scholarly journals 293 A Reflection of Experience Gained in Emergency General Surgery During The COVID-19 Pandemic at A London University Hospital

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
N Angamuthu ◽  
J Gilliland ◽  
S Chowdhury ◽  
R D'Souza ◽  
C Hart ◽  
...  
Keyword(s):  
General Surgery ◽  
University Hospital ◽  
Surgical Service ◽  
Medical Assistance ◽  
Emergency General Surgery ◽  
Tertiary Institution ◽  
Surgical Department ◽  
Surgical Services ◽  
Male Preponderance ◽  
Group A

Abstract Background During COVID-19, acute surgical services witnessed an overhaul of practice due to constraints on staff and resource (beds, imaging, and theater) availability. Fear of COVID-19, among general population potentially added to delay in patients seeking medical assistance. This study describes experiences of acute general surgery at a COVID-19 designated tertiary institution wherein elective surgical work was put on hold and emergency on-call rota was modified during the pandemic. Method A retrospective analysis (March-April 2019 vs 2020) of the surgical work from a prospectively maintained surgical database during COVID-19 was performed. Results Emergency surgical admissions during March 2020 vs 2019 was 106 vs 207. Comparing the workload March-April 2020 vs 2019, emergency referrals were 266 vs 341, operations performed 71 vs 92. 31.5% (84/266) of patients were tested for COVID and 30% (25/84) were positive. Emergency surgery was performed in 71 patients (including appendectomies (28), hernia repair(3), laparotomy(3), Hartman’s procedure(3), hemicolectomy(7) and anterior resection with covering ileostomy(2)). In this group, a male preponderance was noted (M:F 1.84:1), the average age was 43.2 years (6-91), length of stay 4.8 days (<23 hours-34 days). In the operative group, the 30-day mortality was 4.23% (3/71) and the morbidity was 31%. Conclusions With local changes, stopping elective services, modifying on-call rota, a surgical department can continue to be functional and offer emergency surgical service for a sustained period during a pandemic. During the COVID pandemic, the average number of referrals, admissions and surgeries were lower when compared to the non-covid period.

Comparison of Outcome of one Versus two Drains Insertion for Seroma Formation Following Modified Radical Mastectomy in Breast Carcinoma

2021 ◽  
Vol 17 (1) ◽  
pp. 52-55
Author(s):  
Shiraz Shaikh ◽  
Ambreen Munir ◽  
Shahnawaz Abro ◽  
Shahida Khatoon ◽  
Zameer Hussain Laghari ◽  
...  
Keyword(s):  
Breast Carcinoma ◽  
General Surgery ◽  
Stable Condition ◽  
Radical Mastectomy ◽  
Seroma Formation ◽  
University Hospital ◽  
P Value ◽  
Modified Radical Mastectomy ◽  
Group A ◽  
Group B

Objective: Comparative outcome of one versus two drains insertion for in the term of seroma formation following modified radical mastectomy in breast carcinoma. Methodology: This Prospective Interventional trial was conducted at Department of General Surgery, Liaquat University Hospital Hyderabad from February 2018 to January 2019.  Females with breast carcinoma admitted for modified radical mastectomy were included. Patients were divided into two groups.  Groups I underwent one drain placement and group II underwent two drains placement. All patients were observed to measure and record the volume of the fluid. Patients were discharged from Hospital in stable condition and after removal of drains, and followed up weekly for one month. Data was recorded on self-made proforma and analyzed by using SPSS-20. Results: Total of 80 patients were selected, 38 in group A and 42 in group B. Mean age of patients of group A was 49.08 ± 9.89 years and group B was 51.40 ± 13.59 years. , Excised Mass weight was lesser in group A as compared to group B. Mean volume of drain discharge was significantly higher in Group B 323.43 ± 158.88 ml, while it was in group A 230.29± 200.98, findings were statistically significant 0.013. Seroma formation was statistically insignificant among both groups as 8(21.1%) in group A and   10(23.8%) in group B, p-value 0.768. Conclusion: One-drain and two-drain insertion are equally effective to reduce the seroma formation after modified radical mastectomy; however, one drain insertion leads to more patient compliance and comfort with probably less morbidity and cost.

