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Rxivist combines biology preprints from bioRxiv and medRxiv with data from Twitter to help you find the papers being discussed in your field. Currently indexing 150,706 papers from 635,107 authors.

Most downloaded biology preprints, since beginning of last month

in category surgery

103 results found. For more information, click each entry to expand.

81: Multifocal breast cancers are more prevalent in BRCA2 versus BRCA1 mutation carriers
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Posted 13 Sep 2019

Multifocal breast cancers are more prevalent in BRCA2 versus BRCA1 mutation carriers
16 downloads medRxiv surgery

Alan D McCrorie, Susannah Ashfield, Aislinn Begley, Colin Mcilmunn, Patrick J. Morrison, Clinton Boyd, Bryony Eccles, Stephanie Greville-Heygate, Ellen R Copson, Ramsey I. Cutress, Diana M Eccles, Kienan I Savage, Stuart A McIntosh

Multifocal breast cancer is generally considered to be where two or more breast tumours are present within the same breast, but are clearly separated with no intervening in situ or invasive disease. It is seen in [~]10% of breast cancer cases. This study investigates multifocality prevalence in BRCA1/2 mutant patients via cross-sectional analysis. Data from 211 women with BRCA1/2 mutations (BRCA1 - 91), (BRCA2 - 120), with breast cancer were collected including age, tumour focality, size, type, grade, and receptor profile. The prevalence of multifocality within this group was 25%, but within subgroups, prevalence amongst BRCA2 carriers was more than double that of BRCA1 carriers (p=0.001). Women affected by multifocal tumours had proportionately higher oestrogen receptor positivity (p=0.001), lower triple negativity (p=0.004), and were more likely to be younger at diagnosis compared with those with unifocal tumours (p=0.039). Odds of a BRCA2 carrier developing multifocal cancer were almost four-fold higher than a BRCA1 carrier (OR: 3.71, CI: 1.77-7.78, p=0.001). BRCA2 carriers show much greater multifocality than those carrying BRCA1 - multifocal tumours are strongly associated with being both BRCA2 mutant and oestrogen receptor positive.

82: A prospective study to identify rates of SARS-CoV-2 virus in the peritoneum and lower genital tract of patients having surgery
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Posted 01 Aug 2020

A prospective study to identify rates of SARS-CoV-2 virus in the peritoneum and lower genital tract of patients having surgery
16 downloads medRxiv surgery

Dominique Jones, David Faluyi, Sarah Hamilton, Nicholas Stylianides, Kenneth Ma, Sarah Duff, Nicholas Machin, Richard Edmondson

Introduction The risks to surgeons of carrying out aerosol generating procedures during the COVID pandemic are unknown. To start to define these risks, in a systematic manner, we investigated the presence of SARS-CoV-2 virus in the abdominal fluid and lower genital tract of patients undergoing surgery. Methods We carried out a prospective cross sectional observational study of 113 patients undergoing abdominal surgery or instrumentation of the lower genital tract. We took COVID swabs from the peritoneal cavity and from the vagina from all eligible patients. Results were stratified by pre operative COVID status. Results In patients who were presumed COVID negative at the time of surgery SARS-CoV-2 virus RNA was detected in 0/102 peritoneal samples and 0/98 vaginal samples. Peritoneal and vaginal swabs were also negative in one patient who had a positive nasopharyngeal swab immediately prior to surgery. Conclusions The presence of SARS-CoV-2 RNA in the abdominal fluid or lower genital tract of presumed negative patients is nil or extremely low. These data will inform surgeons of the risks of restarting laparoscopic surgery at a time when COVID19 is endemic in the population.

83: Bangla Technique of Laparoscopic Cholecystectomy: a Novel, Safe and Cost-effective modification of American and French Technique
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Posted 12 Oct 2020

Bangla Technique of Laparoscopic Cholecystectomy: a Novel, Safe and Cost-effective modification of American and French Technique
16 downloads medRxiv surgery

Md Jafrul Hannan, Kohinoor Parveen, Alak Nandy

BackgroundLaparoscopic cholecystectomy (LC) can be performed by following either of the two approaches proposed by the American and the French school. The two approaches have comparable operative times, but use different arrangements for the patients and operators positions, and sites for port insertions. The aim of the present paper is to describe an alternative to the American and the French approaches, referred to as the Bangla technique, which uses a standard four port approach but requires the presence of only one assistant along with the surgeon. It is hoped that the Bangla technique will improve surgery outcomes for gallbladder disease patients and encourage healthcare professionals in resource-poor settings to adopt minimally invasive/laparoscopic approaches to surgical problems. MethodsThe sample consisted of a total of 280 gallbladder disease retrospective observational cases (of which 21 were children between 6 and 16 years of age) who were treated with the Bangla technique at the South Point Hospital Chittagong, Bangladesh, between January 2018 and February 2020. ResultsSurgery data showed that using the Bangla technique, the average operating time and average operation theater time were36.25 and 45.9 minutes, respectively. Of the patients, 86% left the hospital on the same day of operation, while the remaining left the following day. In 91.7% of the cases, there were no complications, while content leakage and bleeding occurred in 6.7% and 1.4% cases, respectively. ConclusionThe proposed LC technique will benefit infection prevention and control by reducing the number of personnel in the operation theatre (one assistant and the surgeon) and, as such, reducing surgery-related expenses, which can be further decreased by using only one monitor. More so, the Bangla technique can be combined with the cystic artery sparing technique to reduce the risk of intraoperative bleeding and injury to the common bile duct.

