2025

Colorectal cancer mortality rates in an English county, Shropshire (2025)

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Type of publication:

Conference abstract

Author(s):

*Wilson R.; *Shah J.; *Shittu S.; *Goh Y.L.; *Ball W.

Citation:

British Journal of Surgery. Conference: Annual Congress of the Association of Surgeons of Great Britain and Ireland. Edinburgh United Kingdom. 112(Supplement 13) (pp xiii69), 2025. Date of Publication: 01 Aug 2025.

Abstract:

Aim: To evaluate outcomes of patients dying within 12 months of colorectal cancer diagnosis in Shropshire County. Method(s): A single-centre retrospective review was conducted on patients who died within 12 months of diagnosis between 2020 and 2024. Patient demographics, performance status, time from referral to imaging, diagnosis, MDT, death, and treatment intent were collected. Result(s): A total of 103 patients (44 male, 59 female), with a mean age of 74 (range 32-96) years. Most had a performance status of 1 and lived in their own home (92%). Geographically, 60% lived in Shrewsbury, 34% in Telford, and 9% in Wolverhampton. Referral sources were mainly from GPs (55%), with 74% seen within two weeks. Other referral sources include emergency admission to SAU (20%) and AMU (16%). All patients underwent CT imaging, and 57% had endoscopic procedures. The average age at death was 75 (range 34-97), with the most common cause being distant metastatic sigmoid cancer. The average time from diagnosis to death was 4.4 months. Treatment intent was palliative for 90% of patients (44% best supportive care, 56% oncology), and 59% of those referred to oncology received palliative treatment. Eight patients with curative intent died due to emergency presentation with sepsis and multiorgan failure (2), prior to commencing treatment (1), complications of treatment (3), or declined treatment (2). Conclusion(s): This audit highlights that colorectal cancer patients in Shropshire are predominantly elderly, over 70 years, with significant co-morbidities and a performance status of at least 1.

DOI: 10.1093/bjs/znaf166.263

Endoscopic Follow-up after Acute Diverticulitis (2025)

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Type of publication:

Conference abstract

Author(s):

*Sultana E.; *Chakrabarty A.; *Ball W.

Citation:

British Journal of Surgery. Conference: Annual Congress of the Association of Surgeons of Great Britain and Ireland. Edinburgh United Kingdom. 112(Supplement 13) (pp xiii59), 2025. Date of Publication: 01 Aug 2025.

Abstract:

Introduction: Acute diverticulitis is one of the most common causes for surgical emergency hospital admissions in the UK. The guidelines for endoscopic follow-up for patients with diverticulitis has changed over the last few years. This study aimed to assess the local follow-up of patients who present with diverticulitis. The objective was to identify the outcome of patients with diverticulitis and establish the new local guidelines for endoscopic follow-up. Method(s): A single-centre retrospective study was done for all patients who had CT proven diverticulitis at the Royal Shrewsbury Hospital in 2022. Data was collected about the patient demographics, vital statistics on presentation, Hinchey Classification, mode of management, previous admissions with diverticulitis, readmissions in one year, surgery in one year, and their follow-up results. Result(s): There were 193 patients in the study with a median age of 61 (IQR: 51-73) and 37.8% were male. Follow-up endoscopy was done in 45.6% (87/193) of the patients, amongst which 85.1% (74) had uncomplicated diverticulitis. There was one cancer detected in colonoscopy and one in flexible sigmoidoscopy both of which were suspicious on the initial CT scan. 13 patients had a follow-up CT scan within 1 year, of which 2 confirmed cancer. Median time for endoscopy and CT scan was 10 and 26 weeks from discharge, respectively. Conclusion(s): Diagnosis of cancer on an isolated follow-up colonoscopy or flexible sigmoidoscopy after uncomplicated diverticulitis is rare. These investigations should be reserved for patients with complicated diverticulitis or suspicious features of cancer on the initial CT scan.

DOI: 10.1093/bjs/znaf166.222

Evaluation of outcomes in patients with pelvic pain in paediatric gynaecology clinics (2025)

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Type of publication:

Conference abstract

Author(s):

*Wadi T.; SudhakarKalaivani N.; George A.; McCan A.; *Ritchie J.; O'Mahony F.

