6th European Surgery and Surgeons Meeting
Scientific Program
Keynote Session:
Title: Surgery at a crossroad: Is the technical hype the answer ?
Biography:
Walter Bini has completed his Diploma at Westminster School, Simsbury Conn. USA and Post-graduate degree at Universidad de Zaragoza, Facultad de Medicina, Zaragoza-Spain. In 2014, he was the Middle East Chairman of ISLASS. He was Head of Neurosurgery at Sheikh Khalifa General Hospital, UAQ-UAE from 2014- 2016. Currently, he is Consultant Neurosurgeon in Orthopedic department, spine section of Lanzo Hospital COF, Lanzo d Intelvi in Italy and also Visiting Consultant Neurosurgeon in Orthopedic department at Healthpoint Hospital, UAE. He is an Executive Board Member and Dean of the Faculty of the WAMS and also holds a Faculty position at the London Medical Education Academy, UK.
Currently he is Consultant Neurosurgeon, Orthopedic Department, spine section of Lanzo Hospital COF, Lanzo d’Intelvi in Italy and also Visiting Consultant Neurosurgeon, Orthopedic Department of Health point Hospital in Abu Dhabi - UAE. His ongoing project includes Composite for Bio-gradable coating on transpedicular intraosseous fixation devices, MRI Spectroscopy in the Grading and Therapy Monitoring of Gliomas, Active Participant in the GLIADEL Trial (closed).
He is an active member of 31 national and international societies and is also Organising Committee Member and honourable speaker for the 6th European Surgery and Surgeons Meeting, taking place in Amsterdam, Netherlands on September 16-17, 2019
Abstract:
Oral Session 1:
- General Surgery | Plastic surgery | Gynecology Surgery | Vascular Surgery | Surgical Oncology
Chair
F S Fahmy
Countess of Chester Hospital
Title: Comparative study between two techniques used in male circumcision
Biography:
Ramy Aly is a plastic surgery registrar graduated from Cairo University in 2007/2008. After completing residency training, MSc and MRCS worked in Maldives and helped to establish the very first plastic surgery service in the country, currently working as a registrar at the Countess of Chester Hospital, United Kingdom.
Abstract:
In this study, I did a comparison between 2 recognized techniques for male circumcision, regarding post-operative complications rate, follow up was immediate postoperative, 1 week and 4 months post operatively, this was done in one centre, 200 candidates for the study, 50% had circumcision done using guillotine technique, and the other 50% had circumcision done using dissection techniques, postoperative complications rate shows more bleeding and infection in case of dissection technique, but higher rate of incomplete circumcision in case of guillotine technique.
Title: Surgical skills workshops should be a part of the undergraduate medical curriculum
Biography:
Muhammad Aadil Hakim is pursuing medical degree at the University of Bristol, UK and very keen to pursue a career in academia and surgery. He has special interest in neurosurgery and ENT surgery. He has accomplished BSc degree in physics from King’s College London University. He has held positions as president of the University of Bristol Surgery Society, the Bristol representative for NANSIG (Neurology and Neurosurgery Interest Group) and currently the vice president for NNS (the Neurosurgical and Neurological Society).
Abstract:
Introduction: Medical students in the UK report poor satisfaction with surgical teaching. The Surgical Skills Day (SSD), set up by medical students at the University of Bristol UK, begin to address this by exposing medical students to surgery through an easily accessible one-day practical workshop. This study shows how the SSD encourages undergraduate engagement in surgery.
Method: Feedback forms were emailed to attendees of the SSD and their anonymised responses were used to evaluate the SSD.
Results: A total of 144 students attended the SSD across three years and the feedback response rate was 74% (n=107). Key findings were that 100% (n=107) of respondents would like the SSD to be an annual event, 79% (n=83) were more inclined to pursue a surgical career following the event and 97% (n=103) would like to see practical surgical skills incorporated into the curriculum. The SSD was able to engage undergraduates with surgery through mentorship, practical skills, specialty exposure and teaching of General Medical Council (GMC) mandated skills.