84: Risk Factors for Clinically Relevant Postoperative Pancreatic Fistula (CR-POPF) after Distal Pancreatectomy: A Single Center Experience
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Posted 08 May 2020

Risk Factors for Clinically Relevant Postoperative Pancreatic Fistula (CR-POPF) after Distal Pancreatectomy: A Single Center Experience
15 downloads medRxiv surgery

Gao Qing Wang, Dipesh K Yadav, Wei Jiang, Yongfei Hua, CaiDe Lu

Clinically relevant postoperative pancreatic fistula (CR-POPF) is the considerable contributor to major complications after pancreatectomy. The purpose of this study was to evaluate the potential risk factor contributing to CR-POPF following distal pancreatectomy (DP) and discussed the risk factors of pancreatic fistula in order to interpret the clinical importance. All the patients who underwent DP in between January 2011 and January 2020 were reviewed retrospectively in accordance with relevant guidelines and regulations. The univariate and multivariate analysis was performed was performed to test an independent risk factors for pancreatic fistula. P<0.05 was considered statistically significant. In all of the 263 patients with DP, pancreatic fistula was the most common surgical complication 19.0%. The univariate analysis of 18 factors showed that the patients with a malignant tumor, soft pancreas, and patient without ligation of the main pancreatic duct are more likely to develop pancreatic fistula. However, on multivariate analysis the soft texture of the pancreas (OR= 2.381, P= 0.001) and the ligation of main pancreatic duct (OR= 0.388, P= 0.002) were only an independent influencing factor for CR-POPF. As a conclusion, pancreatic fistula was the most common surgical complication after DP, and the texture of pancreas and ligation of main pancreatic duct can influence an incidence of CR-POPF.

85: The impact of the Covid-19 pandemic on emergency and elective hip surgeries in Norway
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Posted 11 Sep 2020

The impact of the Covid-19 pandemic on emergency and elective hip surgeries in Norway
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Karin Magnusson, Jon Helgeland, Mari Grosland, Kjetil Elias Telle

Objective: To assess the effects of Covid-19 pandemic lockdown restrictions on the number of emergency and elective hip joint surgeries, and explore whether these procedures are more/less affected by lockdown restrictions than other hospital care. Methods: In 1.344.355 persons aged [&ge;]35 years in the Norwegian emergency preparedness (BEREDT C19) register, we studied the daily number of persons having 1) emergency surgeries due to hip fractures, and 2) electively planned surgeries due to hip osteoarthritis before and after Covid-19 lockdown restrictions were implemented nationally on March 13th 2020, for different age and sex groups. Incidence Rate Ratios [IRR] reflect the after-lockdown number of surgeries divided by the before-lockdown number of surgeries. Results: After-lockdown elective hip surgeries were one third the number of before-lockdown (IRR ~0.3), which is a greater drop than the drop seen in all-cause elective hospital care (IRR ~0.6) (no age/sex differences). Men aged 35-69 had half the number of emergency hip fracture surgeries (IRR ~0.6), whereas women aged [&ge;]70 had the same number of emergency hip fracture surgeries after lockdown (IRR ~1). Only women aged 35-69 and men aged [&ge;]70 had emergency hip fracture surgery rates after lockdown comparable to what may be expected based on analyses of all-cause acute care (IRR ~0.80) Conclusion: Important to note for future pandemics management is that lockdown restrictions may impact more on scheduled joint surgery than other scheduled hospital care. Lockdown may also impact on the number of emergency joint surgeries for men aged [&ge;]35 but not for women aged [&ge;]70.

86: Safety and efficacy of three-cavity clearance in the management of cryptoglandular perianal abscess: A multicentre randomized controlled study
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Posted 15 Apr 2020

Safety and efficacy of three-cavity clearance in the management of cryptoglandular perianal abscess: A multicentre randomized controlled study
14 downloads medRxiv surgery

xinyi zhang, Chen cheng, Ping wei, Yu-Yao Wang, Li-Jiang Ji, Qiong Zhang, Chunxia zhang, Heiying Jin

OBJECTIVE: To evaluate the safety and efficacy of three-cavity clearance in the management of cryptoglandular perianal abscess. METHOD: This was a multicentre randomized controlled study. The study was designed and approved by the ethics committee of the Second Affiliated Hospital of Nanjing University of Traditional Chinese Medicine. The study was registered in the Chinese Clinical Trial Register centre (ChiCTR1800016958).Patients with cryptoglandular perianal abscess in 5 Hospitals from Sept.2018 to Sept. 2019 were included.The anal fistula rate, anal incontinence, abscess recurrence, success rate, postoperative pain , wound healing time, and hospitalization duration were compared. RESULTS: Total 334 patients were enrolled in the study, who were 162 in the three-cavity clearance group and 172 in the control group. The anal fistula rate and abscess recurrence rate were 6.2% and 1.9% in the three-cavity clearance group (P=0.001) and 18.0% and 8.1% in the control group (P=0.009). No patients experienced fecal incontinence. The success rate in the three-cavity clearance group was 92.0% and that in the control group was 73.8% (P=0.00001). The postoperative pain on day 3 was lower in the three-cavity clearance group than that in the control group (P=0.002). The hospitalization duration was 9.0 days in the three-cavity clearance group and 10.41days in the control group (P=0.049). The wound healing time was 27.1 days in the three-cavity clearance group and 28.2 days in the control group (P=0.764). CONCLUSIONS: This randomized controlled study showed that three-cavity clearance is a safe and effective management of cryptoglandular perianal abscess.

