Abstracts of the XXXIXth Sir Peter Freyer Memorial Lecture and Surgical Symposium, September 5-6, 2014, Galway, Ireland.

ROYAL ACADEMY OF MEDICINE IN IRELAND IRISH JOURNAL OF MEDICAL SCIENCE

XXXIXth Sir Peter Freyer Memorial Lecture and Surgical Symposium

Arts Millennium Building, NUI Galway, 5th & 6th September, 2014

Irish Journal of Medical Science Volume 183 Supplement 5 DOI 10.1007/s11845-014-1168-2

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Ir J Med Sci (2014) 183 (Suppl 5):S201–S261

Disclosure Statement The 2014 Sir Peter Freyer Surgical Meeting is funded with the support of commercial bodies. These bodies are Leo Pharma, Johnson & Johnson, Genomic Health, KCI Medical, Allergan, Covidien Ireland Ltd, Intraveno healthcare, KCI Medical, Medserv, M.E.D. Surgical, Roche, Sanofi Aventis Pharma, Tekno Surgical Ltd Ireland.

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Sponsors 2014 The 39th Sir Peter Freyer Meeting gratefully acknowledges the support given to the meeting by the following companies:

Gold Sponsors Leo Pharma

M.E.D. Surgical

Johnson & Johnson Ireland Ltd

Silver Sponsors Baxter

Covidien Ireland

Fresenius Kabi Ltd

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Ipsen Pharmaceuticals Ltd

KCI Medical Ireland Ltd

Medserv

Olympus Ireland

Sanofi Ireland Ltd

Tekno Surgical Ltd

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Sponsored by Johnson & Johnson

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XXXIXth Sir Peter Freyer Memorial Lecture and Surgical Symposium 2014 Arts Millennium Building, National University of Ireland, Galway Programme FRIDAY, 5th SEPTEMBER 2014 SESSION 1: LOWER GASTROINTESTINAL SESSION

Time Allowed: Location: Chair:

7 Minutes Speaking 3 Minutes Discussion ´ Tnu´thail Theatre, AM150 Theatre The Maírtıń O Professor Calvin Coffey & Mr David Waldron

9.00 a.m. Paper 1:

A Novel Behavioural Animal Model of Obstetric Related Faecal Incontinence L Devane1, E Lucking1, R O’Connell2, J Jones1 1. Department of Medicine & Medical Science, University College Dublin, Belfield, Dublin 4, Ireland 2. Centre for Colorectal Disease, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland

9.10 a.m. Paper 2:

Transanal Endoscopic Microsurgery for Rectal Polyps with High Grade Dysplasia W Butt, M Shahbaz, D Collins, J O’Riordan, D Kavanagh, D Buckley, P Neary Department of Colorectal Surgery, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland

9.20 a.m. Paper 3:

Diverticular Disease Coding incorporated into CT Colonography Reporting and Data System (C-RADS) T Abdulsalam1, B Meshkat1, M Towers2, J Hanson2, A Quinn2 1. Department of Surgery, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland; 2. Department of Radiology, Our Lady of Lourdes Hospital, Drogheda, Co Louth, Ireland

9.30 a.m.

Enterobius Vermicularis Infestation in the Setting of Acute Appendicitis In A Paediatric Population – Annual Incidence and Predictive Factors C Fleming, D Kearney, P Moriarty, HP Redmond, E Andrews Department of General Surgery, Cork University Hospital, Wilton, Cork, Ireland

Paper 4:

9.40 a.m. Paper 5:

Effect of Perioperative Fluid Volumes on Outcomes after Surgery For Rectal Cancer – Do They Really Matter? MR Boland, I Reynolds, N McCawley, S El Masry, RA Cahill, J Deasy, DA McNamara Department of Colorectal Surgery, Beaumont Hospital, Beaumont, Dublin, Ireland

9.50 a.m. Paper 6:

An Appraisal of Inflammatory Markers as Adjuncts to Clinical Diagnosis in Acute Appendicitis S Beecher1, J Hogan2, P O’Leary1, R McLaughlin1, MJ Kerin1 1. Department of Surgery, University College Hospital Galway, Ireland; 2. Department of General Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland

10.00 a.m.

CRP and White-Cell-Count Lymphocyte Ratio (WLR) are the most Accurate Inflammatory Parameters in Distinguishing Complicated and Uncomplicated Diverticulitis HJ Song, W Lin, R Seghal, P O’Leary, J Hogan, JC Coffey Department of General Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland

Paper 7:

10.10 a.m. Paper 8:

The Potential Patient Benefit of Colon Cancer Screening and the Role of the Multidisciplinary Team In The Management of Colorectal Cancer in a General Hospital Setting: A Prospective Cohort Analysis K Joyce, P Waters, T Burke, M Hegazy, W Khan, I Khan, K Barry, R Waldron Department of Surgery, Mayo General Hospital, Mayo, Ireland

10.20 a.m. Paper 9:

Diverticular disease in younger patients—is it clinically more complicated? SF Murphy1, PS Waters1, F Bennani2, RS Ryan3, W Khan1, I Khan1, R Waldron1, K Barry1 1. Department of Surgery, Mayo General Hospital, Castlebar, Co. Mayo, Ireland; 2. Department of Pathology, Mayo General Hospital, Castlebar, Co. Mayo, Ireland; 3. Department of Radiology, Mayo General Hospital, Castlebar, Co. Mayo, Ireland

10.30 a.m.

COFFEE

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SESSION 2: BREAST CLINICAL SESSION Time Allowed: Location: Chair: 9.00 a.m. Paper 10:

7 Minutes Speaking 3 Minutes Discussion The Patrick F Fottrell Theatre, AM200 Theatre Mr Karl Sweeney & Ms Ruth Prichard A Comparison of Level III Axillary Nodal Disease Burden in Patients undergoing Axillary Lymph Node Dissection with and without Neo-Adjuvant Chemotherapy D McCartan1, M Boland1, R Prichard1, J Rothwell1, J Geraghty1, D Evoy1, C Quinn2, A O’Doherty3, EW McDermott1 1. Department of Breast and Endocrine Surgery, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; 2. Department of Pathology, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; 3. Department of Radiology, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland

9.10 a.m. Paper 11:

Clinical and Economic Advantages of General Practitioner Integration to a Symptomatic Breast Service C Donlan, DP O’Leary, R McLaughlin, MJ Kerin, KJ Sweeney, C Malone Department of Breast Surgery, University College Hospital, Galway, Ireland

9.20 a.m.

The Role of Bone Scintigraphy in Patients with Breast Cancer Selected for Systemic Staging in the Era of MultiDetector CT R MacDermott1, D McCartan1, J Rothwell1, J Geraghty1, D Evoy1, C Quinn2, S Skehan3, A O’Doherty3, R Prichard1, EW McDermott1 1. Department of Breast and Endocrine Surgery, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; 2. Department of Pathology, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; 3. Department of Radiology, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland

Paper 12:

9.30 a.m. Paper 13:

Is There A Role for Surgery for Locoregional Disease in Stage IV Breast Cancer? EM Quinn1, R Kealy2, S O’Meara2, C Malone2, R McLaughlin2, M Kerin3, KJ Sweeney1 1 Department of Surgery, Breastcheck Western Unit, University Hospital Galway, Galway, Ireland; 2. Department of Surgery, University Hospital Galway, Newcastle Rd, Galway, Ireland; 3. Discipline of Surgery, School of Medicine, NUI Galway, Galway, Ireland

9.40 a.m. Paper 14:

Is it Appropriate to Transfer Long-Term Surveillance of Breast Cancer Patients to a General Practice Setting? D Kerrigan1, P Waters1, M Ryan1, J Hanaghan2, M Irfan1, W Khan1, R McLaughlin3, MJ Kerin3, K Barry1 1. Department of Surgery, Mayo General Hospital, Castlebar, Mayo, Ireland; 2. Department of Radiology, Mayo General Hospital, Castlebar, Mayo, Ireland; 3. Discipline of Surgery, School of Medicine, NUI Galway, Galway, Ireland

9.50 a.m. Paper 15:

Predicting Invasive Breast Cancer in Women with Screen Detected Ductal Carcinoma-In-Situ on Initial Core Biopsy SR Tee1, DP McCartan1, J Rothwell1, J Geraghty1, D Evoy1, C Quinn2, A O’Doherty3, EW McDermott1, RS Prichard1 1. Department of Breast and Endocrine Surgery, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; 2. Department of Pathology, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; 3. Department of Radiology, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland

10.00 a.m.

The Diagnostic Efficacy of Subareolar Duct Excision for Patients with Unilateral Spontaneous Nipple Discharge: An Analysis of Excision Pathology G Guevara1, DP McCartan1, J Rothwell1, J Geraghty1, D Evoy1, C Quinn2, A O’Doherty3, EW McDermott1, RS Prichard1 1. Department of Breast and Endocrine Surgery, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; 2. Department of Pathology, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; 3. Department of Radiology, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland

Paper 16:

10.10 a.m. Paper 17:

Oncotype Dx: A Cost Effectiveness Analysis F McHugh1, Z Al Hilli1, T Cassidy1, AM O’Shea2, M Staunton2, B Hennessy1, M Patrick1, M Allen1, C Power1, A Hill3 1. Department of Breast and Endocrine Surgery, Beaumont Hospital, Beaumont, Dublin 9, Ireland; 2. Department of Pathology, Beaumont Hospital, Beaumont, Dublin 9, Ireland; 3. Department of Surgery, Royal College of Surgeons in Ireland, St. Stephen’s Green, Dublin 2, Ireland

10.20 a.m. Paper 18:

Factors Affecting Hormonal Therapy Adherence in Breast Cancer Patients C Fleming, E Quinn, M O’Sullivan Department of Breast Surgery, Cork University Hospital, Wilton, Cork, Ireland

10.30 a.m.

COFFEE

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SESSION 3: ORTHOPAEDIC I SESSION Time Allowed: Location: Chair:

7 Minutes Speaking 3 Minutes Discussion ´ hEocha Theatre, AM250 Theatre The Colm O Mr John McCabe & Mr Michael O’Sullivan

9.00 a.m. Paper 19:

Functional Outcomes after Cauda Equina Syndrome S O Neill, J Baker, T Williamson, C Fitzgerald, C Fleming, F Rowan, K Synnott Department of National Spinal Injuries Unit, Mater Misericordiae Hospital, Eccles Street, Dublin, Ireland

9.10 a.m. Paper 20:

The Evolution of Spinal Surgery in the West Of Ireland (2006–2013), The Impact of Intrinsic and Extrinsic Factors M O’Sullivan, M Jadaan, A Devitt, E Rahall, JP McCabe Department of Surgery, NUI Galway, Galway, Ireland

9.20 a.m. Paper 21:

Transfer of Bacterial Pathogens during Skin Preparation - A Laboratory Experiment C Ni Fhoghlu, L Zulkifli, S Brennan, A Walsh Department of Orthopaedic Surgery, Our Lady of Lourdes Drogheda, Drogheda, Co. Louth, Ireland

9.30 a.m. Paper 22:

Bacterial Contamination of Diathermy Tips used During Orthopaedic Procedures A Abdulkarim, A Moriarty, P Coffey, E Sheehan Department of Orthopaedic Surgery, Midland Regional Hospital, Tullamore, Offaly, Ireland

9.40 a.m. Paper 23:

Diathermy A Surgeon Awareness of Principles of Use P McQuail, J Baker, D Byrne, P Kenny Department of Trauma and Orthopaedics, James Connolly Memorial Hospital, Blanchardstown, Dublin 15, Ireland

9.50 a.m.

Correlating Posture and Gait Using A Marker Free Motion Analysis System With Pain And Disability Scores among Patients Seen At Spine Clinic R Hurley, A Devitt Department of Orthopaedic Surgery, Galway University Hospital, Galway, Ireland

Paper 24:

10.00 a.m. Paper 25:

Administration of Low Molecular Weight Heparin in Spinal Surgery at 24 Hours: A Single Surgeon’s Experience E Murphy, A Shafqat, E Rahall Department of Orthopaedic Surgery, Galway University Hospital, Galway, Ireland

10.10 a.m. Paper 26:

Nationwide Study of General Practitioners’ Expectations Regarding Total Hip Arthroplasty O Carmody1, M Nugent2, F Rowan2, A Kearney3, P Kenny2 1. Department of Orthopaedic Surgery, Temple Street University Hospital, Dublin, Ireland; 2. Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Dublin, Ireland; 3. Department of School of Nursing, Trinity College, Dublin, Ireland

10.20 a.m. Paper 27:

Elective Orthopaedic Information on the Internet S C O’Neill1, M Nagle2, JF Baker1, F Rowan1, S Tierney3, JF Quinlan1 1. Department of Trauma and Orthopaedics, Tallaght Hospital, Dublin, Ireland; 2. Department of Trauma and Orthopaedics, Limerick University Hospital, Dooradoyle, Co. Limerick, Ireland; 3. Department of Surgical Informatics, Royal College of Surgeons Ireland, Dublin, Ireland

10.30 a.m.

COFFEE

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SESSION 4: GENERAL SESSION Time Allowed: Location: Chair:

7 Minutes Speaking 3 Minutes Discussion ´ Tnu´thail Theatre, AM150 Theatre The Maírtıń O Professor Patrick Broe & Mr Ronan Cahill

11.00 a.m. Paper 28:

A Profile of Head Injury Admissions to a Regional Trauma Centre in the West of Ireland P Owens, N Lynch, P O’Leary, MJ Kerin Discipline of Surgery, Galway University Hospital and School of Medicine, NUI Galway, Galway, Ireland

11.10 a.m.

A Prospective Cohort Study Examining the Parent Reported Improvements in Health following Paediatric Adenotonsillectomy G Thong, K Davies, E Murphy, I Keogh Department of General Surgery, Galway University Hospital, Galway, Ireland

Paper 29:

11.20 a.m. Paper 30:

Predicting the Length of Stay (LOS) of Acute Surgical Admissions at First Patient Contact A Stirling, K Brown, M Whelan, A Gillis, K Conlon, P Ridgway Department of Surgery, AMNCH, Tallaght, Dublin, Ireland

11.30 a.m.