Conclusions: Undergraduate surgical teaching in the UK is insufficient. The student-led annual SSD shows improved engagement in practical surgical skills and increased enthusiasm for a surgical career. In light of this, the authors feel the SSD or similar event should be integrated into the medical school curriculum.
Title: The lymphoma-lipoma diagnostic challenge
Biography:
Deniz Hassan is a Plastic Surgery Registrar in Merseyside. He is working as a plastic surgeon in Countess of Chester Hospital, United Kingdom.This topic willbe presented by Ms Rong.
Abstract:
Curious ‘lumps and bumps’ are common in the plastic surgery outpatient clinic, with clinical diagnosis formulated from a good history and clinical examination. Simple lipomas account for the vast majority of these cases in the outpatient setting however atypical presentation can be puzzling for the clinician. The following case presented a diagnostic challenge emphasizing the role of an experienced clinician and an MDT approach in questioning the results of investigations which are at odds with the clinical examination. Ultrasound, CT scan and MRI results were deceptive in this case as revealed by the lack of demonstrable correlation with the clinical findings. The case also highlights the need for appropriate tissue diagnosis. In this case, a ‘trucut’ biopsy established a tissue diagnosis without interfering with any potential future management plans. The presented case was diagnosed as lipoma by radiology, only to prove to be Lymphoma on histological diagnosis. We pay particular attention to the role of ultrasound and tissue diagnosis in the work up for lipomas and unusual subcutaneous lumps.The case study looks at the principles in decision making in a plastic surgery clinic. It is important that a clinician is aware of the sensitivity and specificity of examinations ordered (1 and 2). This case study highlights the limitations of Ultrasound and the need for a clinician to use their experience in interpreting results and ordering relevant investigations in an MDT forum.
Title: Novel pre-mastectomy permanent implant reconstruction (PPIR): Initial experiences from Saudi Arabia
Biography:
Loai Abdullah Alsalmi is associated with King Fahad Medical City, Saudi Arabia. He completed his Hand and Microsurgery Fellowship from The University of Texas Southwestern Medical School and University of Pennsylvania. He has completed his Experimental Surgery Fellowship from Mc Gill University. He has completed his bachelor of medicine and surgery from King Saud University.
Abstract:
Background: Alloplastic, breast reconstruction is a most common method of breast reconstruction. Multiple techniques have been utilized to decrease complications and improve overall aesthetic outcome and patient satisfaction. These traditional techniques are shown advantageous, however, associated with some significant disadvantages. We are presenting a novel two stage technique, pre-mastectomy permanent implant reconstruction (PPIR), which shows better aesthetic outcome with high patient satisfaction in breast cancer patients not requiring adjuvant radiotherapy.
Methods: Four patients randomly recruited underwent the pre-mastectomy permanent implant reconstruction (PPIR), by insertion of silicone implant 3 weeks before proposed mastectomy Patient satisfaction was assessed using the Michigan Breast Reconstruction Outcomes Survey. All patients followed up for a period of more than six months for assessments.
Results: Among Four patients with stage I, II breast cancer, three patients were diagnosed with invasive ductal carcinoma and one patient was having sclerosing adenosis. All four patients had no mastectomy flap complication, implant related complications, and showed excellent aesthetic out come and high patient satisfaction.
Conclusion: Pre-mastectomy permanent implant reconstruction (PPIR) is a promising potential technique with a good aesthetic outcome, patient satisfaction which carries no tissue expander complications and eliminates multiple clinic visits.
Title: What’s women know about their maternal health and what’s they practiced in an underprivileged community of Bangladesh
Biography:
Narayan Chandra Das, after passing the Examinations, SSC(1972) &HSC(1974) from Dhaka Board with distinction, he was admitted in Mymensingh Medical College under the Dhaka University, Bangladeh in 1976. He passed four professional Examinations regularly and obtained MBBS Degree in 1982. Then he had to undergone one year of strenuous in service training in Mymensingh Medical College Hospital, In Medicine, Surgery and Obstetrics & Gynaecology. After completion of inservice training and passing competitive Bangladesh Civil service(BCS)Examination under the Public Service Commision (PSC) in 1984, he obtained Government Service, one year training in Anesthesiology in Dhaka Medical College Hospital, Dhaka University, Bangladeh. Six Month training in Medical Ultrasonography and Obstetrics& Gynaecologcal Ultrasound under Bangladesh Society of Ultrasonography(BSU) and Jafferson University USA, he have been doing Ultrasonography practice for the last 18 years. During this long period of Govt. Service he had been promoted from Medical Officer to Upazila Health & Family Planning Officer, Civil Surgeon(Administrative Head of a District), he retired in 2015 from the Govt. Service as Principal Scientific Officer (PSO), from the Institute of Epidemiology Disease Control & Research(IEDCR), Directorate of Health Services(DGHS) Mahakhali, Dhaka, Bangladesh.
