals
Aims: The aim of the study was to assess the appropriateness of surgical
virtual clinic practice (VC) in the University of Sussex hospitals.
Methods: A retrospective assessment of Six consecutive clinics of three
consultants, a total of 216 patients, was audited according to guidelines
of the Royal College of Surgeons (1). Additionally, feedback forms were
obtained from ten Consultants and matched against RCS guidelines.
Ethical approval was obtained from the quality improvement
department.
Results: The study cohort mean age was 67 (20–94) years with 1: 1.2
female to male ratio. VC site was 68% from home. The VC attendance
rate was 97.5% (2.5% DNA rate) and 93% patients were suitable for VC
appointment because 2.8% needed physical examination and
remaining percentage was not suitable due to hearing impairment
and language barrier. Telephone was the mode of virtual consultation
in addition to 100% documentation and 100 conclusion
documentations. Four blocks of RCS guidelines compliance based
upon the opinion of the consultant surgeon was reported from 65% to
97.5%.
Conclusion: The attendance of VC clinics was 97.7% with suitability for
VC up to 93%. There was a good compliance with RCS guidelines
reaching up to 97.5%. However, few areas which needs improvement
are obtaining consent (documentation if consent was taken),
confirmation of alternative contact details, length and details of VC
and reassurance that VC is equivalent to face to face clinic in terms of
service provision.
Abstract citation ID: znac245.063
EP-244 A “missed” nasal button battery in a child during the
COVID-19 pandemic
Sofia Anastasiadou1, Jacqueline Chan2, Ah Janjua2
1
Imperial College NHS Trust
2
University Birmingham Hospitals
A 5-year-old boy was referred acutely to the on-call ENT doctor following
multiple remote consultations with his general practitioner with 2
months history of worsening left-sided foul-smelling nasal discharge
and bleeding. He underwent examination under anaesthesia and
removal of nasal foreign body which was subsequently identified as a
button battery (intra-operative as well as imaging pictures included).
This case highlights the challenges posed to clinicians during the
COVID-19 pandemic but also serves as a reminder to keep a high
index of suspicion and low threshold for clinical examination in
suspected cases of nasal foreign body. It also highlights that since
COVID19 omicron variant has emerged it is more than significant to
evaluate cases that are assessed remotely with increased care to avoid
any further misses or mistakes.
Abstract citation ID: znac245.064
EP-245 A snapshot review of the use of prophylactic antibiotics
for emergency gastrointestinal surgeries: a tertiary care centre
experience
Hussameldin Mohamed Nour1, Dmitria V Peristeri1, Shehram Shafique2,
Prof Mansoor Khan1, Krishna K Singh1, Mr Muhammad S Sajid1
1 remains a diagnostic challenge for clinicians and often is an autopsy
University Hospital Sussex NHS foundation Trust
2 finding (1–1.5% of all adults’ autopsy). We conducted a thematic
Warwick School of Medicine, University of Warwick
Aim: The administration of recommended prophylactic antibiotics on
time for emergency gastrointestinal surgery (GIS) is effective in
reducing surgical site infections (SSI) and expediting post-operative
recovery. This audit aims to assess the optimum use of prophylactic
antibiotics in patients undergoing emergency GIS.
Methods: The data of all patients undergoing emergency GIS over a 1-
month period was reviewed according to UH Sussex NHS trust
(microguide) guidelines. The data was extracted, transferred and
analysed using Microsoft Excel.
Abstracts | v123
Results: Forty-one patients underwent emergency GIS during the study
period. Emergency GIS procedures included laparoscopic
appendicectomy (n=20), open colorectal resections (n=5), laparoscopic
colorectal resections (n=3), perforated duodenal ulcer repair (n=2),
inguinal hernia repair (n=2), diagnostic laparoscopy (n=2),
defunctioning ileostomy (n=2) and other (n=5). Recommended
antibiotics were administered in 17 (41.5%) patients and 29 (70.8%)
patients were administered antibiotics at the correct time. Surgical
site infections (SSI) were seen in 6 (14.5%) patients, of which 2 (11%)
patients were in the recommended-antibiotics group and 4 (16.5%)
in the non-recommended antibiotics group (p= 0.05). Two patients
(2/29; 6.8%) contracted SSI in the group which received antibiotics
on time. The major factor behind using non-recommended
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antibiotics and not administering antibiotics at the recommended
time was the continuation of antibiotics commenced at the time of
admission.
Conclusion: A significantly higher proportion of patients undergoing
emergency GIS were not administered the recommended antibiotics.
Moreover, almost one third of patients were not administered
antibiotics on time. Use of non-recommended antibiotics results in
higher incidence of SSI in patients undergoing emergency GIS.
Abstract citation ID: znac245.065
EP-250 A closed-loop clinical audit on the impact of
implementing the STAR Score at a tertiary level hospital in
India: Where do we stand?
Akatya Vidushi Sinha, Sameer Kadam
MGM Medical College & Hospital
Aim: To perform an audit to check Quality & Compliance of Surgical
documentation using STAR Score at a tertiary hospital in India.
Method: A total of 90 case files were studied and assessed in detail from
all surgical departments. The audit was done for a period of 1 month at a
tertiary hospital in India. The “STAR: Surgical tool for auditing records”
tool was used to collect data accordingly. The results were compared
with standard guidelines and further analyzed. A series of
departmental training and implementation meetings were carried out.
After 2 weeks, a re-audit was performed.
Result: The overall compliance score of the hospital was found to be
74%. While the departments of General surgery and orthopaedics
showed a higher rate of compliance, each constituting 82%,
Neurosurgery showed the least compliance of 62%. It was also seen
that the maximum percentage of missing information constituted of
anaesthetic records and subsequent entries. After the re-audit, a
considerable improvement was observed, with the compliance rate
improving to 90% in all departments.
Conclusion: We believe that compliance and implementation of the
STAR Score is mandatory, as it can significantly improve the quality of
documentation and can be implemented universally.
Abstract citation ID: znac245.066
EP-254 Do not forget about bowel ischemia: a thematic review
at Bedford Hospital
Francesca Muscara, Abigail Mwendauya, Khaled Kattaria, Jose Soriano,
Katharine Bevan
Bedford Hospital
Introduction: Bowel ischaemia (BI) is a life-threatening emergency with
a mortality rate of 60–80%, which requires early diagnosis and surgical
intervention. Clinical presentation is nonspecific, being characterised
by initial discrepancy between severe abdominal pain and minimal
clinical findings, abdominal CT has poor sensitivity and specificity. BI
review to identify major issues which led to fail to recognise BI.
Methods: Data was collected retrospectively from NELA database on 626
patients who underwent emergency laparotomy, between 2013–2021 at
Bedford Hospital, including preoperative clinical-radiological data,
operation details, postoperative complications according to Clavien-
Dindo (CD) classification and mortality.
Results: A total of 68 (10.8%) patients had BI as intra-operative finding,
average age 71.3 (37–99), 35 (51.4%) female and 33 (48.5%) male. 25
(36.7%) had BI as indication for emergency laparotomy. 65 (95.5%)
presented as emergency versus 3 (0.5%) as elective admission. The
v124 | Abstracts
average waiting time for surgery was 8.9 hours. 53 (77.9%) patients
received CT AP (46 triple phase, 4 angiogram, 3 without contrast),
presence of BI was highlighted in 11 (21.1%) cases. In 14 (20.5%)
patients a stoma was fashioned during laparotomy. 28 (41.2%)
complications were recorded, of which 8 (28.5%) CD grade I, 5 (17.8%)
CD grade 3b and 13 (46.4%).
Conclusions: Our results showed a mortality rate of 19.1% at 30 days
postoperatively. We recommend strong clinical suspicion and
aggressive approach should be adopted to improve the clinical
outcome of BI.
Abstract citation ID: znac245.067
EP-257 A case report of Furuncular myiasis affecting the glans
penis of a young boy caused by the larvae of Cordylobia
anthropophaga (The Tumbu Fly)
Damilola Jesuyajolu, Paul Jesuyajolu
General Surgery Department, First Graceland Hospitals, Abijo, Lagos
Introduction: Cutaneous myiasis is endemic in West Africa, and it is
most commonly caused by the larvae of Cordylobia anthropophagia.
In English literature, recorded cases of this cutaneous myiasis
affecting the glans penis are rare. This rarity calls for a need to
consider this as a differential when looking at furuncular lesions of
the glans penis. This awareness is important for practitioners who
may come across this case.
We report a case of furuncular myiasis of the glans penis due to the
larvae of C.anthropophaga of an 11-year-old boy living in Lagos, Nigeria.
Case presentation: We present an 11-year old boy who presented to the
surgical emergency department with a lesion on his glans penis, initially
thought to be a boil. Upon examination, the lesion contained a single
larva of C.anthropophaga. After sedation of the patient, It was
extracted in the mini-theatre with a non-toothed forceps and dressed,
and the area healed well.
Discussion: Although endemic, furuncular myiasis of the glans penis is
a very rare condition, likely related to the living circumstance of the
patient. An awareness of the clinical features is important to prevent
misdiagnoses of foruncular lesions that occur on the glans penis,
especially in people with identified risk factors.
Health education and promotion of good hygiene are important in
reducing the incidence of Cordylobia anthropophagia infestation in
endemic regions as well as among frequent travelers to and from
endemic areas.
Keywords: myiasis, cutaneous myiasis, Cordylobia anthropophagia,
glans penis, Tumbu fly
Abstract citation ID: znac245.068
EP-262 Neoadjuvant imatinib for Resectable Gastrointestinal
Stromal Tumors. A State-of-the-art
Dimitra Peristeri, Shameen Jaunoo
Surgery Department, Brighton and Sussex University Hospitals NHS
Trust-Esophagogastric Research Group
Type of Total Number of New Male:
appointment patients patients Female
Virtual 612 162 1:1.3
In Person 266 129 1:1.2
p-value* 0.60
* unpaired t test and chi squared.
Discussion: Implementation of virtual appointments significantly
lowered the carbon footprint of our surgery clinic.
This has the potential to be a positive development in
the efforts against climate change. Factors such as quality
assurance, patient and physician satisfaction need to be
determined however.
Aims: Surgical removal remains the cornerstone of primary GIST
treatment and complete surgical resection offers prognostic value
toward risk of relapse. However, primary tumors, particularly of
the stomach, are of advanced size when detected, and
multivisceral resection seems to be the treatment of choice.
Existing results of recent clinical trials have established the
feasibility of neoadjuvant imatinib therapy mainly in unresectable
GISTs. Yet, proof of the survival effectiveness of neoadjuvant
imatinib therapy in borderline resectable tumors has not been
sufficiently demonstrated.
Methods: A review of the literature was performed to identify the
current evidence for preoperative treatment of large GISTs with
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Imatinib regarding R0 resection and oncological outcome.
Results: Data supporting benefit of neoadjuvant imatinib are available from
several case reports and small retrospective series, most of which include a
mix of patients with borderline resectable and unresectable primary
disease. In addition, a single-phase II United States Intergroup trial and an
Asian phase II trial of neoadjuvant therapy in large stomach tumors,
concluded that Neoadjuvant imatinib therapy is preferred for marginally
resectable tumors. Progressive disease after neoadjuvant treatment was a
rare event, and partial response was achieved in 40–80% of all patients.
Conclusion: Neoadjuvant therapy with imatinib is safe and
recommended for patients with resectable, locally advanced GIST. It
may also enable less invasive and organ-sparing surgery, increase the
complete resection rate, and avoid the surgical rupture by decreasing
the tumor size. Clinical questions still remain about the most
appropriate period of pre- and post-operative imatinib administration
in the neoadjuvant protocol.
Abstract citation ID: znac245.069
EP-269 An Audit of Carbon Emissions Generated by Virtual and
In-Person Clinic Appointments During The COVID-19
Pandemic
Ellen McKay1, Gupreet Singh-Ranger2, Krystal Schimp-Manuel2
1
Mount Allison University
2
Upper River Valley Hospital
Background/Introduction: Virtual appointments have been considered
in our department for many years, as a strategy to lower carbon
emissions. The advent of COVID-19 prompted urgent implementation
as in person appointments were limited.
We performed a prospective audit to assess the effectiveness of this
approach in lowering carbon footprint.
Method: Audit study of all surgical clinic appointments from 18/03/20–
31/03/21at the Upper River Valley Hospital, New Brunswick. Mileage
calculated based on a round trip from patient postcode to hospital
address.
CO2 / CO2 equivalents (CO2-e) emitted calculated from previously
published data - mobile phone CO2-e; 0.0092751142 g/minute, laptop;
0.269216134 g/minute, standard car emissions 128.002 g/km.
Results were analysed statistically.
Results:
Mean Distance from Total Mean CO2-e per Median CO2-e per
Hospital (range/km) CO2-e / kg patient / kg (range) patient / kg
40.06 (6.6–566) 0.16 2.5xE-4 (9.27 xE-5 9.3xE-5
-0.61)
38.80 (6.6–546) 2617.41 9.9 (0.84–69.89) 6.6
0.567 <0.0001
Abstract citation ID: znac245.070
EP-270 A meta-analysis of the randomized controlled trials
exploring the effectiveness of oral versus topical use of
metronidazole following excisional haemorrhoidectomy
Anja Imsirovic1, Mirza K Baig2, Parv Sains3, Muhammad S Sajid4
1
Brighton and Sussex Medical School, University of Sussex

2
Worthing Hospital, University Hospitals Sussex NHS Foundation Trust
3
Spire St Anthony’s Hospital
4
Brighton and Sussex Hospital, University Hospitals Sussex NHS Foundation Trust
Objective: Metronidazole has been proven an effective proctological
analgesic and antimicrobial agent in patients undergoing excisional
haemorrhoidectomy. The aim of this article is to evaluate the efficacy
of topical versus oral administration of metronidazole to in controlling
the post-operative pain following excisional haemorrhoidectomy.
Method: A comprehensive systematic search was undertaken with the
help of local librarian and relevant published randomized controlled
trials (RCT) were shortlisted according to the inclusion criteria.
Summated outcomes of the poste-operative pain on day one and day
seven were analyzed using the principles of meta-analysis on RevMan 5
statistical software.
Result: Two RCTs on 286 patients undergoing excisional
haemorrhoidectomy were included in this review. There were 143
patients in topical metronidazole group and same number of patients
were in oral metronidazole group. the antibiotics group (AG) and 877
patients in the no-antibiotics group (NAG). In the random effects model
analysis, day 1 [standardized mean difference -0.06, 95% CI (-0.30–0.17),
z = 0.55, p = 0.59] and day 7 [standardized mean difference 0.09, 95% CI
(-1.29–1.47), z = 0.12, p = 0.90] post-operative pain score was statistically
similar in both groups. There was significant heterogeneity [Tau2 =
0.96, chi2 = 32.49, df = 1; p = 0.00001, I2= 97%] between included trials.
Conclusion: Both topical and oral administration of metronidazole as
post-haemorrhoidectomy proctological analgesic is an effective
modality. However, this evidence is based upon the findings of two
RCTs on 286 patients and should be taken cautiously. A major, high
quality RCT is mandatory to validate these findings.
Abstract citation ID: znac245.071
EP-271 Assessing the Impact of Implementing the STAR Score
at a Tertiary Level Hospital in India: A Closed-loop Clinical
Audit
Akatya Vidushi Sinha, Sameer Kadam
MGM Medical College & Hospital
Aim: To perform an audit to check Quality & Compliance of Surgical
documentation using STAR Score in the general surgery department
of a tertiary hospital in India.
Method: A total of 20 case files were studied and assessed in detail from
the general surgery department. The audit was done for a period of 1
month at a tertiary hospital in India. The “STAR: Surgical tool for
auditing records” tool was used to collect data accordingly. The results
were compared with standard guidelines and further analyzed.
Interventions were carried out by a series of departmental training
and meetings. After 2 weeks, a re-audit was performed.
Result: The overall compliance score of the general surgery department
was seen to be 82% in the first cycle. While the initial clerking
constituted 21% compliance, operative records, and discharge
summaries, showed compliance of 33% and 22% respectively. Consent
and Anesthetic records showed the least compliance of 7% and 14%.
The highest compliance was seen in subsequent entries, constituting
35%. In the second cycle, a significant change was reported as the
overall compliance score increased to 95%. All sections showed a
statistically significant increase. Consent and anesthetic records
demonstrated an increase of 75% and 70% compliance, respectively.
Conclusion: We believe that compliance and implementation of the
STAR Score is mandatory, as it can significantly improve the quality of
documentation and can be implemented universally.
Abstract citation ID: znac245.072
EP-273 Magnetic nanoparticle administration to a model of
penetrating neurotrauma in vitro
Raja Haseeb Basit1,2, Jessica Wiseman1, Divya Maitreyi Chari1
1
Department of Neural Tissue Engineering, Keele University
2
Bradford Royal Infirmary
Introduction/Aims: Functional recovery in penetrating traumatic brain
injury (pTBI) is hampered due to the lack of clinically approved
regenerative therapies. Although a surgical emergency, pTBI
management is largely supportive, with no targeted neuroregenerative
therapies. Reactive gliotic and neuroinflammatory responses with a lack
Abstracts | v125
of spontaneous axonal regeneration represent a major barrier to
repair. Emergent nanotechnologies including magnetic nanoparticles
(MNPs) show promise to attenuate such responses through
immunomodulation, with potential of delivery of neurotherapeutic
molecules to lesion sites during surgical intervention. However, there
is a lack of high throughput, neuropathomimetic, models for nano/
biomaterial testing in experimental neurology. Our group recently
showed glial cell interactions with a surgical biomaterial scaffold
(DuraGen PlusTM) in a novel in vitro model of pTBI.
Methods: Mice cerebral cortices were extracted and cultured 8–10 days
in vitro (DIV) using previous methodology (Basit et al, Mat Sci Eng C,
2021) with a modified chemical medium. At 8 DIV, a sterile pipette
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was used for transection of the culture simulating penetrating injury
in vitro with injection of carboxymethyl dextran-coated magnetic
nanoparticles and polyethylene glycol-coated magnetic nanoparticles
into the lesion site. MNP-neural cell responses were evaluated using
immunocytochemistry methods.
Results: Our model demonstrates hallmark reactive gliotic responses,
immune cell infiltration and axonal transection in injury sites. We
demonstrate preferential and competitive microglial uptake of
delivered MNPs versus other neural cell types (p<0.05, n=5).
Conclusion: The model is adaptable to study neural cell responses to
range of materials, offering high versatility for testing promising
surgical neuromaterial based therapeutic interventions in
experimental clinically relevant research.
Abstract citation ID: znac245.073
EP-276 Tall Cell Carcinoma with Reverse Polarity (TCCRP) of
the breast; a rare form of breast cancer
Zachary Shulman1, Anne O’Neill1, Sofia Kouneli1, Abeer Shaaban2,
Stephanie Jenkins1
1
University Hospitals Plymouth NHS Trust
2
Queen Elizabeth Hospital Birmingham
Aim: A case report on the diagnosis and treatment of this rare low grade
triple negative breast cancer.
Case Report: A 41 year old female presented with a palpable left breast
lump. Family history includes a sister with a rare myeloproliferative
disorder. On examination, a left breast lower outer quadrant 2–3 cm
hard irregular lump was palpable. Mammography and ultrasound
revealed a 25 mm suspicious lesion (which was biopsied), with normal
appearing lymph nodes.
Results: Biopsy revealed a grade 2 invasive apocrine carcinoma.
Oestrogen and Herceptin receptors negative. Breast conserving
surgery with sentinel lymph node biopsy was performed. Histology
revealed a 22 mm well circumscribed tumour with nests of epithelial
cells in micropapillary pattern with apocrine like appearance. The
most striking feature was that the nuclei were at the apical rather
than the basal poles of the epithelial cells (reverse polarity). No
lymphovascular invasion present. Lymph nodes were negative (0/3).
Diagnosis was then confirmed by molecular testing.
Conclusion: Tall cell carcinoma with reverse polarity (TCCRP)1, a rare
cancer resembling tall cell variant of papillary thyroid carcinoma, was
first reported by Eusebi et al in 20032. Although morphologically similar
to metastatic papillary thyroid cancer, neither the immunohistochemical
markers nor genetic profiles have established any connection3. Accurate
diagnosis of TCCRP is important as it carries an excellent prognosis.
Treatment is local regional radiotherapy. There is no indication for
systemic therapy in this case, due to its indolent low metastatic potential.