Balancing the Normal Appendicectomy Rate with Perforated Appendicitis Rate in the Era of Advanced Imaging and Diagnostic Laparoscopy M Aremu, B Meshekat, M Salama Department of General Surgery, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland

Paper 31:

11.40 a.m. Paper 32:

Declining Operative Experience in Colorectal Malignancy; Adequacy of Oncologic Resection I Robertson1, G Elamin1, P Waters1, F Bennani2, W Khan1, K Barry1 1. Department of Surgery, Mayo General Hospital, Castlebar, Mayo, Ireland; 2. Department of Pathology, Mayo General Hospital, Castlebar, Mayo, Ireland

11.50 a.m. Paper 33:

Diagnostic Needs of an Acute Surgical Service- A Single Centre Experience of Diagnostic Burden N Bambury, J Donaghy, K Mealy Department of Surgery, Wexford General Hospital, Wexford, Co. Wexford, Ireland

12.00 p.m. Paper 34:

Enhanced Exercise Training is associated with Early Discharge: A Case Control Study G Sheridan1, N Bhatt1, M Connolly1, A Gillis1, K Conlon1, S Lane2, E Shanahan3, P Ridgway1, S Kelly1 1. Department of General Surgery, Tallaght Hospital, AMNCH, Dublin 24, Co. Dublin, Ireland; 2. Department of Respiratory Medicine, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland; 3. Department of Anaesthesia, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland

12.10 p.m. Paper 35:

Novel Nanogold SERS Based Photosensitizers as Optical Diagnostic Probes for Oral Cancer K Davies1, J Connolly2, P Owens2, Y Lang2, P Dockery3, M Olivo2, Ivan Keogh1 1. Department of Otolaryngology, Galway University Hospital, Galway, Ireland 2. Department of Biophotonics, Galway University Hospital, Galway, Ireland 3. Department of Anatomy, Galway University Hospital, Galway, Ireland

12.20 p.m.

Factors Determining Minimal Conversion Rates for Laparoscopic Cholecystectomy in the General Hospital Setting – An 11 Year Audit of Surgical Activity TP Burke, P Waters, I Khan, RM Waldron, W Khan, K Barry Department of Surgery, Mayo General Hospital, Castlebar, Mayo, Ireland

Paper 36:

12.30 p.m.

LUNCH

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SESSION 5: BREAST RESEARCH/ENDOCRINE SESSION Time Allowed: Location: Chair: 11.00 a.m. Paper 37:

7 Minutes Speaking 3 Minutes Discussion The Patrick F Fottrell Theatre, AM200 Theatre Professor Tom Gorey & Mr Ray McLaughlin Comparing Axillary Burden For Node-Positive Breast Cancer Patients Detected by Fine-Needle Aspiration Cytology with those Detected by A Sentinel Lymph Node Biopsy – How Big is the Difference? MR Boland, I Daskalova, Z Al-Hilli, D Evoy, J Geraghty, J Rothwell, A O’Doherty, C Quinn, RS Prichard, EW McDermott Department of Surgery, St Vincent’s Hospital, Elm Park, Dublin 4, Ireland

11.10 a.m. Paper 38:

The Economic Impact of Breast Cancer Management D Joyce1, H Heneghan1, C Curran1, C O’Neill2, MJ Kerin1 1. Discipline of Surgery, School of Medicine, NUI Galway, Galway, Ireland 2. Department of Economics, College of Business and Economics, National University of Ireland Galway, Galway, Ireland

11.20 a.m.

Contextualising the Significance of Isolated Spikes in Intra Operative Parathyroid Hormone (IOPTH) During Parathyroidectomy over a Twelve Year Period N Foley, MR O’Donovan, MA Corrigan, HP Redmond Department of Surgery, Cork University Hospital, Wilton, Cork, Ireland

Paper 39:

11.30 a.m. Paper 40:

Cystic Adrenal Lesions - The Tallaght Experience M Durand, E Mansour, A Gillis, M Sherlock, J Gibney, P Ridgway, K Conlon Professorial Surgical Unit, Tallaght Hospital, Belgard Road, Dublin 24, Ireland

11.40 a.m. Paper 41:

Dynamic Science - A Bibliometric Review of MicroRNAs in Literature MC Casey, N Miller, JAL Brown, MJ Kerin, KJ Sweeney Discipline of Surgery, School of Medicine, NUI Galway, Galway, Ireland

11.50 a.m. Paper 42:

A Phenotype-Genotype Analysis: BRCA1 and BRCA2 Breast Cancer Susceptibility Gene Mutations R Mulligan1, T McVeigh1, R Irwin1, N Cody2, T McDevitt2, N Miller1, K Sweeney1, A Green2, MJ Kerin1 1. Discipline of Surgery, School of Medicine, NUI Galway, Galway, Ireland 2. National Centre for Medical Genetics, Our Lady’s Hospital for Sick Children, Crumlin, Dublin, Ireland

12.00 p.m. Paper 43:

Impact of Retroperitoniscopic Approach on Adrenalectomy in Galway University Hospital TK Khani, D Bowden, J King, D Quill Department of Endocrine Surgery, Galway University Hospital, Newcastle Road, Galway, Ireland

12.10 p.m.

Early Post-Operative PTH as A Predictor of Recurrent Primary Hyperparathyroidism In Patients Undergoing Minimally Invasive Parathyroidectomy without Intra-Operative PTH Monitoring A Stroiescu1, DP McCartan1, D Evoy1, D Gibbons2, SJ Skehan3, EW McDermott1, RS Prichard1 1. Department of Breast/Endocrine/General Surgery, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; 2. Department of Pathology, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; 3. Department of Radiology, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland

Paper 44:

12.20 p.m. Paper 45:

Exosomal Transfer of MicroRNAs as a Potential Path for Gene Therapy D Joyce1, C Glynn1, S Khan1, J Brown1, P Dockery2, MJ Kerin1, R Dwyer1 1. Discipline of Surgery, School of Medicine, NUI Galway, Galway, Ireland 2. Discipline of Anatomy, NUI Galway, University Road, Galway, Ireland

12.30 p.m.

LUNCH

SESSION 6: UROLOGY SESSION Time Allowed: Location: Chair: 11.00 a.m. Paper 46:

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7 Minutes Speaking 3 Minutes Discussion ´ hEocha Theatre, AM250 Theatre The Colm O Mr Kilian Walsh & Mr Garrett Durkan PSA Testing: Whom, by Whom and How Often? O Adhmed, D Moran, P Daly, N Hegarty, D Galvin, K O Malley Department of Urology, Mater Misericordiae Hospital, Eccles St, Dublin 7, Ireland


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11.10 a.m. Paper 47:

Radical Prostatectomy Experience in the West of Ireland UM Haroon, J Forde, N Nusrat, K Walsh, G Durkan Department of Urology, University College Hospital Galway, Galway, Ireland

11.20 a.m. Paper 48:

Adrenal Sparing Radical Nephrectomy, Is There A Survival Benefit? M Burke1, G J Nason1, BB McGuire2, N P Kelly1, DJ Galvin2, DW Mulvin2, GM Lennon2, DM Quinlan2, HD FLood1, SK Giri1 1. Department of Urology, University Hospital Limerick, Dooradoyle, Limerick, Ireland; 2. Department of Urology, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland

11.30 a.m.

Comparative Analysis of Perioperative Outcomes in Laparoscopic Nephrectomy for T1 Renal Cell Tumours versus T2 and Selected T3 Tumours E Bolton, D Hennessey, P Lonergan, A Thomas, A Walsh, F Darcy, T Lynch Department of Urology, St. James’s, Dublin, Dublin 8, Ireland

Paper 49:

11.40 a.m. Paper 50:

Patient Outcomes following Open Partial Nephrectomy for Small Renal Tumours BM Barea, BW Cham, H Ghous, JC Forde, S Jaffrey, E Rogers, K Wlash, GC Durkan, M N Nusrat Department of Urology, Galway University Hospital, Ireland

11.50 a.m. Paper 51:

Mirna Expression Profiling Across Progressive Grades of Prostate Cancer A Walsh1, C O’Rourke2, A Tuzova2, B Hayes3, J Hansen4, M Emmert-Buck4, S Finn3, T Lynch1, A Perry2 1. Department of Urology, St James’s Hospital, Dublin 8, Dublin, Ireland; 2. Department of Prostate Molecular Oncology, Trinity College Dublin, St James Hospital, Dublin 8, Ireland; 3. Department of Pathology, St James Hospital, Dublin, Dublin 8, Ireland; 4. Department of Laboratory of Pathology, National Cancer Institute, Bethesda, Maryland, USA

12.00 p.m. Paper 52:

Should Trans-Peritoneal Template Biopsy Become The New Standard For Prostate Cancer Diagnosis? D Moran1, C McGarvey1, N Hegarty2, T Lynch2, K O Malley2 1. Department of Urology, Mater Misericordiae Hospital, Eccles St, Dublin 7, Ireland; 2. Department of Urology, Mater Private Hospital, Eccles Street, Dublin 7, Ireland

12.10 p.m. Paper 53:

A 4-Year Audit of Practice in the Rapid Access Prostate Clinic in Beaumont Hospital T Aherne, LG Smyth, D O’Neill, S White, E Dunne, G Smyth, RE Power Department of Urology, Beaumont Hospital, Beaumont, Dublin, Ireland

12.20 p.m.

Impact of Pulsatile Machine Perfusion of Organs Procured From Donors Aged 65 Years and Above, on the Waiting Time for the Elderly Patients in Need of Renal Transplant M Azhar, W Shields, J Zimmermann, D Hickey National Kidney and Pancreas Transplantation Unit, Beaumont Hospital, Beaumont, Dublin, Ireland

Paper 54:

12.30 p.m.

LUNCH

SESSION 7: VASCULAR SESSION Time Allowed: Location: Chair:

7 Minutes Speaking 3 Minutes Discussion ´ Tnu´thail Theatre, AM150 Theatre The Maírtıń O Professor Stewart Walsh & Professor Sherif Sultan

1.30 p.m. Paper 55:

The Development of A Multi-Modal Pro-Angiogenic for the Treatment of Critical Limb Ischaemia C Herron1, C Hastings1, F O’Brien1, C McDonnell2, G Duffy1 1. Department of Anatomy, Tissue Engineering Research Group, RCSI, 123 St Stephens Green, Dublin 2, Ireland; 2. Department of Vascular Surgery, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland

1.40 p.m.

Impact of Neck Radiation Therapy on Atherosclerosis Disease Progression and Treatment of Extra-Cranial Carotid Arteries: Systematic Review and a Meta-Analysis K Bashar1, E Khierelseid1, D Healy1, M Clarke Moloney1, P Burke1, E Kavanagh1, S Walsh2 1. Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland; 2. Discipline of Surgery, School of Medicine, NUI Galway, Galway, Ireland

Paper 56:

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1.50 p.m. Paper 57:

Risk Factors Associated with the Diagnosis of Abdominal Aortic Aneurysm in an Irish Screened Population W White1, S McHugh1, P O’Halloran1, B Murphy2, E Boyle1, M Allen2, P Naughton1, D Moneley1, A Leahy1 1. Department of Vascular Surgery, Beaumont Hospital, Beaumont, Dublin 8, Ireland; 2. Department of Surgery, Connolly Memorial Hospital, Blanchardstown, Co. Dublin, Ireland

2.00 p.m. Paper 58:

Late Dacron Patch Reaction after Carotid Endarterectomy M Alawy, M ElKassaby, M Zaki, W Tawfick, S Sultan Department of Vascular Surgery, Galway University Hospital, Galway, Ireland

2.10 p.m.

A 13 Year Experience with Botox Treatment for Axillary Hyperhidrosis: Cost Effectiveness and Quality of Life Analysis J Gibbons, E Nugent, N O’Donohoe, B Egan, M Feeley, S Tierney Department of Vascular Surgery, Tallaght Hospital, Tallaght, Dublin 24, Ireland

Paper 59:

2.20 p.m. Paper 60:

Catheter Directed Thrombolysis of Iliofemoral Vein Thrombosis in an Irish Centre P Staunton, S McHugh, A Leahy, D Moneley, A Keeling, M Given, F McGrath, P Naughton, M Lee Department of Vascular Centre, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland

2.30 p.m. Paper 61:

Fenestrated Stent Grafts for Treatment of Juxtarenal Aortic Aneurysm G Roche-Nagle, BB Rubin, G Oreopoulos, L Tse, J Jaskolka*, KT Tan*, TF Lindsay Department of Vascular Surgery, Department of Interventional Radiology* Toronto General Hospital, Toronto, Canada

2.40 p.m.

COFFEE

3.00 p.m.

SIR PETER FREYER MEMORIAL LECTURE

Introduction: Speaker: Topic: Location:

Professor Michael Kerin Dr John D Birkmeyer Strategies for Improving the Quality of Surgical Care ´ hEocha Theatre - AM250 Theatre The Colm O

4.00 p.m.

Plenary Session

SESSION 8: PLASTICS SESSION Time Allowed: Location: Chair: 1.30 p.m. Paper 62:

1.40 p.m. Paper 63:

1.50 p.m. Paper 64:

2.00 p.m. Paper 65:

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7 Minutes Speaking 3 Minutes Discussion The Patrick F Fottrell Theatre, AM200 Theatre Professor Jack Kelly & Mr Alan Hussey Complication Rates of Diep Flap Donor Site versus Elective Abdominoplasty - A Single Plastic Surgery Unit Experience F Sheil1, A Pabari2, A Mosahebi2 1. Department of Student, RCSI, 123 St. Stephen’s Green, Dublin 2, Ireland; 2. Department of Plastic and Reconstructive Surgery, Royal Free Hampstead NHS Trust, Pond Street, London NW3 2QG, UK A Comparison of Fibrin Sealant versus Standard Closure in the Reduction of Postoperative Morbidity After Groin Dissection: A Systematic Review And Meta-Analysis K Bashar1, T O’Sullivan1, M Clarke Moloney1, SR Walsh2 1. Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland 2. Department of Surgery, NUI Galway, Galway, Ireland Current Practice Patterns of Prophylactic Drains in Bilateral Breast Reductions- Scientific Evidence is still being Ignored C Sugrue1, N McInerney2, C Joyce2, M Kerin1, P Regan2 1. Department of Surgery, University College Hospital, Galway, Ireland 2. Department of Plastic and Reconstructive Surgery, University College Hospital, Galway, Ireland Impact of the Formal Introduction of Guidelines on Key Performance Indicators in the Management of Cutaneous SCC A Granahan, A Collins, S O Neill, C Lawlor, S Carroll, T O’ Reilly, C Morrison Department of Plastic and Reconstruction Surgery, St. Vincent’s University Hospital, Elm Park, Merrion Rd, Dublin 4, Ireland

Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 2.10 p.m. Paper 66:

Composite Anterolateral Thigh-Tensor Fascia Lata Flap for Reconstruction of Complex Skull Defects M Azhar, B Kneafsey, N Ajmal Department of Plastics and Reconstructive Surgery, Beaumont Hospital, Beaumont, Dublin, Ireland

2.20 p.m. Paper 67:

Patterns of Melanoma Recurrence Following a Negative Sentinel Lymph Node Biopsy E O Connell, P O’Leary, K Fogarty, HP Redmond Department of Surgery, Cork University Hospital, Wilton, Cork, Ireland

2.30 p.m.

COFFEE

3.00 p.m.