Abstract:
Introduction: Every year around 5500 mothers are dying due to maternal complications in Bangladesh. A large number of deaths are still occurring in the marginalized community. Women living in the hard to reach tea gardens areas in Moulvibazar district are straggling with early marriage, adolescent pregnancy and poor health seeking behaviour during gestational period.
Aim: The study explored knowledge and practices on maternal health of women at reproductive age in the tea garden community of Moulvibazar district,Bangladesh.
Methods: A cross sectional study was performed. 25 gardens were selected purposively in Moulvibazar districts out of 92 gardens. 529 mothers aged between 15-49 years who had a live birth between 1 March 2015 and 29 February 2016 was enrolled. Structured pretested questionnaire was used for face to face interview. Descriptive analysis of findings was performed.
Results: The study revealed that over 56% of the women aged between 20-49 years did not know about antenatal care (ANC) during pregnancy, only 8% mothers aware of recommended four ANC. Whereas, 51% of women aged between 15-19 years also unaware of ANC and only 6% mothers aware of four ANC. 77% of mothers had their last delivery at home, 35% of them performed by the garden health care provider (paramedic) and rest of them conducted by untrained birth attendant. Only around 18% of the mothers had their post-natal care in the last pregnancy. 40% of the others don’t have any ideas of maternal complications during pregnancy.
Conclusions: Women living in the tea gardens are still behind of knowledge on antenatal, delivery and post-natal care. Specific intervention focusing improvement of knowledge and practices of women on maternal health issues can help to improve overall maternal health status of this marginalized group. This will reflect on overall reduction of maternal mortality to reach sustainable developmental goal by 2030.
Title: Combinations of non surgical and surgical methods rejuvenation of the periorbital area amd mid face and new paradigm non surgical methods on rhinoplasty
Biography:
Galyna Khrushch belongs to Russia and is a board certified plastic surgeon, board certified maxillofacial surgeon, international member of the American Society of Plastic Surgeons, member of MOSBT, member of the OSEM, certifaited trainer of IPSEN, specialist in injection techniques of the company “Melis”, Melis, Member of Russian Association of Plastic and Reconstruction Surgery, Individual Membership Journal of clinical review and case reports
Abstract:
Introduction: The face of modern socially active person remains a region of interest because it is a trigger zone that reflects the most natural appearance of early signs of aging. Everywhere the increasing need to improve the quality of life determines the relevance and importance of procedures for facial rejuvenation, the key point of the application which is undoubtedly the region of the mid face.
Main part: Question injection correction of the middle third of the face, including the periorbital area, despite the large number of proposed injection methods of rejuvenation is still open. Largely this is due to the contradicting hypotheses development of age-related changes in this area in different time period. Soft tissue model of facial aging, according to which the leading factor of age-related changes is the effect of gravity on the skin, resulting in their stretching, have lost the dominant value. But this ignores the role of the underlying anatomical levels. There is essential value of detailed description and study of age-related changes of anatomical structures of the middle third. With the emergence of volumetric concept of aging based on the manifestations of atrophy and redistribution of fat compartments; the theory of the restraint of the ligaments, which involves ptosis as a result of stretching the fixing structures; the hypothesis of a dynamic age-related changes of tone and length of muscle (Le Louarn); and theory of age changes with the prevailing skeletotopy factor of involution facial area, it’s understanding what triggers any age manifestation that gives us a range extension for the successful correction, suggesting a complex effect on all the causal-effect components of this change. However, due to accumulation of clinical experience, the question arises: are all patients the same age category, which celebrates the age-related changes in the middle third we can offer the same correction algorithm?