Abstract citation ID: znac245.074
EP-277 Emphysematous cholecystitis: A diagnostic dilemma
and treatment challenge
Mariana Rita Afonso Matias, Ahmed Elnabil-Mortada, Roger Ackroyd
Sheffield Teaching Hospitals, NHS Foundation Trust
Background: Emphysematous cholecystitis (EC) is a rare life-
threatening variant of acute cholecystitis. It is commonly seen in
elderly men who are immunocompromised, known diabetes mellitus
or peripheral vascular disease. EC is caused by gas-forming organisms
such as Escherichia coli, Clostridium perfringens and Bacteroides
fragilis and has a reported mortality of up to 25%. Computed
Tomography is the most sensitive diagnostic imaging study for the
detection of intraluminal or intramural gallbladder gas.
v126 | Abstracts
Methods: We report a diagnostic dilemma and multidisciplinary
management of a case of emphysematous cholecystitis with unusual
presentation in a young, healthy patient with no risk factors.
Results: A 47-year-old male chef, otherwise fit and well, presented with
a clinical picture of sepsis and abdominal pain. Initial investigations
were normal apart from bilateral basal atelectasis, hence he was
treated for pneumonia, although without clinical improvement. Due
to persistent fever, patient underwent further investigations that
established the diagnosis of emphysematous cholecystitis. His clinical
condition improved dramatically after urgent laparoscopic
cholecystectomy with patient being safely discharged home 6 days
post-op, with an uneventful postoperative recovery.
Conclusion: A high index of clinical suspicion and multidisciplinary
team management including surgery, radiology, and microbiology is
crucial for early diagnosis of the rare life-threatening condition of EC.
Our clinical case highlights that EC is not limited to elderly morbid
patients and urgent laparoscopic cholecystectomy is the best
treatment when feasible.
Abstract citation ID: znac245.075
EP-279 Impact of a Subspecialty Emergency Service on
Emergency Laparotomy Workload
EZ Farrow, TA Cook
Gloucestershire Hospitals NHS Foundation Trust
Aims: Subspecialist emergency surgical care, shared between Upper GI
(UGI) and Colorectal (CR), can bring clinical benefits. Currently
subspecialist emergency care is provided in around 20% of units but is
likely to become more common in larger units with a view to driving
improvement in outcomes. A subspecialty emergency service was
introduced in our Trust in April 2020. The purpose of this study was to
assess the impact of the subspecialty emergency service on
emergency laparotomy workload for each team.
Methods: Data recorded on the NELA Database over an 18-month period
(April 2020 - September 2021) were reviewed. Consultant involvement
and subspecialty team were recorded
Results: There were 14 surgeons (7 UGI, 7CR) participating equally in the
emergency service (two consultants available 24/7). There were 589
emergency laparotomies (mean 33/month) performed in the 18-month
period, 6 were excluded from analysis due to incomplete data. A
consultant surgeon was present for 94% of all cases. 357 cases (51 per
surgeon) were performed under a CR consultant compared with 226
(32.3 per surgeon) under an UGI consultant. CR consultants performed
more laparotomies out of hours then their UGI colleagues.
Conclusions: There was good consultant involvement for all emergency
laparotomies. CR surgeons performed 61.2% of emergency laparotomies
reflecting the presenting pathology of emergency patients. This had an
impact on the amount of out of hours operating for individuals within
the service as a whole. These differences should be taken into
consideration in units looking to establish a subspecialty emergency
service.
Abstract citation ID: znac245.076
EP-280 Title: The impact of agricultural injuries on a regional
Major Trauma Service
Mary Catherine Gribbon, Eilis Magill, Ruth Houston, Susan Yoong
Royal Victoria Hospital Belfast- Major Trauma Unit
Aims: This study aims to review the impact of agricultural trauma on a
Regional Major Trauma service. In this study we identify the patient
demographic most likely to be admitted with agricultural injuries, and
the most common mechanisms of injury in this patient cohort.
Furthermore, we outline the proportion of patients who require
surgical intervention, and examine which surgical specialties were
involved in the care of these patients. Finally, this study reviews the
mortality associated with agricultural injuries in our Regional Major
Trauma Centre.
Methods: Using data from the electronic care record and the major
trauma database we retrospectively identified patients admitted with
agricultural trauma over a two year period from January 2019 to
January 2022.
Results: 58 patients were admitted to the Major Trauma service over the
two year period. 72% required surgical intervention, while 28% were
managed conservatively. Of the patients that required surgical
intervention, the majority required orthopaedic surgery (68%) followed
by thoracic surgery (14%), general surgery (8%) neurosurgery (6%), and
interventional radiology (4%). There was a 3.3% mortality rate. Median
length of stay was 12 days. The average patient age was 48 years.
Conclusions: Agricultural injuries represent a significant proportion of
patients admitted to our major trauma centre. Many of these injuries
are potentially avoidable, and ongoing work is required from a public
health perspective to minimise the risk of injury and improve safety
in this sector.
Abstract citation ID: znac245.077
EP-283 A rare cause of headache – cerebral sinus venous
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thrombosis after COVID-19 vaccination
Cheuk Tung Kam, Jaideep Rait
Maidstone and Tunbridge Wells NHS Trust
Introduction: Cerebral sinus venous thrombosis (CSVT) is a rare
complication of COVID-19 vaccination. There is an incidence of 0.55
per 100,000 person-months. We describe a case of CSVT post COVID-
19 vaccine.
Case description: A 58-year-old male presented to a district general
hospital after being involved in an RTC with a 3 month history of left
sided headache which had followed his first COVID-19 vaccine
(AstraZeneca). No focal neurological deficits were elicited. Blood
results were unremarkable. Radiological workup suggested left
transverse and sigmoid sinus thrombosis with no other intracranial
complications. The patient was admitted and managed with low
molecular weight heparin with an uneventful recovery.
Discussion: CSVT is a rare and sometimes fatal disease. An increased
risk of CSVT after COVID-19 vaccination has been suggested. An
underlying immunological mechanism is suspected with the
involvement of platelet factor-4 (PF4) antibody. Headache is the most
common presenting symptom with onset within one week of
vaccination. Positive D-dimer, PF4 IgG assay and thrombocytopenia
may also support the diagnosis. CSVT may progress to major
complications including intracranial haemorrhage and even death.
Prompt diagnosis and appropriate treatment prevents neurosurgical
intervention such as decompressive craniotomy and may improve
neurological outcome.
Conclusion: This case describes an important and rare finding of
complications following COVID-19 vaccine. Consideration should be
made in management for patients with a recent history of COVID 19
vaccination presenting with features of headache. A high level of
clinical suspicion is needed to investigate and manage these patients
appropriately with potential CSVT.
Abstract citation ID: znac245.078
EP-289 Acute gallstone pancreatitis – if a picture is worth a
thousand words, how many images do we need?
Si Chen, Smriti Karki, Qamar Iqbal, Sreelakshmi Mallappa
The Hillingdon Hospitals NHS Trust
Aims: Accurate diagnosis and prompt definitive management of
choledocholithiasis is vital in acute gallstone pancreatitis (GSP).
Sensitivity of detection of choledocholithiasis varies across imaging
modalities. Magnetic resonance cholangiopancreatography (MRCP) is
most sensitive, but may not be necessary, and may result in delayed
implementation of definitive management.
We aimed to evaluate the range of radiological investigations patients
with acute GSP underwent at our Trust, and the clinical
appropriateness of MRCP if performed.
Methods: An observational study of patients diagnosed with acute GSP
between 01/05/2019 and 26/02/2021 was performed. Data were collected
from electronic patient records.
Results: 50 patients were diagnosed with acute GSP (median age
56years). 41 had transabdominal ultrasound (USS), 22 had computed
tomography (CT) and 16 patients had MRCP. Median waiting time was
1, 0 and 4 days for respectively. All patients who had MRCP had prior
USS and/or CT (Table 1).
As definitive management, 14% underwent endoscopic retrograde
cholangiopancreatography (ERCP), 28% underwent laparoscopic
cholecystectomy and 30% had initial ERCP followed by laparoscopic
cholecystectomy. 14% patients were readmitted with pancreatitis
prior to definitive management.

Table 1
No CBD CBD Choledocholithiasis Total
assessment not dilated
of common dilated
bile duct
(CBD)
USS 2 7 2 0 11
CT 2 2 1 0 5
MRCP 0 9 3 4 16
Conclusions: Detailed description of the CBD in initial radiology reports
in acute GSP may mitigate the need for unnecessary subsequent
imaging, reducing cost and facilitating early definitive management.
We recommend establishment of a guideline to streamline imaging in
the assessment of acute gallstone pancreatitis.
Abstract citation ID: znac245.079
EP-295 Mentoring Scheme for Medical Students Interested in a
Career in Surgery
Kathryn Bowerman1, Reena Agarwal2
1
Leicester Medical School
2 Results: 99 patients were admitted with acute sigmoid diverticulitis in
University Hospitals of Leicester
Aim: A career in surgery requires dedication and commitment from
medical school onwards. Having a mentor is proven to help facilitate
career progression and improve self-confidence as well as providing
supportive, non-biased, non-judgemental career advice. Mentors
report increased job satisfaction and self-esteem when mentoring
junior colleagues.
Method: The senior author, along with the local medical school’s
surgical society, launched a pilot scheme for medical students and
volunteering consultant surgeons in April 2021. 46 students were
recruited, and 28 consultant surgeon mentors. Mentees were then
paired with mentors, with some mentors taking on multiple mentees.
Results: Feedback forms were sent out 6 months later to establish
perceptions on progress and any suggestions for improvement. We had
a low return rate of the feedback forms with 19 returns from mentees, 13
of which had met their mentors. 8 forms were returned by mentors, 5 of
whom had met their mentees. 82.35% of mentees who returned the form
said the pilot scheme had either ‘met or exceeded their expectations’.
Conclusion: This pilot scheme was launched just as Covid-19 pandemic
recovery work started, with surgical specialities trying to clear the back
log, which may be the reason of the meetings not taking place or the
feedback forms not being completed. In the future, we hope to recruit
surgical trainees to help with the mentorship programme and by time
constraining the programme, trying to ensure that all mentees get the
benefit of limited number of mentors.
Abstract citation ID: znac245.080
EP-296 Introduction of an Information Leaflet for Patients
Presenting with Hand Injuries
Kathryn Bowerman1, Stephen Frost2, Reena Agarwal2
1 safely discharged home.
Leicester Medical School
2
University Hospitals of Leicester
Aim: Patient Information Leaflets (PILs) are an effective way to educate
patients, involve them in their care, and improve communication
between patient and clinician. Our department did not have a PIL
covering all hand injuries in single leaflet, therefore we decided to
make one.
Method: We created a PIL to give to all patients with hand injuries that
were seen in the Emergency Department by Plastic Surgery. The PIL
explains what will happen if they need surgical intervention, or if the
injury can be managed conservatively. In our hospital, Plastic Surgery
covers hand injuries on Fridays, Saturdays, and Sundays and then
patients are either planned for dedicated trauma lists during the week
or for follow up in the Hand Trauma Review Clinic.
Results: The leaflet detailed the follow up patients could expect, as well
as red flag symptoms to look out for, and who to contact should any
problems arise. The PIL enabled us to emphasise the importance of
Abstracts | v127
adherence to advice given by healthcare professionals, particularly on
any dressings and splints provided to the patients.
Conclusion: While the leaflet is generic in nature to cover all injuries,
specific advice is given in addition to the leaflet to ensure that
patients have the best possible care. In the future, we would like to
make the leaflet electronic in order to reduce waste and risk of
infection. Ideally, patients could scan a QR code taking them directly
to the relevant part of the leaflet.
Abstract citation ID: znac245.081
EP-306 Management of acute sigmoid diverticulitis in a district
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general hospital – a retrospective audit
Azelle Egbe
Kingston Hospital NHS Foundation Trust
Aim: Acute sigmoid diverticulitis is one of the most common emergency
general surgery conditions. Guidelines from the European Society of
Coloproctology published in 2020 outline best practice in
management, including a move away from routine antibiotic therapy.
This audit aims to assess compliance with these guidelines.
Methods: Electronic records of all patients admitted under the
emergency general surgery team with acute sigmoid diverticulitis in
2021 were analysed to obtain information on management. These
data were compared against the 2020 guidelines to assess compliance.
2021. 97% of patients underwent an abdominal CT scan and 100%
received IV antibiotics.
65% of cases were classified as uncomplicated and 35% were classified as
complicated (i.e. abscess formation or perforation).
The mean length of stay for all patients was 5.7 days. The length of stay for
patients with uncomplicated diverticulitis was 3.7 days compared to 9.3
days for complicated diverticulitis. 10% of patients underwent surgical
intervention and no patients underwent radiological intervention.
Only 57% of patients were referred for an outpatient lower GI
endoscopy.
Conclusion: These results raise three main insights for further
consideration. Firstly, it appears that the evidence against routine
antibiotic therapy for acute diverticulitis is not yet being reflected in
clinical practice. Secondly, patients admitted with uncomplicated
diverticulitis have a relatively short length of stay, indicating a role for
ambulatory management of this common condition. Lastly, referral
rates for outpatient endoscopy must be improved to ensure that
patients with an underlying malignant lesion can be identified.
Abstract citation ID: znac245.082
EP-313 Timeliness of ultrasound investigation in patients
presenting with acute abdominal pain – single-centre audit
Daniela Ioana Mateescu1, Abdul Hakeem2, Youssef Chedid2,
Dipankar Chattopadhyay2
1
Darent Valley Hospital
2
Bedford Hospital, South Wing
Aim: To identify patients delays in ultrasound investigation in patients
who present with acute abdominal pain; patients who require
ultrasound investigation to decide if they require admission or can be
Methods: Patients who presented to our hospital’s Accident and
Emergency department with acute abdominal pain and an ultrasound
was requested were included in the analysis. The indication was
divided into 3 main categories (Upper abdominal pain, post-
cholecystectomy and other pathology). Data were analysed in relation
to admission and discharge. Patients who had outpatient ultrasounds
were excluded from the study. Mean and standard deviations were
used for the delays.
Results: A total of 322 patients were included in the study, 160 (49.7%)
patients were due to cholelithiasis or upper abdominal pain, 158
(49.1%) were due to other pathologies, 4 (1%) were post-
cholecystectomy ultrasounds. The mean admission to ultrasound
request was 1.77 (±5.48) with 290 (90.1%) being requested within 2
days of admission. Mean days from request to ultrasound being
performed was 1.37 (±4.04) with 299 (93.1%) performed within 2 days.
Conclusions: The study concluded that the average time from
ultrasound being requested to being performed in patients with acute
v128 | Abstracts
abdominal pain was 0–2 days, this shows that the ultrasound is
performed appropriately and there are minimal delays.
Abstract citation ID: znac245.083
EP-319 Evaluating the outcomes of patients treated with
surgical vs IR cholecystostomy during the COVID-19 pandemic
Christopher Gunn, Imran Alam
Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust
Aims: We evaluated the outcomes of patients treated with laparoscopic
cholecystostomy versus percutaneous (IR) cholecystostomy during the
COVID-19 pandemic.
Methods: Electronic records of patients undergoing cholecystostomy
during the COVID-19 peak in 2020 were analysed. Our primary
outcomes were the number of readmissions and subsequent
completion of laparoscopic cholecystectomy.
Results: 6 patients underwent laparoscopic cholecystostomy between
January and December. 3 were performed following failure of
cholecystectomy, 2 were unfit for cholecystectomy and one
underwent surgery due to lack of radiologist availability. 9 IR
cholecystostomies occured between March and July. 4 were unfit
surgical candidates, 5 were due to COVID related restrictions on
operating. 6 readmissions came from the surgical cohort, 4 for
infection compared to 3 from the IR cohort with only 1 for infection.
Notably, of the 4 IR-drained patients deemed unfit, only one had a
subsequent gallbladder related admission. 3 surgical patients
underwent definitive surgery, 2 subtotal and 1 total cholecystectomy
with a mean time to definitive treatment of 27.5 weeks. 4 IR patients
underwent surgery with 1 abandoned, 1 subtotal and 2 total
cholecystectomies with a mean time to definitive management of
20.25 weeks.
Conclusions: IR cholecystostomy showed reduced readmission rates
compared to laparoscopic cholecystostomy, especially related to
infection with rates of 11% and 66%, respectively. More patients
underwent total laparoscopic cholecystectomy following IR drainage.
However, adhesion formation proved troublesome in both methods. IR
cholecystostomy showed a reduced time to definitive surgery. Finally,
most high-risk patients undergoing IR cholecystostomy had no further
gallbladder related admissions therefore proving its utility in such
groups.
Abstract citation ID: znac245.084
EP-325 Congenital peritoneal encapsulation rare pathology for
Acute intestinal Obstruction
Ashim Chowdhury, Md Shamsuzzama, Evangelos Paisios, Ankur Shah
William Harvey Hospital
Background: Congenital peritoneal encapsulation (CPE) is a rare,
congenital entity in which the small bowel is surrounded by an
accessory peritoneal membrane. This condition is usually
asymptomatic and rarely causes intestinal obstruction. This report
highlights this rare congenital anomaly as a cause of intestinal
obstruction.
Case: A 28-year-old fit man presented to A&E with classical features of
intestinal obstruction. Abdominal CT scan showed features of
mechanical small bowel with 360-degree rotated mesentery, and a
suspicion of closed loop obstruction. An emergency laparotomy was
performed. A large congenial peritoneal sac, wrapped the small bowel
from D-J flexure to proximal part of ileum, and this sac was rotated
360 degrees with multiple adhesions and a single band to the left
lateral wall. Early ischemic changes were noted, along with congested
mesentery. The sac was opened, dissected and adhesiolysis was
performed. The thick solitary band was released. There was
immediate restoration of the blood supply and the bowel was viable.
Patient recovered and discharged home on day 3
Discussion and conclusion: Worldwide, only 50 cases on CPE have
been published till date, with the maximum reported from the UK.
The other common conditions that mimic CPE are internal
paradodenal hernia, abdominal cocoon and sclerosing encapsulating
peritonitis. Young patients with abdominal pain and feature of
closed loop high small bowel obstruction on CT scan will need a
high index of suspicion, before confirming the diagnosis. At this
point, it will remain a rare occurrence and an incidental finding at
laparotomy.
Abstract citation ID: znac245.085
EP-334 The Impact of Combined DNA Repair and Oncogene
Mutations in Colorectal Cancer Survival
Keeley Barnable1, Vett Lloyd1, Gurpreet Singh-Ranger1,2
1
Mount Allison University
2
Upper River Valley Hospital
Aims: To examine the coexistent effect of either KRAS or BRAF gene
status with MMR gene status on patient outcomes in a rural
population of colorectal cancer patients.
Methods: Using a colorectal cancer database, results for patient
mutation status for mismatch repair genes and other oncogenes,
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obtained by DNA sequencing and immunohistochemical analysis,
were assessed to see if there were significant differences in survival
probability in patients with and without single and combined risk
factors. Kaplan-Meier survival analyses were performed to examine
overall survival probability in the different groups of patients.
Results: Comparison of survival outcomes in patients with and without
KRAS and MLH1 mutations showed a significant difference (p=0.018).
Pairwise analysis reveals that this difference is mostly between the group
with wild-type status for both genes and a patient with mutant KRAS and
EGFR status with wildtype MLH1 status (p=0.062 with bonferroni
correction). Combined KRAS and PMS2 status results in a borderline
insignificant (p=0.056) survival difference as well. The effects of mutations
in other combinations of oncogenes, as well as sex or tumour sidedness
and mutation statuses, were not significant on survival probability.
Conclusions: These preliminary results should be interpreted with
caution owing to the relatively small sample size. This study supports
previous findings that mutant oncogenes, combined with altered MMR
genes can be predictive of colorectal cancer survival outcome.
Abstract citation ID: znac245.086
EP-336 Compliance of Fluid Balance Charts in Surgical Patients
According to NICE Guidelines
Hesham Morsy, Michael Li, Chris Davidson, Kat Gu, Dharti Patel,
James Hollingshead, Maryam Ali
West Hertfordshire NHS Hospitals Trust
Aim: Assess compliance of presence & completion of fluid balance
charts for fluid replacement in accordance with NICE Guidelines in the
acute surgical admissions population
Method: Total of 158 patients were included. We collected data
prospectively for surgical patients admitted between 25/02/21–18/
03/21 (first cycle) & 12/09/2021–4/10/2021 (2nd cycle). Maximum of
5 patients daily randomly selected via Google random number
generator. Data collected in Wards after clerking Data analysed on
Day 1 of admission. Surgical Proforma was used to identify if fluid
balance chart was requested. Fluid Balance charts used to assess
presence & completion of charts Admissions by audit authors were
excluded to prevent selection bias.
Intervention: Posters in Emergency Assessment Unit and Wards,
Teaching to junior doctors, Regular reminder messages to on-call teams.
Results: Presence and completion of fluid balance chart in acute surgical
admissions in compliance with NICE guidelines for IV Fluid replacement
rose from 48% to 64% between cycle 1 and 2, respectively. However,
presence and completion of the chart rises significantly from 64% to
100% when it is requested, compared to 58% to 87% in cycle 1.