Citation:

BJOG: An International Journal of Obstetrics and Gynaecology. Conference: RCOG World Congress 2025. London United Kingdom. 132(Supplement 5) (pp 137), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background: Pelvic pain is a common problem encountered in the paediatric and adolescent gynaecology clinic. Pelvic pain has an impact of the patients attendance at school, mood and quality of life. Diagnosing conditions such as endometriosis can be challenging in adolescents as most of the literature and guidelines are for adults. Objective(s): To evaluate the outcomes for patients with primary presentation of non-acute pelvic pain, reviewing the management offered and assessing the response. Design(s): This study employs a retrospective design, analyzing patient data from two secondary care clinics to evaluate treatment pathways for adolescents with chronic pelvic pain. By reviewing patient journeys from referral to discharge, we aim to assess treatment effectiveness and identify gaps in care. Method(s): Both clinic database's were screened to include all patients who attended, for 12 months for the tertiary unit and 18 months for the smaller DGH. All consultations were screened for reason for attendance, and only those who attended for non-acute pelvic pain were followed up for the outcomes. Follow up consultations were additionally reviewed. <br/>Result(s): Initial screening of 438 referrals found 104 patients at tertiary centre and 20 at DGH attended with pelvic pain. In both majority were offered and managed medically with hormonal treatment. One patient at DGH was offered and booked for surgery but this was later cancelled by the patients as her symptoms were improved with medical management. Two are currently on the surgical waiting list at the tertiary centre. Across both sites, all patients diagnosis relied upon clinical history first line, supported by optimal medical management, thus adhering the ESHRE endometriosis guidelines. Conclusion(s): With increasing awareness of conditions l ike endometriosis there are increasing number of referrals for pelvic pain. Optimising medical management can prevent the immediate need for diagnostic laparoscopy, which is beneficial due to the long waiting lists for surgery Reassuring most were managed with medical management and showed improvement in symptom control.This is important as the guidance on managing endometriosis in adolescents is still unclear.

DOI: 10.1111/1471-0528.18215

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Factors associated with conversion from day-case to in-patient elective laparoscopic cholecystectomy across England: An observational study using administrative data (2025)

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Conference abstract

Author(s):

*Olagunju N.; *Cheetham M.; Briggs T.; Gray W.K.

Citation:

British Journal of Surgery. Conference: Annual Congress of the Association of Surgeons of Great Britain and Ireland. Edinburgh United Kingdom. 112(Supplement 13) (pp xiii25), 2025. Date of Publication: 01 Aug 2025.

Abstract:

Aims: Day-case laparoscopic cholecystectomy is safe, cost-effective and patient friendly; however, some planned day case patients may convert to in-patient stay following an elective laparoscopic cholecystectomy. The aim of this study was to determine the rate of conversion from planned day-case to in-patient laparoscopic cholecystectomy across England and trends in same-day discharge over the study period. This study also aimed to evaluate factors contributing to these conversions. Method(s): This was an exploratory analysis of administrative data from the Hospital Episode Statistics (HES) database for England of planned day-case laparoscopic cholecystectomies from April 2017 to March 2024. Result(s): Of 286,754 planned day-case patients, the conversion rate to in-patient stay was 26.1% (74,957). Patients who converted to in-patient stay were older, more likely to be male and have open surgery, more comorbidities and were more likely to be operated on by a low annual volume surgeon. Post-procedural complications of haemorrhage, pain and venous thromboembolism were strongly associated with conversion. Across the 42 ICBs in England, model-adjusted conversion rates varied from 14.5% to 39.0%. Conversion to in-patient stay was associated with higher emergency hospital admissions within 30 days of discharge (4,290, 5.7%) when compared with same-day discharge (8,306 3.9%). Conclusion(s): The rate of conversion from planned day-case to in-patient laparoscopic cholecystectomy across England have declined over the past 7 years. Our study highlights patient selection, intra-operative haemostasis, and peri-operative pain management as target areas for centres hoping to improve day-case laparoscopic cholecystectomy rates.

DOI: 10.1093/bjs/znaf166.094

Assessment of Predictors of Recurrence, Surgical and Radiological Intervention in Acute Colonic Diverticulitis: A Multicentre Study with One-Year Follow-Up (2025)

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Type of publication:

Conference abstract

Author(s):

Mohamedahmed A.Y.; Albendary M.; Issa M.; *Sultana E.; Hamid M.; Zaman S.