scholarly journals Geriatric Surgical Service Complements Care of Older Adult Emergency General Surgery Patients

2021 ◽  
Vol 233 (5) ◽  
pp. e75
Author(s):  
Frances Y. Hu ◽  
Lynne O'Mara ◽  
Masami Kelly ◽  
Emma Kerr ◽  
Christina Sheu ◽  
...  
Keyword(s):  
Older Adult ◽  
General Surgery ◽  
Surgical Service ◽  
Emergency General Surgery

scholarly journals Outcome of emergency general surgery in a university hospital

2014 ◽  
Vol 12 ◽  
pp. S91
Author(s):  
Sadaf Jafferbhoy ◽  
Owain Fisher ◽  
Phillipa Dann ◽  
Achilles Tsiamis
Keyword(s):  
General Surgery ◽  
University Hospital ◽  
Emergency General Surgery

scholarly journals INGUINAL HERNIOPLASTY

2015 ◽  
Vol 22 (06) ◽  
pp. 782-786
Author(s):  
Mujeeb Rehman Abbasi ◽  
Razzak Shaikh ◽  
Ahmed Khan Sangrasi ◽  
Noshad A Shaikh ◽  
Ubedullah Shaikh
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Groin Hernia ◽  
Operation Time ◽  
University Hospital ◽  
Inguinal Hernioplasty ◽  
Surgical Department ◽  
Group A ◽  
Group B

Objective: To compare laparoscopic TEP Inguinal hernioplasty with & withoutdissection balloon. Study Design: Observational study. Setting: Minimal Invasive SurgicalCentre Jamshoro and General Surgical Department at Dow University Hospital, Ojha CampusKarachi. Period: May 2011 and Dec 2012. Subjects and methods: Twenty (20) male patientswith uncomplicated unilateral or bilateral inguinal hernia were prospectively randomized in twogroups; group A Commercially available dissection balloon & group B. Telescopic dissectionfor creating TEP working space. Results: We had 20 male patients for this study. The averageage was 43.6 & ranging between 17 to 64 years. Only 2 patients 10% had bilateral groin hernia,4 patients 40% had direct inguinal hernia in group A & 5 patients 50% had direct hernia in groupB. Peritoneum was breached in 5 (50%) patients with telescopic dissection. One patient (10%)with bilateral groin hernia in group B had large tear in peritoneum converted to TAPP whileother group normal. The incidence of scrotal edema/seroma was greater in group B then groupA. 40% patient in group B developed seroma while 0nly 1 (10%) patient with bilateral groinhernia in group A developed seroma. Pain was scored on VAS at 1 & 4 hours after surgerywas higher in group B. The mean operation time was 55 min (45-100) in the group with theballoon and 73 min (50-120) in the group without the balloon (p = 0.004). Conclusion: TEPlaparoscopic inguinal hernia repair is probably the best option amongst the two techniquesused in laparoscopic inguinal hernia repair & dissection with balloon is though costly but morehelpful in dissection & safer.

Service Comparison between Vascular and General Surgery in the Treatment of Chronic Venous Insufficiency with Special Reference to Preoperative Doppler Techniques

2006 ◽  
Vol 95 (1) ◽  
pp. 45-48 ◽  
Author(s):  
A. Oinonen ◽  
N. Sugano ◽  
A. Lehtola ◽  
N. Suokas ◽  
U. Keränen ◽  
...  
Keyword(s):  
General Surgery ◽  
Venous Insufficiency ◽  
Preoperative Assessment ◽  
Clinical Findings ◽  
Lower Limbs ◽  
Surgical Service ◽  
Surgical Services ◽  
Doppler Techniques ◽  
Surgical Unit ◽  
Vein Reflux

Aims: To compare the ability of vascular and general surgical services to abolish reflux in superficial venous system with aspecial reference to preoperative use of Doppler techniques. Materials and Methods: 68 lower limbs operated on for venous insufficiency based on either preoperative Duplex evaluation and Doppler marking in avascular surgical unit (Vascular Surgical Service, VSS: 33 limbs, clinical class C2–C6) or clinical findings in a general surgical unit (General Surgical Service, GSS: 35 limbs, clinical class C2–C4) were re-examined clinically and with duplex scanning for reflux some three years postoperatively. Results: Marked superficial or perforator vein reflux was observed in 27 of 68 (39.7 %) operated limbs, thirteen of which in VSS and fourteen in GSS. However, axial reflux at saphenofemoral or thigh level was observed significantly less in VSS compared to GSS (3 vs 13, p = 0, 006). Conclusion: Total ablation of any reflux appeared difficult irrespective of the preoperative assessment. Preoperative Duplex examination, however, aided in identifying and treating axial reflux at thigh level.

