Introduction Bariatric surgery has become one of the most rapidly growing subspecialty performed globally, and it has been well reported to be associated with low morbidity and mortality rates. Splenic abscess is a rare but serious complication of bariatric surgery that has not been previously systematically reviewed in the literature. Methods The authors have performed a systematic review of the evidence that has looked into the pathophysiology, clinical presentation, and the management options of splenic abscess complicating bariatric surgery. Results This systematic review has been unsurprisingly based on level-IV evidence due to the rarity of the explored condition. The final analysis included 27 relevant reported cases. The mean age was 38 years and the mean of the time interval between the initial operation and developing splenic abscess was 72 days, with the male to female ratio being 1:1.6. Laparoscopic sleeve gastrectomy was the initial operation in 85.2% of the patients. Nearly half of the patients did not have an objective evidence of local or systemic sepsis that could explain the abscess formation. Nonsurgical management was attempted in 14 patients, with 34% success rate only. Splenectomy was needed in 41.7% of the patients. No mortality was reported. Conclusions Splenic abscess is a rare and rather late but serious complication of bariatric surgery that could result in splenectomy in a relatively young group of patients. It is more commonly reported following laparoscopic sleeve gastrectomy. Early diagnosis with intervention in a timely manner is crucial to avoid life threatening complications.

Introduction Early during the COVID-19 pandemic, surgeons were advised to use conservative management/open surgery for appendicitis. This single-centre study has explored the resulted management differences. Method Retrospective study covering Prepandemic-data over March-May,2019 & Pandemic-data over March-May,2020. Results Prepandemic-(43 patients): Mean age was 38.3 years. Mean length-of-stay was 1.7 days. Preoperative imaging was used in 32(74.4%) patients; this was diagnostic in 28(87.5%). Non-surgical management was used in 4(9.3%) patients; one needed surgery eventually. Surgical approaches in 40 patients were (laparoscopic: 38(95%), open: 2(5%)). Neither significant morbidity nor mortality was reported. Pandemic-(35 patients): Mean age was 31.2 years. Mean length-of-stay was 2.2 days. Preoperative imaging was used in 30(85.7%) patients; this was diagnostic in 26(86.6%). Non-surgical management was used in 8(22.9%) patients; one needed surgery eventually. Surgical approaches in 28 patients were (laparoscopic: 10(35.7%), open: 18(64.3%)). Neither significant morbidity nor mortality was reported, apart from one patient with COVID-19 postoperative infection. Conclusions There was a tendency towards conservative approach/open surgery during the pandemic. Though this was statistically significant (p < 0.05), the total number of patients was small to achieve stronger conclusions. Laparoscopy was selectively used during the pandemic where the benefit outweighed the risks.

Introduction COVID 19 affected surgical training owing to changes in rotations, moving trusts/departments, surgical skills acquisition and new guidelines/protocols during unprecedented times. Aim was to infer how redeployment impacted surgical skills via an objective and subjective study. Method A retrospective observational study comparing lead surgeons in Laparotomy and Appendectomies between 23rd March- 31st July (2019/2020). A subjective survey was done to elucidate perspectives on skill, academic advancement and trust/deanery support. A focussed group discussion was also done to gain insight on physical and psychological well-being. Results Laparotomy 2019 (n = 75) had 59%; 41%; 0% - Consultants/Registrars/ fellows respectively as lead surgeons. 2020 Laparotomies (n = 50) had 40% consultants; 41% registrars; 20% fellows Similarly, Appendectomy 2019 (n = 94) had 8.5% consultants; 71.3% registrars; 3.2% clinical fellows, whereas 2020 Appendectomies (n = 67) had 18% consultants; 71.6% registrars and 10.4% fellows. The Likert questionnaire showed 42.86% had mental exhaustion, less confidence/skills due to lesser opportunities/procedures. 57.14% expressed COVID 19 extremely affected surgical training while 28.14% believed in a reduction of 81-100% operative log book entries from before. Conclusions Although, the results were not significant in number of cases managed by trainees; many reported perceived loss of training( log book/portfolio), less teaching/training opportunities and mental exhaustion.

Introduction COVID-19 pandemic has posed a major challenge to healthcare systems globally. In NHS, around 36,000 cancer operations have been estimated to be cancelled during the peak time alone. This regional study evaluated the risk of COVID-19 in patients undergoing surgery for colorectal cancer during the peak time. Method This prospective multicentre observational study conducted in four busy district hospitals included 52 patients with colorectal cancer who underwent surgery during the COVID lockdown period (23rd March to 5th May). PCR swab testing was used to detect COVID. Data was collected from patient notes, MDT files and pathology results. Results 73% (38/52) underwent elective procedures, 90% with curative intent. Overall, mean (SD) age was 70 (12.2) years, 50% were female. 60% (32/52) had left sided cancers and a total of 48% (25/52) patients had stage 3 or above. 27% (14/52) had post-operative complications, with 4% (2/52) being Grade 3 Clavien-Dindo. Total mortality was 6% (3/52) of which 1 was elective patient. Only one patient developed COVID infection during the inpatient stay. Conclusions Data suggests, local policies to prevent COVID spread have been effective. Local lockdown in case of second peak may be a reasonable option. Improvement in COVID testing could have major impact on outcomes.