87: Minimizing Population Health Loss in Times of Scarce Surgical Capacity
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Posted 30 Jul 2020

Minimizing Population Health Loss in Times of Scarce Surgical Capacity
14 downloads medRxiv surgery

Benjamin Gravesteijn, Eline Krijkamp, Jan Busschbach, Geert Geleijnse, Isabel Retel Helmrich, Sophie Bruinsma, Celine van Lint, Ernest van Veen, Ewout Steyerberg, Cornelis Verhoef, Jan van Saase, Hester Lingsma, Robert Baatenburg de Jong, Value Based Operation Room Triage team collaborators

Background COVID-19 has put unprecedented pressure on healthcare systems worldwide, leading to a reduction of the available healthcare capacity. Our objective was to develop a decision model that supports prioritization of care from a utilitarian perspective, which is to minimize population health loss. Methods A cohort state-transition model was developed and applied to 43 semi-elective non-paediatric surgeries commonly performed in academic hospitals. Scenarios of delaying surgery from two weeks were compared with delaying up to one year, and no surgery at all. Model parameters were based on registries, scientific literature, and the World Health Organization global burden of disease study. For each surgery, the urgency was estimated as the average expected loss of Quality-Adjusted Life-Years (QALYs) per month. Results Given the best available evidence, the two most urgent surgeries were bypass surgery for Fontaine III/IV peripheral arterial disease (0.23 QALY loss/month, 95%-CI: 0.09-0.24) and transaortic valve implantation (0.15 QALY loss/month, 95%-CI: 0.09-0.24). The two least urgent surgeries were placing a shunt for dialysis (0.01, 95%-CI: 0.005-0.01) and thyroid carcinoma resection (0.01, 95%-CI: 0.01-0.02): these surgeries were associated with a limited amount of health lost on the waiting list. Conclusion Expected health loss due to surgical delay can be objectively calculated with our decision model based on best available evidence, which can guide prioritization of surgeries to minimize population health loss in times of scarcity. This tool should yet be placed in the context of different ethical perspectives and combined with capacity management tools to facilitate large-scale implementation.

88: Research transparency promotion by surgical journals publishing randomised controlled trials: a survey
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Posted 22 Jul 2019

Research transparency promotion by surgical journals publishing randomised controlled trials: a survey
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N. Lombard, A. Gasmi, L. Sulpice, K. Boudjema, Florian Naudet, D. Bergeat

ObjectiveTo describe the surgical journal position statement on data-sharing policies (primary objective) and to describe the other features of their research transparency promotion. MethodsOnly "SURGICAL" journals with an impact factor superior to 2 (Web of Science) were eligible for the study. They were not included if there were no explicit instructions for clinical trial publication in the instructions for authors and if there were no RCT published between January 2016 and January 2019. The primary outcome was the existence of a data-sharing policy in the instructions for authors. Details on research transparency promotion were also collected, namely the existence of a "prospective registration of clinical trials requirement" policy; a "COIs" disclosure requirement and a specific reference to reporting guidelines such as CONSORT for RCT. ResultsAmong the 87 surgical journals eligible, 82 (94%) were included in the analysis: 67 (77%) had explicit instructions for RCT and of the remaining, 15 (17.2%) had published at least one RCT between 2016-2019. The median impact factor was 2.98 [IQR=2.48-3.77] and in 2016 and 2017, the journals published a median of 11.5 RCT [IQR=5-20.75]. Data-sharing statement instructions (primary outcome) were ICMJE-compliant in four cases (4.88%), weaker in 45.12% (n=37) and inexistent in 50% (n=41) of the journals. As for data-sharing statements, no association was found between journal characteristics and the existence of data-sharing policies (ICMJE-compliant or weaker). A "prospective registration of clinical trials requirement" was associated with ICMJE allusion or affiliation and higher impact factors. Journals with specific RCT instructions in their OIA and journals referenced on the ICMJE website more frequently mandated the use of CONSORT guidelines. ConclusionResearch transparency promotion is still limited in surgical journals. Uniformization of journal requirements vis-a-vis ICMJE guidelines could be a first step forward for research transparency promotion in surgery.