Goal and objectives: Systematization and classification of changes of the middle third; development and implementation of complex correction algorithms that take into account the prevailing factor in the occurrence of this manifestation; the study of the optimal combination of treatments for their synergistic effects; injection rhinoplasty as part of a comprehensive program of beautification of the middle third; non surgical rhinoplasty with PDO threads the election to demonstrate how the concept of remodeling of the middle third depending on the degree of manifestation of age-related changes and of belonging to a morphotype; compliance with the principle of “layerwise” exposure to all levels of anatomical lesions of the middle third (skin, malar and deep fatty tissue, SMAS (OO muscle, zygomatic muscles, lLSAN and LLS), retaining ligament (ORL, zygomatic); clinical testing of new techniques to demonstrate well-proven quality and safe medicine for injectable correction hernial and malar “bags” use PDO threads with a view to strengthening orbital septum; for rejuvenation skin of the periorbital area.
Conclusions: The application of the concept of selective remodeling in comprehensive nonsurgical rejuvenation of the middle third is based on the assessment and differentiation of patients according to the morphotype of aging and degree of manifestation of age-related changes; medical rhinoplasty with threads and fillers as a part of beautification of the mid face targeted effect on the cause of manifestation according to the prevailing mechanism of change; preparation of the complex, layered, relevant gerontological medical and protector program correction; and demonstrate how innovative technologies use well-proven quality with the purpose of correctio of age changes of the middle third(clinical cases).
Title: Medical selfie a triage tool for trauma patients
Biography:
Omer Salahuddin did his medical graduation from King Edward Medical College, Pakistan in 2005. After a year of internship, he joined Wah Medical College as teaching assistant. He completed his MRCS Glasgow degree in 2009 and completed his plastic surgery training after being qualified as plastic surgeon in 2013 from Pakistan. He completed his 2 years RCS Edinburgh sponsored fellowship in craniofacial Surgery from John Radcliffe Oxford in 2015. He also successfully completed his Fellowship from European Board of Plastic and Reconstructive Surgery in the same year. He is currently working as a Senior Clinical Fellow in Plastic Surgery at the Countess of Chester Hospital, UK.
Abstract:
Aims: Smartphones and selfies have become one of the daily life routines for the young and old. With the increased demands and curtailed public health resources, alternative means of the initial face to face patient management are sought. The patient self-acquired photograph is potentially an innovative approach to be considered in the initial assessment and triage of Plastic surgery trauma patients. Patients are asked to send unidentifiable selfies (wound) direct to the on-call team via a secure email address.It triages the urgency of referrals, reduces the number of hospital visits, less traumatic experienceto patients, reduces pain and costs associated with multiple dressing changes, particularly in children. Medical staff handover is greatly facilitated by the visual aid with no need for further dressings.
Methods: All trauma patients referred were included in this prospective study. A&E / GPs trauma referrals were provided with instructions on encouraging patients for taking good quality photographs of the sustained injuries. The selfies were forwarded to the on-call team to a secure NHS email address.
Results: Our results discuss the impact of this approach on the number of patient visits, the accuracy of the triage process, the cost reduction, the convenience to patients, compliance in submitting photographs and the ease of hand over amongst medical staff.
Conclusion: Medical selfie in the era of smartphone and digital technology can be a very useful costeffective aid in triaging and improving patient-related management. It is a useful tool for discussion and advice between the juniors and seniors.
Title: Laparoscopic trans-gastric endoscopy in patients with duodenal structure and Roux-en-Y gastric bypass: A case series
Biography:
Muhammad Aadil Hakim is pursuing medical degree at the University of Bristol, UK and very keen to pursue a career in academia and surgery. He has special interest in neurosurgery and ENT surgery. He has accomplished BSc degree in physics from King’s College London University. He held positions as president of the University of Bristol Surgery Society, the Bristol representative for NANSIG (Neurology and Neurosurgery Interest Group) and currently the vice president for NNS (the Neurosurgical and Neurological Society).