Professor Michael Kerin Dr John D Birkmeyer ‘Strategies for Improving the Quality of Surgical Care’ ´ hEocha Theatre - AM250 Theatre The Colm O

4.00 p.m.

Plenary Session

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SESSION 9: UPPER GASTROINTESTINAL & CARDIOTHORACIC Time Allowed: Location: Chair: 1.30 p.m. Paper 68:

7 Minutes Speaking 3 Minutes Discussion ´ hEocha Theatre, AM250 Theatre The Colm O Professor Tom Walsh & Mr Chris Collins An Enhanced Recovery Program following Minimally Invasive Oesophagectomy Decreases Duration of Hospital Stay and Perioperative Morbidity with Improved Patient Outcomes P Carroll1, S Cushen2, A Griffith3, A Ryan2, T Murphy1 1. Department of Surgery, Mercy University Hospital, Cork, Co. Cork, Ireland; 2. Department of Nutrition, University College Cork, Cork, Co. Cork, Ireland; 3. Department of Anaesthetics, Mercy University Hospital, Cork, Co. Cork, Ireland

1.40 p.m. Paper 69:

Minimally Invasive Gastrectomy: Feasibility, Surgical and Oncological Outcomes of an Early Experience A Salih1, M Arumugasamy2, T Walsh1 1. Department of Academic Surgery, Connolly Hospital Blanchardstown, Dublin 15, Ireland 2. Department of Surgery, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland

1.50 p.m.

Minimally Invasive Ivor-Lewis Oesophagectomy Following Neoadjuvant Chemoradiotherapy For The Treatment of Oesophageal Cancer: First 30 Consecutive Unselected Cases P Carroll1, D Power2, S O’Reily2, F Vernimmen3, J Gilmore3, P MacEneaney4, A Griffith5, M Bennett6, TJ Browne6, M Buckley7, C Daly1, T Murphy1 1. Department of Surgery, Mercy University Hospital, Cork, Ireland; 2. Department of Medical Oncology, Mercy University Hospital, Cork, Ireland; 3. Department of Radiation Oncology, Mercy University and Cork University Hospitals, Cork, Ireland; 4. Department of Radiology, Mercy University Hospital, Cork, Ireland; 5. Department of Anaesthetics, Mercy University Hospital, Cork, Ireland; 6. Department of Pathology, Mercy University Hospital, Cork, Ireland; 7. Department of Gastroenterology, Mercy University Hospital, Cork, Ireland

Paper 70:

2.00 p.m. Paper 71:

2.10 p.m. Paper 72:

New-Onset Atrial Fibrillation Post-Oesophageal Cancer Surgery: Incidence, Management and Impact on Short and Long-Term Outcomes A Zaborowski1, O Mc Cormack1, S King1, L Healy1, C Daly2, N O’Farrell1, CL Donohoe1, N Ravi1, JV Reynolds1 1. Department of Surgery, St James’ Hospital and Trinity College Dublin, St James’ Street, Dublin 8, Ireland; 2. Department of Cardiology, St James’ Hospital, St James’ Street, Dublin 8, Ireland Objective Measurement of Gallbladder Volume Using Abdominopelvic Computed Tomography B O Connor1, S McWilliams2, P McLaughlin2, O O’Connor2, M Maher2 1. Department of General Surgery, Mercy University Hospital, Grenville Place, Cork, Ireland; 2. Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland

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Paper 73:

Advanced Materials for Cardiac Regeneration (AMCARE): Improving Stem Cell Delivery To The Infarcted Heart Using Biomaterial Approaches A Hameed1, C Hastings1, E Roche2, F O’Brien1, C Walsh2, D Mooney2, G Duffy1 1. Department of Anatomy, RCSI, St. Stephens Green, Dublin 2, Dublin, Ireland; 2. Department of Engineering and Applied Science, Harvard Univ/Wyss Institute, Cambridge, MA, USA

2.30 p.m.

COFFEE

3.00 p.m.



Professor Michael Kerin Dr John D Birkmeyer ‘Strategies for Improving the Quality of Surgical Care’ ´ hEocha Theatre - AM250 Theatre The Colm O

4.00 p.m.

Plenary Session

SESSION 10: PLENARY SESSION Time Allowed: Location: Chair: 4.00 p.m. Paper 74:

7 Minutes Speaking 3 Minutes Discussion ´ hEocha Theatre, AM250 Theatre The Colm O Professor Paul Redmond & Professor Kevin Conlon Association of Prostate Cancer Susceptibility Loci with Disease Aggressiveness and Disease Specific Clinical Endpoints: A Single Centre Analysis with Long Term Follow Up J Sullivan, K Stratton, R Kopp, C Manschreck, J Eastham, K Offit, R Klein Department of Urology, Memorial Sloan Kettering, 1275 York Avenue, Manhattan, NYC, USA

4.10 p.m. Paper 75:

Diminished P38 Signalling in M1-Polarised Macrophages in Response to Bacterial Stimulation N Foley, JH Wang, HP Redmond Department of Academic Surgery, Cork University Hospital/University College Cork, Wilton, Cork, Ireland

4.20 p.m. Paper 76:

Secretion of Exosome-Encapsulated MicroRNAs by Basal Breast Cancer Cells in Vitro D Joyce1, C Glynn1, J Brown1, E Holian2, P Dockery3, MJ Kerin1, R Dwyer1 1. Department of Surgery, National University of Ireland Galway, University Road, Galway, Ireland; 2. Department of School of Mathematics, Statistics and Applied Mathematics, National University of Ireland, University Road, Galway, Ireland; 3. Discipline of Anatomy, National University of Ireland Galway, University Road, Galway, Ireland

4.30 p.m.

Efficacy of a Laparoscopically delivered Transversus Abdominis Plane Block Technique during Elective Laparoscopic Cholecystectomy; A Prospective Double Blind Randomised Trial G Elamin1, P Waters1, H Hamid1, H O’Keeffe1, M Duggan2, R Waldron1, W Khan1, K Barry1, I Khan1 1. Department of Surgery, Mayo General Hospital, Castlebar, Mayo, Ireland 2. Department of Anaesthetics, Mayo General Hospital, Castlebar, Ireland

Paper 77:

4.40 p.m. Paper 78:

Exosome-Encapsulated MicroRNAs Secreted by Colorectal Cancer Cells: Mediators of Intercellular Cross-Talk in the Tumour Micro-Environment C Clancy, J Brown, E Holian, M Joyce, MJ Kerin, RM Dwyer Discipline of Surgery, School of Medicine, National University of Ireland, Galway, Ireland

4.50 p.m. Paper 79:

Circulating Fibrocytes in Crohn’s Disease-Novel Biomarker of Disease Severity S Sahebally1, M Kiernan1, J Burke2, C Dunne1, R O’Connell3, S Martin (4), JC Coffey1 1. Department of GEMS, University of Limerick, Castleroy, Limerick, Ireland; 2. Department of Surgery, University Hospital Limerick, Dooradoyle, Ireland; 3. School of Medicine and Medical Science, UCD, Dublin, Ireland; 4. Centre for Colorectal Disease, St Vincent’s Hospital, Dublin 4, Ireland

5.00 p.m.

Microbes and the Mucus Gel Layer in Ulcerative Colitis – The Role of Mucolytic and Hydrogen Sulphide Producing Bacteria H Earley1, G Lennon1, A Balfe1, A Lavelle2, C Coffey3, D Winter2, R O’Connell2 1. Department of Medicine and Medical Sciences, UCD, Belfield, Dublin 4, Ireland; 2. Department of Colorectal Disease, St Vincent’s University Hospital, Dublin, Ireland; 3. Department of GEMS, Limerick, Ireland

Paper 80:

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5.10 p.m. Paper 81:

The Role of the TNFSF15 Gene in Surgical Diverticulitis T Connelly, A Berg, L Harris III, D Brinton, S Deiling, W Koltun Department of Colon and Rectal Surgery, HMC Penn State, Hershey, PA, 17033, USA

5.20 p.m.

Lipopolysaccharide (LPS)-Induced Tolerisation Contributes to an Altered Metastatic Potential in Colorectal Cancer Cells D Hechtl, JH Wang, HP Redmond Department of Academic Surgical Research, Cork University Hospital, Wilton, Cork, Ireland

Paper 82:

5.30 p.m. Paper 83:

Differential Abundance of Mct1 in the Human Colon N Fearon1, L Ryan1, D Collins1, G Stewart2, A Baird2, D Winter1 1. Department of Surgery, St Vincent’s University Hospital, Elm Park, Dublin, Ireland; 2. School Of Veterinary Medicine, University College Dublin, Belfield, Dublin, Ireland

5.40 p.m.

Cartilage Repair in A Rabbit Model: Development of A Novel Subchondral Defect And Assessment of Early Cartilage Repair Using Rabbit Mesenchymal Stem Cell Seeded Scaffold M Neary, V Barron, F Barry, F Shannon, M Murphy REMEDI, NCBES, NUI Galway, Galway, Ireland

Paper 84:

7.30 p.m.

SIR PETER FREYER BANQUET– RADISSON BLU HOTEL, GALWAY

Saturday, 6th September 2014 SESSION 11: EVIDENCE BASED MEDICINE/META-ANALYSIS SESSION Time Allowed: Location: Chair:

7 Minutes Speaking 3 Minutes Discussion ´ Tnu´thail Theatre, AM150 Theatre The Maírtıń O Mr Ronan Waldron & Mr Diarmuid O’Riordain

10.00 a.m. Paper 85:

Ratios Derived From an Array of Standard Hematologic Indices Predict Oncologic Outcomes In Colon Cancer J Hogan, J East, G Samaha, S Polinkevych, W MacKerricher, S Walsh JC Coffey Department of General Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland

10.10 a.m.

Conversion from A Laparoscopic to Open Colorectal Cancer Resection is Associated with Adverse Oncological Outcomes: A Meta-Analysis C Clancy, DP O’Leary, J Burke, JC Coffey, MJ Kerin, E Myers Department of Surgery, School of Medicine, National University of Ireland, Galway, Ireland

Paper 86:

10.20 a.m. Paper 87:

The Impact of Mechanical Bowel Preparation in Anastomotic Leakage after Rectal Surgery: A Meta-Analysis D Courtney, J Burke, M Kelly, F McDermott, D Winter Department of Surgery, St Vincent’s University Hospital, Elm Park, Dublin, Ireland

10.30 a.m. Paper 88:

The Practice of Emergency Department Thoracotomies: Rational and Perils Y AlJabi1, T Aherne1, J Clerkin1, P Staunton1, S McHugh1, A Hill2, P Naughton1 1. Department of Vascular Surgery, Beaumont Hospital, Beaumont, Dublin, Ireland; 2. Department of General Surgery, Beaumont Hospital, Beaumont, Dublin, Ireland

10.40 a.m.

Remote Preconditioning and Major Clinical Complications following Adult Cardiovascular Surgery: Systematic Review and Meta-Analysis D Healy1, K Bashar1, M Clarke Moloney1, S Walsh2, The Remote Preconditioning Trialists’ Group (?) 1. Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland; 2. Department of Surgery, NUI Galway, Galway

Paper 89:

10.50 a.m. Paper 90:

11.00 a.m. Paper 91:

Network Meta-Analysis Assessing Survival Outcomes for the Different Surgical Approaches For Synchronous Colorectal Liver Metastasis M Kelly1, G Spolverato2, T Pawlik2, D Winter1 1. Department of Surgery, St Vincent’s University Hospital, Elm Park, Dublin, Ireland 2. Department of Surgery, Johns Hopkins, Baltimore, USA Laparoscopic Cholecystectomy In Acute Cholecystitis: Who Should Have Immediate Surgery? R Lyons, P Waters, MJ Kerin Department of Surgery, Galway University Hospital, Galway, Ireland

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11.10 a.m. Paper 92:

Predicting Length of Stay in Emergency Surgical Admissions Remains Challenging MR Boland1, I Reynolds1, F Alquraish2, M Quirke2, N McCawley1, ADK Hill2, DA McNamara1 1. Department of Colorectal Surgery, Beaumont Hospital, Beaumont, Dublin, Ireland; 2. Department of Surgery, Beaumont Hospital, Dublin 9, Ireland

11.20 a.m. Paper 93:

Investigate Outcome Variables in the Timing of Acute General Surgery S Beecher, DP O’Leary, R McLaughlin, MJ Kerin Department of Surgery, University Hospital Galway, Newcastle, Galway, Ireland

11.30 a.m.

COFFEE

SESSION 12: UROLOGY SESSION Time Allowed: Location: Chair:

7 Minutes Speaking 3 Minutes Discussion The Patrick F Fottrell Theatre, AM200 Theatre Mr Eamonn Rogers & Mr Patrick O’Malley

10.00 a.m. Paper 94:

Cystic Renal Masses: Concordance between Radiological and Pathological Findings J Costelloe1, E Bolton1, M Quinlan1, D Galvin1, G Lennon1, D Quinlan1, I Murphy2, D Mulvin1 1. Department of Urology, SVUH Dublin, Elm Park, Dublin 4, Ireland; 2. Department of Radiology, SVUH, Elm Park, Dublin 4, Ireland

10.10 a.m. Paper 95:

Validation of Selection of Patients for Active Surveillance in Prostate Cancer: A Retrospective Study S Elamin, N Davis, P Sweeney Department of Urology, Mercy Hospital, Cork, Cork, Ireland

10.20 a.m. Paper 96:

Review of Prostate Ca in the Over 70’s In Our Institution UM Haroon1, J Forde1, T McHale2, F Sullivan3, G Durkan1 1. Department of Urology, University Hospital Galway, UHG, Galway, Ireland; 2. Department of Anatomic Pathology, University Hospital Galway, Galway, Ireland; 3. Department of Radiation Oncology, University Hospital Galway, Galway, Ireland

10.30 a.m.