89: Prognostic significance of compound combined peri-operative biomarkers in gastric cancer
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Posted 24 Apr 2020

Prognostic significance of compound combined peri-operative biomarkers in gastric cancer
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Arfon G Powell, Alexandra Harriet Coxon, David BT Robinson, Osian James, Adam Christian, Stuart Ashley Roberts, Wyn G Lewis

Objective: Survival after gastric cancer surgery is largely attributed to tumor biology, neoadjuvant chemotherapy (NAC), and surgical approach, yet other prognostic factors have been reported, including pre-operative systemic inflammatory response (SIR), and Morbidity Severity Score (MSS). The hypothesis tested was that a SIR, MMS, and pathological composite score, would be associated with disease-free (DFS) and overall survival (OS). Methods: Consecutive 358 patients undergoing potentially curative gastrectomy for adenocarcinoma were studied. Complications were defined as a MSS of Clavien-Dindo classification (CDSC) >1. Serum SIR measurements were performed on the day before surgery, and a composite score (CIMpN) (0-3) was developed based on CRP, morbidity, and pN-stage. Primary outcome measures were DFS and OS. Results: Post-operative complications occurred in 138 (38.5%) patients, (8 (2.2%) deaths), and was associated with higher CRP (28.3% vs. 15.5%, p=0.003), vascular invasion (55.8% vs. 36.8%, p<0.001), and R1 status (26.1% vs. 9.5%, p=0.001). Five-year DFS and OS were 32.9% and 33.3% for patients with post-operative complications compared with 62.5% and 64.0% in controls (p<0.001). Five-year DFS and OS were 31.4% and 37.3% in patients with raised CRPs compared with 58.5% and 59.5% in controls (p=0.005, p=0.001, respectively). Five-year DFS for CIMpN scores of 0, 1, 2, and 3 were 85.9%, 50.0%, 26.2%, and 15.4% (p<0.001) respectively. On multivariable analysis CIMpN score was independently associated with DFS [HR 3.00, 95% Confidence Interval (CI) 1.90-4.73, p<0.001] and OS [1.93 (1.43-2.59), p<0.001]. Conclusion: A novel composite score, CIMpN, based on SIR, MSS and pN-stage, offers important prognostic signals.

90: Protocol for Project Recovery: Cardiac Surgery - Leveraging Digital Platform for Efficient Collection of Longitudinal Patient-Reported Outcome Data Towards Improving Postoperative Recovery
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Posted 16 Jan 2020

Protocol for Project Recovery: Cardiac Surgery - Leveraging Digital Platform for Efficient Collection of Longitudinal Patient-Reported Outcome Data Towards Improving Postoperative Recovery
13 downloads medRxiv surgery

Makoto Mori, Cornell Brooks, Erica Spatz, Bobak Mortazavi, Sanket S. Dhruva, George C. Linderman, Lawrence A. Grab, Yawei Zhang, Arnar Geirsson, Sarwat I. Chaudhry, Harlan Krumholz

IntroductionImproving postoperative patient recovery after cardiac surgery is a priority, but our current understanding of individual variations in recovery and factors associated with poor recovery is limited. We are using a health-information exchange platform to collect patient-reported outcome measures (PROMs) and wearable device data to phenotype recovery patterns in the 30-day period after cardiac surgery hospital discharge, to identify factors associated with these phenotypes and to investigate phenotype associations with clinical outcomes. Methods and analysisWe designed a prospective cohort study to enroll 200 patients undergoing valve, coronary artery bypass graft, or aortic surgery at a tertiary center in the U.S. We are enrolling patients postoperatively after the intensive care unit (ICU) discharge, and delivering electronic surveys directly to patients every 3 days for 30 days after hospital discharge. We will conduct medical record reviews to collect patient demographics, comorbidity, operative details and hospital course using the Society of Thoracic Surgeons (STS) data definitions. We will use phone interview and medical record review data for adjudication of survival, readmission, and complications. We will apply group-based trajectory modeling to the time-series PROM and device data to classify patients into distinct categories of recovery trajectories. We will evaluate whether certain recovery pattern predicts death or hospital readmissions, as well as whether clinical factors predict a patient having poor recovery trajectories. We will evaluate whether early recovery patterns predict the overall trajectory at the patient-level. Ethics and disseminationThe Yale Institutional Review Board approved this study. Following the description of the study procedure, we obtain written informed consent from all study participants. The consent form states that all personal information, survey response, and any medical records are confidential, will not be shared, and are stored in an encrypted database. Strengths and limitations of this studyO_LIThis study will assess the patient perspective on recovery after cardiac surgery at a high frequency within the 30-day postoperative period with surveys and activity monitoring via a health information platform and wearable devices. C_LIO_LIUsing longitudinal patient-reported outcomes measure (PROM) data, this study will define recovery patterns and factors associated with different recovery trajectories and guide the development interventions to improve recovery and support expansion of the study to additional sites. C_LIO_LIThe study is single center and the sample size is limited. C_LI

91: Machine Learning Assisted Intraoperative Assessment of Brain Tumor Margins Using HRMAS NMR Spectroscopy
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Posted 26 Feb 2020

Machine Learning Assisted Intraoperative Assessment of Brain Tumor Margins Using HRMAS NMR Spectroscopy
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Doruk Cakmakci, Emin Onur Karakaslar, Elisa Ruhland, Marie-Pierre Chenard, Francois Proust, Martial Piotto, Izzie Jacques Namer, A. Ercument Cicek