Conclusions: Most patients had a fluid balance chart made available by
the nurses still, regardless of having it requested in their surgical
proforma. However, we need to request fluid balance charts for all
surgical admissions in order to have all of them present and
completed properly as most of them will require replacement. This
needs to be clearly documented in the surgical proforma on clerking.
Abstract citation ID: znac245.087
EP-341 Haemorrhagic Cholecystitis with cystic artery
pseudo-aneurysm
Ashrafun Nessa1, James Milburn1, George Ramsay,1
1
Aberdeen Royal Infirmary
2University of Aberdeen
Introduction: Haemorrhagic cholecystitis and cystic artery pseudo-
aneurysm (CAP) are two very uncommon causes of right upper

abdominal pain. However, the development of haemorrhagic
cholecystitis induced by ruptured cystic artery pseudo-aneurysm and
haemobilia are extremely rarely documented with few occurrences
documented in the literature.
Case presentation: A 80year-old frail patient was admitted with RUQ
pain, deranged LFTs and melaena. She had known gall stones,
hypertension, chronic kidney disease and fibromyalgia. She
demonstrated localized tenderness in the right abdomen and bloods
showed a significant drop in haemoglobin which required blood
transfusion. Abdominal ultrasound showed cholecystitis and MRCP
showed CBD dilatation with no choledocholithiasis. She was found to
have haemorrhagic cholecystitis and CAP along with a cholecysto-
colonic fistula on triple phase liver CT. The patient underwent urgent
embolization of the CAP and remained clinically stable. She was
discharged home with a plan of further review before consideration
for cholecystectomy.
Clinical discussion: Haemorrhagic cholecystitis and CAP are rare.
Clinical suspicion is warranted to diagnose the case – the combination
of features of cholecystitis with acute anaemia should raise the
suspicion. Diagnosis is made primarily by pathognomonic findings on
appropriate phase of CT and US imaging. Prompt diagnosis and
management is essential in preventing mortality and/or significant
morbidity.
Conclusion: A rare consequence of intra-biliary bleeding due to
ruptured CAP leading to haemorrhagic cholecystitis is a potential
differential diagnosis in patients presenting with right upper
abdominal pain and haemoglobin drop. Close liaison with radiologist
is warranted to organise appropriate investigation for diagnosis and
successfully manage the condition.
Abstract citation ID: znac245.088
EP-343 Compliance of Prescription of Intravenous
Maintenance Fluids in Acute Surgical Patients According to
NICE Guidelines
Hesham Morsy, Michael Li, Chris Davidson, Kat Gu, Maryam Ali,
James Hollingshead, Dharti Patel
West Hertfordshire NHS Hospitals Trust
Aim: Assess compliance of prescription of for intravenous maintenance
fluids in accordance with NICE Guidelines in the acute surgical
admissions population.
Method: Total of 158 patients were included. We collected data
prospectively for surgical patients admitted between 25/02/21–18/03/
21 (first cycle) & 12/09/2021–4/10/2021 (2nd cycle). Maximum of 5
patients daily randomly selected. Data collected in wards after
clerking on Day 1 of admission. Surgical Proforma was used to identify
feeding plan for patients. Drug charts used to assess volume and types
of intravenous fluids prescribed. Admissions by audit authors were
excluded to prevent selection bias.
Intervention: Posters in Emergency Assessment Unit and Wards,
Teaching to junior doctors, Regular reminder messages to on-call teams.
Results: Prescription of Intravenous Maintenance Fluids in Acute
Surgical Patients in compliance with NICE guidelines for IV Fluid
maintenance rose from 6% to 22% between cycle 1 and 2, respectively.
In non-compliant prescriptions, the issue was due to excess volume
(73%), sodium and chloride (88%) as well as inadequate potassium
(75%) and glucose (40%).
Conclusions: Most acute surgical admissions require maintenance
fluids. Some patients did not have their weight recorded which is
necessary for correct calculation of fluid requirements. Some patients
were prescribed maintenance fluids although they were not indicated.
Most patients received an excessive fluid volume, sodium & chloride.
Most patients received inadequate potassium & glucose. Ward based
nursing staff are reluctant to give maintenance fluids containing
potassium. More teaching and awareness on correct prescription of
maintenance fluids is needed.
Abstracts | v129
Abstract citation ID: znac245.089
EP-345 How do we get these lines out?
Tessa Teo1, Adam Alim1, Biruntha Vasanthan1, Abiola Durojaiye,
Fatima De Figueiredo, Raghvinder Gambhir
1
King’s College London
2Department of vascular surgery King’s College Hospital
Aims: The aim of our study was to identify the factors influencing
patient decision-making in conversion from tunnelled lines to arterio-
venous fistulas/ grafts (AVF/G).
Methods: We consented and interviewed 40 patients who were
currently dialysing through lines at a main dialysis unit in a tertiary
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hospital to understand factors influencing their decision. We
designed and implemented a patient intervention education
programme.
Results: Age range 24 to 86 years, (median 59), Females to Males
ratio-1:1.4. Twenty-three patients (57.5%) started dialysis on a
line and have remained on a line, 8 (20%) have a maturing graft and
9 (22.5%) have a fistula that is not maturing well or one that has
failed.
None on lines had had any previous face-to-face education regarding
the benefits of fistulas over lines. After one session, 14/18 patients
(78%) agreed to attend the access clinic. The remaining 5 patients
did not participate in the intervention.
Conclusion: We were able to convert 78% of patients in just one single
face-to-face education session. In the Patient Reported Experience of
Kidney Care in the UK 2020 (PREM) report “Patient experience of
Sharing Decisions About Your Care” received the lowest scores (5.49/7)
among the 13 theme scores. Just providing a leaflet to the patient is
not enough. Hence, an educational intervention like ours should be
made part of the routine practice at all dialysis units.
Reference: The Renal Association and Kidney Care UK (2020) ‘Patient
Reported Experience of Kidney Care in the UK 2020’, p. 14. Available at:
https://renal.org/sites/renal.org/files/KQuIP/PREM report 2021.pdf
Abstract citation ID: znac245.090
EP-346 Laparoscopic extraction of a migrated gastric balloon
from the terminal ileum causing small bowel obstruction
Ahmed ELzaafarany1, Haider Al-Shurafa2
1
East Surrey Hospital
2
Riyadh National Hospital, Riyadh, Saudi Arabia
Aim: Laparoscopic management of small bowel obstruction secondary
to a migrated gastric balloon.
Method: A 57 years old female patient with BMI of 45 presented to ED
by central colicky abdominal pain and recurrent attacks of vomiting
with absolute constipation since 2 days. The patient had history of
insertion of a gastric balloon since a year. On examination:
abdomen: lax soft, mild abdominal distension, central abdominal
tenderness, no signs of peritonitis. observations: Pulse:122bpm, BP
90/60, RR 25. blood tests: WCC 22.0×10 /L and CRP 129 mg/L. Venous
lactate of 4.
PMH:DM type 2, Missed appointments for gastric balloon extraction
about 6months ago.
Admitted under the surgical team resuscitated with IV fluid, IV
antibiotics, sepsis 6 protocol activated. AXR: dilated small bowel
loops.
CT abdomen with I.V and oral contrast revealed impaction of the
gastric balloon at the terminal ileum causing high grade small
bowel obstruction.
Patient had underwent laparoscopic extraction of the migrated
gastric balloon from the terminal ileum and primary closure of the
ileum by endo-stitch.
Patient has smooth recovery postoperatively and discharged home
two days after the surgery.
v130 | Abstracts
This case highlights one of the complication of the gastric balloon
which is migration of a gastric balloon into a terminal ileum as a
result of missed appointments for its extraction after 6 months time.
Conclusion: laparoscopic management of SB obstruction in morbid
obese patient should be the first choice provided that the surgeon has
the required skills and experience.
Abstract citation ID: znac245.091
EP-351 Extended VTE prophylaxis in patients undergoing
elective surgery for colorectal cancer in a district general
hospital and its Compliance with NICE guidelines
Ahmed Elzaafarany, Ahmed Tawfik, Tosin Igbekele, Andrew Day
East Surrey Hospital
Aim: A This audit aims to assess the department’s current compliance
with guidance, understand reasons for non-adherence and implement
a plan of action to improve future compliance and subsequent patient
outcomes.
Background: NICE guidance recommends extended VTE prophylaxis for
up to 28 days post colonic resection for cancer
Methods: A single centre, retrospective, observational study was
performed between January 2018 –January 2019. We included all the
Patients who underwent elective colorectal resections for cancer.
Results: A total of 123 patients had elective elective colorectal resections
for cancer. 91 (73%) were laparoscopically, 8 (6.5%) laparoscopic
converted to open and 24 (19.5%) were done as open operations from
the start. The summary of the operations done were as follows; 62
RHC, 25 HAR and 36 LAR. LMWH for extended VTE prophylaxis for 28
days was prescribed for 91% (112/123) of the patients among the
studied period. 5.7% (7/123) were already receiving alternative
anticoagulation thus the NICE guidance was achieved for 96.7% (119/
123). The patients who did not receive VTE prophylaxis were 3.3%, 4/
123), there was no clinical reason documented or identified for this
omission. A postoperative VTE was experienced in 4.8% (6/123), 3 of
them required a hospital admission (50%). There was no VTE related
mortality documented
Conclusion: This audit has demonstrated 96.7% of patients who
underwent surgery for colorectal cancer received extended VTE
prophylaxis as per NICE guidelines. This is a significant improvement
from previous audit cycle, though the aim is for 100% compliance with
guidelines. We implement plan of action to achieve that
Abstract citation ID: znac245.092
EP-364 The new normal in the post-pandemic world: Our
experience of organising a three-part webinar series for the
CST 2022 Applicants
Atiqur Rahman1, Marwa Badawi1, Mohamed Swamad1, Ramla Ali2,
Elizabeth Vincent2, Elizabeth Sharp2
1
East Sussex Healthcare NHS Trust
2
East Kent Hospitals University NHS Foundation Trust
Introduction: In the time of COVID-19, the influx in the use of the online
platform has been paramount. The surgical world is no exception with
the first virtual selection process for Core Surgical Training (CST) 2021
applicants. We, the current core trainees from the Kent, Surrey and
Sussex (KSS) deanery organised this three-part webinar series for CST
2022 applicants to aid our future colleagues.
Materials and Methods: The event poster was circulated among the
surgical tutors, medical education department across the KSS region,
all the foundation schools and to Foundation Trainees Surgical
Societies (FTSS) across the UK. It was advertised on Facebook, Twitter,
WhatsApp and Eventbrite. Google Workspace was used to manage
registered participants and Microsoft Teams were used for the
webinars.
Discussion: A total of 526 participants registered. 69.9% of them
registered through social media whereas 16.4% and 9.8% through the
medical education department and word of mouth respectively. The
first part covering the CST program overview and self-assessment
guidance was attended by 96 of them on 16 November 2021. The
second part covering interview stations was attended by 29
participants on 14 December 2021. We received positive feedback from
42 and 8 participants following each webinar respectively. We
currently have 88 participants registered for our mock interview
sessions planned for late January 2022.
Conclusions: The virtual selection process is here to stay.
Well-organised events like this will help the candidates prepare well
for their interview as well as helping the current trainees with their
teamwork, leadership and organisation skills.
Abstract citation ID: znac245.093
EP-368 Intraoperative identification of colorectal cancer
lesions using indocyanine green labelled antibodies in
preclinical murine models
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Nicholas Lyons1,2, John Hooper1,2, David Clark2,3, Andrew Riddell2,4,
Thomas Kryza1,2
1
Mater Research Institute
2
University of Queensland
3
RBWH Colorectal Cancer Research Unit
4
RBWH Colorectal Cancer Research Institute
Aims: The ability to identify cancerous tissue intraoperatively has the
potential to allow for real time identification of involved margins,
lymph node involvement and extra-colonic deposits. Here we
investigate whether antibodies targeting a novel receptor,
anonymously referred to as LN1, a frequently over expressed protein
in colorectal cancer (CRC), labelled with indocyanine green (ICG) can
be used for the intraoperative detection of malignant tissue in
preclinical models.
Methods: Representative metastatic CRC models were generated in 20
NSG mice using HCT116 human CRC cells. Mice were treated with
either intravenous ICG labelled LN1 antibodies (LN1-ICG) or control
treatments (untreated, free ICG or cotreatment unlabelled LN1
blocking antibody + LN1-ICG). Signal intensity of normal and
malignant tissue was quantified from near infrared (NIR) endoscopy
and IVIS® in-vivo imaging system.
Results: LN1-ICG labelled antibodies was highly effective in identifying
cancerous lesions down to 500nm diameter. Quantification of NIR and
IVIS images demonstrate significantly greater tumour signal in the
LN1-ICG group versus controls (p=0.004 and p=0.001 respectively).
Examination of normal organ tissues demonstrated signal in the liver
and digestive tract in keeping with hepatobiliary clearance of ICG but
nil further off-site accumulation of LN1-ICG. No difference in signal
from the liver, small bowel or colon was noted between groups (p>0.05).
Conclusion: LN1-ICG labelled antibodies were highly effective at
identifying even small cancerous deposits in murine models. It is
highly likely that these effects could be replicated in human
procedures which may allow for perioperative identification of
extra-colonic deposits, involved tumour margins or lymph node
involvement.
Abstract citation ID: znac245.094
EP-369 Examining EphA2 expression in Colorectal Cancer
Nicholas Lyons1, John Hooper3, Thomas Kryza3, David Clark,
Andrew Riddell,5
1
Mater research institute
2University of Queensland
3
Mater Research Institute
4RBWH Colorectal Research Unit
5
RBWH Colorectal Research Institute
Aims: EphA2 is a potential therapeutic target for the treatment of
colorectal cancer (CRC), however reports of EphA2 expression in CRC
are inconsistent and often lack the context of a normal tissue
comparator. The aim of this investigation is to undertake a detailed
assessment of EphA2 protein expression across a range of
pathological and normal specimens.
Methods: 177 patient specimens (100 paired primary and normal colon,
42 paired primary and metastasis and 35 unpaired samples as part of a
multi-tumour TMA) underwent immunohistochemical analysis (IHC)
probing for EphA2 expression alongside a normal tissue array.
Results: Weak/moderate EphA2 expression was noted in normal tissues
of the proximal GI tract (stomach, small intestine) with little expression
in the colon/rectum with a significant upregulation of EphA2 noted in
primary lesions compared to matched normal tissue controls
(p<0.0001). No difference in expression between stage of disease, sex
or effect of patient age, location of samples (edge vs centre), stage of

disease, T-stage or N-stage. EphA2 expression was significantly higher
in primary lesions associated with M1 disease primaries (p=0.03). No
difference in EphA2 expression was noted between matched primary
and metastatic lesions (p>0.05).
Conclusion: In this study, EphA2 protein expression was significantly
higher in CRC lesions compared to healthy tissue (p<0.0001) with no
diminution noted across a wide range of stages or lesion types. On
this basis, diagnostic or therapeutic interventions targeting EphA2 are
likely to be useful across a wide spectrum of disease.
Abstract citation ID: znac245.095
EP-370 Contemporary clinical management strategies in lower
gastrointestinal bleeding: A single-centre retrospective
observational study
Barbara Julius1, Kin Yik Chan1, Alisha Jaffer2, Yun Hui Liau1,
Shona Tormey1
1 fundoplication for gastro-esophageal reflux disease (GERD) in a
University Hospital Limerick
2 university tertiary care center.
University of Limerick Medical School
Aim: Significant heterogeneity exists in the recommendations for the
diagnosis and management of acute lower gastrointestinal bleeding
(LGIB). This study aims to demonstrate the contemporary
management strategies adopted by a busy tertiary hospital.
Methods: We conducted a single-centre retrospective review of adults
presenting to our institution with LGIB between January and March
2021. Demographic data, observations, laboratory results, endoscopy
and radiology reports, operation notes and discharge summaries were
collected for each patient via a retrospectively maintained registry.
Results: 23 patients were included. Mean age was 66.6 years with a mean
initial haemoglobin of 10.9 g/dL (Range 4.1–15.5g/dL). 17% of patients
were in circulatory shock on presentation. 70% of patients presented
with haematochezia. 47.8% of patients were on either an
anticoagulant or anti-platelet agent at presentation. The transfusion
index in this cohort was 30%. 26.1% of patients had a re-bleed during
their admission. The diagnostic yield of cross-sectional imaging
amongst 11 patients was 27.3% with no correlation with
haemodynamic status or active bleeding. 47.8% of patients underwent
endoscopy and 27% of patients who underwent an endoscopic
procedure required endoscopic haemostasis. Flexible sigmoidoscopy
was the commonest endoscopic modality (55%), followed by
gastroscopy (27%) and colonoscopy (18%). No patients required
surgical or radiological intervention. No cause of bleeding was
identified in 26% of patients.
Conclusion: This study confirms the variation in diagnosis and
management of LGIB. Despite access to onsite interventional
radiology, endoscopy remained the predominant diagnostic and
therapeutic modality. Routine cross-sectional imaging may not be
justified given its suboptimal diagnostic yield.
Abstract citation ID: znac245.096
EP-373 Appropriate requesting of tumor marker, CEA, at a
district hospital in Ireland: An audit cycle to improve practice
Iayla Fatima1,2, Gearoid Murphy1, Niamh Ni Mhaonaigh1,
Adham Sadoon1
1 between delayed and non delayed surgery as per NCEPOD
St. Luke’s General Hospital, Kilkenny, Ireland
2 classification.
Manchester Royal Infirmary, England
Aims: Tumor markers play an important role in oncology and the
appropriate requesting of tumor marker tests are facilitated by
national and international guidelines, inappropriate use increases
both the laboratory workload and overall cost of management. Our
aim was to assess our practice against the ACBI (Association of
Clinical Biochemists in Ireland) guidelines for carcinoembryonic
antigen (CEA) and conduct teaching sessions to improve practice.
Methods: 1st cycle: All carcinoembryonic antigen (CEA) tests ordered in
the hospital between the 1st to 31st of October 2020 were obtained
through the HSE Online Lab Web Inquiry System, files were then
reviewed for indications. Results from the initial audit were presented
to the department and two separate teaching sessions were
conducted to educate on the guidelines. 2nd cycle: All CEA test
ordered from 1st January to 28th February 2021 were obtained,
re-audited and results were compared.
Abstracts | v131
Results: 76% of the tests ordered by General Surgery in the second cycle
were appropriately ordered and incorrectly ordered tests decreased
from 35.7% to 23.8%.
Conclusions: Through the process of this audit an improvement was
seen in practice of the department. More tests ordered adhered to
indications in guidelines.
Abstract citation ID: znac245.097
EP-379 Day-case laparoscopic Nissen fundoplication.
Experience from a tertiary center
Dimitra Peristeri, Shameen Jaunoo
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Surgery Department, Brighton and Sussex University Hospitals NHS
Trust-Esophagogastric Research Group
Aim: For day-case laparoscopic surgery to be successful, patient
selection is of the utmost importance. This study aimed to assess the
acceptability, feasibility, and results of day-case laparoscopic
Methods: A Day-case surgery for GERD was proposed routinely to all
patients with proven asymptomatic, uncomplicated GERD. All of
them were fulfilling predetermined inclusion criteria from January
2020 and December 2021. All patients underwent standard
anesthetic, surgical, analgesic, and antiemetic protocols. Patient
age, social circumstances, and other demographics were also
recorded as well as any comorbidities and ASA score. The primary
endpoint measured was the rate of readmission and complication
rates.
Results: Of 23 patients undergoing laparoscopic fundoplication for
GERD during the study period, 16 (69.56%) had day-case procedures.
Most of them (81.6%) were discharged 6 to 8h after operation. Five
patients were converted to in-patient hospitalization because of
nausea (n=1), inadequate pain control (n=3), or anxiety (n=1). There
were no complications and no re-admissions recorded.
Conclusion: Day-case laparoscopic Nissen fundoplication is a feasible,
effective, and safe option for treating selected patients with
gastroesophageal reflux disease (GERD) subject to careful patient
selection and surgeon expertise.
Abstract citation ID: znac245.098
EP-383 Correlation between delays to emergency laparotomy
and outcomes at a large District General Hospital (DGH)
Maitreyi Patel, Joel Joy Thomas, Xavier Aguayo, Daniel Gutmann,
Mehmood Wain
Department of General Surgery, Barking, Havering and Redbridge University
Hospitals NHS Trust
Aims: Significant morbidity and mortality are associated with
emergency laparotomies. Delays to theatre inevitably increase the risk
of sepsis, deterioration, failure to rescue and death. The aim of our
study was to determine the outcomes associated with delays of
non-vascular emergency laparotomies at a large DGH.