Citation:

British Journal of Surgery. Conference: Annual Congress of the Association of Surgeons of Great Britain and Ireland. Edinburgh United Kingdom. 112(Supplement 13) (pp xiii1), 2025. Date of Publication: 01 Aug 2025.

Abstract:

Background: Recurrent acute diverticulitis (AD) significantly impacts patient's quality of life and increases morbidity and healthcare costs. This study aims to assess risk factors for recurrence and the need for surgical and radiological intervention during one year from index presentation. Method(s): This multicentre study was performed in four UK hospitals. All patients presented with a CT scan confirmed colonic AD during 12 months were included. Patients were followed up for one year from the index presentation. Outcomes of interest were the patient factors associated with recurrent episodes of diverticulitis and the requirement for a radiological or surgical intervention, using both univariate and multivariate logistic regression. Statistical analysis was performed using R version 4.4. Result(s): A total number of 542 patients were included; the median age was 62 (51-73) years, and 64.2% had Hinchey 1a AD. The recurrence rate over 1 year was 19.5%, with increased likelihood in patients with previous diverticulitis (P=0.006), Temperature >= 38degreeC on index admission (P=0.021), and LOS >= 3 days (P=0.009). Surgical and radiological intervention during follow-up was reported as 11.8% and 2%, respectively. Factors associated with increased likelihood of surgical intervention within 1 year were previous diagnosis of complicated diverticulitis (P=0.002), pyrexia(P=0.009) and hypotension(P=0.013) on index admission, CRP >300 (P=0.037), WCC >=15(P=0.007), and Hinchey grades >= 2 (P=0.001). Conclusion(s): High inflammatory markers, prolonged LOS and previous history of diverticulitis are associated with an increased risk of recurrence of diverticulitis. Treatment of acute diverticulitis must be tailored according to the patient's risk stratification.

DOI: 10.1093/bjs/znaf166.003

Losing Sense of Direction or Anatomical Variation? - Failure of Biliary Duct Clearance Through Endoscopic and Surgical Interventions (2025)

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Conference abstract

Author(s):

*Lakshmipathy G.; *Pattar J.; *Jain R.;

Citation:

British Journal of Surgery. Conference: Annual Congress of the Association of Surgeons of Great Britain and Ireland. Edinburgh United Kingdom. 112(Supplement 13) (pp xiii122-xiii123), 2025. Date of Publication: 01 Aug 2025.

Abstract:

Clinical Details: 61-year-old man with obesity and type II diabetes, presents with abdominal pain and obstructive jaundice. MRCP showed gallstones and 12mm common hepatic duct (CHD) stone. However, ERCP could not identify calculus in the then thought CHD. Second MRCP and bloods demonstrated the same CHD stone and worsening bilirubin. Therefore, laparoscopic cholecystectomy and common bile duct (CBD) exploration were done; with the extraction of three proximal CBD stones and flushing two distal CBD stones. Operative choledochoscopy of CBD and the then presumed CHD were considered clear. Post-operatively, bilirubin climbed and MRCP confirmed the persistent CHD stone and identified anatomical variation in drainage of right posterior sectoral duct (RPSD). Subsequently, ERCP could not retrieve the large CHD calculus and spyglass ERCP referral was made. Discussion(s): Negative operative choledochoscopy and endoscopy of CHD occurred because of preferential entry into aberrant RPSD rather than CHD. This aberrant RPSD drained into cystic duct, which is type 5 variation in prevalence-based classification of anatomical biliary variants or type 3C of Choi classification. Aberrant RPSD is the least prevalent bile duct variant seen in 0.6% of patients. Type 4 and 5 variants are relevant in operative choledochoscopies and ERCP, as RPSD could be mistaken for CHD. This case demonstrates a rare anatomical variation of the biliary tree which can derail surgeons and endoscopists in diagnosing and managing patients with choledocholithiasis. We therefore emphasise high index of suspicion and utilise three-dimensional reconstruction of biliary tree, pre-procedurally in all cases of CBD exploration.

DOI: 10.1093/bjs/znaf166.475

Standardisation of colorectal robotic-assisted surgery (RAS) training: A roundtable discussion (2025)

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Type of publication:

Conference abstract

Author(s):

*Kawar L.; Shakir T.; *El-sayed C.

Citation:

Colorectal Disease. Conference: Association of Coloproctology of Great Britain and Ireland Annual Meeting. Harrogate United Kingdom. 27(Supplement 2) (no pagination), 2025. Date of Publication: 01 Sep 2025.