Complete resection of the tumor is important for survival in glioma patients. Even if the gross total resection was achieved, left-over micro-scale tissue in the excision cavity risks recurrence. High Resolution Magic Angle Spinning Nuclear Magnetic Resonance (HRMAS NMR) technique can distinguish healthy and malign tissue efficiently using peak intensities of biomarker metabolites. The method is fast, sensitive and can work with small and unprocessed samples, which makes it a good fit for real-time analysis during surgery. However, only a targeted analysis for the existence of known tumor biomarkers can be made and this requires a technician with chemistry background, and a pathologist with knowledge on tumor metabolism to be present during surgery. Here, we show that we can accurately perform this analysis in real-time and can analyze the full spectrum in an untargeted fashion using machine learning. We work on a new and large HRMAS NMR dataset of glioma and control samples (n = 568), which are also labeled with a quantitative pathology analysis. Our results show that a random forest based approach can distinguish samples with tumor cells and controls accurately and effectively with a mean AUC of 85.6% and AUPR of 93.4%. We also show that we can further distinguish benign and malignant samples with a mean AUC of 87.1% and AUPR of 96.1%. We analyze the feature (peak) importance for classification to interpret the results of the classifier. We validate that known malignancy biomarkers such as creatine and 2-hydroxyglutarate play an important role in distinguish tumor and normal cells and suggest new biomarker regions. The code is released at http://github.com/ciceklab/HRMAS_NC.

92: Early Impact of COVID-19 Pandemic on Paediatric Surgical Practice in Nigeria: a National Survey of Paediatric Surgeons.
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Posted 25 May 2020

Early Impact of COVID-19 Pandemic on Paediatric Surgical Practice in Nigeria: a National Survey of Paediatric Surgeons.
13 downloads medRxiv surgery

Ibukunolu O Ogundele, Felix M Alakaloko, Collins C Nwokoro, Emmanuel A Ameh

Introduction The novel Coronavirus disease has had significant impact on healthcare globally. Knowledge of this virus is evolving, definitive care is not yet known, and mortality is increasing. We assessed its initial impact on paediatric surgical practice in Nigeria, creating a benchmark for recommendations and future reference. Methods Survey of 120 paediatric surgeons from 50 centres to assess socio-demographics and specific domains of impact of COVID-19 on their services and training in Nigeria. Seventy four surgeons adequately responded. Responses have been analysed. Duplicate submissions for centres were excluded by combining and averaging the responses from centres with multiple respondents. Results Forty-six (92%) centres had suspended elective surgeries. All centres continued emergency surgeries but volume reduced in March by 31%. Eleven (22%) centres reported 13 suspended elective cases presenting as emergencies in March, accounting for 3% of total emergency surgeries. Nine (18%) centres adopted new modalities for managing selected surgical conditions: non-operative reduction of intussusception in 1(2%), antibiotic management of uncomplicated acute appendicitis in 5(10%), more conservative management of trauma and replacement of laparoscopic appendectomy with open surgery in 3(6%) respectively. Low perception of adequacy of Personal Protective Equipment (PPE) was reported in 35(70%) centres. Forty (80%) centres did not offer telemedicine for patients follow up. Twenty-nine (58%) centres had suspended academic training. Perception of safety to operate was low in 37(50%) respondents, indifferent in 24% and high in 26%. Conclusion Majority of paediatric surgical centres reported cessation of elective surgeries whilst continuing emergencies. There is however an acute decline in the volume of emergency surgeries. Adequate PPE need to be provided and preparations towards handling backlog of elective surgeries once the pandemic recedes. Further study is planned to more conclusively understand the full impact of this pandemic on children's surgery. Key words pandemic, COVID-19, children's surgery.

93: Pre operative fitness score accurately predicts uneventful post operative course in gastrointestinal and hepatobiliary surgery.
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Posted 17 Apr 2020

Pre operative fitness score accurately predicts uneventful post operative course in gastrointestinal and hepatobiliary surgery.
13 downloads medRxiv surgery

BHAVIN VASAVADA, hardik patel

Background: Aim of our study was to analyze if we can acuratly predict uneventful post operative course pre operatively in gastrointestinal and HPB surgery patients so that we can better explain risk benefit ratio to the patients and prognostify the results. Material and Methods: We retrospectively evaluated patients who have undergone gastrointestinal and hepatobiliary surgery at our institute in last 3 years and analyzed 90 days mortality and morbidity rates among these patients. We described any 90 day morbidity and mortality as an event. We performed univariate and multivariate analyses for factors predicting an event. Then based on pre operative factors that predicted an event we formulated a score and then evaluated sensitivity, specificity, positive predictive and negative predictive value of that score and also evaluated ROC curve. We also performed kaplan-meier analysis for 90 days event free survival. Statistical analysis was done using SPSS version 23. Results: Total 264 patient operated for gastrointestinal and HPB surgeries between april 2016 to may 2019 were evaluated .Total 45 (17%) events occurred. On univariate analysis CDC grade, ASA score,Operative time,Blood products used, emmergency surgeries and open surgeries predicted an event.We developed score based on pre operative factors like ASA score, CDC grade of surgery,open surgery and emmergency surgeries included in the score. Each variable was given 1 point.We proposed score grater than 2 was associated with 90 day event. This score had sensitivity of 77.78%, specificity of 81.65%. low positive predictive value of 46.67% but very high negative predictive value of 94.68%. AUROC showed AUROC of 0.797 (p < 0.0001, 95 % confidence interval 0.721-0.874). Pre operative fitness score, Open Surgery and operative time independently predicted an event on multivarious analysis. (p =0.003 and 0.026 respectively.) Conclusions: Pre operative fitness score accurately predicts uneventful post operative course in gastrointestinal and hepatobiliary surgery.