The Clinic-Pathological Characteristics of Prostate Cancer in an Irish Subpopulation with A Serum PSA Less Than 4.0 ng/Ml F O Kelly, B McGuire, R Flynn, R Grainger, T McDermott, J Thornhill Department of Urological Surgery, Tallaght Hospital, AMNCH, Tallaght, D24, Ireland

Paper 97:

10.40 a.m. Paper 98:

10.50 a.m. Paper 99:

11.00 a.m. Paper 100:

11.10 a.m. Paper 101:

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Prevalence of Extended Spectrum Beta Lactamase Producing Enterobacteriaceae in the Urology Patient Population – A Prospective Audit J De Marchi1, P O’Malley2, A Shah1, D Bouchier-Hayes2, L Joyce3 1. Department of Medical Administration, Beaumont Hospital, 9 Beaumont Road, Beaumont, Dublin 9, Ireland; 2. Department of Urology, Galway Clinic, Doughiska, Co. Galway, Ireland; 3. Department of Surgery, Galway Clinic, Doughiska, Co Galway, Ireland Post-Chemotherapy Retroperitoneal Lymph Node Dissection in the Management of Metastatic Testis Cancer; The 16-Year Experience In An Irish Setting S Considine1, R Heaney1, R Casey2, R Conroy3, J Thornhill1 1. Department of Urology, Tallaght Hospital, Tallaght, Dublin 24, Ireland; 2. Department of Urology, Colchester General Hospital, Colchester, Essex, UK; 3. Department of Biostatistics, RCSI, St Stephen’s Green, Dublin 2, Ireland Cancer Specific and Overall Survival of Patients undergoing Preoperative Renal Artery Embolization Prior to Radical Nephrectomy for Renal Cell Carcinoma N P Kelly, GJ Nason, L Walsh, E Redmond, MJ Burke, A Aslam, HD Flood, SK Giri Department of Urology, Limerick University Hospital, Dooradoyle, Limerick, Ireland Testicular Pain Requiring Surgery; An Audit of Patients Undergoing Scrotal Exploration in Our Lady of Lourdes Hospital Drogheda T Subramaniam, C Reilly, S Fahy, B Meshkat, HK Perthiani, S El Masry Department of Surgery, Our Lady of Lourdes Hospital, Drogheda, Co Louth, Ireland

Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 11.20 a.m. Paper 102:

Active Surveillance Experience on Favorable-Risk Prostate Cancer in HSE West S Gnanappiragasam1, J Forde1, M Moloney1, S Kiely2, K Walsh1, G Durkan1 1. Department of Urology, University College Hospital, Galway, Ireland; 2. Department of Urology, Limerick Regional Hospital, Ireland

11.30 a.m.

COFFEE

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SESSION 13: TRAINING AND EDUCATION SESSION Time Allowed: Location: Chair:

7 Minutes Speaking 3 Minutes Discussion ´ hEocha Theatre, AM250 Theatre The Colm O Dr Dara Byrne & Ms Carmel Malone

10.00 a.m. Paper 103:

One Year Review of Emergency Abdominal CT Scans Performed in a University Hospital M Kelly1, A Heeney1, C Redmond2, J Costelloe1, J Dodd2, D Winter1 1. Department of Surgery, St Vincent’s University Hospital, Elm Park, Dublin, Ireland; 2. Department of Radiology, St Vincent’s University Hospital, Elm Park, Dublin, Ireland

10.10 a.m. Paper 104:

Medical Students’ Attitudes towards Basic Surgical Skills and the Undergraduate Curriculum D O Connor, G Browne, N Lynch, M Kerin Discipline of Surgery, School of Medicine, NUI Galway, Galway, Ireland

10.20 a.m. Paper 105:

Patients Attitude towards Surgeons Attire in Our Lady of Lourdes Hospital Drogheda B Meshkat, G Bass, M Matcovici, Z Farnez, C Buckley, O Al Saffar, P Gillen Department of Surgery, Our Lady of Lourdes, Drogheda, Ireland

10.30 a.m. Paper 106:

Planning and Development of a Clinical Research Database: An Illustrative Example for Clinicians C Gormley1, J De Marchi2 1. Department of Research, RCSI, 123 St. Stephen’s Green, Dublin 2, Ireland; 2. Department of RCSI, The Galway Clinic, Doughiska Rd, Galway, Ireland

10.40 a.m.

The Evolution of General Paediatric Surgery Provision and Training In Ireland: What’s Being Done and What More Do We Need To Do? B O Connor, E Andrews Department of Surgery, Cork University Hospital, Wilton, Cork, Ireland

Paper 107:

10.50 a.m. Paper 108:

Acute Surgical Admissions Not Requiring A Surgical Procedure - Can We Improve Efficiency? D Collins1, G Kelliher2, D Kavanagh1, K Mealy2, FB Keane2 1. Department of Surgery, Tallaght Hospital, Dublin, D24, Ireland; 2. Department of National Clinical Programme in Surgery, RCSI

11.00 a.m.

From The ‘‘Jes’’ To The ‘‘Res’’ – Delivering High Fidelity Manikin-Based Simulated Scenarios To All Levels of Expertise G Browne, T McVeigh, P O’Connor, MJ Kerin, D Byrne Department of Surgery, School of Medicine, NUI Galway, Ireland

Paper 109:

11.10 a.m. Paper 110:

Global Rating Scale (GRS) Under the Microscope S Shaharan1, DM Ryan1, O Traynor1, D Buckley2, P Neary2 1. Department of Surgical Affairs, RCSI, 121 St Stephen’s Green, Dublin 2, Ireland; 2. Department of Surgery, AMNCH, Tallaght, Dublin 24, Ireland

11.20 a.m. Paper 111:

The Use of Cross-Platform Smartphone Messaging Technology to Aid Vascular Patient Care R Murphy, S McHugh, E Murphy, A Leahy Department of Vascular Surgery, Beaumont Hospital, Dublin 9, Dublin, Ireland

11.30 a.m.

COFFEE

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SESSION 14: ORTHOPAEDIC II SESSION Time Allowed: Location: Chair:

7 Minutes Speaking 3 Minutes Discussion The Siobhan McKenna Theatre Mr Michael Leonard & Mr Bill Curtin

10.00 a.m. Paper 112:

Trauma Centre Experience with Air Ambulance Service 2013 - A Retrospective Study J Gibbons, O Breathnach, J Quinlan Department of Orthopaedic Surgery, Tallaght Hospital, Tallaght, Dublin 24, Ireland

10.10 a.m. Paper 113:

Tibial Plateau Fractures - Long Term Outcomes Following Operative Repair A Nic an Riogh, GN Solayar, FJ Shannon Department of Trauma and Orthopaedic Surgery, Galway University Hospitals, Galway, Ireland

10.20 a.m. Paper 114:

Halo Vest versus Cervical Collar in Conservative Management of Stable Isolated Atlas Fractures P O Sullivan1, T Fahey2, Mr. Charles Marks1 1. Department of Neurosurgery, Cork University Hospital, Wilton, Cork City, Ireland; 2. Department of Division of Population Health Sciences, RCSI Medical School and HRB Centre for Primary Care Research, 123 St. Stephen’s Green, Dublin 2, Ireland

10.30 a.m. Paper 115:

Upper Limb Surgeons - So You Think You’re Funny! A Study of Nominative Determinism in Orthopaedics P Mc Quail, L Murphy, J Kelly, K O’ Shea Department of Trauma and Orthopaedics, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland

10.40 a.m.

A CT Evaluation of 200 Normal Ankles to Determine the Optimal Anatomical Position When Inserting Syndesmotic Screws O Carmody1, M Kennedy2, C Kennedy3, M Dolan3 1. Department of Orthopaedic Surgery, Temple Street University Hosp, 202 Beechwood Court Apartments, Stillorgan, Ireland; 2. Department of Trauma and Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Cappagh, Dublin, Ireland; 3. Department of Trauma and Orthopaedic Surgery, Cork University Hospital, Cork, Ireland

Paper 116:

10.50 a.m. Paper 117:

Plotting Fibular Length for Children with Leg Length Discrepancy using CT Scanogram NP McGoldrick, K Olajide, J Noel, P Kiely, DP Moore, P Kelly Department of Trauma and Orthopaedic Surgery, OLCHC, Crumlin, Dublin 12, Ireland

11.00 a.m. Paper 118:

Childhood Obesity as a Risk Factor for Upper Extremity Fractures A Abdulkarim, A Moriarty, E Sheehan Department of Orthopaedic Surgery, Midland Regional Hospital, Tullamore, Offaly, Ireland

11.10 a.m.

The Availability of Accessible and Good Quality Information on the Internet for Patients Regarding Rotator Cuff Tears D Dalton1, E Kelly2, D Molony2 1. Department of Surgery, UCHG, Newcastle Road, Galway, Ireland; 2. Department of Orthopaedics, Waterford Regional Hospital, Ardkeen, Waterford, Ireland

Paper 119:

11.20 a.m. Paper 120:

Standardised Consent: The Effect of Patient Information Sheets on Information Retention K Clarke, P O’Loughlin, J Cashman Department of Orthopaedics, MMUH, Eccles St, Dublin 7, Ireland

11.30 a.m.

COFFEE

SESSION 15: ‘World War I – Insights 100 Years On’ Location:

´ hEocha Theatre - AM250 Theatre The Colm O

Chair:

Professor Michael Kerin

12.00 p.m.

Galway Doctors in World War I Mr Joe Duignan Consultant General Surgeon Royal College of Surgeons in Ireland

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Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 12.20 p.m.

Irish Poll: Galway Doctors in World War I Mr Kilian Walsh Consultant Urological Surgeon Galway University Hospital

12.40 p.m.

Discussion

12.45 p.m.

STATE OF THE ART LECTURE


Professor Oliver McAnena Mr James M Sheehan ‘Irish Surgery; Reflections on the Past and a Vision for the Future’ ´ hEocha Theatre - AM250 Theatre The Colm O

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POSTER ASSESSMENT Chair:

Professor Kevin Barry & Mr Edward Myers

BREAST 1. Biobanking of Clinical Samples: A Crucial Resource for Effective Translational Research E Ramphul, E Hennessy, C Curran, RM Dwyer, MJ Kerin Discipline of Surgery, School of Medicine, NUI Galway, Galway, Ireland 2. Referral Patterns for BRCA Genetic Testing at A Single Institution T Cassidy1, Z Al-Hilli1, T Roche1, A Green2, M Allen1, C Power1, A Hill1 1. Department of Breast and Endocrine Surgery, Royal College of Surgeons Ireland, Beaumont Hospital, Dublin 9, Ireland; 2. National Centre for Medical Genetics, Our Lady’s Hospital for Sick Children, Crumlin, Dublin 12, Ireland 3. An Audit of the Surgical Workload Associated with Mutations in Breast Cancer Susceptibility Genes T McVeigh1, R Irwin1, N Cody2, N Miller1, K Sweeney1, A Green2, M Kerin1 1. Discipline of Surgery, School of Medicine, NUI Galway, Galway, Ireland 2. National Centre for Medical Genetics, Our Lady’s Hospital for Sick Children, Crumlin, Dublin, Ireland 4. Identifying Novel Breast Cancer Subtypes Effect on Clinical Response to Neoadjuvant Chemotherapy N Bhatt1, C Fiuza-Castinieria1, S Murphy1, M O’Connor2, G O’Donoghue1 1. Department of Breast Surgery, Waterford Regional Hospital, Waterford, Ireland; 2. Department of Medical Oncology, Waterford Regional Hospital, Ireland 5. The Three-Step Principle of Breast Analysis Applied to the Skin Sparing Mastectomy C Buckley1, R Dolan1, P Blondeel2, C Morrison1 1. Department of Plastic and Reconstructive Surgery, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; 2. Department of Plastic and Reconstructive Surgery, University Hospital Gent, Gent, Belgium 6. Breast Cancer Risk Perception M Varzgalis, FA Kelly, C Ni Foghlu, KJ Sweeney, MJ Kerin Discipline of Surgery, School of Medicine, NUI Galway, Galway, Ireland 7. Changes in Management of Breast Cancer Patients with Nodal Metastases without Distant Disease A Nic an Riogh1, EM Quinn2, M McAllister1, MJ Kerin1, KJ Sweeney2 1. Department of Breast Surgery, Galway University Hospital, Galway, Ireland 2. Breastcheck Western Unit, Galway, Ireland 8. Dietary Intakes and Use of Complementary and Alternative Dietary Supplements among Patients Attending A Breast Clinic L Owens1,2, C Corish1, R Salman3 1. School of Biological Sciences, Dublin Institute of Technology, Kevin Street, Dublin 2. Trinity Centre for Health Sciences, St James’s Hospital, Dublin 8 3. RCSI, Beaumont Hospital, Beaumont, Dublin 9, Republic of Ireland 9. The Centricity Score: Trying to Get It Right First Time Round In Breast Conservative Surgery N Aslam, R Sugrue, C McNamara, M Sugrue, K McGowan Donegal Clinical Research Academy, Breast Unit Letterkenny Hospital, Letterkenny, Co Donegal CARDIOTHORACIC 10. A Review of a Lightweight Titanium Closure Device for Sternal Closure in Patients with a High Risk of Sternal Dehiscence M O’Sullivan, C Fernando, D Veerasingam Department of Surgery, NUI Galway, Galway, Ireland ENDOCRINE 11. Cystic Adrenal Lesions - The Tallaght Experience M Durand, E Mansour, A Gillis1, M Sherlock, J Gibney, P Ridgway, K Conlon Professorial Surgical Unit, Tallaght Hospital, Belgard Road, Dublin 24, Ireland

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12. Parathyroid Surgery: Assessment of Primary Intervention and Surgical Adjuncts MC Casey, M Mozo, TP McVeigh, JAL Brown, DS Quill, MJ Kerin Department of Surgery, NUI Galway, Galway, Ireland GENERAL 13. Human Factors and Patient Safety in Paediatric Surgery B O Connor, E Doherty Department of Surgery, National Surgical Training Centre, 123 St Stephens Green, Dublin 2, Ireland 14. Is the Irish Health System Ready for Day Case Laparoscopic Cholecystectomy? M Salama, I Ahmed Department of General Surgery, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland; 15. Management of Paediatric Acute Appendicitis in the General Hospital Setting – A National Survey of Preferred Surgical Technique I Robertson, M Costello, N Shea, I Z Khan, RM Waldron, W Khan, K Barry Department of Surgery, Mayo General Hospital, Castlebar, Co Mayo, Ireland 16. Laparoscopic Cholecystectomy:Trends In Resource Utilisation And Surgical Service Delivery H Mohan, G Kelliher, F Keane, K Mealy Department of National Clinical Programme in Surgery, RCSI, St. Stephen’s Green, Dublin 2, Ireland 17. Analysis of the Impact of a 24-Hour Emergency Theatre on Time to Appendicectomy C Fleming, D Kearney, P Moriarty, HP Redmond, E Andrews Department of General Surgery, Cork University Hospital, Wilton, Cork, Ireland LOWER GI 18. Stoma: A Contraindication to Vaginal Delivery? K Memeh, A Hogan, M Quigley, A Mahmood, O McAnena, M Regan, M Joyce Division of Surgery, University College Hospital Galway, Galway, Ireland 19. Rectal Cancer and the Peritoneal Reflection: A Prospective Evaluation J O Kelly1, J De Marchi2, W Joyce2 1. RCSI, 123 St Stephens Green, D2, Ireland; 2. Department of Surgery, The Galway Clinic, Doughiska, Co. Galway, Ireland 20. A Comparison of Efficacy of Staging CT Thorax in Colon and Rectal Cancer J Hogan, C O’Rourke, M Burton, E Burton, G Duff, G Samaha, N Kelly, JC Coffey Department of General Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland 21. Comparison of Risk Scoring Systems as Predictors of Post-Operative Morbidity and Mortality in Benign Major Colorectal Surgery J De Marchi1, L Joyce2 1. Department of Medical Administration, Beaumont Hospital, Beaumont, Dublin 9, Ireland; 2. Department of Surgery, Galway Clinic, Doughiska, Co. Galway, Ireland ORTHOPAEDICS 22. Initial Experience with a Dedicated Ultrasound Screening Programme for Developmental Dysplasia of the Hip in Ireland B O Connor, M Hennessy, S Boran, C Taylor Department of Orthopaedic Surgery, South Infirmary-Victoria University Hospital, Old Blackrock Road, Cork, Ireland 23. The Effect of Orthopaedic Surgery on the Intrinsic Properties of Surgical Gloves A Abdulkarim, A Moriarty, E Sheehan Department of Orthopaedic Surgery, Midland Regional Hospital, Tullamore, Offaly, Ireland 24. The Impact of Scoliosis Awareness Month on Internet Search Activity- Hit or Miss? P Mc Quail1, J Kelly2, M Tarazi1, D Moore2, P Kiely2 1. Department of Trauma and Orthopaedics, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; 2. Department of Trauma and Orthopaedics, Our Lady’s Children’s Hospital, Crumlin, Dublin 12, Ireland 25. The 60 Classic Papers of Orthopaedic Oncology: A Bibliometric Study NP McGoldrick, SC O’Neill, JS Butler, Mr Sean Dudeney, Mr Gary C. O’Toole1 Department of Trauma and Orthopaedic Surgery, Cappagh Orthopaedic, Finglas, Dublin 11, Ireland 26. The 100 Most Cited Papers in Spinal Deformity Surgery: A Bibliometric Analysis S O Neill, N McGoldrick, J Butler, R O’Leary, K Synnott Department of National Spinal Injuries Unit, Mater Misericordiae Hospital, Eccles Street, Dublin, Ireland