General Surgery Residency and Emergency General Surgery Service Reduces Readmission Rates and Length of Stay in Nonoperative Small Bowel Obstruction

2020 ◽  
Vol 86 (9) ◽  
pp. 1178-1184
Author(s):  
Sarah Waterman Manning ◽  
Scotta L. Orr ◽  
Katherine S. Mastriani
Keyword(s):  
Small Bowel ◽  
Length Of Stay ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
General Surgery ◽  
Surgical Service ◽  
Emergency General Surgery ◽  
Residency Programs ◽  
General Surgery Residency ◽  
Significant Difference

Background Nonoperative management of adhesive small bowel obstruction (ASBO) results in resolution for the majority of patients. Previous studies have demonstrated that outcomes for patients with ASBO are improved when patients are admitted to a surgical service, but the effect of general surgery resident coverage is unclear. This study measures quality outcomes for patients with ASBO after the establishment of a new general surgery residency program. Methods An institutional review board-approved retrospective chart review of admissions for ASBO was conducted following the implementation of a protocol for ASBO nested within a newly developed resident-run emergency general surgery (EGS) service. Patients successfully treated without operative intervention were analyzed. Results During the study period, 612 patients were admitted for ASBO. After initiation of the residency, 74% of ASBO were admitted to a surgical service compared with 35% prior to residency ( P < .01). Length of stay was reduced by 0.77 days ( P = .016), average direct total cost per patient was reduced by 24% ( P = .002), and 30-day readmissions were reduced by 35.7% ( P = .046). There was no significant difference in mortality (1.4% vs 1.0%). Discussion Admission to a resident-run surgical service was associated with statistically significant improvement in outcomes for patients with ASBO. These data corroborate prior studies demonstrating the positive impact of residency programs on patient outcomes and provide additional evidence that general surgery residency programs improve outcomes for patients with surgical disease.

scholarly journals HAEMORRHOIDS

2012 ◽  
Vol 19 (04) ◽  
pp. 531-536
Author(s):  
MUJEEB REHMAN ABBASSI ◽  
UBEDULLAH SHAIKH ◽  
AHMED KHAN SANGRASI
Keyword(s):  
Coming Out ◽  
University Hospital ◽  
Anal Stenosis ◽  
Artery Ligation ◽  
Female Ratio ◽  
Surgical Department ◽  
Male Female Ratio ◽  
Group A ◽  
Bleeding Per Rectum ◽  
Group B

Objective: The objectives of the study are to compare the outcome of the Doppler Guided Haemorrhoidal Artery Ligation andopen Haemorrhoidectomy in 2nd & 3rd Degree Haemorrhoids. Study design: Comparative study. Place and duration of study: Study wascarried out at the General Surgical Department at Liaquat University Hospital, Jamshoro & private hospital Hyderabad from 2008 – 2009.Methodology: Study consisted of 50 patients of diagnosed cases of heamorrhoid. Patients were divided in two groups. In Group A Standardopen Haemorrhoidectomy and Group B we used Doppler Guided Haemorrhoidal artery ligation. Detailed history was taken from all the patientswith special regard to the bleeding per rectum or some thing coming out during defecation and Clinical examination of anal canal DRE andProctoscopy was done. Results: In both groups male were 37 (74%) and female 13 (26%) with male: Female Ratio of 2:8:1. Age ranging from20 to 60 years in both group, mean ages of patients were 38.28 + 10.355 years. 3rd degree haemorrhoid 31(62%) while 2nd degree 19(38%).Complications were mild to moderate pain 24(96%) patients in DG – HAL group while moderate to severe pain 23(92%) in excisionalheamorrhoidectomy group. Anal stenosis in 2(8%), patients, anal fissure 1(4%) patients and feacal incontinence 1(4%) patients were observedonly in excisional heamorrhoidectomy. Recurrence occurred in one case (4%) in each group. Conclusions: DG – HAL procedure has a low rateof complications, earlier mobilization, implies a shorter hospital stay and offers the patient a more comfortable postoperative period thanExcisional heamorrhoidectomy procedure.

