341 Is CT Imaging Mandated for Confirming the Diagnosis of Acute Appendicitis in Patients Over the Age of 40?

Aim

Acute appendicitis remains a largely clinical diagnosis, with clinical scoring systems such as the Alvarado score calculated to give a quantitative assessment of the diagnostic probability. It remains common practice amongst surgeons to rely on CT scanning to confirm the diagnosis however, especially in older patients. Our aim was to assess the diagnostic performance of CT scanning compared with that of the Alvarado score in patients aged over 40 years old.

Method

We conducted a retrospective observational study of 149 patients greater than 40 years old who had a diagnosis of acute appendicitis and had undergone an appendicectomy with subsequent histological analysis. Data was extracted from patients’ electronic medical records. This was recorded in Microsoft Excel and analysed using NCSS.

Results

When using an Alvarado score cut-off point of ≥7, the sensitivity and specificity were 44.1% and 60.0% respectively. The sensitivity of the test improved to 80.3% when using a cut-off point of ≥ 5, however the specificity decreased to 50%. The accuracy improved to 78.1% from 45.3%, when using ≥ 5 as a cut-off point. On the other hand, the sensitivity of the CT scan was 84.9% and the specificity was 45.5%. The accuracy of CT scanning was 81.8%.

Conclusions

When comparing performance, pre-operative CT scanning did not show a statistically significant improvement in the diagnosis of acute appendicitis relative to Alvarado score. We recommend using an Alvarado score cut-off point of ≥ 5 to aid in diagnosing appendicitis in patients older than 40, as it accounts for a higher sensitivity.

262 Full Cycle Audit on Definitive Management of Biliary Pancreatitis

Aim

To reaudit the practice of definitive management of gall stones pancreatitis in our trust for the period of 1st May-31st October and compare the result with previous one (1st June 2019–31st Dec 2019).

Method

It was a retrospective collection of data of patients admitted to our trust with biliary pancreatitis. Electronic notes, PACS for US report, Electronic discharge summary and Operative notes analysed.

Results

We identified 4 patients admitted with biliary pancreatitis during the re-audit period. US report was checked for confirmation of diagnosis of gall stones. The EDN was checked for date for Laparoscopic cholecystectomy. Unfortunately, none of them had their procedure time in 2 weeks’ time of their diagnosis. The reason behind this was because of COVID-19 pandemic, we were backlogging with our elective list. All the patients eventually underwent their procedure, but not in 2 weeks’ time as per the guidelines. All suitable patients had their cholecystectomy in a timely manner during first audit. None had it in timely manner during second audit.

Conclusions

Early Laparoscopic cholecystectomy for simple gallstone pancreatitis prevents life threatening Pancreatitis and readmissions.

The UK guidelines on management of pancreatitis issued by British society guidelines (BSG) states that all mild gall stones pancreatitis should have definitive management of lithiasis on the same admission or within 2 weeks (Recommendation B). In our practice, all our suitable patients during first audit had timely Laparoscopic cholecystectomy, however, no one had it in timely manner on the next audit for COVID-19 pandemic.

950 Experience of Inguinal Mesh Hernioplasty Under Local Anaesthesia: A 3-Year Experience in A Teaching Hospital

Objective

To prove Inguinal mesh hernioplasty under L/A is safe and acceptable. Helps with post-operative pain and enables rapid recovery as a day case.

Method

All patients who underwent inguinal hernia repair under local anaesthesia were retrospectively analysed in our hospital between July 2014- July 2017. Clinical judgement was used for inclusion and exclusion parameters.

Results

From July 2014- July 2017, 260 patients were included in study who underwent Inguinal mesh hernioplasty under L/A. ASA grade for all patients ranged between I-III. The mean age was 37 (20-65). Intraoperatively (9.1) 3.5% patients had problems such as pain, hypotension or sweating. About (86.3%) 224 patients were discharged home the same day and remaining stayed overnight for less than 24 hours. Hematoma was seen in 5 (1.92%) patients, Urinary retention in 2 (0.7%) patients, Wound infection seen in 24(9.2%) patients, Readmission in 10 (3.8%) patients. Chronic groin pain was seen in 10 (3.9%) patients and no recurrence on 6 months follow up.