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PLASTICS 27. Does Loupe Magnification Improve Microscopic Margin Status of Facial Basal Cell Carcinomas?- A Prospective Randomised Controlled Study C Sugrue, N McInerney, A Hussey Department of Plastic and Reconstructive Surgery, University College Hospital, Galway, Galway, Ireland 28. The 100 most influential papers in Breast Reconstruction N Mahon, C Joyce, AM Kennedy, E Concannon, J Kelly Department of Plastic Surgery, Galway University Hospitals, University Road, Galway, Ireland 29. Multiple Primary Melanoma; Synchronous and Metachronous Melanoma In An Irish Patient Cohort E Concannon, N Mahon, A Hussey, D Jones, J Kelly, P Regan Department of Plastic Surgery, Galway University Hospitals, University Road, Galway, Ireland 30. Melanoma in Situ: An Assessment of Surgical Margins and Recurrence K Joyce, C Joyce, D Jones, A Hussey, J Kelly, P Regan Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland 31. Necrotising Soft Tissue Infection (Nsti) in a UK Metropolitan Cohort F Sheil1, G Glass2, J Ruston2, P Butler2 1. RCSI, 123 St. Stephen’s Green, Dublin 2, Ireland; 2. Department of Plastic and Reconstructive Surgery, Royal Free Hampstead NHS Trust, Pond St, London, UK TRAINING AND EDUCATION 32. Creation of a Readily Accessible Online Clinical Teaching Repository Using TwitterTM B O Kelly1, S McHugh1, TJ McHugh2, F Narouz1, E Boyle1, A Hill3 1. Department of Surgery, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland; 2. School of Medicine, Trinity College Dublin, College Green, Dublin 2, Ireland; 3. Department of Surgery, Royal College of Surgeons in Ireland, 123 St Stephen’s Green, Dublin 2, Ireland 33. High Fidelity Surgical Simulation – Low Risk, High Cost C Bryan, T McVeigh, D Byrne, MJ Kerin Discipline of Surgery, School of Medicine, NUI Galway, Galway, Ireland 34. Ileal Pouch Anal Anastomosis: Challenges in Training A Hogan, E Myers, O McAnena, M Regan, M Joyce Division of Surgery, University College Hospital Galway, Galway, Ireland, 35. Assessing NCHD Attitudes to EWTD in A Regional Hospital M Carter, B Meshkat, R Khalid, HK Perthiani, S El-Masry Department of General Surgery, Our Lady of Lourdes Hospital, North Drogheda, Co. Louth, Ireland 36. A N 1. 2.

Pilot Simulation Based Teaching Program For Final Year Medical Students Lynch1, Y Finn2, M Kerin1 Discipline of Surgery, School of Medicine, NUI Galway, Galway, Ireland; Discipline of Medicine, NUI Galway, Galway, Ireland

37. The Effects and Implications of Adoption of the European Working Time Directive For Urology Training In Ireland S Considine, A Walsh, TED McDermott1, T Lynch, R Manecksha Department of Urology, St James’s Hospital, James’s Street, Dublin 8, Ireland UPPER GI 38. A Novel Approach in Oesophageal Stents Deployment without Fluoroscopy A Salih, N Kharytaniuk, G Bass, T Walsh Department of Academic Surgery, Connolly Hospital Blanchardstown, Blanchardstown, Dublin 15, Ireland UROLOGY 39. Indeterminate Small Renal Masses: Accuracy of Diagnosis by Radiologically-Guided Biopsy J Costelloe, E Bolton, M Quinlan, D Galvin, G Lennon, D Quinlan, D Mulvin Department of Urology, SVUH Dublin, Elm Park, Dublin 4, Ireland 40. Should The Penile Cancer Treatment Centralised In A Limited Number of Centres Arranged As Supraregional Networks? S Elamin1, N Davis1, BK Breen1, P Ahern1, M Fitzgerald1, C Brady1, D Power2, P Hegarty3, P Sweeney 1. Department of Urology, Mercy Hospital, CORK, Ireland; 2. Department of Oncology, Mercy Hospital, Cork, Ireland; 3. Department of Urology, Mater Private, Cork, Ireland

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41. Artificial Urinary Sphincter Placement after Radical Prostatectomy; A 5 Year National Review M Burke, GJ Nason, E Redmond, A Aslam, NP Kelly, CM Akram, SK Giri, HD FLood Department of Urology, University Hospital Limerick, Dooradoyle, Limerick, Ireland 42. Serum Testosterone Levels Are Not Predictably Altered By Radical Prostatectomy J Sullivan, D Stember, C Nelson, J Mulhall Department of Urology, Memorial Sloan Kettering, 1275 York Avenue, Manhattan, NYC, USA 43. Mechanical Properties of Benign Prostate Tissue Are Related To Voiding Symptoms NP Kelly1, J Mulvihill2, D Hoey2, S Giri1, M Walsh2, H Flood1 1. Department of Urology, Limerick University Hospital, Dooradoyle, Limerick, Ireland; 2. Department of Centre for Applied Biomedical Engineering Research, Mechanical and Surface Sciences Institute, University of Limerick, Limerick, Ireland 44. Fluids Used in flexible Cystoscopy Audit W Elbaroni, B Thomas, P Downey Department of Urology, Causeway Hospital, 4 Newbridge Rd, BT52 1HS, UK 45. Repeat Prostate Biopsy After A Finding Of ASAP Or High Grade PIN A - The Experience of a Tertiary Referral Centre for Prostate Cancer R Waldron, JC Forde, GC Durkan Department of Surgery, Galway University Hospital, Galway, Ireland VASCULAR 46. Aorto-Uniiliac Stent Grafts With and Without Cross over Femoro-Femoral Bypass for Treatment of Abdominal Aortic Aneurysms: A Comparative Study M Elkassaby, M Alawy, M Zaki, W Tawfick, S Sultan Department of Vascular Surgery, Galway University Hospital, Newcastle Road, Galway, Ireland 47. Role of Far Infra-Red Therapy in Dialysis Arterio-Venous Fistula Maturation and Survival: Systematic Review and Meta-Analysis K Bashar1, D Healy1, E Kheirelseid1, M Clarke Moloney1, P Burke1, E Kavanagh1, S Walsh2 1. Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland; 2. Department of Surgery, NUI Galway, Galway, Ireland 48. Supervised Exercise Therapy in the Management of Peripheral Arterial Disease: An Evaluation of Compliance T Aherne1, T AlZaabi1, N McCaffrey2, P Naughton1 1. Department of Vascular Surgery, Beaumont Hospital, Beaumont, Dublin, Ireland; 2. Department of Sports Medicine, Dublin City University, Dublin, Ireland 49. Perineural Catheter Analgesia After Amputation O Ayling1, J Montbriand2, J Jiang2, S Ladak2, L Love1, N Eisenberg1, J Katz3, H Clarke2, G Roche-Nagle1 1. Division of Vascular Surgery, Toronto General Hospital, Peter Munk Cardiac Centre, University Health Network, University of Toronto. Toronto, Ontario, Canada (OA, LL, NE, GRN) 2. Department of Anesthesia and Pain Management, Pain Research Unit, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada (JM, JJ, SL, JK, HC) 3. Department of Psychology, York University, Toronto, Ontario, Canada (JK) 50. Novel Pro-Angiogenics for the Treatment of Critical Limb Ischaemia S Panesar, C Herron, F O’Brien, G Duffy Department of Anatomy Tissue Engineering, RCSI, 123 St. Stephens Green, Dublin 2, Ireland

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SESSION 1: LOWER GASTROINTESTINAL SESSION Chair: Professor Calvin Coffey & Mr David Waldron 1. A Novel Behavioural Animal Model of Obstetric Related Faecal Incontinence L Devane1, E Lucking1, R O’Connell2, J Jones1 (1) Department of Medicine and Medical Science, University College Dublin, Belfield, Dublin 4, Ireland; (2) Department of Centre For Colorectal Disease, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland Introduction: Faecal incontinence is a common condition especially among parous women. The pathophysiology is complex and poorly understood yet no behavioural animal model exists to help elucidate this. Aim: To establish a novel behavioural model of faecal incontinence in the rat using a simulated obstetric injury of the pudendal nerve. Methods: Nulliparous female Wistar rats (n = 19) were individually housed in cages. A latrine box was secured in the corner furthermost from the food and drink. Faecal pellets were counted daily in the latrine and non-latrine areas and time spent in each area was monitored using a video tracking system. The defaecation rate (pellets/h) for each area was determined and an incontinence index was calculated (non-latrine defecation rate/total defecation rate). After 2 weeks, all animals underwent retro-uterine balloon inflation for 1 h to simulate the second stage of labour. Animals were then followed up for 3 weeks post operatively. Data is presented as mean ± SD Results: Pre-operatively the incontinence index was 0.11 ± 0.07. Post-operatively, the incontinence index in 13 animals remained unchanged at 0.11 ± 0.07. However in 6 animals, the incontinence index increased to 0.46 ± 0.23. Conclusion: Similar to human obstetric injury, not all animals developed faecal incontinence and the reason for this is unknown at present. To the authors’ knowledge this is the first quantitative animal model of faecal incontinence and may prove useful in studies of sacral neuromodulation.

2. Transanal Endoscopic Microsurgery for Rectal Polyps with High Grade Dysplasia W Butt, M Shahbaz, D Collins, J O’Riordan, D Kavanagh, D Buckley, P Neary Department of Colorectal Surgery, Adelaide and Meath Hospital, Tallaght, Dublin, Ireland Introduction: Transanal Endoscopic Microsurgery (TEMS) offers a minimally invasive approach for local excision of rectal tumours without the need for formal resection and its associated morbidity and mortality. We evaluated our own units experience with excision of sessile high grade dysplastic (HGD) adenomas to determine recurrence rates. Methods: Data was collected over a 5 year period from January 2009 to December 2013. 142 cases were included of which 26 cases of HGD were identified. Patients underwent a sigmoidoscopy and scar biopsy at 3–6 months and full colonoscopy at 1 year. Those with suspected recurrence at 3 months had a further excision.

S223 Results: The mean age was 62.9 (±11.1) years. 61.5 % were male. Polyp size varied from single quadrant to circumferential lesions. The majority of lesions 23 (88 %) were tubulovillous adenomas. Clear margins were obtained in 69.2 % (18) patients. Six patients required a second procedure to resect persistent disease and 2 patients required a third procedure. 4 patients (15.3 %) had recurrence on the 3 month surveillance sigmoidoscopy, with two having HGD and the other two having LGD. At 1 year follow up, only two patients developed recurrence with LGD. No patients required resectional surgery or progressed to invasive cancer. Conclusion: Patients with high grade dysplastic rectal polyps managed with TEMS can develop recurrent adenomas and require endoscopic surveillance and subsequent excision. Repeat TEMS offers a safe minimally invasive option obviating the need for resectional surgery.

3. Diverticular Disease Coding Incorporated into CT Colonography Reporting and Data System (C-RADS) T Abdulsalam1, B Meshkat1, M Towers2, J Hanson2, A Quinn2 (1) Department of Surgery, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland; (2) Department of Radiology, Our Lady of Lourdes Hospital, Drogheda, Co Louth, Ireland Introduction: Computer topographic colonography (CTC) is an important investigation in evaluation of the colon following incomplete colonoscopy. CTC-reporting and data system or C-RADS has provided a standardised method of reporting findings on CTC. Aim: To evaluate the addition of a novel structured reporting method for diverticular disease (DD) to C-RADS using a 4-points coding system. Methods: A standardised reporting system for DD was developed by the department of radiology and incorporated into C-RADS in December 2011. The diverticular associated CTC findings were coded using a four point scale, with 1–3 representing mild to severe DD and 4 suggestive of complications of DD. Patients with D3/D4-coding were automatically referred for MDM-discussion. We conducted a retrospective review of CTCs performed during December 2011– February 2014. Data were collected on patient demographics and radiological findings, and correlated with MDM-outcome. Results: A total of 514 CTC were reviewed, with 29.6 % (n = 152) male and 70.4 % (n = 362) female. The mean age of patients during the study period was 66-years and the most common DD associated finding was D1 accounting for 70 % (n = 360) of all cases. Only 4.8 % (n = 25) of cases were D3/4 and referred for MDM-discussion, of whom 44 % (n = 11) had diverticular stricture and required no further treatment, 20 % (n = 5) had stricturing DD and underwent surgery, 8 % (n = 2) had fistulating DD and had surgery, with the remaining 28 % (n = 7) being downgraded to D2 after MDM-discussion. Conclusions: The reporting system allowed for appropriate identification of complex cases and ensured a multidisciplinary approach to their management.