Methods: A retrospective review of a prospectively maintained
database was performed of all patients who underwent general
surgical emergency laparotomy over a 10 week period from 10th June
2021 to 25th September 2021. Outcomes of patients were compared
Results: 76 patients were included in the study, 46.05% were males. 15
(19.74%) patients had a delay to surgery. The most common indication
for surgery was obstruction (63.16%), followed by perforation (27.63%).
The patients requiring urgent surgery were least likely to arrive in
theatre within the correct timeframe. 18.34% of patients experienced
a delay if a decision is made for surgery during the day (0800–2000)
compared to 30% at night (0000–0800). Severe complications, (Grade
3 and 4 on Clavien Dindo classification) occurred in 13% of those
who had a delay to surgery, compared to 16% in those without
delays. Total 30-day mortality was 9.2%. There was no significant
difference in the outcomes of patients who had a delay and those
who did not.
Conclusion: Delay in arrival to theatre was more amongst patients
requiring urgent surgery. The time of day or week did not affect the
time to theatre. Delay did not result in significant difference in
outcomes.
v132 | Abstracts
Abstract citation ID: znac245.099
EP-384 Surgical site infections: A prospective study of
incidence and risk factors at a District General Hospital
Maitreyi Patel1, Adam Anad2, Ibrahim Warrag2, Ahmed Abidia2
1
Department of General Surgery, Barking, Havering and Redbridge University
Hospitals NHS Trust
2
Department of General Surgery, The Princess Alexandra Hospital NHS Trust
Aims: To determine the incidence of surgical site infection (SSI)amongst
patients undergoing general surgery between 1/10/2020 to 30/11/2020
and identify factors associated with SSI.
Methods: Data of adult patients operated between October 10, 2020, and
November, 2020 was prospectively collected. Southampton wound
scoring was used for categorizing the wound complication. Patient
data was collected using electronic patient records. Data were
analyzed using Excel Microsoft 2016. Chi square and t-test were used
for analysis as appropriate. P-value < 0.05 was considered statistically
significant.
Results: The overall incidence of SSI was 13.84% (22 out of 159 patients).
The associated risk factors (p<.05) were found to be an increased age, pre
operative haemoglobin <100, type of surgery, longer duration of surgery
(> 2 h), post operative critical care admission and prolonged duration of
hospital stay. Most patients (36%) had Southampton grade of III. They
were all managed conservatively with antibiotics and dressing.
Emergency surgery did not significantly increase risk of SSI.
Conclusion: Our data suggests that these risk factors could be
considered as indicators of SSI. Relevant strategies for targeting the
at-risk patients to optimize the modifiable factors where feasible,
would enable to decrease the incidence of surgical site infections.
Emergency surgery did not significantly increase risk of SSI.
Abstract citation ID: znac245.100
EP-393 Antegrade Colonic Enema (ACE) Stoma beyond
Childhood: A Literature Review
Tehmina Nadeem, Muhammad Umair, Katherine Mockford
Hull Royal Infirmary/Castle Hill Hospital
Background: Refractory constipation and faecal incontinence among
adults is a common presentation to surgical clinics. ACE stoma has
been tried and proven as a successful treatment modality in children.
Although it is an acceptable treatment modality in adults, there is
little prospective evidence available regarding its use and hence it has
not yet come in vogue.
Methods: A literature review was carried out using PubMed, Cochrane
Library, Embase, Cinahl and Scopus for studies involving ACE stoma in
adults with refractory constipation or faecal incontinence; with a view
to determine ACE Stoma as a safe treatment modality among adult
population.
Results: A total of 27 studies were identified through database searches.
6 full text articles were included in the literature review describing a
total of 209 adult patients; with male to female ratio of 1:3.4, mean age
of 35 years and a mean follow up of 42.9 months. Complications
discussed include perioperative and long-term stenosis (29%) and leak
rates (60%); affecting the quality of life. No statistical difference was
noted among the different types of ACE Conduit used. There was
significant heterogeneity amongst the studies.
Conclusions: ACE stoma is not without complications; however studies
reveal that this can be offered as a safe treatment modality among
carefully selected adult patients for the treatment of refractory
constipation or fecal incontinence.
Keywords: Adults, Refractory Constipation, Faecal Incontinence,
Antegrade Colonic Enema (ACE) Stoma
Abstract citation ID: znac245.101
EP-408 Colonic mucosal dehiscence in a patient with ischemic
colitis- A case report
Fatima Rauf, Fakhar Munir Sial, Muhammad Hanif, Tashfeen Farooq,
Alifa Sabir, Huma Sabir Khan
Benazir Bhutto Hospital, Rawalpindi
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.
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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.
Abstract citation ID: znac245.102
EP-410 Improving data quality for emergency surgery: the
effect of a dedicated NELA Fellow in a general surgical unit
Madara Kronberga, Arin Saha
Calderdale and Huddersfield NHS Trust
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.
Abstract citation ID: znac245.103
EP-415 The use of gastrografin in the management of adhesive
small bowel obstruction
Y Vijayakumar, S Kim, N Kumaran, H Habib, K Malik
Northampton General Hospital NHS Trust
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.
Abstract citation ID: znac245.104
EP-420 Delayed primary repair of zone 2 flexor tendon injury
after 4 weeks: Does it work?
Amir Labib, Vidhya Lingamanaicker, Emily Fay, Megan Blakeway,
Andrew Fleming
St. George’s University Hospitals NHS Trust
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.
Abstract citation ID: znac245.105
EP-422 Operating in the outpatient department: the future of
flexor tendon repair?
Anthony Rayner1, Ahmed Mohamed2, Mark Mikhail3,
Matthew Gardiner4
1
Department of General Surgery, University Hospitals Sussex NHS Foundation
Trust, Chichester, UK
2
Department of General Surgery, Frimley Health NHS Foundation Trust, Slough,
UK
3
Department of Plastic Surgery, Chelsea and Westminster Hospital NHS
Foundation Trust, London, UK
4 of abdominal pain, not tolerating oral feeds on a background of being
Department of Plastic Surgery, Frimley Health NHS Foundation Trust, Slough,
UK
Aims: Flexor tendon injuries are debilitating with rupture of repair
leading to significant morbidity. The SARS-CoV-2 pandemic has led to
a shift to out-of-theatre operating, with many flexor tendon repairs
being performed on the same day as initial assessment in our
outpatient department (OPD) procedure room. We aimed to compare
the rupture rates before and after the start of the pandemic to assess
the safety of this change in practice.
Methods: Patients who underwent repair of one or more flexor tendons
were included from two six-month periods: July to December 2019 and
April to September 2020. Patient records were reviewed to identify
Abstracts | v133
operation location, number of flexor tendons repaired per patient and
rupture incidence. In the second period, patients whose operation was
performed in theatre were excluded.
Results: 28 patients were included for the initial period with a total of 49
flexor tendons injured. All repairs were performed in theatre and 3
ruptures were recorded (6%). 17 patients underwent flexor tendon
repair during the second period. 11 patients were operated on in the
OPD with a total of 16 flexor tendons injured. 1 rupture was recorded
(6%).
Conclusions: The rupture rate of OPD operating is comparable to that of
the traditional theatre pathway. OPD operating also allowed us to
circumvent theatre waiting lists and thus avoid costly delays to
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patient care. This project demonstrates maintained safety for patients
and offers a platform for further research to confirm OPD operating as
a viable and sustainable alternative for future practice.
Abstract citation ID: znac245.106
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’
Adam Ismail, Pranav H Patel, Chetan Parmar
Department of Bariatric and Upper GI Surgery, Whittington Health NHS
Foundation Trust
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.
Abstract citation ID: znac245.107
EP-440 A novel approach to extraction of a bezoar
Kirolos Abdelsaid, Balaji Jayasankar, Yasser Abdul Aal, Charles Bailey
Maidstone and Tunbridge Wells NHS
Introduction: A young girl presented with a confounding clinical picture
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
v134 | Abstracts
Abstract citation ID: znac245.108
EP-449 Gall Bladder Torsion - A twist in tale
Balaji Jayasankar, Yasser Abdul Aal, Francois Porte, Shoaib Saeed
Maidstone and Tunbridge Wells NHS
Introduction: A 90 year old lady presented with history of sudden onset
abdominal pain. The pain was continuous, severe with a tender abdomen.
Methods: Blood investigations were not conclusive. A CT of the
abdomen revealed a possible torsion of the gall bladder around its axis
with impending gangrene. She went on to have a successful
emergency laparoscopic cholecystectomy.
Results: A work up and successful surgical intervention with an
extremely unusual gall bladder presentation of torsion.
Abstract citation ID: znac245.109
EP-458 Robotic surgery improves outcomes for patients with
benign and malignant colorectal conditions
Athanasios Karategos, Ja’quay Farquharson, Ben Liu, Nuha Yassin
Royal Wolverhampton NHS Trust
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.
Abstract citation ID: znac245.110
EP-468 Impact of COVID19 on surgical training
Katherine Fox1, Benjamin Parkin2
1
Golden Jubilee National Hospital
2
Forth Valley Royal Hospital
Aims:
1) To explore how the COVID19 pandemic has impacted surgical training
2) To establish how this might impact trainees moving forwards
3) To establish ways to mitigate these effects, aside from increased
theatre time
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.
Abstract citation ID: znac245.111
EP-473 Laparoscopy versus Laparotomy for Abdominal
Trauma: a Case of Iatrogenic Haemoperitoneum in a
Haemodynamically Unstable patient
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Stavroula Stavropoulou - Tatla1, Dora Imad2, Armin Fardanesh1,
Spiridon Volteas2
1
Royal Free NHS Foundation Trust, London, UK
2
Hippokration General Hospital, Athens, Greece
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.
Abstract citation ID: znac245.112
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
Chloe Rodger1, Kinza Fatima1, Thomas Trinder1, Feldheim McGivney2,
Keith Hussey2
1
Glasgow University Medical School, Glasgow, Scotland
2
Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow,
Scotland
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.
Abstract citation ID: znac245.113
EP-482 What is the evidence from in vivo studies that
mesenchymal stem cell derived extracellular vesicles can
facilitate tendon and ligament repair?
Victor Lu1, Maria Tennyson1, James Zhang1, Wasim Khan2
1
University of Cambridge
2
Addenbrooke’s Hospital, Cambridge
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.
Abstract citation ID: znac245.114
EP-483 Adipose Tissue-Derived Mesenchymal Stem Cells as a
potential restorative treatment for Cartilage Defects: A PRISMA
review and Meta-analysis
Henry Meng1, Victor Lu, Wasim Khan3
1
Chinese University of Hong Kong
2University of Cambridge
3 PRECICE® nail - A Case Report
Addenbrooke’s Hospital, Cambridge
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.
Abstracts | v135
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<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<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<0.001).
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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.
Abstract citation ID: znac245.115
EP-488 Pre-operative electronic checklists as a systematic
method to improve patient care
Srushti Bhat1, Nada Al Yasen2, Periklis Perikleous1, Kelvin Lau1
1
St. Bartholomew’s Hospital, London, UK
2
Queen Mary University of London, Barts and the London School of Medicine and
Dentistry
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.
Abstract citation ID: znac245.116
EP-490 Management of femoral non-union with
post-traumatic bone defect using second-generation
Victor Lu1, James Zhang1, Matija Krkovic2
1
University of Cambridge
2
Addenbrooke’s Hospital, Cambridge
Introduction: The management of post-traumatic bone defects with
non-union remains a surgical challenge. Common limb length
discrepancy (LLD) procedures involve Masquelet technique,
vascularised bone grafts, distraction osteogenesis using external
fixators, yet they pose a functional and economical challenge for
patients, given high complication rates and need for revision surgery.
Magnetically-driven PRECICE nails are self-lengthening internal
devices activated via an external controller. We present one patient
with post-traumatic femoral non-union with concomitant bone
defect, using second-generation PRECICE nail.
v136 | Abstracts
Case: One 57 year-old gentlemen suffered open femoral fracture after a
motorcycle accident. Having previously undergone open reduction
internal fixation, he presented to us with atrophic non-union and
bone defect, which were simultaneously treated with a
second-generation PRECICE nail. Our treatment protocol was based on
the strain theory, and involved initial distraction by ∼5mm at
non-union site, at a rate of 1mm per day, to decrease strain on bone
graft cells and promote callus formation. One week later, the
non-union site was compressed to close the gap completely. After
another four weeks, distraction using the PRECICE nail started, in
increments of 0.25mm, four times a day, until the desired length was
achieved. The patient achieved union and the initially planned limb
lengthening regime was achieved with minimal complications.
Conclusions: By initially distracting the bone defect by ∼5mm, then
compressing the gap, before distraction started, strain on bone graft
cells was minimised, allowing robust callus and regenerate growth.
Self-lengthening, magnetically-driven PRECICE nails can successfully
restore union and manage limb length discrepancies with reasonable
patient satisfaction and minimal complications.
Abstract citation ID: znac245.117
EP-491 Retrograde Hindfoot Nailing for the Treatment of Acute
Ankle Fractures in the Elderly - A Systematic Review and
Meta-Analysis
Victor Lu1, Maria Tennyson1, Andrew Zhou1, Mary Fortune2,
Azeem Thahir3, Matija Krkovic3
1
University of Cambridge
2
Department of Public Health and Primary Care, University of Cambridge,
Cambridge
3
Addenbrooke’s Hospital, Cambridge
Aim: Fragility ankle fractures are traditionally managed conservatively
or with open reduction internal fixation (ORIF). Tibiotalocalcaneal (TTC)
nailing is an alternative option for the geriatric patient. This
meta-analysis provides the most detailed analysis of hindfoot nailing
for fragility ankle fractures.
Methods: A systematic search was performed on MEDLINE, EMBASE,
Cochrane Library, Scopus, Web of Science, identifying fourteen studies
for inclusion. Studies including patients over 60 with a fragility ankle
fracture, treated with TTC nail were included. Patients with a previous
fracture of the ipsilateral limb, fibular nails, and pathological fractures
were excluded.
Meta-regression analyses were performed to explore sources of
heterogeneity, and publication bias was assessed using Egger’s test.
Results: 312 ankle fractures were included. The mean age was 77.3 (32–
101) years. 26.9% were male, and 41.9% were diabetics. The pooled
proportion of superficial infection, deep infection, implant failure,
malunion, and all-cause mortality was 0.10 (95%CI:0.06–0.16; I2=44%),
0.08 (95%CI:0.06–0.11, I2=0%), 0.11 (95%CI:0.07–0.15, I2=0%), 0.11 (95%
CI:0.06–0.18; I2=51%), and 0.27 (95%CI:0.20–0.34; I2=11%), respectively.
The pooled mean post-operative OMAS score was 54.07 (95%CI:48.98–
59.16; I2=85%). The best-fitting meta-regression model included age
and percentage of male patients as covariates (p=0.0263), and were
inversely correlated with higher OMAS scores. Egger’s test (p=0.56)
showed no significant publication bias.
Conclusion: TTC nailing is an adequate alternative option for fragility
ankle fracture management. However, current evidence includes
mainly case series with inconsistent outcome measures reported and
post-operative rehabilitation protocols. Prospective RCTs with long
follow-up times and large cohort sizes are needed to clearly guide the
use of TTC nailing for ankle fractures.
Abstract citation ID: znac245.118
EP-494 Ankle Fusion with Tibiotalocalcaneal Retrograde Nail
for Fragility Ankle Fractures: Outcomes at a Major Trauma
Centre
Victor Lu1, Maria Tennyson1, James Zhang1, Andrew Zhou1,
Azeem Thahir2, Matija Krkovic2
1
University of Cambridge
2
Addenbrooke’s Hospital, Cambridge
Aim: Fragility ankles fractures in the geriatric population are
challenging to manage, due to fracture instability, soft tissue
compromise, and patient co-morbidities. Traditional management
options include open reduction internal fixation, or conservative
treatment, both of which are fraught with high complication rates. We
aimed to present functional outcomes of elderly patients with fragility
ankle fractures treated with retrograde ankle fusion nails.
Method: 171 patients received a tibiotalocalcaneal nail over a six-year
period, but only twenty met the inclusion criteria of being over sixty and
having poor bone stock. Primary outcome was mortality risk from
co-morbidities according to Charlson co-morbidity index (CCI), and
patients’ post-operative mobility status compared to pre-operative
mobility. Secondary outcomes include intra-operative and post-operative
complications, six-month mortality rate, time to mobilisation and union.
Results: Mean age was 77.82 years old. The average CCI was 5.05.
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Thirteen patients returned to their pre-operative mobility state.
Patients with low CCI are more likely to return to pre-operative
mobility status (p=0.16;OR=4.00).
Average time to bone union and mobilisation were 92.5 days and 7.63
days, respectively. Mean post-operative AOFAS ankle-hindfoot and
Olerud-Molander scores were 53.0 and 50.9, respectively. There were
four cases of superficial infection. Patients with high CCI were more
likely to acquire superficial infections (p=0.264,OR=3.857). There were
no deep infections, periprosthetic fractures, nail breakages,
non-unions. Average follow-up time was 499.3 days.
Conclusions: Tibiotalocalcaneal nailing is an effective and safe option
for managing fragility ankle fractures in the elderly. This technique
leads to lower complication rates and earlier mobilisation than
traditional fixation methods.
Abstract citation ID: znac245.119
EP-496 Hip Arthroscopy for the Primary Management of
Femoroacetabular Impingement with Concomitant Chondral
Lesions - A Systematic Review and Meta-Analysis
Victor Lu1, Octavian Andronic2, James Zhang1, Vikas Khanduja2
1
University of Cambridge
2
Young Adult Hip Service, Department of Trauma and Orthopaedics,
Addenbrooke’s Hospital, Cambridge
Introduction: Femoroacetabular impingement (FAI) is an important cause
of hip pain in the young, active population. Treated by hip arthroscopy
(HA), chondral lesions are frequently seen, and there are concerns that
patients with chondral defects leading to hip osteoarthritis (OA) will not
benefit from HA. This review analyses the use of HA in FAI patients with
chondral lesions according to Outerbridge classification.
Methods: A systematic search was performed on MEDLINE, EMBASE,
Cochrane Library, Web of Science. From twenty-four included studies,
patient related outcome measures (PROMs), total hip arthroplasty
(THA) conversion rate, radiological outcomes were collected. Clinical
studies of HA used for primary FAI management, classifying chondral
lesions according to Outerbridge classification were included. Patients
treated with open procedure, osteonecrosis, Legg-Calve-Perthes
disease, previous ipsilateral hip fractures were excluded. Risk of bias
was assessed using ROBINS-I.
Results: Improved post-operative PROMs included mHHS (n=18; mean
difference:-2.42; 95%CI:-2.99 to -1.85; p<0.0001), NAHS (n=8; mean
difference:-1.73; 95%CI: -2.23 to -1.23; p<0.0001), VAS (n=7;
mean difference:2.03; 95%CI:0.93–3.13; p<0.0001). Pooled rate of
revision surgery was 10% (95%CI: 7%-14%). Most of this included
conversion to THA, with a 7% pooled rate (95%CI: 4%-11%).
Patients had worse PROMs if they underwent HA with labral
debridement (p=0.0149), have Outerbridge 3 and 4 lesions (p=0.0116),
kissing lesions (p=0.0292). Reconstructive cartilage techniques were
superior to microfracture (p=0.0416). Even in “kissing" lesions,
employing either microfracture or cartilage repair/reconstruction
provided a benefit in PROMs (p=0.0267).
Conclusion: This meta-analysis suggests that acceptable post-operative
outcomes following HA in patients with FAI and concomitant
moderate-to-severe chondral lesions, can be achieved.
Abstract citation ID: znac245.120
EP-499 Is cleaner and greener NHS a pipe dream or a real
possibility?
Shruti Bodapati1, Raghvinder Pal Singh Gambhir2, Shiori Kimura2
1
University Hospitals Plymouth NHS Trust
2
King’s College Hospital NHS Trust
 Abstracts | v137

Aim: In October 2020, the NHS committed to become the world’s first
carbon net-zero National Health Service by 2045. The aim of the study
was to see what is Surgeon’s role towards sustainability.
Methods: To review the Sustainable NHS with target of Net zero NHS
proposal and analyse the changes being implemented at national and
regional level. To assess how the surgical practice needs to contribute.
Results: Operating theatres contribute 30% of hospitals carbon footprint
as the NHS contributes to nearly 5% of the country’s carbon emissions.
Exhaled anaesthetic gases are major contributors to the greenhouse
effect and account for 5% of NHS foot print. Switch to more renewable
sources of energy, to LED lights will offset some of that as will local
products in the Supply chains.
the Whittington Hospital, an audit was conducted to determine how
closely the guidelines are being followed and whether that is reflected
in the documentation.
Methodology: We evaluated 57 outpatient letters in the first cycle and 36
in the second. Our intervention was a poster of the guidelines in all clinic
rooms for all consenting doctors to see prior to talking to patients.
The four criteria were:
1) Informing the patient of their diagnosis and prognosis and uncertainties
surrounding diagnosis including options for further investigations.