Abstract:
Oesophagogastroduodenoscopy (OGD) for visualization and treatment of the duodenum is technically challenging due to the mobile nature and complex foldings of the anatomy. D3 and D4 of the duodenum and the duodenal flexure are especially difficult to access with an OGD due to their distal locations. Duodenal anatomy proximal to D3 can even be difficult to access when there have been alterations to the normal gastrointestinal (GI) anatomy. Such cases include those having undergone Roux-en-Y gastric bypass surgery, who later develop biliary disease requiring endoscopic access to the biliary tree. Traditional transoral routed endoscopic retrograde cholangio-pancreatography (ERCP) is difficult in these patients due to the anatomical rearrangements. In the past these patients underwent open surgery for biliary tree access, but the associated morbidity, cost and length of post-operative recovery made this a suboptimal treatmentv. A possible solution for endoscopic distal duodenum access and biliary tree access in Rouxen- Y patients is laparoscopic transgastric endoscopy (LTGE). In this paper we report a series of patients admitted to the Bristol Royal Infirmary hospital (BRI) who were diagnosed and treated with LTGE. This case series identified LTGE as advantageous in terms of providing a shorter access route to duodeno-jejunal anatomy, which is otherwise difficult to access via traditional OGD.
Title: Cross cover subspecialties and the handover challenges
Biography:
Ramy Aly is a plastic surgery registrar graduated from Cairo University in 2008. After completing residency training, MSc and MRCS, he worked in Maldives and helped to establish the very first plastic surgery service in the country, currently working as a registrar at the Countess of Chester Hospital, UK.
Abstract:
Efficient handover is the backbone in any clinical setting for patient safety and continuity of care. Since the European Work Time Directive (EWTD) came into place with partial hybrid shifts and multiple specialties covering as cross cover, its importance has further increased especially out of hours and over the weekend. Royal College of Surgeon, Royal College of Physicians and British Medical Association have published guidelines for a safe and efficient handover. In this study we will share our hand over process, the compliance amongst the subspecialties involved in the cross over of reviewing trauma cases, any patterns amongst different specialties, the difficulties being faced and ideas to improve the handover process based on the above guidelines. We monitored the hand over sheets used in the process, over a 6 months period, collected data and analyzed missing information, processed ideas on how to decrease the chances of missing any patient information which included use of trust shared drive, further modifications in handover sheets, devised self-explanatory hand injury proformas and face to face simulated scenarios and hand examination during specialty induction. This is to ensure patient safety and delivering the appropriate management with continuity of care in a timely fashion.
Title: Outcomes of breast free flap reconstruction in Middle East
Biography:
Loai Abdullah Alsalmi is associated with King Fahad Medical City, Saudi Arabia. He completed his Hand and Microsurgery Fellowship from the University of Texas Southwestern Medical School and University of Pennsylvania. He has completed his Experimental Surgery Fellowship from Mc Gill University. He has completed his bachelor of medicine and surgery from King Saud University.
Abstract:
Objectives: Reviewing patient satisfaction and quality of life following post-mastectomy breast reconstruction in breast cancer patients of the Middle East.
Methods: Retrospective study of 68 patients of postmastectomy who underwent free flap based breast reconstruction with a mean follow up of 6 months were studied over a period of 5½ years (between July 2012 to December 2017).Patients collected data included age at the time of reconstruction, any comorbid illness, contraindication for surgery, whether or not chests were irradiated post-mastectomy. The specific preoperative investigation included CT angiography of the abdominal wall for proper localization of the skin perforators. All of the breasts were reconstructed by standard methods of microsurgical free flap breast flap reconstruction based on Inferior epigastric artery vascular pedicle (Deep and Superficial). A questionnaire was developed for the postoperative patients in order to assess their satisfaction grades and the scores were calculated at successive followups in the clinics.