4. Enterobius Vermicularis Infestation in the Setting of Acute Appendicitis in a Paediatric Population: Annual Incidence and Predictive Factors C Fleming, D Kearney, P Moriarty, HP Redmond, E Andrews

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S224 Department of General Surgery, Cork University Hospital, Wilton, Cork, Ireland Introduction: Enterobius Vermicularis (EV) is an important finding in appendectomy specimen, most commonly seen in paediatric cases. The role of this pinworm in the aetiology of appendicitis is controversial. We sought to identify the annual incidence of EV infestation in a paediatric population undergoing appendectomy for clinically suspected acute appendicitis and identify subjective predictive factors for EV. Methods: This study was performed in a University Teaching Hospital. We identified all paediatric appendectomies performed at our institute from January to December 2012 using prospectively maintained operating theatre logbooks. In-hospital Histopathology database, medical notes and operative findings were reviewed for each patient and relevant data recorded. Statistical analysis was performed using IBM SPSS, version 21. Results: In total 184 paediatric appendectomies were performed for clinically suspected acute appendicitis. Demographics included: mean age 11.2 years (3–16), gender 1 M:1F. 56 % of procedures were completed laparoscopically and 44 % open. The negative appendectomy rate was 15 % (n = 27). The annual incidence of EV infestation in appendicectomy specimen from a paediatric cohort was 7 % (1 in 14). In specimen containing EV, a negative appendicectomy rate of 69 % was seen, this was statistically significant compared to negative appendicectomy rate for non-EV containing specimen (p \ 0.001). Possible factors to predict EV infection at presentation did not show statistical significance [apyrexia (p = 0.54), normal neutrophil count (p = 0.23) and eosinophilia (p = 0.24)]. Conclusion: EV is seen in 7 % of appendicectomy specimen. These patients have a significantly higher negative appendicectomy rate. Thus, EV is an important differential for right iliac fossa pain in paediatric patients.

5. Effect of Perioperative Fluid Volumes on Outcomes After Surgery for Rectal Cancer: Do They Really Matter? MR Boland, I Reynolds, N McCawley, S El Masry, RA Cahill, J Deasy, DA McNamara Department of Colorectal Surgery, Beaumont Hospital, Beaumont, Dublin, Ireland Introduction: Recent studies have advocated the use of perioperative fluid restriction in patients undergoing major abdominal surgery as part of an enhanced recovery protocol. Series reported to date include a heterogenous group of high and low risk procedures but few studies have focussed on rectal cancer surgery alone. Aim: To assess the effects of perioperative fluid volumes on outcomes in patients undergoing elective rectal cancer resection. Methods: A prospectively maintained database of patients with rectal cancer who underwent elective surgery over a 2 year period was reviewed. Total volume of fluid received intra-operatively was calculated. The primary outcome was post-operative morbidity (Clavien–Dindo classification) and the secondary outcome was length of stay (LOS). Data were analysed using the Chi square test and Pearson’s correlation co-efficient. Results: 70 patients who underwent surgery for rectal cancer over a 2 year period were analysed. 56 patients underwent anterior resection with the remainder undergoing APR/other procedures. The mean total intraoperative fluid volume that patients received was 3,572 ml (range 1,000–7,780). 39/70 (55.7 %) had any complication with 24/70 (34.3 %) classified as major (Clavien–Dindo Grade II–IV). Intra-

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Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 operative volume in excess of 3,000 ml correlated with increased major (p \ 0.037) or all cause morbidity (p \ 0.001). Although intraoperative fluid volume correlated poorly with LOS (Pearson’s correlation co-efficient = 0.33) patients who received [3,000 ml intraoperatively were more likely to have a LOS [7 days (p \ 0.002). Conclusions: Increased intra-operative fluid volumes are associated with increased morbidity and LOS in patients undergoing elective surgery for rectal cancer.

6. An Appraisal of Inflammatory Markers as Adjuncts to Clinical Diagnosis in Acute Appendicitis S Beecher1, J Hogan2, P O’Leary1, R McLaughlin1, MJ Kerin1 (1) Department of Surgery, National University of Ireland, Galway, Ireland; (2) Department of General Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland Introduction: Acute appendicitis is a clinical diagnosis but it is difficult to distinguish between uncomplicated (UAP) and complicated acute appendicitis (CAP). The current study aimed to evaluate inflammatory makers with respect to accuracy in distinguishing UAP and CAP. Methods: A retrospective study was undertaken to evaluate the association between inflammatory markers and CAP. Patients diagnosed with appendicitis were categorized as (A) UAP and (B) CAP. Inflammatory markers were recorded at admission. Hematological indices were combined to generate ratios: white cell/lymphocyte (WLR) ratio, white cell/neutrophil (WNR) ratio and neutrophil/lymphocyte (NLR) ratio. Parameter accuracy was assessed using summary receiver operating characteristic curves, classification and regression tree analysis and confusion matrix generation. Results: On sROC analysis, neutrophils (area under the curve/AUC 0.79, p \ 0.001), WLR (AUC 0.79, p \ 0.001) and NLR (AUC 0.79, p \ 0.001) were the most accurate parameters in distinguishing CAP and UAP. WCC (AUC 0.76, p \ 0.001) and CRP (AUC 0.75, p \ 0.001) were less accurate. Confusion matrices were generated based on CART identified cut-off points (training set/100 and test set/ 500). Neutrophil count [9.35 (sensitivity 72.74 %, specificity 70.80 %, accuracy 72.74 %), WLR [7 (sensitivity 77.03 %, specificity 70.17 %, accuracy 72.13 %) and NLR [5.47 (sensitivity 80.11 %, specificity 70 %, accuracy 72.13 %) demonstrated greater clinical utility than WCC (sensitivity 70 %, specificity 70 %, accuracy (69 %) and CRP (sensitivity 70.90 %, specificity 64.57 %, accuracy 72.98 %). Conclusion: Absolute neutrophil count, WLR and NLR were more accurate than the more typically used inflammatory markers (WCC and CRP) in identifying CAP.

7. CRP and White-Cell-Count Lymphocyte Ratio (WLR) are the Most Accurate Inflammatory Parameters in Distinguishing Complicated and Uncomplicated Diverticulitis H Jong Song, W Lin, R Seghal, P O’Leary, J Hogan, JC Coffey Department of General Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland Introduction: The lack of a single sensitive test for diverticulitis (DD) has posed a great challenge in assessing disease severity. The aim of

Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 this study was to determine whether inflammatory markers and hematological ratios could be utilized to predict disease activity in DD. Methods: Hematological and inflammatory indices were recorded for each admission with CT confirmed DD (101 complicated, 127 uncomplicated). Cases were divided into training (n = 20) and test sets (n = 208). A classification and regression tree analysis was employed in the training set to identify optimal inflammatory marker cut-off points associated with complicated DD. Samples (test set) were categorized as (A) greater than and (B) less than CART identified cut-off points. The predictive properties of inflammatory marker cut-off points (in distinguishing complicated DD) were assessed using a univariate logistic regression analysis and summary receiver operating characteristic curves (sROC). Results: CRP [109 (odds/OR ratio 3.07, 95 % CI 1.43–6.61, p = 0.004, area under the curve/AUC = 0.64) and white cell lymphocyte ratio (WLR) [17.72 (OR 4.23, 95 % CI 1.95–9.17, p \ 0.001, AUC = 0.64) were the most accurate parameters in distinguishing complicated and uncomplicated diverticulitis. WCC [21 (p = 0.02, AUC = 0.60) and lymphocyte count [0.55 (p = 0.009, AUC 0.60) were less accurate. Conclusions: The current study demonstrates the predictive properties of inflammatory markers in identifying complicated DD. CRP and WLR are the most accurate parameters in distinguishing complicated and uncomplicated DD.

8. The Potential Patient Benefit of Colon Cancer Screening and the Role of the Multidisciplinary Team in the Management of Colorectal Cancer in a General Hospital Setting: A Prospective Cohort Analysis KM Joyce, P Waters, M Hegazy, W Khan, I Khan, K Barry, R Waldron Department of Surgery, Mayo General Hospital, Castlebar, Mayo, Ireland Background: Colorectal cancer currently represents the second most common cause of cancer death in Ireland. The National Cancer Screening Service recently introduced Bowel Screen—which offers free bowel screening to men and women aged 60–69 years. Aims: We sought to analyse the proportion of our cohort of colorectal cancer presentation with advanced disease, who may have benefited from the introduction of colorectal screening. Methods: We present a prospective, independent cohort-based study of all patients presenting to Mayo General Hospital with a new diagnosis of colorectal cancer from December 2011 to December 2013. Results: During the study period, 209 patients were discussed at the colorectal multidisciplinary team meeting (MDT) from our institution. Of these, 113 patients had a new diagnosis of colorectal cancer. Their median age was 70 (range 25–89) years and 69 % were male. A significant proportion of our cohort presented with metastatic disease (32/113, 28.3 %), with only one case of metastatic disease undergoing resective surgery. The rate of curative resection was 71.7 %. Of the 18 patients with isolated hepatic metastases only one case proceeded to undergo liver resection. The rate of abdominoperineal resections for resectable rectal tumours was 5.4 %. Conclusion: Our study highlights that a large proportion of our cohort presented with late-stage unresectable disease. Our results support the benefit of multidisciplinary team meetings in terms of optimising, accessing and planning diagnostic and therapeutic interventions. The present findings support the definite role for colorectal cancer screening to diagnose disease at an earlier stage leading to increased survival.

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9. Diverticular disease in younger patients—is it clinically more complicated? SF Murphy1, PS Waters1, F Bennani2, RS Ryan3, W Khan1, I Khan1, R Waldron1, K Barry1 (1) Department of Surgery, Mayo General Hospital, Castlebar, Co. Mayo, Ireland; (2) Department of Pathology, Mayo General Hospital, Castlebar, Co. Mayo, Ireland; (3) Department of Radiology, Mayo General Hospital, Castlebar, Co. Mayo, Ireland Introduction: Diverticular disease is a condition strongly associated with low fibre intake and obesity. There have been reports of an increasing incidence in younger individuals ranging from 12-21% of all cases1,2. The aim of this study is to evaluate the experience of a single institution in management of diverticular disease in patients less than 49 years. Methods: An analysis of a prospectively updated database of all patients admitted with a primary diagnosis of acute diverticulitis from 2005-13 was performed. Data collected included age, length of stay (LOS), inflammatory markers on admission, use of computed tomography (CT) and Hinchey Classification. Minitab V.18 was used for statistical analysis and a p-value of 0.05 or less was considered significant. Results: A total of 120 (54F, 66M) patients less than 49 (28–49, 42.1) years were noted to have a diagnosis of diverticulitis. In this cohort, a Hinchey classification of 3 and 4 was seen in 8 and 5 patients respectively. A total of 3 patients had drains placed under radiological guidance. Twelve patients (10%) required surgical intervention for complicated diverticulitis. Histological evaluation revealed five cases of stricture, two obstruction and 5 perforations. Index CRP of patients requiring intervention was significantly higher at 134.2 (5.1–359.3, p \ 0.05). Average LOS was 5 days (1-48 days). Conclusions: The majority of younger patients with acute diverticulitis can be treated successfully by conservative means. However, a small proportion of patients require aggressive surgical management. References 1. Schweitzer J, Casillas RA, Collins JC. Acute diverticulitis in the young adult is not virulent. Am Surg 2002; 68:1044–7 2. Zaidi E, Daly B. CT and clinical features of acute diverticulitis in an urban U.S. population: rising frequency in young, obese adults. AJR Am J Roentgenol 2006; 187: 6899–94

SESSION 2: BREAST CLINICAL SESSION Chair: Mr Karl Sweeney & Ms Ruth Prichard 10. A Comparison of Level III Axillary Nodal Disease Burden in Patients Undergoing Axillary Lymph Node Dissection with and Without Neo-Adjuvant Chemotherapy

D McCartan1, M Boland1, R Prichard1, J Rothwell1, J Geraghty1, D Evoy1, C Quinn2, A O’Doherty3, EW McDermott1 (1) Department of Breast and Endocrine Surgery, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; (2) Department of Pathology, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; (3) Department of Radiology, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland Introduction: With improved sensitivity of axillary ultrasound, approximately 50 % of patients with node positive breast cancer will

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S226 be identified pre-operatively. Increasingly these patients are being selected for neoadjuvant chemotherapy. Previous non-neoadjuvant studies have shown that in those with node positive disease, the rate of positive level III nodes approaches 20 %. Aims: The aim of this study was to assess whether neoadjuvant chemotherapy has any impact on reducing the burden of axillary disease in level III. Methods: Patients undergoing axillary lymph node dissection (ALND) between 2007 and 2012 were included. The definition of node positive disease was taken as the presence of nodal macrometastases. Results: Over the study period, 348 patients with symptomatic breast cancer underwent ALND. Total lymph node yield was higher in patients who had not undergone neoadjuvant chemotherapy (24 vs 21, p \ 0.001) accounted by a higher yield in level I rather than level II or III nodes. Overall, 97 % of those proceeding straight to axillary clearance had positive nodes removed compared to 66 % in patients treated with neoadjuvant chemotherapy. This difference in nodal positivity was accounted for by a greater level of positivity in level I (p \ 0.001). However, no difference in the rate of positive nodes removed was noted between the groups at level II (p = 0.467) or level III (p = 0.416). Conclusion: Neoadjuvant chemotherapy does not appear to impact on rate of nodal disease above level. Further work is required to identify those with a good response to neoadjuvant chemotherapy who may be spared ALND.

11. Clinical and Economic Advantages of General Practitioner Integration to a Symptomatic Breast Service C Donlan, DP O’Leary, R McLaughlin, MJ Kerin, KJ Sweeney, Carmel Malone Department of Breast Surgery, University College Hospital, Galway, Newcastle Road, Galway, Ireland Introduction: Integration of General Practitioners (GPs) into a tertiary care team is a model used internationally to assist with provision of patient care. On this basis, GPs were introduced to our symptomatic breast clinic in August 2013. Aims: To examine the input of general practitioners working in the Symptomatic Breast Clinics (SBC) and to measure the cost effectiveness of their employment. Methods: A prospectively maintained database was used to identify 1,614 new and 1,453 review patients seen in the SBC between September and December 2013. The S, R and B scores of patients seen first by GPs were compared to those seen first by Registrars and to the overall number of patients seen. Results: 29 % of new patients were seen first by GP while 36 % were seen first by Registrar. 24 % of review patients were seen first by GPs while 45 % were seen first by Registrar. 10 % of new patients with S4/S5 lesions were seen first by GP and 38 % were seen first by Registrar. 17 % of review patients with S4/S5 lesions were seen first by GP and 42 % were seen first by Registrar. The weekly cost of employing three GPs for approximately 15 h is €835, with an hourly rate of €55.66. This compares favorably with the cost of employing a full-time NCHD to provide the same service. Conclusion: This study demonstrates that GPs can play a substantial role in the provision of a symptomatic breast service and that their integration in this manner is a cost-effective approach.