scholarly journals 94 An Observational Cohort Study to Evaluate Volume and Severity of Emergency General Surgery Admissions During The COVID-19 Pandemic: Is There A “Lockdown” Effect?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
R McLean ◽  
J Young ◽  
A Musbahi ◽  
J X Lee ◽  
H Hidayat ◽  
...  
Keyword(s):  
General Surgery ◽  
Service Provision ◽  
Patient Characteristics ◽  
Surgical Service ◽  
Emergency General Surgery ◽  
Surgical Disease ◽  
Significant Difference ◽  
Observational Cohort ◽  
The Government ◽  
Grade 3

Abstract Introduction The COVID-19 pandemic has led to changes in NHS surgical service provision. This, combined with the government-imposed lockdown, may have impacted on patient attendance, severity of surgical disease, and outcomes. This study aimed to investigate a possible ‘lockdown’ effect on the volume and severity of surgical admissions and outcomes. Method Two cohorts of adult emergency general surgery admissions 30 days immediately before (16/2/2020 to 15/3/2020), and after UK government advice (16/3/2020 to 15/4/2020). Data were collected relating to patient characteristics, disease severity, clinical outcomes, and compared between these groups. Results Following lockdown, a significant reduction in median daily admissions from 7 to 3 (p &lt; 0.001) was observed. Post-lockdown patients were significantly older, frailer with higher inflammatory indices and rates of AKI, and more likely to present with gastrointestinal cancer, obstruction, and perforation. Patients had significantly higher rates of Clavien-Dindo Grade ≥3 complications (p = 0.001), all-cause 30-day mortality (8.5% vs. 2.9%, p = 0.028), but no significant difference was observed in operative 30-day mortality. Conclusions There appears to be a “lockdown” effect on general surgical admissions with fewer admissions, more acutely unwell patients, and an increase in all-cause 30-day mortality. Patients should be advised to present promptly, and this should be reinforced for future lockdowns during the pandemic.

708 Examining the Management of Acute Lower GI Bleeds in Order to Improve Policies and Reflect Safe and Updated Guidance

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
L Han ◽  
H White ◽  
K Bosch ◽  
M Nair
Keyword(s):  
Gastrointestinal Bleeding ◽  
Surgical Intervention ◽  
Lower Gastrointestinal Bleeding ◽  
University Hospital ◽  
British Society ◽  
Shock Index ◽  
Surgical Department ◽  
Upper Gi ◽  
Cardiovascular Comorbidities ◽  
New Guidelines

Abstract Introduction Acute lower gastrointestinal bleeding (LGIB) tends to occur in elderly patients with complex comorbidities. At North Middlesex University Hospital (NMUH), LGIB patients are primarily managed by the surgical department. We amended local policies by integrating aspects of new guidelines published by the British Society of Gastroenterology (BSG). Method Handover documentation between November 2019 and January 2020 established patients admitted with LGIB (n = 45). Further data regarding the management of these patients was collated from clinical software and compared to standards set from BSG guidelines. Results We found NMUH to be efficient in ruling out upper GI bleeds via 24-hour OGDs and had low surgical intervention rates (0.02%). 40% of patients were transfused with an admission haemoglobin above suggested NICE thresholds, accounting for cardiovascular comorbidities. 56% of patients were discharged without a documented anticoagulation plan. Over 50% of patients did not have BSG recommended inpatient investigations. Conclusions Updated Trust guidelines aim to uphold areas that NMUH were shown to excel in, while reiterating NICE transfusion thresholds and include guidance regarding anticoagulant and antiplatelet medications. The Oakland score and shock index have been integrated into local protocols and will aid clinicians in making safe decisions in the management of LGIB patients.

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