94: A new ischemic grading system to aid combat extremity vascular injury decision making
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Posted 07 Aug 2020

A new ischemic grading system to aid combat extremity vascular injury decision making
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Amila S. Ratnayake, Viktor A Reva, Miklosh Bala, Achala Upendra Jayatilleke, Sujeewa PB Thalgaspitiya, David S Kauvar, Tamara J Worlton

Abstract Introduction In resource limited combat settings with frequent encounters of mass casualty incidents, the decision to attempt limb salvage versus primary amputation is refined over time based on experience. This experience can be augmented by grading systems and algorithms to assist in clinical decisions. Few investigators have attempted to explicitly grade limb ischemia according to clinical criteria and study the impact of limb ischemia on clinical outcome. We suggest a new ischemia grading system based on the Rutherford ischemic classification and the V.A. Kornilov classification which we adapted to apply to the combat setting. This new tool was then retrospectively applied to combat trauma patients from the Sri Lankan Civil War. Method We retrospectively queried a prospectively maintained, single surgeon registry containing 129 extremity vascular injuries managed at a Role 3 military base hospital (MBH) from 2008 December to June 2009 during the last phase of Sri Lankan Civil war. 89 patients were analyzed for early limb salvage according to the modified Kornilov extremity ischemia index (MKEII). Result According to the MKEII, subcohort analysis of C1 (viable), C2 (threatened), and C3 (irreversible) classified injuries demonstrated a statistically significant (P < 0.001) difference in limb salvage. Further statistical evaluation demonstrated injury to popliteal region (P=0.006), severe arterial injury (P=0.018) and venous injuries (P< 0.001) had statistically significant differences in distribution between C1, C2 and C3. Conclusion By application of the MKEII, combat surgeons can rapidly and correctly select and prioritize vascular injured extremities to optimally use limited resources to achieve realistic limb salvage goals. A rigid ankle was correlated with the worst index of extremity ischemia. Further investigation into this sign as an indication for primary amputation is warranted.

95: Comparison of surgical quality and long-term outcome between hybrid trans-anal total meso-rectal excision and laparoscopic total meso-rectal excision: a systematic review and meta-analysis
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Posted 05 May 2020

Comparison of surgical quality and long-term outcome between hybrid trans-anal total meso-rectal excision and laparoscopic total meso-rectal excision: a systematic review and meta-analysis
12 downloads medRxiv surgery

Yingchi Yang, Huihui Wang, Kaixin Zhao, Xiangyu Chu, Kai Pang, Yun Yang, Jun Li, Hongwei Yao, Lan Jin, Zhongtao Zhang

BACKGROUND Laparoscopy-assisted trans-anal TME (ta-TME), or hybrid ta-TME, inherited the advantages of both trans-anal surgery and trans-abdominal surgery, and is gaining increasing acceptance from colorectal surgeons worldwide. This research aims to make a comprehensive comparison between hybrid ta-TME surgery and traditional laparoscopic TME (la-TME) surgery regarding surgical quality and long-term survival. METHODS Cochrane Library, EMbase, Web of Science and PubMed were searched for studies comparing hybrid ta-TME with traditional la-TME. Indicators for surgical quality and long-term prognosis were extracted and pooled. Heterogeneity was assessed with I2 index and was significant when p<0.1 and I2>50%. Publication bias was estimated by Egger test, where p<0.1 was considered statistically significant. RESULTS 13 studies with 992 patients were included in meta-analysis, of which 467 were in hybrid ta-TME cohorts, and 525 were in traditional la-TME cohorts. Compared with traditional la-TME, hybrid ta-TME has lower rate of positive circumferential margin (RR=0.454, 95%CI 0.240~0.862, p=0.016) and lower conversion rate (RR=0.336, 95%CI 0.134~0.844, p=0.020). On rate of positive distal resection margin, completeness/near-completeness of meso-rectum, overall complications, anal leakage, ileus, urinary dysfunction, 2-year DFS and 2-year OS, there were no significant difference between the two techniques. CONCLUSIONS Hybrid ta-TME is significantly superior to traditional la-TME in ensuring CRM safety and lowering intra-operative conversion rate, and is meanwhile not inferior on other major outcome indicators concerning surgical quality and long-term survival. To further understand this new surgical technique, we need high-quality RCTs, as well as previous researchers updates with results of prolonged follow-up.