Conclusions

Our results showed that this procedure is feasible under L/A and can be performed safely. It showed satisfactory acceptance by the operating surgeon and patient, without significant perioperative issues. It is reliable and showed shorter hospital stay.

579 The Impact of Coronavirus 2 (SARS-CoV-2) in Emergency Surgery. Our experience at the General Surgery Department in Queen Elizabeth Hospital, London

Background

The outbreak of the COVID-19 has had global impact on elective and emergency surgical care. So far, we possess few data to understand the effect of the CoViD-19 on emergency surgery.

Aim

To compare the total number of patients who were referred, admitted, and had an emergency operation under General Surgery (GS) between March and May 2020, to the same period between 2016-19.

Method

Retrospective analysis of prospectively collected local data from surgical take lists and operative data obtained from the hospital’s Business Intelligence Team.

Results

A 22.4% reduction was seen in the referrals per day 15.18+/-2.45 vs. 11.77 +/- 4.54 (2016-9 vs. 2020, mean+/-SD) and a 36% reduction in admissions per day 7.40 +/-1.07 vs. 4.69+/- 2.03 (2016-9 vs. 2020, mean+/-SD). A 55% reduction in the total number of emergency operations during the CoViD-19 outbreak was observed 87 (total, 2020) vs. 194+/-35.96 (mean+/-SD, 2016-19).

Conclusions

CoViD-19 had a significant impact on the number of patients presenting to GS. Interestingly, an even greater reduction in operative treatment was also observed. This may reflect reduction in theatre availability or use of a higher threshold for conservative treatment.

957 Comparison of Inguinodynia In Patients Undergoing Prophylactic Ilioinguinal Neurectomy vs No Neurectomy In Lichtenstein Mesh Hernioplasty

Objective

The objective of this study is to compare the frequency of inguinodynia in ilioinguinal neurectomy VS no neurectomy in patients undergoing Lichtenstein mesh hernioplasty.

Method

200 male patients with unilateral, primary, reducible inguinal hernia were randomly distributed in to two groups by using lottery method to undergo Lichtenstein’s hernia repair i.e., with and without ilioinguinal neurectomy. All the operation were carried out under local anesthesia. Pain score was calculated using the VAS system at 3rd month and inguinodynia was labelled if it is more than 1 on VAS scale.

Results

200 male patients with mean age of 53.25 ± 6.768 were included. 42 (21%) had Inguinodynia after surgery. When we cross tabulated both groups with inguinodynia, results came up significant (p = 0.001). In neurectomy group 10 patients had inguinodynia while in no neurectomy group, 32 patients were having Inguinodynia. There was no effect of malnutrition on outcome. Younger age group benefitted more from procedure.

Conclusions

It is concluded that there is difference in frequency of inguinodynia in ilioinguinal neurectomy versus no neurectomy in patients undergoing Lichtenstein hernia repair. Patients with ilioinguinal neurectomy had reduced incidence of inguinodynia.

575 Management of Acute Appendicitis During the COVID-19 Pandemic. Our Experience at The General Surgery Department in Queen Elizabeth Hospital, London

Introduction

The pandemic of CoViD-19 had a major impact on provision of emergency services. National (CoViD-19) Guidelines (NG) were issued by the Colleges of Surgeons for the management of surgical patients.

Aim

To assess the impact of CoViD-19 in the management of patients with acute appendicitis (AA) and review patients’ characteristics and compliance with NG.

Method

A single-centre retrospective analysis of prospectively collected data on surgical admissions with suspected AA between March and May 2020. Main outcomes of interest were the pre-operative investigation, the type of operation and the negative appendicectomy rate (NAR) comparing to 2019.

Results

A total of 109 patients were referred for suspected AA. Out of 39 patients who had surgery 21 (53.8%) were investigated with a CT and 13 (33%) with an ultrasound. There was a 31.6% reduction in appendicectomies compared to 2019. 30 patients (76.9%) had an open procedure vs 9 laparoscopic (23.1%) in alignment with the NG2. Histology showed AA in 37 out of 39 of the cases. The NAR was 5.12 vs 12.2 for 2019.

Conclusions

There was a 31.6% reduction in appendicectomies during CoViD-19. Most patients were investigated with a CT and underwent an open procedure. Pre-operative investigation with a CT led in reduction of NAR.