Abstract:

Purpose: The current landscape of colorectal robotic-assisted surgery (RAS) training is marked by significant variability. In order to gather opinions, a webinar was hosted by The Dukes' Club, the UK network for colorectal surgical trainees. This seeked to understand from a panel of expert RAS surgeons with various stakeholder roles in RAS training, the optimal method of delivering standardised RAS training in the UK. Method(s): This consensus study is based on a one-hour webinar held on 4th March 2024. Panellists included robotic surgery preceptors and proctors from both CMR Surgical (UK) and Intuitive (USA) respectively; members of robotic subcommittees within speciality associations, and providers of European fellowships. A thematic analysis was conducted to systematically analyse the qualitative data. Result(s): The roundtable featured two consultant urologists and three consultant colorectal surgeons. Four main themes with relevant sub-themes emerged: (1) the current state of robotic training, (2) training components of RAS, (3) challenges in delivering training, and (4) strategies for improvement. The discussion highlighted the variability in training based on geographical location and surgical speciality. Trainer readiness was discussed, with emphasis placed on the temporary nature of this. The importance of adopting RAS skills early in training with stepwise progression, was highlighted. Essential components of a standardised curriculum were identified including e-learning, simulation, and mentorship. Conclusion(s): Standardising colorectal RAS training is vital for equitable and effective skill development. Future directions include enhancing access and resource allocation, implementing stepwise certification, and integrating artificial intelligence and machine learning.

DOI: 10.1111/codi.70177

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Acute management of severe inflammatory bowel disease: a clinical audit for quality improvement (2025)

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Conference abstract

Author(s):

*Baumert A.; *Cheetham M.

Citation:

Colorectal Disease. Conference: Association of Coloproctology of Great Britain and Ireland Annual Meeting. Harrogate United Kingdom. 27(Supplement 2) (no pagination), 2025. Date of Publication: 01 Sep 2025.

Abstract:

National guidelines for the acute management of inflammatory bowel disease (IBD) have been developed to advise clinicians on first-line investigations and optimal treatment pathways. Clinical audits are vital at a trust level for identifying gaps in these pathways and creating opportunities to implement positive change. For this project, a retrospective review was carried out on patients who underwent an emergency subtotal colectomy following admission with acute severe ulcerative colitis. Surgical patients were identified via a histopathology database and elective surgeries excluded. Key points throughout each admission were audited against national standards outlined in IBD UK and the BMJ (Lamb et al, 2019). This project specifically collected data on initial investigations (stool cultures and sigmoidoscopy), medical management (steroids and biologics) and surgical intervention (first contact with surgeons and timeframe until surgery). This audit primarily identified inconsistencies in organising investigations: 37.5% of patients did not have stool cultures recorded, and sigmoidoscopy was often delayed, occurring on average 5 days post-admission. Following the results of this audit, implementations have been suggested to create a more standardised approach for initial investigations of acute flares of ulcerative colitis. Guidelines have been made more accessible, alongside informative resources explaining why these investigations are necessary. Finally, while all patients ultimately underwent surgery within an acceptable timeframe, further education has been proposed to develop a clear pathway for appropriate surgical review. We hope that easy visualisation of the IBD treatment pathway can remind clinicians when to re-assess and escalate treatment accordingly.

DOI: 10.1111/codi.70177

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STONE Score as a Triage Tool to Guide Computed Tomography of the Kidneys, Ureters, and Bladder (CT-KUB) Requests in Suspected Renal Colic: A Quality Improvement Initiative (2025)

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Type of publication:

Journal article

Author(s):

*Hassouba, Omar Nasr; Abdullah Omar, Abdulaziz Alsamani; Awan, Manahil; Ahmad, Shahzad; Taha, Mawada; Venkatachalapathi, Sharmila; Abouelsadat, Mohamed K; Mercy, Albina; Sahnon, Abdelrahman Sahnon Abaker; Shafique, Usama; *Herman, Dodi I.

Citation:

Cureus. 17(9):e92080, 2025 Sep.