2) Informing the patient of alternative treatments available, including
the option to take no action
3) The nature of each option, what would be involved and the desired

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In theatres abandoning the use of single use plastics and switching to
reusable instruments, as well as water free hand washes will help. outcome
Blue-zone technologies’ that capture, reclaim and purify halogenated 4) The potential benefits and risks of each option include the option to
agents should become a standard practice. Record of daily theatre take no action
waste is not being recorded.
Optimal use of video technology for remote clinics and providing Results:
diagnostics and some interventions at non hospital sites will decrease
patients need to travel and their carbon footprint.
Number of criteria met Number of patient letters
Conclusions: There is need to accelerate awareness and encourage
evaluated in the first cycle
surgical care groups to change practice. Green sustainable theatres
have to be standard in all new builds. Specialty specific, theatre waste 0/4 21
analysis reports need to be presented in Monthly audits. 1/4 16
Reference: 1. https://www.gov.uk/government/news/uk-health-services- 2/4 7
make-landmark-pledge-to-achieve-net-zero 3/4 12
4/4 1
TOTAL 57
Abstract citation ID: znac245.121
EP-503 An Audit of Day case surgery for Inguinal Hernia Repair
Number of criteria met Number of patient letters
Nadia Gulnaz, Farhan Akram, Ilaria Masala, G.Murtaza Dar, evaluated the second cycle
Khurram Siddique
Royal Oldham Hospital 0/4 6
1/4 6
Aims: To compare the trust-wide performance with the standard by the 2/4 13
British Association of Day Surgery in the management of inguinal 3/4 9
hernias. 4/4 2
Methods: Electronic data of patients who underwent Inguinal Hernia TOTAL 36
Repairs in the trust from September 2019 to December 2019 was analyzed.
Results: A total of 122 male and 11 female patients had hernias repaired
in this time period.18 were emergency while the rest of the cases were
elective. The ages ranged from 19–91 with a mean age of 62. Of the 115
Conclusion: We see slight improvement during the second cycle. Still,
electives, 60% were performed as day-case. The mean length of stay
the numbers are not satisfactory. A third audit cycle will be conducted
was 1.7days (R 0–12).34 out of 46 (74%) patients who stayed inpatient
once another round of interventions is implemented.
were actually booked as day-case. 73% had no documented reason for
their admission.4 patients were admitted for medical reasons 2 for
post-operative surgical complications. Of patients pre-booked as
Abstract citation ID: znac245.123
inpatients,10 were quoted to have serious medical issues while 5 had
no clear reason. The vast majority had open repairs while 26% of the EP-506 Kidney transplant rejection rate comparing
115 patients had laparoscopic repairs. Alemtuzumab versus Basiliximab during covid pandemic
Conclusion: Our Performance was noted to be 30% lower than the BADS against pre-covid period
standard. There is a need of:
Jason Rai, Sanjay Sinha
Development of inpatient surgery booking criteria and adherence.
Oxford Transplant Centre, Old Road, Headington, Oxford
Discussion with anesthetic colleagues to assist drive towards day-case
surgery. Aims: To review kidney transplant rejection rate following change in
Clear documentation in the clinical letters to explain the reason for immunosuppression regime due to covid pandemic. Induction
inpatient management and booking. immunosuppression changed from Alemtuzumab pre-covid to
Perioperative notes need improvement. Basiliximab during covid pandemic period. Maintenance
immunosuppressant included the addition of prednisolone to
tacrolimus and mycophenolate in the covid period.
Abstract citation ID: znac245.122
Methods: Retrospective analysis of patients that underwent cadaveric
EP-505 Audit assessing compliance with General Medical kidney transplant in a single transplant surgical unit. Rejection was
Council (GMC) guidelines at Whittington Hospital Colorectal confirmed following transplant kidney biopsy.
Department (NHS Trust) Results: Total of 192 patient records were reviewed. 96 patients
underwent kidney transplant between March to November 2019
Nikolaos Efthymiou1, William Braithwaite2, Rami Benhimda1,
(pre-covid group). 96 patients underwent kidney transplant between
Mohamad Iskandarani1, Hasan Mukhtar1
1 March to July 2020 (covid pandemic group). Rejection number
Whittington Hospital
2 pre-covid group was 6 (total number of biopsy was 30). Rejection
UCLH
number covid group was 5 (total number of biopsy was 14). Pre-covid
Introduction: The General Medical Council (GMC) released new group follow up was for 16 months. Covid group follow up period was
guidelines titled ‘Decision making and consent’, which came into for 6 months.
effect on the 9th of November 2020. It contains guidelines and Conclusions: Early follow up result suggests possibly higher rejection
standards for consenting patients for elective procedures and the rate with Basiliximab when compared to Alemtuzumab group. Longer
documentation of said consent. Within the Colorectal Department of term follow up in post-covid kidney transplant needs to be carried out
v138 | Abstracts
to draw stronger conclusion. Risk of lymphocyte depleting induction
agent during covid crisis versus potential higher risk of rejection with
non-depleting agent needs to be balanced.
Abstract citation ID: znac245.124
EP-511 The influence of the national lockdown during the
COVID-19 pandemic on surgical presentations and admissions
in a university hospital
Vedika Dhunnoo, Iram Haq, Olga Rutka
Aintree University Hospital
Background: The COVID-19 pandemic has significantly revolutionised
medical practice around the world. Healthcare resources had to be
prioritise for the management of patients infected with the virus
whilst routine and elective surgeries were postponed in order to free
up hospital beds in anticipation for the influx of patients with
COVID-19 requiring hospital admission. With the government
announcing a national lockdown in March 2020, a striking reduction
in the number of patients presenting to hospital was noted.
Aim: Our aim was to establish how the COVID-19 pandemic has
impacted on the number and presentations of general surgical
patients in a university hospital.
Method: We conducted a retrospective study on general surgical
patients who were reviewed by the surgical team at the University
teaching hospital. Data was collected over two 7-weeks periods;
between the 23rd March and 10th May 2020 (the first lockdown
duration in the UK) and the corresponding 7-weeks in 2019 (that is
between 25th March and 12th May 2019).
Results: The analysis of our data showed that there was a significant
reduction in the number of surgical patients being admitted. 399
patients were admitted between 25th March and 12th May 2019
compared to only 245 patients during the lockdown period. The
average admissions per day over the 7-weeks period dropped from 9
admissions per day in 2019 to 5 admission per day during national
lockdown. Small bowel obstruction and pancreatitis remained
common diagnoses in both 7-weeks periods, however diverticulitis
was less common during lockdown.
Abstract citation ID: znac245.125
EP-519 A Bit of a Headache: Management of Head Injuries in a
District General Hospital
Nikki Bruce, Jamie Young
NHS Borders
Aim: Head Injury is a common presentation in our DGH, which covers a
large rural area and is now a regional trauma centre. We audited our
management of head injuries against current guidelines and planned
a new pathway to ensure patients receive the correct advice and
follow up on discharge.
Method: Data was requested from IT for all head injury episodes in 2019,
to reflect usual numbers pre-pandemic.
Electronic letters, radiology and notes were used to identify whether
imaging criteria was met/carried out, discharge destinations,
re-presentations, specialty discussions, and head injury advice on
discharge.
Results: 307 individual patients identified.
13 re-presentations.
10 required neurosurgical discussions.
Destinations: 226 (73.6%) discharged direct from ED. Admissions;
Surgical - 37 (12%), Medical - 6 (2%), Paeds – 14 (4.5%), ITU 2 (0.7%), Did
not wait – 2 (0.7%), Not Recorded – 7 (2.3%).
Imaging: 100 patients met NICE criteria for CT, 100% were documented
in notes and had CT. 76% reported normal, 18% had a bleed, contusion or
haematoma.
HI advice 90% of ED discharges, 16% of Surgical and 16% of Medical
discharges had head injury discharge advice documented.
Conclusions: Guidelines were met for 100% of patients requiring
imaging Head injury advice was well documented in ED but fell down
in ward paperwork.
We have written a robust pathway where all inpatients have a proforma
completed during admission with prompts for discharge advice and
rehab referral where appropriate, this is currently undergoing a
re-audit to ensure improvement and if successful will become an
established part of the trauma pathway in our hospital.
Abstract citation ID: znac245.126
EP-524 Implementing Simulation Based Learning (SBL) to
Reduce the Gap in Surgical Training, A Theoretical Evaluation
Approach
Marwa Badawi1, Afroza Sharmin2, Aliaa Shamardal3, Ahmed Shalaby1
1
East Sussex Healthcare Trust, Conquest Hospital, Hastings
2
John Radcliffe Hospital, Oxford
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3
Kettering General Hospital
Background: The current surgical training is severely affected by
COVID-19 pandemic with redeployment and reduced number of
elective procedure across NHS hospitals, this has affected both core
and higher surgical trainees, rendering the traditional apprenticeship
model obsolete. It became evident that the future of Surgical training
and innovation will require a combination of simulation and operative
exposure to overcome the obstacle of reduced exposure in surgical
education and operative training.
Discussion: In our theoretical analysis, we will discuss the efficacy,
safety and impact of relying on SBL to fill the gaps in surgical training.
Clinical exposure alone will not be sufficient to train procedure based
speciality trainees to their highest proficiency. SBL is one design that
is supported by learning theories such as Transformational Learning
and Experiential Learning Theory.
In a high fidelity simulation, such as laparoscopic simulation courses, all
concepts of facilitated learning are fulfilled which strongly supports our
hypothesis.
On balance, given the complexity of skills learnt, it remains difficult to
measure the efficacy of transferring the learnt capabilities into
practice and standardise this among learners. SBL also leaves
non-technical skills un-assessed in depth.
Conclusion: The disruption of training due to COVID-19 affected our
procedure based learning, this leaves us with a dilemma to catch-up
with these unmet training needs. SBL could be one of the adjuncts
that fill in the gaps on the short and medium term. Implementing SBL
in surgical training curriculum, should be evaluated for efficacy and
cost effectiveness.
Abstract citation ID: znac245.127
EP-534 Review of Types of Intravenous Fluid and Rate of
Administration in Resuscitation of Acute Pancreatitis Patients
Iskandar Rakhimov, Marwa Badawi, Sara Lee, Tsz Lun (Allenis) Mak
East Sussex Healthcare Trust, Conquest Hospital, Hastings
Aim: Acute pancreatitis even in its mildest form leads to dehydration
that requires correction by intravenous fluid in timely fashion. The
pathophysiology of fluid deficit is caused by fluid shift as a result of
severe inflammation in the abdomen, lung damage and compromise
to renal functions.
The evidence behind choice of fluid used for resuscitation is limited, but
delayed resuscitation is linked to increased mortality, however overly
aggressive fluid administration could lead to lung injuries.
Aggressive fluid resuscitation is defined as 15ml/kg/hour or >3.1L in
the first 24 hours while conservative administration is defined as
5–10ml/kg/hour.
Methods: We reviewed our admissions with acute pancreatitis in
August & September 2021. The age range was 24–94 years, diagnosis
was confirmed by raised amylase, clinical symptoms and radiological
evidence.
55.5% received Hartman’s solution, 18.5% of patients received normal
saline and 26% received both. The mean amount of fluids was 3Litres
and the mean rate of first, second and third Litres was 4hours, 3.4
hours and 3.7 hours/Litre respectively in the first 24 hours.
Results: The mean LOS was 3.2 days, none of our patients were
re-admitted for complications related to pancreatitis within 90 days, 1
patient had complicated necrotising pancreatitis and 1 patient
deceased during their stay.
Conclusion: NICE guideline NG104 did not specify clear guidance on rate
of fluid resuscitation, low quality evidence suggested possible benefit of
aggressive therapy comparing mortality and systemic complications.
We recommend individual assessment of rate of fluid administration

for every patient to ensure absence of contraindications to aggressive
therapy.
Abstract citation ID: znac245.128
EP-546 Management of breast cancer in different age groups
during pandemic single institute review
Nazli Muhibullah1, James Ng2, Giulio Cuffolo3, Lisa Whisker2
1
Royal Derby Hospital
2
University Hospital Nottingham
3
Berkshire NHS Foundation Trust
Introduction: Covid 19 has huge impact on healthcare in general and
challenges in cancer services in particular. In breast cancer
prioritization strategies for management have been introduced at
start of pandemic by different medical associations.
Aim: We aim to see impact of prioritization strategy in treatment of
premenopausal and postmenopausal breast cancer patient. This is
further stratified as under 50, 50 to 70 and over 70.
Methods: A prospectively collected database from March 2020 to March
2021 analysed. This include patient demographic, tumour
characteristics, Neoadjuvanct endocrine NAET), Neoadjuvanct
chemotherapy (NACT), primary endocrine (PE), type of surgery: breast
conservation surgery (BCS) with or without oncoplastic procedure,
Mastectomy with or without reconstruction and utilization of private
sectors.
Results: Total 454 patients reviewed. Mean age 61 yrs (26–97yrs).
Total patient less than 50 years were 116. BCS 66 (57%), Simple
mastectomy 26 (22%), Mastectomy with reconstruction 24 (20%).In this
group 45 patients were offered NACT and 6 patients had NAET.
Total patients older than 50 years were 236. BCS 191 (80%), Simple
mastectomy 38 (16%) and Mastectomy with reconstruction 7(3%)
patients. In this group 69 patients had NACT and 13 had NAET.
Patients over 70 years were 102. BCS 57(56%), Simple mastectomy
25(24%), 1 (1%) had mastectomy and reconstruction. 8 patients had
NACT, 13 had NAET and 30 had primary endocrine.
Conclusion: Due to swift guidelines in pandemic times breast cancer
services were largely intact and provide standard care.
Abstract citation ID: znac245.129
EP-553 A Review of feedback for the Surgical department
teaching for foundation doctors
Nadia Gulnaz1, Sadia Tasleem2, Khurrum Siddique1
1
Royal Oldham Hospital
2
Shefield Teaching Hospital
Aims: To assess the usefulness of departmental teaching for the
foundation doctors.
Methods: Teaching sessions are arranged every Friday covering the
most common surgical problems and the management steps
appropriate for their level. A feedback questionnaire was sent out to
the foundation doctors at the end of their rotation and the data was
analyzed for the period of August 2020 to November 2020.
Results: The feedback completion rate was 93%. 18 sessions were
planned 14 of which went ahead. 1 session was canceled due to junior
doctors shortage. Maximum attendees in any session were 10/14
(mean 7) Almost all of them found these sessions useful to and agreed
to recommend attending (6–10 on Likert score of 0–10) 75% rated these
sessions as "excellent" and all the rest as "very good". 76% showed
satisfaction with the time and space allocation. 84% agreed that the
session length of 1 hour was adequate. 91% were happy with the
adequacy of communication from the organizer. A vast majority
suggested flexibility in session timings and relief from ward jobs for
improved attendance.
Conclusion: Overall Positive Response. Most suggested the timings/
days be changed.
The topics covered were appropriate for their level and helped them in
their daily practice.
Interactive and simulations sessions were the most appreciated
ones.
Some necessary changes to rota were suggested in order to make
these sessions more accessible and useful.
Abstracts | v139
Abstract citation ID: znac245.130
EP-555 The telescoping sigmoid – a rare presentation of acute
large bowel obstruction
Ali Al-Sabbagh, Shaker Alseifi, G Kaur
Scunthorpe General Hospital
Background: Adult bowel intussusception is a rare cause of bowel
obstruction (1–5%) and requires urgent treatment, usually emergency
surgery.
Aim: We wish to highlight the diagnosis and management of the rare
entity of acute bowel obstruction secondary to intussusception with
our adult patient with sigmoid colon intussusception.
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Case Presentation: We present a 65 years old male who attended with
constipation, abdominal discomfort and per-rectal bleeding. Clinical
examination revealed multiple subcutaneous lipomas, mild LUQ
tenderness and large ‘lump’ 10 cm from anal verge on rigid
sigmoidoscopy. CT abdomen/pelvis showed intussusception of the
sigmoid into the rectum with a large ‘polyp’ as the lead point. On-
table Flexible sigmoidoscopy was unsuccessful in reducing the
intussusception. We proceeded to laparotomy with reduction of
intussusception, high anterior resection with end- to- end stapled
anastomosis. He made an excellent recovery. Post-operative histology
which was reviewed in detail in MDT did not reveal any neoplastic/
lipomatous lesion to account for the intussusception. The patient was
very well on outpatient review.
Conclusion: Adult bowel intussusception is rare (5% of all
intussusceptions), especially in the left colon. When it does occur, it
is usually secondary to lipoma, neoplasm, or nodal mass acting as a
lead point. These patients can be diagnostically challenging due to
lack of clear obstructive symptoms on presentation. Early diagnosis
(via a CT scan) and treatment of adult colonic intussusception
(usually via surgery) is necessary to avoid serious complications
such as bowel perforation/peritonitis. Postoperative histology
review is also imperative to plan any appropriate further
management.
Abstract citation ID: znac245.131
EP-565 Four different causes of bowel obstruction in single
patient – case report and review of management of small bowel
obstruction
Ugam Shah, Simon Lau, Tasveer Javed, G Kaur
Scunthorpe General Hospital
Introduction: The most common causes of Small bowel obstruction
(SBO) in adults are adhesions, hernias, cancer, Crohn’s, Diverticulitis,
volvulus, etc; in children, intussusception. Overall mortality is 10%,
increasing to 30% with complications. Urgent investigation, aggressive
medical management and appropriate timely surgery are key to
successful outcome.
Aim: We present a patient with 4 causes of bowel obstruction due to a
single pathology, to highlight different causes and management of
SBO with the aim of improving patient outcomes.
Case presentation: A 55 year old lady presented with SBO, and mass RIF.
CT demonstrated subacute SBO. Four causes of obstruction were found
at laparotomy 1. intraluminal lesion proximal jejunum
2. intussuscepting ileal lesion 3. terminal - ileal lesion perforated
/adherent to pelvic side wall, and 4. RIF mass lesion from ascending
colon. Right hemicolectomy + terminal ileal resection (lesions 2, 3, 4)
and jejunal resection-anastomosis (lesion 1) were performed. She
made a good post- operative recovery. Histology found the
morphological appearances and immunoprofile were soft tissue
sarcoma arising in the GIT: gastrointestinal clear cell sarcoma/
malignant gastrointestinal neuroectodermal tumour. She is under
review with the specialist regional sarcoma team.
Conclusion: There are over 22 000 admissions for bowel obstruction in
England/Wales each year; 6.4% result in death within 90 days.
Depending on the cause, SBO may resolve with medical therapy but
timely surgery is needed for total obstruction, complications such as
bowel perforation, ischaemia, or failure of conservative therapy. Our
case report highlights the importance of urgent investigations and
appropriate management of SBO.
v140 | Abstracts
Abstract citation ID: znac245.132
EP-566 A case series analysis of intestinal ischemia in
COVID- 19 pandemic
Darshan B M, Kasa Somasekhar
Vijayanagar Institute of Medical Sciences, Bellary
Aims: To determine the presentation and outcomes of cases of
intestinal Ischemia amidst COVID -19 pandemic and to review latest
guidelines in its management.
Methods: A case series analysis of 11 patients admitted and managed
under Department of Surgery, over a duration of 17 months from
September 2020 to January 2022.
Results: Out of the total of 11 cases of intestinal ischemia, 4 were
COVID-19 positive, overall mortality was 54.5% and patients with
COVID-19 were found to have 100% mortality. Mortality in
conservatively managed patients was also 100%, Mortality in
surgically managed patients was 55.5%. Preoperative acidosis, hypoxia
and hypotension were found to be important determinants of
outcome of the disease.
Conclusion: Occurrence of intestinal Ischemia in COVID - 19 patients is
a life threatening complication which demands surgical management
with significant mortality.
Treatment of COVID - 19 and intestinal Ischemia should go
simultaneously and in line with the latest evidence based guidelines
of COVID 19, Patients who survive an acute event are likely to die of
other complications related to the COVID-19 like ARDS, Disseminated
Intravascular Coagulation etc that could have predisposed them to
intestinal ischemia
Abstract citation ID: znac245.133
EP-567 Stress Thrombosis - A case of spontaneous DVT of
upper extremity
Darshan B M, Kasa Somasekhar
Vijayanagara Institute of Medical Sciences
Background: Primary spontaneous upper extremity deep vein
thrombosis is rare with an estimated annual incidence of 1 to 2 cases
per 100,000 population. The majority of cases are secondary and
related to central venous cannulation (eg, central line, pacemaker) or
prothrombotic states. On the offset of COVID-19 pandemic such cases
could become a common entity.
Case Report: An elderly diabetic and hypertensive female patient
presented with a history of acute onset swelling, heaviness, tingling
and numbness of left upper limb since 1 week. Examination revealed,
diffuse swelling of left upper limb extending to neck with small
dilated veins in left upper chest. A provisional diagnosis of left upper
limb DVT was made based on Constants criteria and was confirmed
on Duplex scanning.
