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Aims The mainstay of acute appendicitis treatment is a surgical approach. However, in the tumultuous COVID-19 era, the approach to acute appendicitis management has altered. We sought to assess the applicability of the new RCS COVID-19 guidance after resolution of the global pandemic. Methods A retrospective study was conducted on 244 patients presenting between 01/03/2020 and 17/07/2020. Three sources of data were sought: patients presenting to A&E with signs of appendicitis, operative logs for patients who underwent removal of their appendix and all CT/US scans where the clinician had queried appendicitis in the request. Results 139 patients were treated conservatively with antibiotics (57.0%). 35 (25.2%) represented within 6 months. Conservative treatment was successful in 92.1% of cases. 65 appendectomies were completed during that time. 45 cases presented acutely whereby the surgical management of acute appendicitis was the primary choice. The decision to operate was due to: 13 (20%) because the patient was 16 or younger. 4 cases presenting with signs of severe sepsis. 4 cases had a complicated appendicitis on their imaging results. 22 (33.8%) cases were completed without initial conservative management. 9 (3.7%) cases failed conservative treatment thus requiring surgical management. 11 (4.5%) cases represented within 6 months due to recurrent appendicitis despite successful antibiotic treatment. Therefore, the recurrence rate following conservative treatment was 7.9%. Conclusions There was mixed adherence to the new guidance. Surgical management remains the best approach towards acute appendicitis. However, excellent results can still be achieved with appropriately targeted antibiotic therapy.

Objectives Evaluation of adherence to BHS Standards in IHRs Consent. Primary goal was the documentation of “Mesh” on clinic letter and consent form. Secondary points were the enlisted postoperative complications and advice given to reduce the risk of complications. Introduction Mesh repair is the gold standard for elective inguinal hernias. Recurrence rate is 1-3%. Chronic pain, for different causes, is documented in 10-15% (Most frequent complication). Method Retrospective study looked at first 100 patients, who were subjected to open inguinal hernia repair, in one year time. Patients under 18 years, history of previous repair and laparoscopic repair were excluded. The sample was reduced to 94, as 6 cases had untraceable and insufficient records Results Despite using mesh in all patients, it was not written in 11.7% of the consent forms and half of the clinic letters. Postoperative readmissions were 6.4% ,8.5% and 1.1% at week, month and year, respectively. The main causes were pain (1%), wound dehiscence (1%), hematoma (2%), and recurrence (1%). Overall complications rate after one year was 5.5%. Although recurrence and chronic pain are linked to hernia repair, they were not mentioned in 10% and 15%. In contrast, non-specific complications were documented in > 90%. Damage to cord structures and post-operative advice were found in 60% and 30%. Conclusions All grades surgeons were not adequately adherent to BHS, exposing the firm to negligence and complains. Preprepared forms and leaflets are advised to improve the quality of service, in respect to the GMC Domains.

Background Paralytic ileus is a temporary inhibition of gastrointestinal mobility in the absence of mechanical obstruction. Ileus has previously been observed in up to 40% of patients undergoing bowel surgery, leading to increased morbidity and length of stay. Pelvic and acetabular fractures are often caused by high energy trauma and are associated with a risk of visceral injury. This is the first study to report the incidence of and risk factors for ileus following admission with pelvic and/or acetabular fractures. Method All patients over the age of 16 presenting to a major trauma centre throughout 2019 were included. Data included patient demographics, injury pattern, fracture management and presence of ileus. Previous studies identified patients as having ileus if they failed to tolerate an oral diet and open their bowels for more than three days (GI-2). Analysis assessed risk factors for ileus as well as its effect on length of stay. Results An incidence of ileus of 40.35% was observed in the 57 included patients. Ileus was three times more common in patients with a diagnosis of diabetes mellitus (p = 0.56) and 2.5 times more common in the presence of an open pelvic/acetabular fracture (p = 0.73). Length of stay was significantly longer in patients under 65 years identified as having ileus (p = 0.046). Gender, age, opiate use, fracture management and surgical approach were not identified as risk factors. Conclusions The authors have identified the essentiality of early risk factor identification and hope to encourage further research to create a prognostic tool.

Aims Inguinal hernia repairs (IHRs) are one of the most frequently performed procedures worldwide with approximately 100,000 taking place in the UK each year. This study analyses open IHR consent practice against British Hernia Society standards, in particular, whether the term ‘mesh’ and significant postoperative complications were stated on consent forms. We also identified whether adequate post operative advice was given upon discharge in order to prevent recurrence. Methods This was a retrospective audit of all patients above 18 years old, who underwent open IHR 1 January - 31st December 2019. A total of 94 patients were included. Results Although in all cases a prolene mesh was inserted, 8.5% of patients received no mention of mesh in either the clinic letter or consent form. Postoperative readmission was 5.3% at one week, and 8.5% at one month. Reasons for readmission included pain (1%), haematoma (2%), and wound dehiscence (1%). In over 90% of consent forms, non-specific complications (bleeding, infection) were documented. However, common IHR postoperative complications, such as chronic pain (not mentioned in 15%), were not mentioned in consent forms. Only 38% of patients received written postoperative advice. Conclusion Adherence to consenting standards benefits both patients and doctors. Our study highlights that further intervention is required to ensure surgeons are consenting patients adequately, as well as providing sufficient postoperative advice. We advise use of pre-filled forms and patient information leaflets, both in line with GMC guidance, to improve the quality of service offered.