96: Achieving engagement with a Deliberate Practice programme using portable laparoscopy simulators - 'Incentivised Laparoscopy Practice'.
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Posted 20 Nov 2020

Achieving engagement with a Deliberate Practice programme using portable laparoscopy simulators - 'Incentivised Laparoscopy Practice'.
12 downloads medRxiv surgery

Kenneth G Walker, Jennifer Cleland, Paul M Brennan, Vivienne I Blackhall, Laura G Nicol, Adarsh Shah, Satheesh Yalamarthi, Mark Vella

BackgroundThe transfer validity of portable laparoscopy simulation is well established. However, attempts to integrate take-home simulation into surgical training have met with inconsistent engagement, as reported in our 2014-15 study of an Incentivised Laparoscopy Practice (ILP) programme. Our subsequent multi-centre study examined barriers and facilitators, informing revisions of the programme for 2018-20. We now report engagement with the revised versions. MethodsIn ILP v2.1 and 2.2, two consecutive year-groups of new CSTs (n= 48 and 46) were loaned portable simulators. The 6-month programme included induction, technical support, and intermittent feedback. Six tasks were prescribed, with video instruction and charting of metric scores. Video uploads were required and scored by faculty. A pass resulted in an eCertificate, expected at Annual Review. ILP was set within a wider reform, "Improving Surgical Training". ResultsILP v2.1 and 2.2 saw pass rates of 94% and 76% (45/48 and 35/46 trainees respectively), compared with only 26% (7/27) in v1, despite the v2.1 and v2.2 groups having less electronic gaming experience. In the ILP v2.2 group, 73% reported their engagement was adversely affected by COVID19 redeployments. ConclusionsSimply providing kit, no matter how good, is not enough. To achieve trainee engagement with take- home simulators, as in ILP v2, a whole programme is required, with motivated learning, individual and group practice, intermittent feedback, and clear goals and assessments. ILP is a complex intervention, best understood as a "reform within a reform, within a context." This may explain why trainee engagement fell away during early pandemic conditions. WHAT IS ALREADY KNOWN ON THIS SUBJECTO_LIAttaining automation of motor skills is essential to free up operating surgeons attention for higher cognitive functions. C_LIO_LILaparoscopic operating skills can transfer from simulation to the operating room, and deliberate practice is the most important variable in the development of expertise. C_LIO_LISimply providing take-home portable simulators to surgical trainees, even with online training programmes, is insufficient to facilitate consistent deliberate practice by more than a minority of trainees. C_LI WHAT THIS STUDY ADDSO_LIA package of evidence-based reforms transformed participation of Core Surgical trainees in a 6-month programme of practice using take-home portable simulators, resulting in near- 100% engagement. C_LIO_LISuch reforms are complex, including motivators for learning, individual and group practice, intermittent feedback, clear goals and assessments, and adoption into a wider curriculum reform called "Improving Surgical Training". C_LIO_LIThe improved engagement with this form of remote simulation-based training did not continue in the face of a national "lockdown" for the COVID19 pandemic, where there was widespread redeployment of trainees. C_LI

97: Open and laparoscopic surgeries are associated with comparable 90 day morbidities and mortalities following ERAS protocols- A retrospective Study.
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Posted 10 Apr 2020

Open and laparoscopic surgeries are associated with comparable 90 day morbidities and mortalities following ERAS protocols- A retrospective Study.
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BHAVIN VASAVADA, hardik patel

IntroductionAim of study to evaluate 90 days mortality and morbidity after ERAS protocol and also weather there is any difference in morbidity and mortality between Open and Laparoscopic surgeries. Material and MethodsAll the gastrointestinal surgeries performed between April 2016 to march 2019 in our institution have been analysed for morbidity and mortality after ERAS protocols and data was collected prospectively. ResultsWe performed 245 gastrointestinal and hepato-biliary surgeries between April 2016 to march 2019. Mean age of patients was 50.96 years. 135 were open surgeries and 110 were laparoscopic surgeries. Mean ASA score was 2.40, mean operative time was 111 minutes, mean CDC grade of surgery was 2.56. 40 were emergency surgeries and 205 were elective surgeries. Overall 90 days mortality rate was 8.5% and over all morbidity rate was around 9.79%. On univariate analysis morbidity was associated significantly with higher CDC grade of surgeries, higher ASA grade, more operative time, more blood products use, more hospitalstay, open surgeries,HPB surgeries and luminal surgeries(non hpb gastrointestinal surgeries) were associated with higher 90 days morbidity. On multivariate analysis no factors independently predicted morbidity. On univariate analysis 90 days mortality was predicted by grade of surgeries, higher ASA grade, more operative time, more blood products use, open surgeries and emergency surgeries. However on multivariate analysis only more blood products used was independently associated with mortality ConclusionThere is no difference between 90 day mortality and moribidity rates between open and laparoscopic surgeries.