The patient was started on LMWH for anticoagulation. Evaluation for
occult cancers was unremarkable. Patient showed symptomatic
improvement and recanalisation of thrombosed veins was noted on
repeat duplex scan.
Conclusion: Upper extremity DVT (UEDVT), once a rare entity, can be
seldom thought of, due to widespread interventions and ongoing
COVID-19 pandemic. Focus on evaluation of occult malignancy rather
for hypercoagulable states which do not change the management.
This case report highlights the importance of early recognition of
UEDVT and stresses on the evidence that no added benefit is achieved
by performing expensive tests to rule out prothrombotic states. Early
diagnosis based on Constants criteria and anticoagulation would save
time and prevent grave complications.
Abstract citation ID: znac245.134
EP-568 A prospective study on single layer bowel repair
Darshan B M, Kasa Somasekhar
Vijayanagara Institute of Medical Sciences
Aim: To determine the efficacy of single layer bowel repair with respect
to postoperative complications such as leakage rates, duration of repair,
overall length of hospital stay, cost effectiveness, to assess the
morbidity, mortality and outcome.
Methods: This prospective study was done on 21 patients admitted
under department of surgery from the period of January 2020 to
September 2021. All the patients under bowel repair in continuous
single layer extramucosal fashion for various etiology, follow up data
was collected and analysed.
Results: In our study, 81% (17 cases) of the single layer bowel repair were
done in an emergency setting. The study consisted of 42.9% (9 cases) of
perforation repair and 57.1% (12 cases of resection and anastomosis of
large or small bowel). The average time duration of anastomosis was
14.45 minutes with the average hospital stay of 13.2 days. Our study
showed an anastomotic leak rate of 9.5% (2 cases) with an overall
mortality of 19.04% (4 cases) which included 2 cases with COVID-19
related ARDS.
Conclusion: Our study was determined to analyse the effectiveness of
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single layer bowel repair and found that it is a quicker and
theoretically better technique for bowel repair which avoids
unnecessary tissue ischemia. The leakage rates within the study was
comparable with other studies published and the studies with double
layer bowel repair technique in terms of leak rates and mortality. A
meticulously done single layer repair will best double layer repair and
surgical trainees must be trained early to perfect the art of bowel
anastomosis.
Abstract citation ID: znac245.135
EP-569 Case Report: An unusual case of prodigious
Gigantomastia with macroprolactinemia and suspected
autoimmune disease
Mariam Malik, Phil Brookes, Matthew J Green, Mohammad Iqbal Kasana
Walsall Healthcare NHS Trust
Macroprolactinemia is characterized by most authors, as a benign
condition with no clinical implications. Gigantomastia is the
progressive breast enlargement, usually bilateral. Due to its rare
presentation, fewer numbers of cases have been reported and its
association has yet to be fully established. It is usually presented
during puberty and pregnancy and its association with
hyperprolactinemia, macroprolactinemia, and autoimmune diseases
are reported but in small numbers. Its management is improving the
clinical symptoms and it varies from case to case. A 47 female
premenopausal with sudden onset of massive enlargement of the
bilateral breast without galactorrhea over 18 months. She also noticed
joint pain and swelling with her breast enlargement. She was referred
to the breast clinic for managing breast-related symptoms associated
with gigantomastia like mastalgia, neck and back pain, postural
issues, and recurrent breast skin eruptions. Her serum investigation
showed a Prolactin level of 1708 mIU/L and was also referred to an
endocrinologist to rule out prolactinoma. She underwent bilateral
breast reduction and a total of 12 KG breast tissue from both breasts
were removed and she is under further investigation for autoimmune
diseases. The present report followed this patient from diagnosis,
surgical intervention, and establishing its association to any other
condition. Even though gigantomastia is an erratic condition and is a
rare entity, its timely investigation and association to other clinical
conditions like hyperprolactinemia or macroprolactinemia and
arthritis are essential in the efficacious management of this condition.
Gigantomastia outside the reproductive age group needs further
research.
Abstract citation ID: znac245.136
EP-570 Rare case of pre-pyloric perforation of stomach
secondary to foreign body ingestion
Lucy Hopkisson, Anang Pangeni, Ashish Shrestha
William Harvey Hospital
Background: Gastrointestinal perforation remains a common cause of
acute abdomen in clinical practice. However, pre-pyloric perforation
secondary to ingested foreign body (FB) in the adult population is rare.
Nearly 80–90% of ingested foreign bodies will pass through the GI
system spontaneously with only 1% requiring surgery. We report a
rare incidence of pre-pyloric perforation in a patient unaware of
ingestion of any foreign body.
Case presentation: A 59 year old female with no medical history,
presented to the ED department with severe epigastric pain, vomiting
and fever. She had a peritonitic abdomen and corroborative
inflammatory markers. An urgent computed tomography scan
demonstrated a 7×5cm collection near the transverse colon and a

linear streak of hyperdense material near the collection. Patient had no
recollection of ingestion of FB. Diagnostic laparoscopy followed by
laparotomy, revealed inflammation and necrotic adipose tissue
between the transverse colon and stomach walling of a purulent
cavity. A 2cm shard of glass was retrieved. Examination of the
posterior wall of the stomach eventually located the site of
perforation. Generous washout, debridement and suture repair with
omental plug was performed. She made an uneventful recovery.
Conclusion: Sharp objects do not pass via the pylorus easily and can
cause perforation in the proximal part of gastrointestinal tract. Any
features of complication mandates exploration and examination of
the posterior surface of the stomach is quintessential
Abstract citation ID: znac245.137
EP-573 Does type of surgery influence recurrence of breast
cancer in younger patients?
Alexia Farrugia, Matt Green, Phil Brookes, Iqbal Kasana
Walsall Manor Hospital
It is well established that young age is a risk factor for outcome of breast
cancer, and younger women are more likely to have adverse prognostic
factors. Our aim was to investigate whether type of surgery (wide local
excision vs mastectomy) had any effect on local or distant recurrence
in women under the age of 35.
All women with breast cancer under the age of 35 treated between 1st
January 2010 and 31st December 2020 were included. Data including
age at diagnosis, comorbidities, type of surgery, neoadjuvant/adjuvant
treatment, histology, lymph node positivity, expression of receptors,
local/distant recurrence was collected.
There were 34 patients included, age range 21–34. Ten patients had a
wide local excision (WLE) while the rest had a mastectomy. Four
patients had local recurrence while nine patients had distal
recurrence. In WLE group 1 out of 10 had local recurrence and 2 out of
10 had distant metastasis (one of these patients had both). In
mastectomy group 2 out of 24 had local recurrence and 7 out of 24 had
distant metastasis (two patients had both). The average recurrence
time was 1.7 years after initial diagnosis. Using a Chi-square test,
there was no significant difference found for local, distant or overall
recurrence between patients having wide local excision or
mastectomy (p=0.719, p=0.554, p=0.462 respectively).
Type of surgery did not affect the local or distant recurrence rate. The
sample size is small, and a larger series is required to determine
whether it is equally safer to offer WLE to younger women.
Abstract citation ID: znac245.138
EP-574 Improving gentamicin prescribing for intra-abdominal
sepsis on a general surgical firm
Armin Fardanesh1, Hei-Fen Koo2, Christen Van den Berghe3,
George Gathercole3, Stella Dilke3, Neel Sengupta3
1
University College London Hospital, London, UK
2
Royal Free NHS Foundation Trust
3
Royal Free NHS Foundation Trust, London, UK
Aim: Gentamicin is recommended by local guidelines for the empirical
treatment of intra-abdominal sepsis. However, severe side effects that
can occur through prolonged raised trough levels requires its use
through a specific dosing protocol. Challenges of this means it often
“falls off” the drug chart, leading to suboptimal drug-levels. The aim of
this quality improvement project was to improve the process of
gentamicin prescription.
Methods: A two-week retrospective analysis of all patients admitted
was performed to obtain baseline data. Information was collected on
gentamicin use, if levels were taken at 6–14 hours post-dose, and if
subsequently correctly re-prescribed. PDSA 1 involved placing posters
in the surgical office, reminding the clerking doctor of the gentamicin
protocol. PDSA 2 involved a departmental teaching session to reiterate
the above intervention.
Results: At baseline, only 7% (1/15) of patients prescribed gentamicin
had a correct post-dose level taken and subsequently received a
correct second dose. After PDSA 1, this rose to 67% (2/3). After PDSA 2,
this level was similar at 60% (3/5). Furthermore, at baseline 47% (15/32)
of patients deemed to have intra-abdominal sepsis received
gentamicin. After PDSA 1, this proportion fell to 11% (3/28) and after
PDSA 2 this was 38% (5/13).
Abstracts | v141
Conclusion: Education sessions and posters were effective at increasing
the proportion of patients that received a safely prescribed second dose
of gentamicin, as a result of correctly taken trough levels. However, a
reduction in the percentage of patients receiving gentamicin for
intra-abdominal sepsis possibly suggests further education on the role
of gentamicin is required.
Abstract citation ID: znac245.139
EP-575 Exhaled volatile organic compounds in the detection of
colorectal cancer: A systematic seview and meta-analysis
Daniah Alsaadi1,2, Nicolle Clements2, Natiya Gabuniya3,1,
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Manish Chand1, Francis Nader4,1
1
The Division of Surgery and Interventional Science, University College London,
London, UK
2
Clinical Research Facility Galway, Galway University Hospital, National
University of Ireland, Galway, Republic of Ireland
3
Plastic and Reconstructive Surgery Department, Guy’s and St Thomas’ Hospital,
London, UK
4
Department of General Surgery, Yeovil District Hospital NHS Foundation Trust,
Yeovil, UK.
Aims: There is an apparent need for novel non-invasive colorectal
cancer (CRC) screening tests that are more acceptable to patients and
can reliably detect CRC or reduce the number of unnecessary
colonoscopies performed in cancer-free patients. An emerging
number of studies demonstrate the potential value of exhaled volatile
organic compounds (VOCs) as a diagnostic and triaging test for CRC. A
systematic appraisal and meta-analysis of the published evidence was
done to determine whether exhaled VOCs can be used in the detection
and screening of CRC.
Methods: Nine electronic databases were searched from inception of
the databases until August 2020. Quantitative and descriptive data of
CRC patients and healthy control (HC) participants who underwent
VOCs breath analysis was extracted. In addition, where possible,
sampling methods, analytical platforms, processors, and specific
breath biomarkers found in each study were recorded.
Results: Fourteen articles were included in the systematic review with
491 colorectal patients and 754 HC participants (n=1245). Sub-group
meta-analysis was conducted on nine of those articles and the pooled
sensitivity was estimated to be 0.89 (95% CI = 0.80–0.99) whereas
specificity was 0.83 (95% CI = 0.74–0.92). Heterogeneity of pooled
sensitivity and specificity was estimated as I2=11.11%.
Conclusions: Although this study was limited by small sample size and
different analytical platforms, the proposed future framework resolves
such limitations and standardizes future research. It is reasonable to
deduce that VOCs breath analysis is certainly a field of research that
can progress to replace traditional methods within the framework of
CRC screening and diagnosis.
Abstract citation ID: znac245.140
EP-577 Seasonal Variation of Presentation of Perforated Peptic
Ulcer Disease: An Overview of Patient Demographics,
Management and Outcomes in Northern Ireland
Bakhat Yawar, Ahmed Marzouk, Heba Ali, Tamer Ghorab, Ayeisha Asim,
Mohammad Abousamra, Asim Asim
Altnagelvin Area Hospital
Background: Perforated peptic ulcer disease is one of the most common
causes of acute peritonitis. It carries significant mortality and morbidity.
Several previous studies have reported a seasonal variation in
presentation of patients with perforated ulcers. Here we present this
study from a Northern Irish perspective on perforated peptic ulcers.
Methods: A retrospective cohort study was conducted on perforated
peptic ulcer patients who presented to Altnagelvin Area Hospital
emergency department between 2015 to 2020. Data on patient
demographics, clinical presentation, investigations, management and
outcomes were collected. Primary outcome was to investigate if
seasonality was associated with incidence of perforated peptic ulcers.
Followup data was also collected. Seasons were defined as per UK Met
Office.
Results: A total of 50 patients presented with perforated PUD. Male:
female ratio was approximately 3:2. Peaks were noted in spring and
winter. April was the most common month for presentation followed
by December. Smoking was the most common risk factor followed by
v142 | Abstracts
alcohol abuse. 14 patients (28%) were either very frail or had contained
perforations and were conservatively managed. 3 deaths were noted
(6%). 13 patients (26%) required ICU admission at some stage in their
management.
Conclusions: Slight seasonal variation was noted in presentation of
perforated peptic ulcers in our study with more common incidence in
winter and spring months. The month of April was noted to have the
peak incidence of the disease in our study.
Abstract citation ID: znac245.141
EP-581 Prophylactic onlay mesh at emergency laparotomy:
Promising early outcomes with long-acting synthetic
resorbable mesh
Daniah Alsaadi1,2, Ian Stephens2, Lydia O. Simmons2, Magda Bucholc3,
Michael Sugrue4
1 from the time of admission up to discharge and then follow up, in a
Clinical Research Facility Galway, Galway University Hospital, National
University of Ireland, Galway, Republic of Ireland
2 Kingdom.
Department of Surgery, Letterkenny University Hospital, County Donegal,
Ireland
3
Intelligent Systems Research Centre, School of Computing, Engineering &
Intelligent Systems, Ulster University, Derry, UK
4
Donegal Clinical Research Academy, Letterkenny University Hospital, Co
Donegal, Ireland
Background: Careful surgical strategy is paramount in balancing the
prevention of fascial dehiscence, incisional hernia (IH) and fear of
additional mesh-related wound complications post-laparotomy. This
study aims to review early outcomes of patients undergoing an
emergency laparotomy with prophylactic long-acting resorbable
synthetic TIGR® mesh, used to reduce early fascial dehiscence and
potential subsequent IH.
Methods: A retrospective, ethically approved review of 24 consecutive
patients undergoing prophylactic TIGR® mesh placement during
emergency laparotomies by a single surgeon between January 2017
and June 2021 at a University Hospital. A standardised approach
included onlay positioning of the mesh, small-bite fascial closure, and
a wound bundle. We recorded patient demographics, operative
indications, findings, degree of peritonitis, postoperative
complications, and mortality.
Results: The study included 24 patients; 16/24 (66.6%) were female and
mean age was 66.5 (range 31–86); 14/24 patients were ASA grade III or
greater; 4/24 patients (16.6%) developed six complications and 3/6
occurred in a single patient. Complications included subphrenic
abscess, seroma, intrabdominal hematoma, enterocutaneous fistula
leading to deep wound infection and small bowel perforation. Five
(20.8%) patients died in hospital; central venous catheter sepsis (n=1),
fungal septicaemia (n=1) and multiorgan failure (n=3). Surgical site
infection and seroma rates were low, occurring in 2/24 patients (4%
each).
Conclusions: This small study has identified that prophylactic onlay
mesh in patients undergoing an emergency laparotomy is not
associated with significant wound infection or seroma when used
with an active wound bundle. The wider use of TIGR® to prevent
fascial dehiscence and potential long-term IH prevention should be
considered.
Abstract citation ID: znac245.142
EP-582 Giant bilateral intrathoracic involvement from
pseudomyxoma peritonei
Gabriel Hunduma, Roy Kukreja, Lukacs Veres, Alessandro Tamburrini
University Hospital Southampton NHS Foundation Trust
A 46 year old male never smoker was referred to the unit for
investigation of progressively worsening shortness of breath, 9
months after being treated for pseudomyxoma peritoneum. He had
completed 3 cycles of CAPOX chemotherapy followed by total
colectomy and hyper-thermic intraperitoneal chemotherapy (HIPEC).
Computed tomography showed very extensive and bulky bilateral
intrathoracic disease with large infiltrations in the parietal and
visceral pleura, pericardium and diaphragm, suggesting significant
intrathoracic extension of pseudomyxoma peritoneum.
Following MDT discussion, pleurectomy and decortication with
cytoreductive intent was performed. A pleural mass measuring 5cm
was resected, along with drainage of copious amounts of yellow
gelatinous material. Extra-pleural dissection was continued up to the
apex from the mediastinum and diaphragm. Pericardial tissue was
also resected and reconstructed with a vycril mesh. He was
discharged home on postoperative day 6 and found to have significant
improvement in his symptoms 3 months after surgery.
Abstract citation ID: znac245.143
EP-583 Review of lower limb orthoplastic flap monitoring
protocol
Anannya Ghosh Dastidar1, Earl Gardner2, Mohamed Abdelrahman2
1
Darlington Memorial Hospital
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2
James Cook University Hospital
Aim: To improve upon the existing muscle and fascio-cutaneous flap
monitoring protocol. The objective is to follow the patient’s journey
tertiary care hospital in the Northern region of England, United
Method: The patients were selected from the online plastic surgery
audit tool regularly used for documentation, handover and
maintaining continuity of care. We looked at the patients requiring
free muscle flaps, pedicled muscle flaps and fascio-cutaneous flaps,
following fractures sustained to the lower limb, from April 2016 to
April 2021. The exclusion criteria were elective free flaps or pedicled
flaps and open fracture with no wound management concerns.
The parameters being evaluated were patient observations, flap
observations, urine output, bloods, intravenous fluids,
patient-controlled analgesia, oxygen, dressing, nutrition, mobility and
follow up. Following analysis of the results, a more standardised
protocol was distributed across the wards. The response to the new
monitoring protocol was measured based on continuity of care, staff
satisfaction and outcomes.
Results: There was an initial need for standardisation of monitoring
protocols and elimination of multiple charts. This included the
nutrition status, use of blood products, dressings and physiotherapy,
in addition to the previously mentioned parameters.
Conclusion: The staff feedback was positive and felt better equipped. It
removed the ambiguity and patients were aware of their follow up dates
prior discharge. The collaboration with the physiotherapy team was
well coordinated. This led to an organised recovery period.
Abstract citation ID: znac245.144
EP-584 An evaluation of plastic surgery operation note
documentation in line with RCS standards
Benjamin Carhart1, Rahul Khanna2, William Mwaura3
1
Royal Bolton NHS Foundation Trust
2
Warrington and Halton Hospitals NHS Trust
3
Royal Blackburn Hospital
Aim: To assess the extent to which operation note documentation had
been completed accurately, in line with Royal College of Surgeons (RCS)
standards, in a local plastic surgery department.
Methods: Using an RCS good surgical practice guideline, operation notes
from cases in January 2021 were reviewed. A total of 112 procedures that
were undertaken in both theatres and plastics dressing clinic were
audited. The results were collated and analysed using Microsoft Excel.
As a result of data analysis, interventions were created whereby
results were presented at a local meeting and guidelines were
disseminated via WhatsApp to members of the surgical team. A
re-audit then occurred using all plastic surgery procedures in May
2021, totalling 112 patients again.
Results: The first cycle demonstrated that the majority of the guideline
subsections were met well. This included a defined operative
diagnosis (96% of notes) and operative findings (97% of notes).
However, some guidelines including problems/complications (17% of
notes) and DVT prophylaxis (0.01% notes) were not adhered to as
appropriately. The re-audit concluded that nine subsections of the
guideline improved from the first cycle. This included operative
diagnosis (96% first cycle, 100% second cycle) and details of closure
technique (81% first cycle, 95% second cycle). Notably problems/
complications (17% first cycle, 41% second cycle) also improved.
Conclusions: Initially, the guideline was met to a reasonable standard,
however, improvements were made following the intervention. This

led to an improvement in the documentation of nine subsections of this
guideline.
Abstract citation ID: znac245.145
EP-585 An Evaluation of Plastic Surgery Post-Operative Follow
Up Planning in Line With Local Guidelines
Rahul Khanna1, Benjamin Carhart2, William Mwaura3
1
Warrington and Halton Hospitals NHS Trust
2
Royal Bolton NHS Foundation Trust
3
Royal Blackburn Hospital
Aim: Post-operative follow up is an important aspect of surgical
management plans. This audit evaluated whether the documentation
of post operative follow up plans within plastic surgery operation
notes, for three common operation categories, adhered to local
guidelines.
Methods: This audit looked at one month’s worth of follow up plans
within a plastic surgery department in 2021. Specifically, the
documentation within the operation note was audited for three
operation categories: tendon repairs, K wire insertions and
manipulations under anaesthetic (MUA). These operation notes were
compared to local follow up guidelines and adherence was analysed.
The results were presented within the department. Posters displaying
the guidelines were created and placed in theatres, as well as
circulated via WhatsApp. A second cycle was then undertaken.
Results: Each operation category guideline, consisted of various aspects
of recommended follow up. Issues noted from the first cycle included an
inaccuracy in the timing of follow up appointments. This was
particularly evident in the MUA category where only 55% of cases
having follow up appointments documented for the correct date.