Abstract:

Introduction Urolithiasis is a frequent cause of emergency department (ED) visits, with computed tomography (CT) being the gold standard for diagnosis. Excessive imaging increases radiation exposure and healthcare costs. The STONE score is a validated clinical prediction tool, designed to estimate the probability of ureteric stones and reduce unnecessary imaging. Objective The main objective of this study is to evaluate the diagnostic accuracy of the STONE score in patients presenting with flank pain. Methodology This is a cross-sectional retrospective review conducted at the Shrewsbury and Telford Hospital NHS Trust (SATH), Shrewsbury, England, over a four-month period from April 1, 2023, to July 31, 2023. This quality improvement initiative reviewed 81 eligible ED patients who underwent computed tomography of the kidneys, ureters, and bladder (CT-KUB) for suspected ureteric stones. Demographic, clinical, laboratory, and imaging data were collected. STONE scores were calculated for all patients. Diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis. Results The mean age was 38.5 +/- 16.1 years; 35 (43.2%) were male. Ureteric stones were confirmed in 15/19 (78.9%) high-risk, 9/45 (20%) moderate-risk, and 0/17 (0%) low-risk patients. The STONE score yielded an area under the curve (AUC) of 0.879, with a sensitivity of 91.7% and a specificity of 66.7%. Alternative diagnoses included gallbladder stones, appendicitis, cystitis, diverticulitis, hydronephrosis, renal angiomyolipoma, polycystic kidney disease (PCKD), pyelonephritis, and small bowel obstruction (SBO). Conclusion The STONE score demonstrates good diagnostic accuracy, particularly in high-risk patients, and may help reduce unnecessary CT imaging and radiation exposure in the ED.

DOI: 10.7759/cureus.92080

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A Joint Venture: Advancing Health Equity for Underserved Communities Through Integrated Dermatology–Rheumatology Clinics (2025)

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Type of publication:

Poster presentation

Author(s):

*Zal Canteenwala; *Dimple Jain; Roshan Amarasena; Joseph Thevathasan; Heli Baho; Kunal Amin

Citation:

British Journal of Dermatology, Volume 193, Issue Supplement 1, July 2025

Abstract:

Autoimmune conditions with overlapping dermatological and rheumatological manifestations present significant management challenges in rural healthcare settings. The aim of this study was to evaluate whether a newly established combined dermatology–rheumatology clinic could improve healthcare access and patient satisfaction while maintaining clinical effectiveness. This service was delivered through cross-trust collaboration between two hospitals situated approximately 30 miles apart, serving a geographically dispersed population with significant access barriers. A 6-month prospective quality improvement initiative was conducted from April to October 2022. Monthly combined consultant-led clinics were evaluated using structured questionnaires assessing patient satisfaction, operational efficiency and educational impact. The service integrated specialist care between distinct National Health Service trusts, centralizing care delivery at a single site to enhance healthcare equity for traditionally underserved rural populations. Data collection included both quantitative metrics and qualitative responses from patients attending these integrated clinics. Data were analysed using descriptive statistics, with 95% confidence intervals (CIs) calculated for key metrics. Qualitative responses were coded thematically to identify common patterns. The study demonstrated unanimous patient satisfaction at 100% (49 of 49, 95% CI 92.7–100) with the combined clinic format. Healthcare access improved significantly, with 92% (45 of 49, 95% CI 78.1–98.3) reporting reduced travel costs and 96% (44 of 46, 95% CI 85.5–99.5) citing streamlined appointment coordination. This impact is particularly significant given the region’s poor public transport infrastructure, which has seen a substantial decline in bus services over the past decade. Employment impact analysis revealed that while 31% (15 of 49, 95% CI 17.7–43.5) of patients previously required time off work for separate appointments, the combined clinic significantly reduced this burden. Qualitative analysis identified consistent themes of improved comprehensive care delivery and enhanced time efficiency. The clinic proved particularly beneficial for managing complex conditions such as psoriatic arthritis and systemic lupus erythematosus, where concurrent specialist evaluation facilitated more precise diagnostic formulation and therapeutic planning. Educational benefits were noted among participating medical students, who reported enhanced understanding of interdisciplinary care and complex disease management. In conclusion, the combined dermatology–rheumatology clinic demonstrates significant efficacy in addressing healthcare inequities in rural settings, with high patient satisfaction and operational efficiency. This cross-trust collaborative model shows particular value in managing complex autoimmune conditions requiring multispecialty input while simultaneously reducing travel burden and improving care coordination. These findings support the broader implementation of integrated specialty clinics across geographically dispersed regions, with potential applications for other specialty combinations.

DOI: 10.1093/bjd/ljaf085.095

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