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12. The Role of Bone Scintigraphy in Patients with Breast Cancer Selected for Systemic Staging in the Era of Multi-Detector CT R MacDermott1, D McCartan1, J Rothwell1, J Geraghty1, D Evoy1, C Quinn2, S Skehan3, A O’Doherty3, R Prichard1, EW McDermott1 (1) Department of Breast and Endocrine Surgery, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; (2) Department of Pathology, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; (3) Department of Radiology, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland Introduction: Approximately 7 % of women will have distant metastases when presenting with breast cancer. NCCP guidelines for systemic staging suggest both a bone scan and CT TAP. Whether the combination of modalities is necessary remains unclear. Aim: The aim of this study was to evaluate the additional diagnostic yield from bone scintigraphy in addition to CT staging of the thorax, abdomen and pelvis in patients with newly diagnosed breast cancer selected for systemic staging. Methods: Patients with newly diagnosed breast cancer who underwent systemic staging with CT-TAP and bone scintigraphy in 2012 and 2013 were included. Results of biopsy and staging investigations were correlated. Criteria for staging included: • • • • •

Locally advanced or inflammatory breast cancer Neoadjuvant therapy Biopsy proven axillary nodal metastases on US axillary staging Patients undergoing mastectomy Symptoms suggestive of metastatic disease

Results: 595 of the 903 patients (66 %, median age 59) underwent systemic staging. 72 patients (12 %) had distant metastases. 21 (29 %) had metastases to multiple organs. Bone was the most common site for single organ metastases (37 of 51). Of those presenting with bone metastases only, 11 of the 37 (30 %) patients had a single site of bone metastasis. All but three of these were to the axial skeleton. CT-TAP alone with omission of bone scintigraphy would have resulted in a false negative rate of 0.5 %. Conclusion: In patients with newly diagnosed breast cancer selected for systemic staging, multi-detector CT is a satisfactory stand-alone investigation.

13. Is There a Role for Surgery for Locoregional Disease in Stage IV Breast Cancer? EM Quinn1, R Kealy2, S O’Meara2, C Malone2, R McLaughlin2, MJ Kerin3, KJ Sweeney1 (1) Department of Surgery, Breastcheck Western Unit, University Hospital Galway, Galway, Ireland; (2) Department of Surgery, University Hospital Galway, Newcastle Rd, Galway, Ireland; (3) Department of Surgery, National University of Ireland, Galway, University Rd, Galway, Ireland Introduction: Patients are not routinely offered surgery if known to have Stage IV breast cancer at diagnosis. However, metastases may only be diagnosed after sentinel lymph node biopsy (SLNB) and subsequent staging scans.


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Aim: This study assessed outcomes of all patients with Stage IV breast cancer in our institution, with specific emphasis on outcomes in patients undergoing axillary lymph node dissection (ALND). Methods: We performed a retrospective review of a prospectively maintained database of all patients with Stage IV breast cancer at diagnosis from 2008–2012. We collected and analysed data regarding tumour type, metastases site/number, surgery performed, adjuvant therapies, disease progression/regression and overall survival. Results: Our main findings from 107 patients are summarised in Table 1. Conclusion: Our data shows a survival advantage for patients undergoing surgery with Stage IV breast cancer with low volume distant metastases. However, performance of ALND does not augment this survival benefit. Table 1 Surgery (n = 50)

No surgery p vs (n = 57) surgery

ALND (44)

SLNB Only p (6)

Age

62.7 ± 11.8

59.8 ± 9.4

0.508 62.1 ± 14.6

0.953

Radiological size

39 mm ± 22.1 22 mm ± 13.5 0.142 39.7 ± 20.0

0.661

Luminal

23

5

0.222

Triple negative

6

0

Phenotype

HER2+ve

0.075 32 3

1

1

Positive axillary ultrasound

16/31 (52 %)

0/3 (0 %)

0.007 36/48 (75 %)

0.021

Bony mets

21/45 (46 %)

4/6 (66 %)

0.636 47/57 (82.5 %)

0.001

Visceral mets

27/45 (60 %)

2/6 (33 %)

0.327 37/57 (64.9 %)

0.555

Single metastatic site

35/45 (78 %)

6/6 (100 %)

0.250 27/57 (47.13 %)

\0.001

[1 metastatic lesion

33/45 (73 %)

5/6 (83 %)

0.516 55 (96.5 %)

0.002

Survival (months)

36 ± 24.6

33 ± 12.5

0.640 23.6 ± 19.1

0.003

been suggested that follow-up of low risk breast cancer survivors be transferred to general practitioners. Aims: The aim of this study was to examine the evidence base for hospital follow up of breast cancer survivors and to identify patient preferences for hospital or community follow-up. Methods: We surveyed General Practitioner attitudes towards community follow up and quantified the incidence of new or recurrent cancers within a patient cohort to identify their primary symptoms and thus cancer detection in the community. A 22 item questionnaire was distributed to 101 breast cancer survivors randomly chosen from a cohort of 921 patients. A 9 item questionnaire was distributed to 81 General Practitioners. Results: There is no evidence base to support hospital follow up after primary treatments are completed. Patients are reassured by hospital outpatient appointments (74 %) but have high levels of confidence in General Practitioner follow up (67 %). General Practitioners are equally divided regarding their support for the transfer of oncologic follow up (51 vs 49 %). Ten of the 14 new cancer episodes identified were associated with obvious overt clinical signs at presentation (p \ 0.05). Conclusion: In conclusion the proposed transfer of follow up for breast cancer patients to general practice by the national cancer control programme is appropriate.

15. Predicting Invasive Breast Cancer in Women with Screen Detected Ductal Carcinoma-in-Situ on Initial Core Biopsy

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14. Is it Appropriate to Transfer Long-Term Surveillance of Breast Cancer Patients to a General Practice Setting? D Kerrigan1, P Waters1, M Ryan1, J Hanaghan2, M Irfan1, W Khan1, R McLaughlin3, MJ Kerin3, K Barry1 (1) Department of Surgery, Mayo General Hospital, Castlebar, Mayo, Ireland; (2) Department of Radiology, Mayo general Hospital, Castlebar, Mayo, Ireland; (3) Department of Surgery, Galway University Hospital, Ireland Introduction: The national cancer control programme (NCCP) centralized the diagnosis and treatment of breast cancer in 2008. The National Cancer Registry Ireland predicts a 53 % increase in breast cancer incidence by 2030 which will place an increased demand on already stretched hospital resources. Due to increasing referrals, it has

SR Tee1, DP McCartan1, J Rothwell1, J Geraghty1, D Evoy1, C Quinn2, A O’Doherty3, EW McDermott1, RS Prichard1 (1) Department of Breast and Endocrine Surgery, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; (2) Department of Pathology, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; (3) Department of Radiology, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland Introduction: Previous studies from this unit have demonstrated that a pre-operative diagnosis of ductal carcinoma in situ (DCIS) based on core needle biopsy is upstaged to a final diagnosis of invasive cancer in 33 % of patients. Recent studies have proposed algorithms to identify patients with a biopsy diagnosis of DCIS that are at risk of upstaging to invasive disease and who should be considered candidates for axillary staging with sentinel node biopsy at initial surgery. Aims: The aim of this study was to assess the ability of pre-operative clinical, radiological and histological features on biopsy of DCIS to identify patients at high risk of upstaging to invasive disease. Methods: Pre-operative factors analysed were grade of DCIS on biopsy (high or intermediate grade versus low grade), subtype of DCIS (cribriform versus others) and size of mammographic abnormality (greater or less than 15 mm). Results: From 2003 to 2012, 380 patients underwent surgery with a pre-operative diagnosis of DCIS. Final diagnosis resulted in upstaging to invasive cancer or micro-invasion in 53 patients (14 %). High/ intermediate grade (p = 0.010), and a size of greater than 15 mm (p = 0.005) were predictive of upstaging on univariate analysis. On multivariate analysis, only a mammographic abnormality of [15 mm retained significance (odds ratio of 2.50; p = 0.046) Conclusion: While controversy surround the value of sentinel node biopsy in DCIS, our experience suggest those with a mammographic abnormality greater than 15 mm should be considered for sentinel lymph node biopsy as part of the initial surgery due to a higher probability of upstaging.

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16. The Diagnostic Efficacy of Subareolar Duct Excision for Patients with Unilateral Spontaneous Nipple Discharge: An Analysis of Excision Pathology G Guevara1, DP McCartan1, J Rothwell1, J Geraghty1, D Evoy1, C Quinn2, A O’Doherty3, EW McDermott1, RS Prichard1 (1) Department of Breast and Endocrine Surgery, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; (2) Department of Pathology, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; (3) Department of Radiology, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland Introduction: Nipple discharge is the third leading cause of referral to symptomatic breast services after breast lumps and pain. While the majority of causes of pathological nipple discharge are benign in nature, a precise preoperative diagnosis, however, is not achieved in most cases. Aim: The aim of this study was to assess the final pathological diagnosis attained following sub-areolar duct excision in patients presenting with persistent, recurrent, unilateral spontaneous discharge. Methods: All patients undergoing sub-areolar duct excision from 2008 to 2013 were included. All patients had an intra-operative specimen taken and sent for histological analysis. Presenting symptoms, duration, results of initial radiological imaging were also recorded. Ductography was not performed pre-operatively. Results: Over a 5-year period, 113 patients with a median age of 52 years (range 30–84 years) underwent sub-areolar duct excision. A pathological abnormality was identified in 90 % of patients. The most common diagnosis was the finding of duct ectasia (42 %) followed by an intra-ductal papilloma (35 %). Ductal carcinoma in situ was found in 7 patients (6 %) with no significant difference age in the subgroup with DCIS compared to those with a benign finding (p = 0.139). Conclusion: These results are concordant with other studies that have shown a rate of DCIS less than 10 % in patients presenting with pathological nipple discharge. While most causes are benign in nature, a pathological cause can be identified in 90 % of cases. The inability to differentiate benign versus malignant causes pre-operatively poses a problem when advocating a conservative approach to patients with pathological nipple discharge.

17. Oncotype Dx: A Cost Effectiveness Analysis F McHugh1, Z Al Hilli1, T Cassidy1, AM O’Shea2, M Staunton2, B Hennessy1, M Patrick1, M Allen1, C Power1, A Hill3 (1) Department of Breast and Endocrine Surgery, Beaumont Hospital, Beaumont, Dublin 9, Ireland; (2) Department of Pathology, Beaumont Hospital, Beaumont, Dublin 9, Ireland; (3) Department of Surgery, Royal College of Surgeons in Ireland, St. Stephen’s Green, Dublin 2, Ireland Introduction: Adjuvant treatment in breast cancer has undergone a paradigm shift in recent years. Oncotype Dx is a 21 gene assay which can identify patients who would benefit from chemotherapy to reduce their risk of recurrence. It thereby establishes the patients in whom chemotherapy may be safely avoided. Aim: The aim of the study was to evaluate the cost effectiveness of Oncotype Dx testing at our institution.

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Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 Methods: A retrospective analysis of all patients who underwent Oncotype Dx test in Beaumont Hospital between October 2011 and April 2014 were included. Oncotype testing was performed on patients with ER positive, node negative breast cancer. Patient demographics, tumour characteristics, Recurrence Score and cost estimates were collected. Results: 104 patients were included in the study. Mean age was 52.5 years (35–74 years). Mean tumour size was 23.2 mm (6–58 mm), mean tumour grade was 2. Oncotype Dx score ranged from 0–54 with a mean of 18. 56 (54 %) patients were categorised as low risk, 42 (40.5 %) as intermediate risk and 6 (5.5 %) as high risk. 29 % (n = 30) received chemotherapy. Average costs of adjuvant chemotherapy included; drug cost (€295–€14,678) in addition to estimates of administration and monitoring (€1,646); adverse event prevention (€3,561) and adverse event management (€756). This gives an average cost of €6,258–€20,651. Compared to the cost of Oncotype Dx (€3,200), savings ranged from €3,058–€17,451 per patient who avoided chemotherapy. Conclusion: Oncotype Dx allows for the optimal allocation of chemotherapy in patients with ER positive early breast cancer. Associated cost-effectiveness is demonstrated in our patient cohort.

18. Factors Affecting Hormonal Therapy Adherence in Breast Cancer Patients C Fleming, E Quinn, M O’Sullivan Department of Breast Surgery, Cork University Hospital, Wilton, Cork, Ireland Introduction: Anti-oestrogen therapies, namely tamoxifen and aromatase inhibitors (AIs), are important adjuvant therapies for oestrogen-receptor (ER)/progesterone-receptor (PR) positive breast cancer. Non-adherence can be associated with increased risk of disease recurrence. Aim: The aim of this study was to assess adherence rates and factors affecting adherence to anti-oestrogen therapy in an Irish population. Method: We performed a questionnaire based cohort study of 263 patients with ER/PR positive breast cancer, currently prescribed antioestrogen therapy. Anonymous questionnaires, including a validated medication adherence score (MAS), were completed by patients attending breast/oncology clinical follow-up between May 2013 and March 2014. Data was collected regarding therapy type, MAS, discontinuation of therapy, switching of therapy, side effects and demographics. Results: Of 263 patients, 64 % reported complete adherence on the MAS. Factors associated with reduced MAS scores were younger age (p \ 0.001), side effects experienced (p = 0.019), lack of emotional support (p = 0.003), unemployment (p = 0.003) and low income household (p = 0.22). 11 % of patients reported stopping their initial hormonal therapy permanently; of these 44 % did so due to side effects experienced. A further 8.4 % reported temporarily stopping their hormonal therapy; again 36 % did so due to unbearable side effects. Overall 70 % of patients reported side effects from their hormonal therapy, most commonly sweats/flushes (76 % of tamoxifen users) and joint pain (39 % of AI users). Only 67.7 % of patients correctly understand why they are prescribed this medication. Conclusion: Our results demonstrate incomplete adherence to prescribed hormonal therapy in this population. Increased attention to managing side effects of hormonal therapies may increase adherence rates.