98: Extrafascial transfissural approach with finger fracture technique approach for liver resection.Old is still gold?
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Posted 10 Apr 2020

Extrafascial transfissural approach with finger fracture technique approach for liver resection.Old is still gold?
11 downloads medRxiv surgery

BHAVIN VASAVADA, hardik patel

Background: Background: We evaluated our protocol of extrafascial transfissural approach for liver resection with intrafascial approach that we use in case of donor hepatectomy. Material and Method: We use extrafascial transfissural approach with finger fracture technique for liver resections and inftrafascial approach with clamp crush technique in case of donor hepatectomy. Major hepatectomy defined as resection of 2 or more adjacent segments.We compared these two techniques with regard to blood loss, operative time, morbidity and mortality.We also evaluated over all factors responsible for 90 days mortality.statistical analysis was done using SPSS version 23.(IBM).Categorical factors were evaluated using chi square test and numerical factors were analyzed using Mann Whitney U test. Multivariate analysis was done using logisitic regression method. Ethical approval for our clinical study was obtained by human research COA number SBI 3246. Results: We evaluated 26 liver resections done in last three years. 19 liver resections were done using extrafascial transfissural approach for various liver tumors and 7 living donor hepatectomies were done using itrafascial technique with clamp crush methods. Mean age of patients was 50.73 years.16 patients were males and 10 were females. Mean blood loss was 273.9 ml and mean operative duration was 184.7 minutes. 22 were major resections ,4 were minor liver resections. All minor liver resections were in transfissural approach however there was no statistical significant difference between them. Being live liver doners patients in intrafacial group they were younger than extrafascial transfissural group. (p=0.01). There was no statistical significant difference in blood loss, blood products requirements, morbidity, in hospital and 90 days mortality in both the groups. However extrafascial transfissural with finger fracture technique was associated with significant less operative time. (168.13 minutes vs 222.86 minutes) (p=0.006). 90 days mortality was associated with higher ASA grade (0.018) and blood loss (0.008). However in multivariate analysis no factor indepedently predicted mortality. Conclusion: Extrafascial transfissural approach significantly reduces operative time, without affecting morbidity and mortality in liver resection.

99: Prognostic significance of compound physiology variables in oesophageal cancer
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Posted 19 Apr 2020

Prognostic significance of compound physiology variables in oesophageal cancer
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Arfon G Powell, Catherine Eley, Alexandra coxon, Carven Chin, Damian M. Bailey, Wyn G Lewis

Aims: Objective identification of patient risk profile in Oesophageal Cancer (OC) surgery is critical. This study aimed to evaluate to what extent cardiorespiratory fitness and select metabolic factors predict clinical outcome. Methods: Consecutive 186 patients were recruited (median age 69 yr. 160 male, 138 neoadjuvant therapy). All underwent pre-operative cardiopulmonary exercise testing to determine peak oxygen uptake (V O2Peak), anaerobic threshold (AT), and ventilatory equivalent for carbon dioxide (V E/V CO2). Cephalic venous blood was assayed for serum C-reactive protein (CRP), albumin, and full blood count. Primary outcome measures were Morbidity Severity Score (MSS), and Overall Survival (OS). Results: MSS (Clavien-Dindo >2) developed in 33 (17.7%) and was related to elevated CRP (AUC 0.69, p=0.001) and lower V O2Peak (AUC 0.33, p=0.003). Dichotomisation of CRP (above 10mg/L) and V O2Peak (below 18.6mL/kg/min) yielded adjusted Odds Ratios (OR) for MSS CD>2, of 4.01 (p=0.002) and 3.74 (p=0.002) respectively. OC recurrence occurred in 36 (19.4%) and 69 (37.1%) patients died. On multivariable analysis; pTNM stage (Hazard Ratio (HR) 2.20, p=0.001), poor differentiation (HR 2.20, p=0.010), resection margin positivity (HR 2.33, p=0.021), and MSS (HR 4.56, p<0.001) were associated with OS. Conclusions: CRP and V O2Peak are collective independent risk factors that can account for over half of OC survival variance.

100: Changes in back pain scores after bariatric surgery in obese patients: A systematic review and meta-analysis
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Posted 31 Aug 2020

Changes in back pain scores after bariatric surgery in obese patients: A systematic review and meta-analysis
8 downloads medRxiv surgery

Froukje W. Koremans, Xiaolong Chen, Abhirup Das, Ashish D Diwan

Objective: To evaluate if back pain scores in morbidly obese patients change after bariatric surgery. Summary Background Data: Obese patients often complain of low back pain (LBP), however the underlying mechanism is not fully understood. Recent research shows that, next to mechanical loading, the chronic low-grade inflammation that arises in obese patients is contributing to LBP due to intervertebral disc degeneration. Therefore, it is hypothesized that bariatric surgery will have an effect on the LBP in obese patients. Methods: We searched four online databases for randomized controlled trials and observational studies. In obese patients, eligible for bariatric surgery, the changes in pre- and postoperative pain scores, assessed by Numeric Rating Pain Scale (NPS) or Visual Analogue Scale (VAS), were considered as primary outcomes. Effect size (ES) and their 95% confidence intervals (CI) were evaluated. Results: Eight observational studies met the eligibility criteria. All studies showed a reduction of LBP following bariatric surgery, with a mean change of -2.9 points in NPS and of -3.8 cm in VAS. Among the patients undergoing bariatric surgery, based on a fixed effect estimated by pain assessment, the pain score decreased significantly in both groups; in NPS (ES -3.49, 95%CI [-3.86, -3.12]) and in VAS (ES -3.975, 95%CI [-4.45, -3.50]). Conclusions: From this meta-analysis, the data of back pain improvement following bariatric surgery seems encouraging. Substantial weight loss following bariatric surgery might be associated with a reduction in back pain intensity.

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