Introduction: Early during the COVID-19 pandemic, the royal college of surgeons advised to use Non-Operative Treatment of appendicitis NOTA or otherwise open surgery for appendicitis. This study has explored the resulted management differences, and the outcome after one year follow up. Methods: Retrospective study covering Pre-pandemic data over March-May,2019 & COVID-19 pandemic data over March-May,2020. We compared the outcome of non-operative treatment approach (NOTA), open and laparoscopic surgical outcome between the 2 groups. Results: The number of admissions was lower in the COVID compared to the Pre-COVID Group (35 vs 43). In the COVID group had more CT scanning of the abdomen and pelvis (65.7% vs 42.2%; p=0.036). There was no difference in the diagnostic value for these imaging methods between the 2 groups (87.5% vs 86.6%) During COVID period Signicantly fewer patients underwent surgery (77.1 vs 92.8; p<0.04), There were signicantly more complicated appendicitis cases in the COVID group compared to Pre-COVID group (59.2 vs 28.2; p:0.021). There was in reduction LOS when comparing Laparoscopic to NOTA (1.7 vs 2.6 days; p:0.03). There has been higher complication rate in the open and NOTA treatments compared to Laparoscopic, but this was not statistically signicant (24.3 % vs 14.8%; p: 0.29). In the NOTA group 41 % of the patients had emergency or interval appendectomy in after one year follow up period. Conclusions: There was a tendency towards conservative approach/open surgery during the pandemic. Our study suggests that Laparoscopic surgery should remain the preferred method of management of appendicitis during COVID-19 pandemic considering the more complicated appendicitis. NOTA should be limited to selected high risk patients. accepting the risk of disease recurrence and need for further interval or emergency surgery

Objective An abdominal aortic aneurysm is considered giant when its transverse diameter is greater than 10–13 cm in diameter. A giant abdominal aortic aneurysm is rare but with a significant risk of rupture if it is not diagnosed or left untreated. Method The authors have performed a systematic review of the evidence that has looked into the clinical presentations, and management methods employed and have presented a 14 cm giant abdominal aortic aneurysm patient. Results The systematic review has been based on level-IV evidence due to the rarity of the condition. The final analysis included 61 relevant reported cases. The mean age was 72.4 years, the male to female ratio was 52: 8, and the average size of a giant abdominal aortic aneurysm was 14.7 cm. These were mostly infra renal (72.58%). Rupture of these aneurysms was found in 23 (37.1%) patients, and was treated by laparotomy in 51 (82.25%) cases. There were 11 (17.74%) mortalities. Conclusion The size of an abdominal aortic aneurysm is known to be the biggest factor in the rupture of an aneurysm. The reason abdominal aortic aneurysms can reach such size without rupturing is unclear but needs further exploring. Early diagnosis with effective screening programmes is essential to diagnose in a timely manner to avoid life-threatening consequences.

Aim Increasing student interest in pursuing a surgical career at an undergraduate level. Background Data suggests that interest in surgical specialties may be declining, even from as early on as medical school. However, studies suggest that engagement with extra-curricular activities influences their likelihood to pursue surgical careers. Our study aimed to assess changes in student perception towards surgical careers following participation in a three-week surgical course. Method Students on placement at St Peter’s Hospital, Chertsey were invited to a course of 3 one-hour sessions covering practical surgical skills and lectures. Participants were tutored by Foundation-Year-Two doctors, with oversight of a surgical clinical teaching fellow and senior consultant. Students completed pre- and post-course surveys focusing on surgical interest, surgical skill confidence, placement-participation, and career preparation. The course was delivered through two cycles. Results Cycle one showed statistically significant improvements in suturing-confidence (mean increase 4.05 out of 10, p = 0.001), confidence in hand-ties (3.63 out of 10, p = 0.015) and understanding of developing a surgical portfolio (mean increase 1.95 out of 10, p = 0.005). After a second cycle, including the introduction of a surgical portfolio development lecture, students demonstrated a statistically significant improvement in mean scores across all areas. Notably, interest in pursuing a surgical career increased from mean 5.85/10 to 8.8/10 (p = 0.028). Conclusions We demonstrate that a short and easily accessible course can significantly improve student interest and understanding of a surgical career; equipping them with fundamental skills to pursue engagement at the undergraduate level.

Aim We aimed to evaluate optimal random biopsy criteria are being followed in our institution to increase the diagnostic yield of a subsequent histopathological examination and to reduce the number of unnecessary biopsies in which histopathology is unlikely to deliver clinically useful information and causing a burden on health resources in terms of cost and manpower. Method Our study was a retrospective on 419 random colonoscopy biopsies performed over 6 months. Data collection included variables such as age, gender, indications, request of urgency, and histology findings. Data analysis was done descriptively. Results Out of 419 random biopsies, only 10.02% had positive findings. The total number of histology results with microscopic colitis was 10. The main indication of the random colonic biopsy was a change in bowel habits (328 cases) followed by significant diarrhea greater than 50 years in 20 cases. In patients with a change in bowel habits, 2.44% of histopathology specimens revealed microscopic colitis. The percentage of random colonic biopsy histology in patients greater than 50 years with significant diarrhea showed microscopic colitis was 10%. Conclusions Our study revealed random biopsy during colonoscopy should only be done in selected patients otherwise it has low diagnostic yields biopsy and should only be reserved for patients with risk factors for optimum utilization of health resources and to reduce the cost burden. A scoring system may be helpful to risk-stratify patients in low and high risk for MC to determine which patients qualify for RCB.