Introduction The prevalence of gallstones up to 15%.20-40% will develop symptomatic gallstones and occupy most of the surgical waiting list. The timing of a cholecystectomy remains controversial. Method Retrospective data analysis over 2 years, including: diagnosis, commodities, ASA class, investigations, readmissions numbers and causes, time to surgery, operative details, and rate of conversion to open procedures. Chi-square test was used for analysis. Results 532 cholecystectomies were performed.44% of the patients had commodities. Presentations were; Acute cholecystitis (41.7%), biliary colic (23.1%), acute pancreatitis (15.9), obstructive jaundice (9.2%). USS was performed in 97.3%, CT scan in 17.8% and MRCP in 45.8%. 14% had ERCP. Re admission rate was 56.4%, between 1-6 times, secondary to; cholecystitis (12.5%), biliary colic (26.7), gallstone pancreatitis (8.2%), obstructive jaundice (8.0%), other complications (0.5-1.5%). Emergency cholecystectomy was performed in 14.9% with conversion rate 1.4%.major complication rate was 2.7. The median time on waiting list was 12 (0-123) weeks. This prolonged to 25 (0-400) weeks, when calculated at time of diagnosis. Complicated gallstones disease (p-value 0.0001) was predictors of recurrent symptoms and readmissions. Conclusions Management plan is due to optimize the timing of cholecystectomy to decrease the negative impact on readmission and complication rates plus the hospitals’ bed capacity and costs.

Background Recurrent hospital admission remains a major issue with patients awaiting surgery for symptomatic gallstones. We evaluated the incidence and predictors of readmission in patients previously admitted with acute gallstone disease. Patients and Method We analysed laparoscopic cholecystectomies performed between January 2018 and December 2019. Data relating to the acute index admissions, readmissions, waiting time to surgery, operative details including emergency, elective procedures and conversion rates were analysed. Results 532 procedures were performed over a two-year period. Patients with non-acute gallstones (111), primary open (4) and abandoned procedures (2) were excluded. Median age 415 included patients was 50(13-89) years and a male to female ratio of 1:3. Index admission presentations were acute cholecystitis (41.7%), biliary colic (23.1%), pancreatitis (15.9), obstructive jaundice (9.2%) and combinations (10.1%). 56.4% of the of the patients were readmitted between 1-6 times before surgery. Readmission diagnoses were cholecystitis (12.5%), biliary colic (26.7), pancreatitis (8.2%), obstructive jaundice (8.0%), acute cholecystitis with gallbladder perforation and abscess (0.5%), post-ERCP pancreatitis (0.5%) and pancreatic pseudocyst (0.2%). 14.9% of the patients underwent emergency procedures. Overall conversion rate was 1.4%. Median waiting time to surgery was 12(0-123) weeks. Waiting time to surgery was significantly lower in gallstone pancreatitis compared with other presentations (p-value 0.008). Acute pancreatitis (p-value 0.0001) and complicated index presentations (p-value 0.0001) were predictors of recurrent symptoms and readmission. Age, gender, comorbidities, high BMI, ASA have no significant impact on readmission episodes. Conclusion Readmission is a common occurrence following acute gallstone attacks with acute pancreatitis and complicated index presentations as significant predictors.

Background The study aimed to assess the effect of oral prophylactic antibiotics (OAB) with mechanical bowel preparation (MBP) on the serial measurement of postoperative inflammatory markers and clinical outcomes of the patients undergoing laparoscopic colorectal cancer resection surgery. Methods A retrospective and prospective data collection was carried out from January 2019 to March 2020 for the patients undergoing laparoscopic colorectal cancer resection. Daily measurements of inflammatory markers were obtained up to 7 days following surgery. The measurements of inflammatory markers were compared between patients who received a 1 week course of OAB along with MBP to those who only received MBP. Results There were a total of 110 patients that were divided into 2 groups: patients who received OAB and MBP (n = 44, 40%) and those who had MBP only (n = 66, 60%). There was no significant difference between the patient characteristics and preoperative staging of the cancer between the 2 groups. The overall length of stay was significantly lower in the patients who received OAB (9.09 days [SD 7.94] vs. 6.63 days [SD 4.96], P 0.02). The patients with OAB and MAP had persistently and significantly low levels of white blood cell count, CRP, and neutrophil count throughout the postoperative period as compared to those who only had MBP. Conclusion The study demonstrated reduction in serial measurement of inflammatory markers throughout postoperative stay for the patients receiving preoperative OAB. The use of OAB helps in physiological recovery of the patient by reducing the inflammatory process postoperatively.

Introduction While the need for gender equality has been well recognised within the medical profession, attitudes of patients towards doctors of different genders has not been addressed. We aim to identify whether gender biases exist within the minds of patients we treat and how we can address this. Method A survey was disseminated through social media platforms and work communication groups. Data was collected on gender, ethnicity, frequency of being mistaken for different members of the healthcare team and frequency of being asked to perform non-medical tasks. A free text option was available for respondents to elaborate on the context and how this made them feel. Results 88 doctors (26 male, 62 female) responded. 65% (40) of females have had their roles misidentified at least once a week, compared to 0%(0) of males. 75% (46) of women reported negative emotions associated with being mistaken in their role, 25% (15) were neutral, none were positive. 62% (38) of female doctor’s report being asked to perform non-medical tasks at least once a week compared to 31% (8) of male doctors. Conclusions There is a clear disparity in how patients perceive male and female roles in medicine, with females being less likely to be identified as a doctor and twice as likely to be asked to perform non-medical tasks. As well as being potentially disruptive to their role, responses suggest that this impacts negatively on the confidence of these respondents. Further exploration of this subject, the impacts and remedies will be required in future.

Introduction The study aimed to assess the effect of oral prophylactic antibiotic (OAB) with mechanical bowel preparation (MBP) on the serial measurement of postoperative inflammatory markers and clinical outcomes of the patients undergoing laparoscopic colorectal cancer resection surgery. Methods A retrospective data collection was carried out from January 2019 to March 2020 for the patients undergoing laparoscopic colorectal cancer resection. Daily measurements of inflammatory markers were obtained upto 7 days following surgery. The measurements of inflammatory markers were compared between patients who received a 1 week course of OAB along with MBP to those who only received MBP. Results There were a total of 110 patients that were divided into 2 groups: patients who received OAB and MBP (n = 44, 40%) and those who had MBP only (n = 66, 60%). There was no significant difference between the patient characteristics and preoperative staging of the cancer between the 2 groups. The overall length of stay was significantly lower in the patients who received OAB (9.09 days [SD 7.94] vs. 6.63 days [SD 4.96], P 0.02). The patients with OAB and MAP had persistently and significantly low levels of white blood cell count, CRP, and neutrophil count throughout the postoperative period as compared to those who only had MBP. Conclusion The study demonstrated reduction in serial measurement of inflammatory markers throughout postoperative stay for the patients receiving preoperative OAB. The use of OAB helps in physiological recovery of the patient by reducing the inflammatory process postoperatively.