Following intervention, the K wire one week follow up appointment
documentation improved from 40% to 67%.
Conclusions: Overall, an improvement in adherence to guidelines was
observed during the second cycle following the intervention. The best
impact was seen in the K-wire category, where all three aspects of
that specific follow up guideline showed an increase in compliance.
Publicising the follow up guidelines had a positive impact on the
documentation of surgical follow up plans.
Abstract citation ID: znac245.146
EP-589 Acute Surgical Referrals from Emergency
Department - A Retrospective Audit
Mohamad Nazmi M Nordin, Lynne Sutton
The Grange University Hospital, Cwmbran
Aim: Emergency Department (ED) is a major source of admission for
patients presenting with acute surgical issues. The Royal College of
Surgeons of England recommends that a patient requiring an
emergency surgical assessment, will receive an appropriate
assessment within 30 minutes of referral being made in the case of
life- or limb- threatening emergencies, and within 60 minutes for a
routine emergency referral. However, there is a huge challenge to
achieve this, given the limited time, capacity and resources, in ED and
inpatient services. We aim to evaluate abdominal pain referral to
general surgery from ED, with an emphasis on the initial diagnosis,
admission rate, time from referral to assessment and operative
management.
Methods: All patients with abdominal pain who were referred to general
surgeons, were retrieved from a local electronic database. Primary
outcomes include the diagnosis for abdominal pain, admission rate,
time from referral to surgical review and operative management.
Results: 81 patients with abdominal pain were referred to general
surgeons within a period of seven days. 56 patients (69.1%) had a
surgical diagnosis, and 25 patients (30.9%) had a non-surgical
diagnosis. 63 patients (77.8%) were admitted as inpatients and 16
patients (19.8%) were discharged. The time from referral to surgical
review ranged between 5 minutes to 476 minutes (mean = 103
minutes). 16 patients (19.8%) had surgical intervention.
Conclusion: The mean time from referral to surgical assessment is 103
minutes, which is longer than the standard recommendation from RCS
England. Measures should be taken to expedite surgical assessment
following referral from ED.
Abstracts | v143
Abstract citation ID: znac245.147
EP-592 Hepatic abscess secondary to intrahepatic migration of
ingested foreign body: A Case Report
Annabelle White, Marwa Badawi, Naomi Cruikshank,
Iskandar Rakhimov
Conquest Hospital
Introduction: Cryptogenic liver abscesses present a unique diagnostic
and therapeutic challenge, especially in patients with delayed
presentation. Presence of a foreign body, not always immediately
apparent on imaging, can explain treatment failure of presumed
cryptogenic liver abscesses, often requiring surgical or endoscopic
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removal for abscess resolution.
Case: We described the case of a 20-year-old female patient, previously
fit and well with no surgical or medical history of note. She initially
presented to a DGH A&E department following ingestion of a pen,
and was discharged clinically stable following review of an
inconclusive chest x-ray. She represented 5 months later with
ongoing epigastric pain and nausea, and underwent a CT scan
showing the foreign body perforating her duodenum and continuing
up to the right lobe of the liver where it lay within an abscess. She
was immediately started on intravenous antibiotics, and referred to a
local hepato-pancreato-biliary unit where she underwent a
laparotomy and removal of the object.
Conclusion: This was an unusual case due to the duration of foreign
body being in situ, and the patient remaining haemodynamically
stable throughout and systemically well. Upon review of the
literature, we found 60 cases reported of liver abscesses secondary to
foreign body ingestion, and key areas for right lobe abscesses
originate from perforation of either first or second part of the
duodenum, pylorus or antrum of stomach. Due to the diagnostic
challenge presented by these patients, diagnostic algorithms
including indirect evidence of FB migration including of fistula tracts
or adhesions have been suggested.
Abstract citation ID: znac245.148
EP-593 Blind loop mucocele of a side-to-end colorectal
anastomosis as a rare cause of large bowel obstruction
Luke Peacock1,2, Anang Pangeni2, Samip Prakash2, Venkata Sontenam2,
Ashish Shrestha2, Veera Allu2
1
St George’s, University of London, London, UK
2
William Harvey Hospital, Kent, UK
Background: Large bowel obstruction (LBO) after colorectal surgery
draws wide differentials. Very few reports of LBO secondary to closed
loop mucocele have been published. To our knowledge, LBO due to
mucocele of the blind colonic limb of a side-to-end colorectal
anastomosis has not been described.
Case Details: A 57-year-old man presented with pain, gradual
abdominal distension and one week history of constipation. He had
extensive surgical history – colo-vesical fistula takedown, sigmoid
resection and Hartmann type end colostomy followed by reversal,
and mesh repair of incisional ventral hernia among others. Notably,
a side-to-end configuration was fashioned as a descending
colo-rectal anastomosis. CT, followed by MRI scans, of the abdomen
and pelvis respectively suggested a mucus-filled short blind colonic
bowel segment compressing the anastomotic site as the cause of
large bowel obstruction proximal to the site. On flexible
sigmoidoscopy under general anaesthesia, external compression of
the rectum with narrowing of the lumen was noted. Transrectal
needle aspiration of the blind colonic segment yielded 145 mL of
mucoid fluid and allowed proximal examination. Anastomotic site
was of normal calibre.
The patient’s symptoms improved and he was discharged with
scheduled outpatient follow-up. Gastrografin enema post-discharge
demonstrated an end-to-side rectosigmoid anastomosis with local
rectal stenosis and showed the blind loop had emptied.
Conclusion: This case highlights that blind colonic loop mucoceles in
colorectal anastomosis can rarely cause obstruction and endoscopic
management is feasible when accurate diagnosis is confirmed on
imaging.
v144 | Abstracts
Abstract citation ID: znac245.149
EP-595 The Use of Scrotal Compression Following Large Open
Inguinoscrotal Hernia Repairs
Damilola Jesuyajolu1,2, Paul Jesuyajolu1
1
First Graceland Hospital
2
Salford Royal NHS Trust
Aims: Large inguinoscrotal hernias are endemic in Sub-Saharan Africa,
and scrotal edema is a common complication following surgery. The use
of scrotal compression has been advised, especially in tropical regions,
to reduce its incidence. We aimed to determine the rate of usage of
scrotal compression following large inguinoscrotal hernia repairs as
recommended.
Method: A review of all herniorrhaphies done for large inguinoscrotal
hernias over one year in the hospital was carried out to evaluate the
application of scrotal compression post-op.
Results: Out of the 22 large inguinoscrotal hernia repairs done, 12 of
them did not have a scrotal compression post-surgery.
Discussion/ Conclusion: Due to the deep dissection needed during open
hernia repairs, as well as the potential space left after surgery, there is a
tendency for fluid to collect in the space, leading to an edematous
scrotum. Although not mandatory, the use of scrotal compression
confers some benefits in preventing the occurrence of scrotal edema.
Following the presentation of the findings to the department and a
re-audit, there was increased usage of scrotal compression and a
reduced incidence of post-operative scrotal edema. The use of scrotal
compression is a useful tool in reducing the incidence of scrotal edema.
Abstract citation ID: znac245.150
EP-601 Biodegradable stents for benign oesophageal
strictures- a single centre experience
Reece-Bolton Obuobi, Yirupaiahgari Viswanath
James Cook University Hospital, Middlesborough
Biodegradable (BD) stents have been used for the management of
various oesophageal strictures (ES). The present study aim to evaluate
our experience and efficacy of BD stents in benign ES at the
endoscopic unit at the James Cook University Hospital,
Middlesbrough, UK.
Methods: A retrospective review of case notes of 9 patients who have
undergone endoscopically placement of BD stent for benign ES
between March 2010 and November 2020. All 9 patients underwent
successful stent placement. None of the patients had previous surgery
for their condition. All patients, prior to stenting had oesophageal
dilatations, some multiple times.
Results: Stent placement was successful in all 9 patients. Some patients
had stent migration and subsequent re stenting. All patients had benign
ES as the cause of dysphagia. One patient had caustic oesophageal
stricture, remaining eight had peptic ulceration and GORD as the
cause of dysphagia. The median number of dilatations prior to stent
placement was 4 (IQR 7), more than the median number of dilatations
post stent placement which was 2.0 (IQR: 3.5).
Conclusion: BD stents offers prolonged dilatation-free interval and
reduces the number dilatations in patients with benign oesophageal
strictures.
Abstract citation ID: znac245.151
EP-602 The impact of COVD-19 on the surgical management of
acute cholecystitis
Christopher Leiberman, Georgis Kizis, Anna-Marie Leipner,
Julianne Hendry
Queen Elizabeth University Hospital, Glasgow
Aim: The Association of Upper Gastrointestinal Surgeons (AUGIS)
recommends performing a laparoscopic cholecystectomy within 72
hours of admission for acute cholecystitis. COVID-19 has drastically
affected the way healthcare is able to be delivered worldwide. This
project was designed to audit the impact of COVID-19 on the surgical
management of acute cholecystitis against AUGIS guidelines.
Methods: All general surgical admission from November 2020 were
retrospectively analysed. Admission records were screened for those
presenting with acute cholecystitis. Those identified had their records
analysed for laparoscopic cholecystectomy. Patients who died before
surgery, had an alternative procedure performed, or who were unfit
for surgery, were excluded.
Results: During this time, 28 patients were admitted with acute
cholecystitis. In total, 3 patients were excluded: 1 died before any
possible intervention, 1 was unfit for surgery, and 1 received a
cholecystostomy. Of the 25 included patients, only 11% (n=3) patients
received a laparoscopic cholecystectomy within seven days from their
hospital admission. The remaining 89% (n=22) of patients were
managed conservatively with fluids, analgesia, and antibiotics.
Conclusion: It can be concluded that COVID-19 has severely impacted
the surgical management of acute cholecystitis as only 11% of those
patients presenting were managed in accordance with AUGIS
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guidelines. Whether conservative management is an alternative
long-term option for management remains to be seen as further
long-term studies are needed.
Abstract citation ID: znac245.152
EP-603 What a difference a year makes: Long-term follow-up
of non-operative management in acute cholecystitis
Christopher Leiberman, Georgis Kizis, Anna-Marie Leipner,
Julianne Hendry
Queen Elizabeth University Hospital, Glasgow
Aim: Surgery is currently the recommended treatment for acute
cholecystitis and the Association of Upper Gastrointestinal Surgeons
(AUGIS) recommends that laparoscopic cholecystectomy be performed
within 72 hours of admission. However, given the impact of the
COVID-19 pandemic on healthcare delivery, this is not always
possible. So, what happens to those who are managed conservatively?
We observed the long-term impact of conservative management of
patients admitted with acute cholecystitis over the course of one year.
Methods: Twenty-eight patients were admitted with acute cholecystitis
to a large tertiary hospital in November 2020; twenty-three were
discharged without having had a cholecystectomy. These patients
were followed up for one year and observed for the development of
any gallstone-related admissions and surgical procedures.
Results: Of the 23 patients observed, 30% (n=7) were admitted for
gallstone-related complications. Biliary colic was responsible for 43%
of these admissions with pancreatitis (14%), cholangitis (14%),
choledocholithiasis (14%), and cholecystitis (14%) causing the rest.
Only 9% (n=2) received a laparoscopic cholecystectomy. In both cases,
it was in an emergency setting during admission for biliary colic.
Conclusion: Long-term observation of conservatively managed acute
cholecystitis was possible in around two-thirds of patients as no
gallstone-related hospital admissions were observed. Biliary colic was
the most common cause of gallstone-related admissions. Longer
observation is required to assess the feasibility of long-term
non-operative management in acute cholecystitis.
Abstract citation ID: znac245.153
EP-604 The Golden Patient Pathway - Improving Efficiency of
Emergency General Surgery Theatres and Bed Management
Nayer Rizkallah, Katherine Smith
University Hospitals of Derby and Burton NHS Foundation Trust
Aim: This closed loop audit aimed at improving efficiency of time
management with good utilisation of the first hour of the day in
emergency theatres. This was reflected on bed management and
patient service.
Methods: Patients who required simple emergency operations were the
target population. Retrospective data of patients’ demographics, time of
attendance to surgical admission unit, time waiting for an operation,
anaesthetic start times, surgical start times and postoperative
inpatient stay were collected. Then the Golden patient pathway was
implemented via a list of agreed criteria for the Golden patient (simple
procedure, non-septic, non-diabetic, etc.). The chosen patient was
labelled as Golden on the booking form. A precise time scale for
anaesthetic review and theatre sending time was agreed. This
pathway was tried for a month followed by data collection to compare
outcomes.
Results: After starting the Golden patient pathway in our emergency
surgery service, the mean anaesthetic start time (+/- standard
deviation) improved from 09:12 +/- 0.11 to 08:32 +/- 0.01.
Consequently, the mean operation start time improved from 09:45 +/-

0.10 to 08:53 +/- 0.01. The percentage of patients with same day
discharge after simple procedures increased from 57% to 100% thus
providing better use of hospital beds.
Conclusion: The Golden patient pathway provides a good utilisation of
the first hour of the day in emergency theatres. It has a positive impact
on patient service and bed management via reducing the waiting times.
The Golden patient pathway is an asset to the emergency general
surgery service.
Abstract citation ID: znac245.154
EP-605 Perineal Partial Myocutaneous Gluteal (PMG) Flap
Reconstruction after Extra Levator Abminoperineal Excision
(ELAPE): Recent Experience and Outcome
Sangram Patil, Ciara Bowers, Bhargavi Chandrashekhar,
Paul Mohammed, Rangasamy Sivakumar, Abdul Mohamed Bashir
The Mid Yorkshire Hospitals NHS Trust
Background: Extra Levator Abminoperineal Excision (ELAPE) is widely
performed surgery for low rectal cancers. A large defect in the
perineum adds significant post-operative morbidity. There is no clear
unanimity about the closure of the defect. The aim of the study is to
evaluate our experience and outcome of the perineal wound
management after ELAPE with partial myocutaneous gluteal (PMG)
flap reconstruction in a large series of 81 patients at a single centre in
the United Kingdom (UK).
Method: Retrospective review of all patients undergoing ELAPE and
primary PMG flap reconstruction between January 2012 and December
2021 in a large district general hospital. Patient demographics, 30 days
morbidity and mortality were studied.
Results: Total 81 patients (male 52, female 29) had ELAPE (laparoscopic 65,
open 11, converted to open 5) and PMG flap closure for low rectal cancer.
Mean age of patients was 67.2 years (SD+- 10.7). Length of stay was
average 19 days (range: 6 to 168 days). Half of the total patients had
neoadjuvant chemoradiation. 18.5% patients developed minor perineal
wound complications, whereas only 2.5% patients needed to return to
theatre for major wound complications. None of patients had perineal
hernia or mortality in 30 days. All flaps were viable during the follow-up.
Conclusion: PMG flap provides safe and reliable method for perineal
closure after ELAPE perineal defect without any additional morbidity
compared to conventional closure offering overall good patient
outcome and experience.
Abstract citation ID: znac245.155
EP-606 An audit to assess the requests for plain abdominal
radiographs for surgical conditions for the patients admitted in
SAU are appropriate
Sharanya Ravindran, Janahan Sarveshwaran
Pinderfields Hospital Mid Yorkshire Trust
Aim: To ensure that requests for plain AXR for surgical conditions for
the patients admitted in SAU are performed appropriately as advised
by Royal College of Radiologists guidelines.
We intend to reduce the radiation dose and early access to more
appropriate investigations.
RCR iRefer guidelines for AXR
• Clinical suspicion of obstruction
• Exacerbation of IBD
• Palpable mass
• Constipation
• Acute and chronic pancreatitis
• Sharp/poisonous/smooth foreign body
Methods: Patients admitted in SAU with abdominal pain in the month of
October 2020 were taken. Total number of patients audited 50.
22 patients had AXR whereas 28 didn’t have any.
In this 28 patients (56%); 16(58%) of them directly underwent higher
imaging CT scan as they were quite unwell on arrival. Remaining 12
(42%) did not have abdominal x ray in line with the guidelines.
Out of 22 patients who had abdominal Xray, we noted that 15 were not
indicated which are shown in the table below.
Group 1. – 28(56%) did not have an x-ray, in that 12 (42%) met the
guidelines
Abstracts | v145
Group 2. – 22(44%) patients had an x-ray 15(68%) of these were not
indicated
Cholecystitis 8 (53%)
Anorectal bleeding 2 (13%)
Appendicitis 3 (22%)
Diverticulosis 1 (6%)
COPD 1 (6%)
Conclusion:
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• The compliance for abdominal x ray needs to 100% in line with the
guidelines.
• Out 22 patients who did have an X-ray, 68% were not indicated which
is too high in keeping with guidelines.
• This in turn delayed the referral to appropriate services and increased
radiation exposure over the patients.
Abstract citation ID: znac245.156
EP-608 Robotic surgery in Inflammatory Bowel Disease: single
centre experience
Karolina Banaskiewicz1, Marta J Madurska2, Neena Randhawa3
1
Newcastle University Medical School
2
The Royal Victoria Infirmary Newcastle Upon Tyne
3
The Newcastle Upon Tyne Hospitals NHS Foundation Trust
Aims: Minimally invasive surgical approach has been shown to be
beneficial especially with its utilization in the rectal dissection for the
management of malignant disease. There has been growing interest in
robotic approach in the surgical management of diverticular disease
and inflammatory bowel disease (IBD). The aim of this study is to
present our local institutional experience following implementation of
a robotic service for surgical management of benign colorectal disease.
Methods: Data on patient demographics, intraoperative details, length
of hospital stay (LOS), and postoperative complications were collected
prospectively with a 30 day follow up. Patients included those who
underwent robotic ileocaecal resection, subtotal colectomy, anterior
resection, panproctocolectomy or proctectomy between April and
December 2021, for benign disease including diverticular disease, IBD,
or chronic constipation.
Results: Seventeen patients were included. 35% were male, median
(IQR) age was 38 (22) years and BMI was 23 (2). Procedure duration was
181 (125) minutes, and one patient underwent conversion to open
surgery. LOS was 9 (6) days and one patient required admission to
HDU for one day. N=3 (18%) had ileus, and n=1 (6%) had an
anastomotic leak, acute renal failure, or a chest infection. Two
patients had collection requiring percutaneous drainage. No return to
theatre or deaths were recorded.
Conclusions: Our early experience demonstrates encouraging
outcomes as well as feasibility and safety of robotic approach in
managing benign colorectal disease. Future studies with larger
samples will allow to draw more definitive conclusions.
Abstract citation ID: znac245.157
EP-609 Doctor-led Straight to Test Service: Streamlining the
Colorectal 2ww referral pathway
Rebecca Nunn, Adil Hassan, Carol Allgrove,
Shanmugam Vivekanandan, Vardhini Vijay
Princess Alexandra Hospital NHS Trust
Aims: Since its introduction in 2000, the Two-week wait referral pathway
(2ww) has become entrenched in NHS practice to fast-track the
investigation, diagnosis and management of suspected cancer.
Straight-to-test (STT) routes further expedite this process: staff screen
referrals and offer a diagnostic test within 2 weeks where appropriate.
Our Trust has provided a doctor-led STT service for the Colorectal
Department since January 2021. We hypothesize that physician-led strict
scrutiny of referral proformas, with incomplete forms being returned to
GPs, has led to improved compliance with the referral process.
Methods: A prospectively maintained database consisting of 2ww
Colorectal referrals from primary care was analysed over a 12-month
v146 | Abstracts
period (January 2021- December 2021). Agreed key referral criteria
required to make an STT decision were identified as ‘complete’ or
‘incomplete’. Incomplete referrals were returned to GPs, with a
request for complete information (usually provided within a median
period of 2 weeks).
Results: There were 1112 referrals during January-April 2021, 1140 during
May-August 2021 and 1158 during September-December 2021. The
proportion of referrals containing incomplete datasets fell from 28%
(January-April 2021) to 17% in the latter two 4-monthly time intervals.
Conclusions: Our data is promising- the proportion of incomplete
referrals has reduced since the introduction of our doctor-led STT
triage service. These figures may reflect a positive change in the referral
practises of local GPs. Submission of complete referral forms improves
communication between primary and secondary care, enabling our
doctors to make timely informed decisions about STT pathways.
Abstract citation ID: znac245.158
EP-617 Early vs delayed laparoscopic cholecystectomy for
acute cholecystitis: A systemic review
Jamil Gibson1, Neill Allen2, Yks Viswanath3
1
Teesside University
2
University Hospital of North Tees
3
James Cook University Hospital/ Teesside University
Background: Gallstones are present in approximately 10% to 15% of the
adult western population with 1% to 4% of patients becoming
symptomatic each year. Laparoscopic cholecystectomy for acute
cholecystitis is usually performed after the acute cholecystitis episode
settles because of the perceived fear of higher morbidity and of need
for conversion from laparoscopic to open cholecystectomy. However,
delaying surgery may expose the individual to gallstone-related
complications.