Results: A total of 67 patients of post-mastectomy females attended our clinic for breast reconstruction. Most of the patients (97.3%) were in the age group of 29-53 years with the mean age of 45.5 years. Rightsided mastectomy (57%) was more common than left and bilateral cases accounted for 6%. Delayed reconstruction was done in 68% of patients and the rest underwent primary reconstruction at the time of mastectomy. Average BMI at reconstruction in most females was 30.1. CT angio demonstrated two ideal medial perforators in 59% of cases whereas single ideal perforator was noted in 32% of patients. Free deep inferior epigastric artery perforator flap was performed in majority 94% of the patients whereas rest underwent reconstruction by superficial inferior epigastric artery flap. Mean operative time was 4.5 hours. Most of the patients tolerated the procedure well and were usually discharged on 3rd postoperative day. Complications occurred in 6.4% of patients and the most common immediate complication included partial abdominal wound dehiscence (2.3%) and late included fat necrosis seen in 2.8%. Only 2 total flap losses were noted. On follow up examination, the patients reported overall satisfaction rates of 92% on long term examinations. At the time of completion of this study, 30% of patients had completed nipple reconstruction on their reconstructed breasts.
Conclusion: Breast cancer is one of leading cancers in women of the Middle East. Early diagnosis and treatment has improved the cure rates considerably. With the availability of “state of the art” microsurgical breast reconstruction, in properly selected patients, the quality of life and satisfaction rates are high and free flap breast reconstruction has proven to be the standard of care in post mastectomy patient population.
Title: A case of mistaken identity
Biography:
Rong Khaw is a Consultant Plastic Surgeon based at the Department of Plastic Reconstructive Surgery of Countess of Chester Hospital. Her special interest includes hand & breast reconstructive surgery.
Abstract:
Background: Incidence of malignant melanoma in the UK has quadrupled since 1970s and accounts for 90% of skin cancer mortality. Atypical melanoma is often mistaken clinically for other skin tumours such as pigmented basal cell carcinoma, pyogenic granuloma or even seborrheic keratosis. The case report highlights the uncommon clinical features of this aggressive skin cancer. Case report: An 83-year-old woman was referred for a suspected squamous cell carcinoma on her chin. She reported a 5-week history of an itchy nodule which did not change in size or bled. She was previously treated for actinic keratosis to her right lower eyelid. She has neither personal nor family history of skin cancer and reports spending 14 years in Middle East earlier in her life. Examination revealed a 1cm well defined, skin coloured, keratotic nodule with central ulceration which scored only two out of seven points on Glasgow checklist for skin cancers. Excision biopsy results revealed a focally ulcerating, superficial spreading non-pigmented melanoma with Breslow thickness 2.5mm.
Conclusion: Uncommon presentations of malignant melanoma are pedunculated, polypoid, amelanotic or hyperkeratotic. It is of paramount importance that clinicians are familiar with rare variations as this could alter the referral pathway, biopsy methods and subsequent management.
Title: Two-stage flexor tendon reconstruction: A single unit’s experience spanning 16 years
Biography:
Sasa Pocnetz is currently working in Countess of Chester Hospital, United Kingdom
Abstract:
Background: Flexor tendon reconstruction poses a technical challenge to the hand surgeon. Twostage tendon reconstruction is indicated in the event of irreparable tendon injury which could be either an acute or delayed event. First stage tendon reconstruction involves resection of the injured tendon and placement of a silicone Hunter rod in its place. The second and final stage of tendon reconstruction involves the harvest of autologous tendon grafts, most commonly palmaris longus and plantaris tendons, and grafting through the pseudosheath formed around the Hunter’s silicone rod.1 This final reconstruction is often performed 2-6 months after the initial operation after regular physiotherapy to maximise passive range of movement.
Materials & Methods: We conducted a retrospective consecutive case series of patients who underwent two-stage flexor tendon reconstruction using the Hunter’s silicone rod at a single plastic surgery unit from 2002-2018. A total of 13 patients underwent two-stage flexor tendon reconstruction. All patients had Hunter’s silicone rod insertion, with utilization of bone anchors and Pulvertaft tendon weave at the second stage.
Results: We present our detailed surgical technique and evaluated treatment outcomes include mean total active motion, mean power grip, mean tip pinch grip, quality of repair was assessed against the Buck- Gramcko scale and postoperative complication rate including need for revision surgery.
Conclusions: This presentation reflects our approach to two-stage flexor tendon reconstruction with particular attention to the surgical approach, Zones of repair, tendon fixation methods, adjusting the repair tension and a strict post-operative physiotherapy regime.