Aims & objectives: To compare early laparoscopic cholecystectomy,
defined as less than seven days of clinical presentation with acute
cholecystitis, versus delayed laparoscopic cholecystectomy more than
six weeks after index admission and conservative treatment for acute
cholecystitis.
Search Criteria: Clinical databases were searched for suitable studies.
Randomised and non-randomised clinical trials comparing early
versus delayed laparoscopic cholecystectomy in participants with
acute cholecystitis published after 1994 were included.
Results: 16 studies were identified for this review and the outcomes
measured were operation time, conversion to open surgery,
postoperative complication, post operative pain and analgesia use,
length of hospital stay, and duration of antibiotic therapy. For all but
one of the criteria it has been found that early and delayed laparoscopic
surgery were equivalent for these end points. The endpoint antibiotic
duration post-surgery still remains an area of contention.
Conclusion: Early and delayed cholecystectomy for the treatment of
uncomplicated acute cholecystitis is both safe and feasible. Early
laparoscopic cholecystectomy is preferred over delayed laparoscopic
cholecystectomy mainly because of decreased length of hospital stay in
the early laparoscopic cholecystectomy group. This is a clear advantage.
Abstract citation ID: znac245.159
EP-623 Can we count on serum hyperbilirubinemia to predict
acute complicated appendicitis?
Sadia Jaskani1, Zaid Al-Hamid2
1
Medway Maritime Hospital
2
Blackpool University Hospital
Introduction and Aims: Acute appendicitis (AA) is usually a clinical
diagnosis and surgical intervention is typically a preferred choice to
avoid potentially lethal complications. The aim of this study was to
evaluate hyperbilirubinemia as a predictor of complicated acute
appendicitis (CA).
Material and Methods: A retrospective analysis of patients who
underwent surgery for AA in a district general hospital in the UK from
Jan 2018 to April 2019. It includes White cell count (WCC), C- reactive
proteins (CRP), and liver function tests (LFTs).
Results: A total of 236 (Median age = xx, IQR , F: M = 1:1.4). The frequency
of normal, uncomplicated, and complicated appendicitis was 25(10.6%),
161 (68.2%), and 50 (21.2%), respectively. There were significant
differences in the rate of negative appendicectomy in females (9.3% F
vs 1.3% M, p-VALUE=0.0001). The bilirubin levels mirrored the CRP
levels and showed statistically significant difference in patients with
normal versus uncomplicated/complicated appendicitis (Bilirubin =
8.36 in normal versus 12.39 in uncomplicated and 16.44 in complicated
appendicitis, p value=0.0001; CRP= 34.09 in normal versus 44.38
in uncomplicated and 114.34 in complicated appendicitis,
p value=0.0001). The Neutrophil count showed increased differences
between normal and uncomplicated/complicated appendicitis
(Neutrophil 8.4 vs 11.2, p-value0.016; WCC 11.8 vs 14.1, p-value=0.003).
In the negative appendicectomy group, 17/25 had preoperative imaging.
In 7/25 (28%) imaging was suspicious of appendicitis, 10/25 (40%) had
normal findings and 8/25 patients did not have any prior imaging.
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Conclusion: SB had low sensitivity and high specificity as compared to
CRP and WCC for AA.
Abstract citation ID: znac245.160
EP-624 Pioneering makeshift endosponge in the management
of Post Low Anterior resection leak: Experience from a resource
limited country
Abdul Rehman, Abdul Wahid Anwer, Usman Mushtaq, Shahid Khattak,
Aamir Ali Syed
Shaukat Khanum Memorial Cancer Hospital Lahore
The aim of our study was to devise a method of salvaging anastomotic
integrity in patients who develop leak post low anterior resection for
rectal cancer. Although endopsonge is an established entity and has
been in use for a while now as minimally invasive method but its
availability is non existent in our region of the world.
We came up with a method based on the principle of endosponge to be
used in patients who develop anastomotic leak. We used a Jackson Pratt
drain to create a low cost and easily reproducible endosponge. We did
regular washouts in the theater, endoscopy suite and in the ward.
Until now we have managed 2 patients who developed defect in
anastomotic integrity.
The results are very promising. Both patients have shown complete
response in terms of complete resolution of pre sacral cavity and
closure of the defect in the anastomotic integrity.
Although these are only 2 cases but this makeshift endosponges can
prove to be a very important part of the armamentarium of a colorectal
surgeon in areas of the world where endosponges are not available.
Abstract citation ID: znac245.161
EP-625 An audit looking at whether consent has been gathered
to upload patient details to the National Vascular Registry in
Countess of Chester Hospital
Jacob Mewse, Faisal Iqbal
Countess of Chester
Aims: The National Vascular Registry (NVR) forms part of The Vascular
Society and aims to improve the quality of care for patients with
vascular disease by measuring the quality and outcomes of care for
patients who undergo major vascular surgery.
Within the vascular department at Countess of Chester Hospital,
patients had not consented for their information to be uploaded to the
NVR but were still being uploaded post procedure.
Methods: A retrospective audit collected data from all vascular
procedures performed in September 2021 in the Countess of Chester
Hospital. For each procedure, we checked whether the data was
uploaded to the NVR and where consent had been gathered from the
patient to upload their data to the NVR.
Results:
Of 57 procedures performed in September 2021:
Data uploaded to NVR with patient consent 10
Data uploaded to NVR without patient consent 13
Data not uploaded to NVR 30
Data excluded 3*
*2 had no consent form uploaded to Evolve and 1 was not on NVR
43.5% of patients were consented to have their data shared on the registry
56.5% of patients were not consented to have their data shared on the registry

Conclusion: Of 57 procedures, data was uploaded to the NVR 42.3% of
the time and of these, consent from the patients was only gained
43.5% of the time.
With these results there is room for improvement within the
department, firstly to consent patients to allow their data to be
uploaded to the NVR and then to upload the data following procedures.
Abstract citation ID: znac245.162
EP-630 Pheochromocytoma Associated with SDHB Mutation: A
case report
Emad Rezkallah, Wael Elsaify
South Tees NHS Foundation Trust
Introduction: Pheochromocytomas and paragangliomas are rare
neuroendocrine tumors arising from the chromaffin cells of the
adrenal medulla or extra-adrenal tissues. 10% to 20% of tumors are
detected before age 18 years. Approximately 10%–15% of
pheochromocytoma and 20%–50% of paraganglioma are malignant. Up
to 24% of the cases are familial where they may be associated with
genetic syndromes like MEN 2, succinate dehydrogenase subunit B
(SDHB) gene mutations and VHL syndrome. Germline mutations in
SDHB gene increase the risk of PGLs/ PHEOs and RCC with 38%-83%
risk of malignancy.
We represent a rare case of pheochromocytoma associated with SDHB
mutation in a child.
Case presentation: A 17-year old patient presented with repeated
vomiting and hypertension. BMI was 14.4 kg/m2, BP was 140/112
mmgh, PR was127 peats/min. The rest of the clinical examination was
unremarkable. Plasma and 24-hour urinary metanephrines levels
were highly elevated together with Chromogranin A level. Abdominal
CT and MRI scans revealed an enlarged right adrenal gland measuring
approximately 45 mm, indenting but not invading the posterior aspect
of the IVC.
Management: Treatment was initiated with α-blockers; (Doxazosin
then phenoxybenzamine); followed by β-blockers. The patient
underwent laparoscopic right adrenalectomy. The tumor was
50×30×30 mm and weighting 58g. The tumor was positive with
chromogranin, and S100. The PASS score was 2. Genetic mutation was
detected at SDGB (c.72+1G>A).
Conclusion: We recommend genetic testing for all suspecting cases of
PHEO/PGLs to establish the appropriate follow-up plan.
Abstract citation ID: znac245.163
EP-631 Left Ovarian Teratoma Containing Follicular Thyroid
Carcinoma: A case Report
Emad Rezkallah, Wael Elsaify
South Tees NHS Foundation Trust
Introduction: A mature cystic teratoma of the ovary is composed of
well-differentiated derivatives of the three germ layers, the ectoderm,
the mesoderm and the endoderm. About 20% of ovarian teratomas
contain thyroid tissues. When thyroid tissue comprises more than
50% of the ovarian teratoma, it is termed; struma ovarii. Patients are
usually asymptomatic or predominantly presented with a pelvic mass
in 45% of cases or abdominal pain.
We represent a rare case of stuma ovarii containing follicular thyroid
carcinoma.
Case Presentation: A 56 years old patient presented with a left ovarian
mass. The patient had no history of any thyroid abnormalities and no
family history of thyroid malignancy. The patient underwent total
hysterectomy (TH) and bilateral salpingo-oophrectomy (BSO). Mature
cystic teratoma of the left ovary containing highly differentiated
follicular carcinoma with omental deposits was discovered.
The case was referred for thyroid MDT for discussion of further
management. Thyroid US and CT scans showed slightly small thyroid
containing multiple hypoechoic nodules with no evidence of distant
metastasis.
Management: The patient had total thyroidectomy and the final
histopathology reported incidental multifocal papillary
microcarcinomas of follicular variant; stage pT1a. Post-operatively the
patient had Radio-iodine ablation. TSH suppression with thyroxin was
initiated. The patient had regular radiological and thyroglobulin
checks and no recurrence was detected on 5 years of follow-up.
Abstracts | v147
Conclusion: The treatment for malignant struma ovarii depends on the
tumor stage. The initial surgery includes TH and BSO with
omentectomy. The adjuvant treatment includes thyroxine, total
thyroidectomy with RAI ablation. Long-term follow-up is
recommended.
Abstract citation ID: znac245.164
EP-641 ‘Feel Good Factor’: Positive recognition impacted staff
morale, encouraged juniors and led to the overall
departmental development during the COVID-19 pandemic
Prizzi Zarsadias, Charlotte Burford, Sujata Rai, Natali Vigneswaran,
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Ankur Shah
East Kent Hospitals University NHS Foundation Trust
Aims: Low doctor morale and mental well-being is associated with poor
patient care, especially during the COVID-19 pandemic. We report on a
local initiative, Feel Good Factor (FGF), and its impact on doctors and the
department.
Methods: FGF is a monthly presentation at the departmental meeting
implemented at WHH, started in December 2019; where kind acts are
applauded. A 10-item questionnaire was distributed to doctors
working in two Surgery Departments (WHH and QEQM) in May 2021.
Questionnaires collected demographic data, awareness of both
positive/negative events and mental well-being using
Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS). Data was
collected on audits, QIP’s, sickness due to mental health, junior
progression and publications.
Results: 48 doctors responded (58.3% QEQM). There was no significant
difference in overall WEMWBS score. Doctors in the WHH department
were more decisive (70% vs 25%, p = 0.043); positive incident reporting
was higher at WHH (25.0% vs 0.0%, p = 0.025). A trust-wide record
number of 45 audits, 22 publications, 6 national studies and 11 juniors
progressed in 2020. Patient clinical marker of NELA mortality was one
of the least. There was no sickness leave due to mental health. FGF
was also shortlisted for the annual BMJ awards.
Conclusion: FGF is associated with increased awareness of positive
events. Improved doctor morale led to widespread participation in
projects and departmental output leading to national recognition.
Initiatives such as FGF should be encouraged and advertised to other
departments, to improve the hospital rating.
Abstract citation ID: znac245.165
EP-642 Case Report: Using the Novel Flamingo Device for
Endoscopic Treatment of Buried Bumper Syndrome in high
risk patients
Kusum Asnani, Roland Fernandes
The William Harvey Hospital, Ashford, Kent
Aim: Buried Bumper Syndrome is a rare, major late complication of
percutaneous endoscopic gastrostomy (PEG) occurring in 1% of cases.
It occurs when the internal bumper of the PEG tube erodes into the
gastric wall. This lead to a loss of patency, leakage and inability to
change the tube endoscopically. Until recently, the treatment was
surgical removal under general anaesthesia. However, patients with
BBS are likely to have significant co-morbidities thus deeming the
procedure high risk.
Method: We present a case report demonstrating successful treatment
of BBS completed endoscopically using the Flamingo device with a
good patient outcome. The Flamingo device is a new endoscopic tool
that acts like a sphincterotome. Appropriate consent was taken from
the patient. This was performed on a 56 year old patient suffering
from multiple sclerosis causing dysphagia for which a PEG tube was
inserted in 2018 for nutrition. Over time, his care home noticed
significant leakage from the site. At gastroscopy, he was diagnosed
with BBS. Due to his risk for surgical intervention, the Flamingo
device was trialled to remove the buried bumper and allow insertion
of a new PEG.
Results: As demonstrated in the photos, the mucosa was successfully
cut allowing the buried bumper PEG to be retrieved. A new PEG was
inserted without complication. The patient was discharged the
following day and no complications have arisen 3 months later.
Conclusion: The Flamingo device has proven to be a safe and
minimally-invasive method to treat BBS endoscopically in this patient.
v148 | Abstracts
Abstract citation ID: znac245.166
EP-653 Diagnosing Acute Appendicitis using Machine
Learning: A Systematic Review
Anthony Chan1, Christopher Yau2
1 can metastasise to the breast, melanoma being most common. On
Manchester University NHS Foundation Trust
2 review of the literature there is a paucity of published cases of
University of Manchester
Introduction: Acute appendicitis is a surgical emergency that usually
presents in the younger population. The mortality risk for
uncomplicated acute appendicitis is less than 0.1%, but this rises to
0.6% should gangrene or a perforation develop during its disease
course. The clinical diagnosis of acute appendicitis remains
challenging, with systems such as the Alvarado score not specific
enough to exclude a diagnosis. The aim of this study is to review
the literature on the use and effectiveness of machine learning (ML) in
the clinical diagnosis of acute appendicitis, with a particular focus on
the parameters used to train the ML models.
Methods: A systematic review was conducted using PubMed and OvidSP
using search terms ‘appendicitis’, ‘artificial intelligence’ and ‘machine
learning’.
Results: There were 255 articles identified, which after excluding
duplicates and screening, 14 articles were reviewed in detail and 6
articles included in the final review. Parameters used to train ML
machines included patient demographics such as age and gender,
clinical assessment such as temperature, presenting symptoms and
examination findings, and biochemical and haematological results
such as white cell count and C-Reactive Protein.
Discussion: The parameters used to train ML models are based on
limited clinical and biochemical components from established scoring
systems such as the Alvarardo score. Despite this limitation, ML
models were generally better in predicting acute appendicitis in terms
of sensitivity and specificity and positive- and negative-predictive
values. Future ML models should use more contemporary markers to
further improve diagnostic accuracy.
Abstract citation ID: znac245.167
EP-664 Remnant of stomach strangulation post Roux-en-y
gastric bypass and hiatal hernia repair for obesity
Mahmoud Al-ardah, Ken Philip, Allwyn Cota
Royal Cornwall Hospital
Introduction and Background: Herniation of the remnant of the
stomach post Roux-en-gastric bypass and hiatal hernia repair is a very
rare complication that require high index of suspicion to diagnose and
immediate surgical intervention. In the literature, there were reported
cases of herniation of gastric pouch and Roux limb but not the
remnant of the stomach hence we report this unusual case.
Case report: A 66-year-old lady was admitted with dysphagia, vomiting,
epigastric and retrosternal chest pain. She has had laparoscopic
Roux-en-y gastric bypass and hiatal hernia repair 8 years before this
admission complicated with recurrence of the hiatal hernia which
was repaired one year prior to this presentation.
CT scan of the chest and abdomen showed herniation of both the
neo-stomach and the gastric remnant up in the posterior
mediastinum through the hiatus. Patient consented for repair on the
next day however her condition deteriorated over night and was taken
to theatre and underwent emergency laparoscopic converted to open
resection of strangulated ischemic remnant of stomach and
preservation of the gastric pouch and the Roux limb.
Conclusion: This a very rare and uncommon event following a
Roux-en-y gastric bypass and hiatal hernia repair, a prompt diagnosis
and early surgical intervention is imperative to avoid catastrophic
complications.
Abstract citation ID: znac245.168
EP-674 Metastases to the breast from a primary lung
adenocarcinoma: A case report and literature review
Kealan Westby, Evan Mannion, Matt Davey
Galway Clinic, Galway, Ireland
Background: Primary breast cancer is the commonest malignancy in
adult females. However, metastases to the breast is a rare occurrence
with a frequency of approximately 0.2% - 1.3%. Lung adenocarcinoma
is the most common type of lung cancer and distant metastases to
other organs carry a poor prognosis. A wide variety of malignancies
primary lung adenocarcinoma metastasizing to the breast.
Case: A 77-year-old lady present to the emergency department (ED) with
a 5-day history of presyncope. There were no other associated symptoms
and the no findings on clinical exam. Computed tomography (CT) of the
thorax, abdomen & pelvis reported diffuse opacities in both lungs and a
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solitary, 3×2cm mass in the upper inner quadrant of the left breast. A
core biopsy of the lesion was carried out. Immunohistochemistry did
not support a diagnosis of breast carcinoma but strongly suggested a
primary lung adenocarcinoma. After a multidisciplinary meeting (MDM)
discussion the plan was to commence a course of chemotherapy.
Conclusion: Given its atypical presentation it can be challenging to
distinguish between a primary breast cancer and metastases.
Metastatic disease, although rare, should be considered in the
differential diagnosis as the treatment and prognosis differ greatly
from primary breast cancer. Immunohistochemistry is essential for
identifying the primary origin of the tumour.
Abstract citation ID: znac245.169
EP-681 Adherence to VTE prophylaxis guidelines in general
surgical patients: a single-centre study
Lalana Songra, Aliyah Hussein, D Baker
Royal Free Hospital NHS Foundation Trust
Introduction: Hospital acquired venous thromboembolism (VTE) is
potentially preventable yet still accounts for 60% of all VTE seen. This
study aimed to establish adherence to guidelines on VTE prevention
including completion of VTE risk assessment within 24 hours of
admission and appropriate prescription of mechanical and
pharmacological VTE prophylaxis.
Methods: A database of all general surgical inpatients in our hospital at
any point during the 48-hour period from 21/12/2021 to 22/12/2021 was
obtained. Electronic records were examined to check for the presence of
11 established risk factors for VTE and to check for adherence to VTE
guidelines. Every surgical patient was reviewed to check whether they
were wearing anti-embolic stockings. Standard statistical analyses
were undertaken.
Results: There were 107 general surgical patients in hospital during the
study period. Of these, 33 (31%) had 3 or more risk factors on admission
for VTE. 106 (99%) patients had VTE assessments completed within 24
hours of admission. Of these 107 patients, 93 (87%) had appropriate
pharmacological VTE prophylaxis or had a documented reason why
this was not prescribed. 14 (13%) patients had no pharmacological VTE
prophylaxis prescribed. 84 patients were assessed as requiring
anti-embolic stockings. Of these, 57 (68%) of patients were prescribed
stockings, and 30 (36%) were physically wearing stockings.
Conclusions: This study has shown that adherence to VTE guidelines
among surgical patients in our hospital is substandard. We suggest
having a VTE safeguard during the ward round responsible for
identifying any deficits in VTE prophylaxis and ensuring
recommendations are acted upon.
Abstract citation ID: znac245.170
EP-682 Management of Superficial Abscesses: Scope for Day
Case Surgery
Ayesha Ahmed, Jola Olugbemi, Aliya Prihartadi, Lucy Ridgway,
Boby Sebastian
West Suffolk Hospital
Background: Superficial abscesses form a large part of surgical
emergencies in many units and are considered a low priority
emergency often leading to delayed definitive treatment.
Aims and objectives: The aim of this study was to investigate the
efficiency of emergency treatment of superficial abscesses and to
identify areas for service improvement. A set criterion for ambulatory

care was made: Apyrexial on admission, White Cell Count of less than
13.5×10*9/L, CRP less than 100mg/L, no significant co-morbidities and no
other medical concerns for admission. Patients who meet this criteria
should be sent home to present for planned procedures the next morning.
Methodology: Retrospective audit of care provided to patients who
required drainage of superficial abscess under general anaesthesia
over a six-month period.
Results: 76 patients were included in the study. 39% of the patients had
their abscesses drained on the day of presentation with another 50%
Abstracts | v149
waited till the next day for procedure while the remaining 11% waited
for 2 or more days. The time interval between admission and surgery
ranged from 2 hours to 94 hours (mean ± SD 19 ± 16.25. The length of
admission ranged from 7 to 167 hours (mean ± 43 hours). Of the 130
overnight beds used by the 76 patients, 53 nights were spent awaiting
surgery and 77 following surgery and awaiting discharge.
Conclusion: Out of 76 patients, 40 patients fulfilled the inclusion criteria
of ambulatory abscess pathway and could have been discharged the
same day for next day surgery.
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