SESSION 3: ORTHOPAEDIC SESSION Chair: Mr John McCabe & Mr Michael O’Sullivan 19. Functional Outcomes After Cauda Equina Syndrome S O Neill, J Baker, T Williamson, C Fitzgerald, C Fleming, F Rowan, K Synnott Department of National Spinal Injuries Unit, Mater Misericordiae Hospital, Eccles Street, Dublin, Ireland Introduction: Cauda equina syndrome (CES) is a condition caused by compression of the cauda equina. It is characterised by symptoms including micturition, defecation and sexual dysfunction. The aim of this study is to assess functional outcome following operative treatment of CES secondary to lumbar disc prolapse. Methods: Patients that underwent operative treatment of CES between 2007–2012 were identified from a prospectively collected database. Presenting symptoms, neurological status, time to surgery, operative approach and injury level were recorded. A self-administered questionnaire assessed post-operative functional status including: pain; micturition; defecation; sexual function (IIEF 5); quality of life (EQ-5D-3L), and; return to work status. Results: 89 patients underwent operative intervention for CES. The mean age was 39.71 years, with 41 (46.1 %) male. L5-S1 was the most common site of prolapse (47 %).The majority presented with low back pain (96 %) and saddle anaesthesia (73 %). Only 21 %(19) underwent surgery within 24 h of symptom onset; 26 % (23) between 24–48 h, and; 53 % (47) greater than 48 h. However 99 % (88) underwent surgery within 24 h of hospital admission. There was so significant difference in post operative quality of life (EQ-5D-3L) in patients who underwent surgery within 24 h, 24–48 h or greater than 48 h P [ 0.05.33 % of patients had residual bowel or urinary dysfunction with 50 % males and 44 % females suffering from sexual dysfunction at latest follow-up. Conclusion: Cauda equina syndrome is associated with significant residual morbidity, despite adequate surgical intervention with often long term neurological sequela. The majority of patients with Cauda equina syndrome had a delayed presentation, however increased time to surgery from symptom onset was not associated with lower quality of life scores.

20. The Evolution of Spinal Surgery in the West of Ireland (2006–2013), the Impact of Intrinsic and Extrinsic Factors M O’Sullivan, M Jadaan, A Devitt, E Rahall, JP McCabe Department of Surgery, NUI Galway, Galway, Ireland Introduction: All spinal surgery in the West of Ireland, prior to 2007, was conducted in a single institution. Subsequently trauma and elective spinal surgery was divided between two institutions. With the advent of the economic recession, the delivery of spinal surgery has been anecdotally impacted by reductions in staff and fiscal support. Aim: To determine the impact (i) Bilocation of spinal services in 2007 (ii) of the Economic Recession associated with service restrictions

S229 on the practice of spinal surgery in Galway University Hospitals (GUH) over a 7 year period, January 2005–2013. Methods: A retrospective review of all spinal cases conducted in both GUH hospitals was recorded for 2005,2006,2008,2009, 2012 and 2013 respectively. Results: A total of 910 spinal cases were preformed during the study period. The cases distributed with respect to anatomical location are as follows, Lumbar 63.62 %, Cervical 24.5 %, Thoracic 11.86 % respectively. The elective to non-elective ratio has remained stable during the study period. (i)

Following the implementation of the bilocation of spinal services in 2007

Instrumented to Non Instrumented Case Ratio and the Multilevel: Single level Case Ratio, have both increased. (ii)

Despite fiscal and staffing challenges, Instrumented to Non Instrumented Case Ratio and the Multilevel: Single level Case Ratio have increased, with a stable surgeon to case ratio.

Conclusions: With respect to the aims of the study, firstly bi-location of services has increased the complexity of spinal surgery being performed in the West of Ireland and secondly despite fiscal challenges this degree complexity has been maintained.

21. Transfer of Bacterial Pathogens during Skin Preparation: A Laboratory Experiment C Ni Fhoghlu, L Zulkifli, S Brennan, A Walsh Department of Orthopaedic Surgery, Our Lady of Lourdes Drogheda, Drogheda, Co. Louth, Ireland Introduction: The skin’s indigenous microflora varies with anatomical site, with a higher density of micro-organisms found in regions such as axilla, groin and toes. During surgical skin preparation, placing a swab in one of these locations prior to the incision site is discouraged, as it may increase the risk of surgical site infection (SSI). It is common practice to discard a swab once contaminated in these regions. Aim: The aim of this study was to determine whether antiseptic soaked swabs act as a vector for the transfer of bacteria from one location to another. Methods: Sterile swabs were soaked in either chlorhexidine gluconate or povidone iodine. Staphylococcus aureus and Staphylococcus epidermidis were tested at various concentrations (4.0, 3.0, 2.0, 1.0, 0.5). These bacterial solutions were pipetted onto the swabs and transferred to agar plates. The plates were incubated at 37 C for 24 to 48 h, and the number of colony forming units (CFUs) recorded. Results: The number of CFUs formed at the different concentrations using povidone iodine were as follows: S. aureus—4.0(15), 3.0(14), 2.0(14), 1.0(7), 0.5(4), S. epidermidis—4.0(6), 3.0(1), 2.0(0), 1.0(1), 0.5(2). There was no bacterial growth seen with chlorhexidine, regardless of bacterial type or concentration. Conclusion: Both S. aureus and S. epidermidis showed positive transfer with povidone iodine. We therefore recommend that the practice of discarding swabs after contamination in one of the aforementioned regions should be maintained. However, negative transfer using chlorhexidine gluconate indicates that the practice of discarding swabs may not be necessary in this case.

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22. Bacterial Contamination of Diathermy Tips Used During Orthopaedic Procedures A Abdulkarim, A Moriarty, P Coffey, E Sheehan Department of Orthopaedic Surgery, Midland Regional Hospital, Tullamore, Offaly, Ireland Introduction: The role of diathermy in orthopaedic surgical practice has increased since its introduction. No single study to date has focused on the potential for diathermy tips to cause wound contamination and infection. We sought to identify whether diathermy tips could be possible sources of infection in orthopaedic procedures. Methods: From July 2013 to September 2013, the diathermy tips from 86 consecutive orthopaedic procedures using diathermy were cultured using direct and enriched media. None of the diathermy tips were used for the skin incision. All patients underwent an orthopaedic procedure for a non-infected condition. For each procedure an unused control diathermy tip was placed on the instrument table at the beginning of the procedure and processed similarly. All patients were followed for any postoperative complications. Results: 108 diathermy tips from 86 orthopaedic procedures were cultured. None of the tips cultured directly on blood agar demonstrated bacterial growth. Following enrichment culture, 6 (5.6 %) of the procedure diathermy tips and 1 (0.92 %) of the control tips demonstrated bacterial growth. Coagulase-negative staphylococci (83.3 %) and propionibacterium (16.7 %) were cultured from the tips. 1 of the patients who had bacterial growth from the diathermy tip developed a superficial surgical site infection. Conclusions: Our study suggests diathermy tips and the tissue coagulated by its use may not be as sterile as previously thought. There may be benefit in changing the diathermy tips during orthopaedic procedures as they may represent a possible source of bacterial contamination.

23. Diathermy A Surgeon’s Awareness of Principles of Use P McQuail, J Baker, D Byrne, P Kenny Department of Trauma and Orthopaedics, James Connolly Memorial Hospital, Blanchardstown, Dublin 15, Ireland Introduction: Diathermy is an integral part of many modern surgical procedures. The basic principle of diathermy now is used in many permutations to yield advanced techniques in minimally invasive procedures. While diathermy is generally accepted as ‘safe’, in the US, electrosurgery induced injuries are among the commonest cause for malpractice lawsuits. Aim: The purpose of this study was to evaluate the awareness among surgeons of the principles, risks, precautions and appropriate use of diathermy. Method: All surgeons employed from Senior House Officer (SHO) to Consultant grade in two teaching hospitals were surveyed. 85 were asked to complete an anonymous questionnaire which recorded level of training and addressed competence in principles, hazards, and precautions to be taken with diathermy. Results: 18 Consultants, 7 Specialist Registrars, 22 Registrars and 13 SHO’s responded (71 % response). All but three subspecialties were represented. 92 % (55/60) had no formal diathermy training. Despite 95 % (57/60) of surgeons regarding diathermy as a safe instrument, 47 % felt they had inadequate understanding of the principles and

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Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 failed to demonstrate an appropriate awareness of the potential risks. 48 % exhibited a dangerous lack of awareness in managing equipment not yielding the desired effect and of patient groups requiring special caution. Only 37 % wanted formal training. Conclusion: This study found a lack of awareness of diathermy principles and hazards among surgeons. This puts patients and staff at potential risk of serious morbidity. An effort is needed to ensure surgeons across all grades are safe in their use of diathermy.

24. Correlating Posture and Gait Using a Marker Free Motion Analysis System with Pain and Disability Scores Among Patients Seen at Spine Clinic R Hurley, A Devitt Department of Orthopaedic Surgery, Galway University Hospital, University Road, Galway, Ireland Introduction: Back pain is an extremely common complaint and posture plays a key role in that. However, dynamic posture measurement is not routinely undertaken, and could shed light on how posture correlates to different types of back pain. Aim: The aim of this study is to correlate the position during walking of a patient’s head over points on their body, with pain/disability questionnaires. Methods: Patients attending the orthopaedic department with back pain were split into two groups: those with pain relieved by walking (worse when standing), and those whose pain is more constant. Patients underwent lateral spinal films to measure sagittal balance, motion analysis using Organic Motion BioStage to measure gait and specifically centre of head over ankles, knees, pelvis, and centre of mass during the gait cycle. Finally, patients completed modified Oswestry disability index questionnaire, SRS 22 questionnaire, and VAS pain score. Results: Preliminary results show that for the patients with pain relieved by walking, their centre of head over the centre of mass/ pelvis/sacrum was positive anteriorly. However, the centre of head over knees/ankles was more neutral in these subjects. Conclusion: Preliminary results indicate that patients with sagittal balance abnormalities on plain film and back pain relieved by walking have a correlation with a forward position of centre of head over pelvis/sacrum/mass and with a neutral position of centre of head over knees/ankles when analysed using a motion analysis system. This indicates that dynamic posture measurement may be a useful tool when analysing back pain.

25. Administration of Low Molecular Weight Heparin in Spinal Surgery at 24 h: A Single Surgeon’s Experience E Murphy, A Shafqat, E. Rahall Department of Orthopaedic Surgery, Galway University Hospital, Newcastle Road, Galway, Ireland Introduction: Chemoprophylaxis against thromboembolic events in spinal surgery is a contentious issue. A paucity of data exists on the safety, timing and outcomes of chemoprophylaxis in spinal surgery. Aims: To identify any complications in our patient cohort who received chemoprophylaxis against thromboembolic events.

Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 Objectives: To establish the prevalence of DVT/PE in our patient cohort. To categorize complications into major and minor complications. Methods: We conducted a year long retrospective review of patients in a tertiary spinal referral unit. Patients were administered low molecular weight heparin at 24 h post spinal surgery in conjunction with anti-embolism stockings. A chart review was carried out. Patients were contacted by telephone subsequently to identify any later complications. Elective and trauma spinal surgery patients were included. We excluded patients who had conditions precluding them from having prophylaxis (concomitant intra cranial bleeds or major abdominal injuries etc.). Findings: 111 patients were included and 3 excluded. There were 72 trauma and 39 elective patients. 63 % of the cohort was male. The average age for males was 67 and the average age for females was 65. 1 patient had a wound haematoma. No epidural haematomas were detected. DVT incidence was 1.8 %, PE was 1.8 %. (2 patients) Risks were identified for both patients. One patient was non compliant with anti coagulation therapy post discharge. The other patient had active malignancy. Conclusion: This patient cohort did not have any adverse outcomes from chemoprophylaxis at 24 h post operation. The need for international guidelines on this subject is apparent.

26. Nationwide Study of General Practitioners’ Expectations Regarding Total Hip Arthroplasty O Carmody1, M Nugent2, F Rowan2, A Kearney3, P Kenny2 (1) Department of Orthopaedic Surgery, Temple Street University Hospital, Dublin, Ireland; (2) Department of Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Dublin, Ireland; (3) Department of School of Nursing, Trinity College, Dublin, Ireland Introduction: General Practitioners provide the vast majority of referrals to Orthopaedic Surgeons in Ireland for consideration of Total Hip Arthroplasty. They are fundamental to the initial referral process. Accordingly, it is imperative that Orthopaedic Surgeons understand what General Practitioners expect for their patients after a Total Hip Arthroplasty. Methods and Aims: We developed a 55-question document, which included an 18-question, validated HSS patient expectation questionnaire 1, and posted it to 350 General Practitioners in the Republic of Ireland. Expectations of complications, rehabilitation and postoperative management were also analysed. We received 119 replies in total. Results: 119 General Practitioners (67 % male, 33 % female) of whom 68 % had more than 15 years experience as GP’s replied. We compared our GP expectation data with similar data from 1,103 completed patient expectation questionnaires 1. We noted marked differences between the expectations of GP’s and patients in relation to Total Hip Arthroplasty.

S231 Furthermore, GP’s tended to overestimate the length of time for a routine procedure (56 % expect over 2 h), overestimate the mortality rate (40.7 % expect it’s over 1 %), underestimate the dislocation rate 2 (44.2 % expect it’s less than 1 %) and only 27 % admit to looking up or receiving information on hip replacements in the past year.

27. Elective Orthopaedic Information on the Internet SC O’Neill1, M Nagle2, JF Baker1, F Rowan1, S Tierney3, JF Quinlan1 (1) Department of Trauma and Orthopaedics, Tallaght Hospital, Dublin, Ireland; (2) Department of Trauma and Orthopaedics, Limerick University Hospital, Dooradoyle, Co. Limerick, Ireland; (3) Department of Surgical Informatics, Royal College of Surgeons Ireland, Dublin, Ireland Introduction: Internet information for patients has been shown to be difficult to read, of variable quality, and largely unregulated. Despite this, the proportion of patients obtaining information from the internet is increasing, with patients commonly researching their condition before attending clinics. Aim: To systematically evaluate the readability and quality of websites related to common orthopaedic procedures. Methods: A total of 225 websites from Google, Yahoo and Bing were analysed using the search terms; ‘‘Total Hip Replacement’’, ‘‘Total Knee Replacement’’ and ‘‘ACL Reconstruction’’. The readability of each website was assessed using the Flesch Reading Ease Score and Flesch-Kincaid grade level. Quality was assessed using the online LIDA tool, and an originally developed procedure specific information checklist based on the British Orthopaedic Association consent guidelines. The HON-code status of each website was also recorded. Results: Only 13.7 % of websites were set at or below the recommended 6th grade readability level. The mean overall LIDA score was 68.86. Only 27.35 % were HON-code certified. A significantly higher mean overall LIDA score was observed from HON-code certified websites compared to non HON-code certified websites 79.24 v 70.15 (P = 0.0045), with no significant difference in the readability 53.15 v 55.14 (P = 0.45). ACL reconstruction websites had the lowest mean qualitative score 62.53 %. Conclusions: Internet information on common orthopaedic procedures is poorly written and unreliable. Given this deficit it is important Orthopaedic surgeons provide patients with high quality, readable information or direct them to an appropriate source. We can recommend HON-code certification as a marker of Orthopaedic website quality. Conclusion: We identify a significant difference between GP expectations and patient expectations. There is a pronounced variability in expectations of post-operative management and complications between GP’s nationwide. We believe this information is fundamental in establishing a robust understanding between Orthopaedic Surgeons and General Practitioners.

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SESSION 4: GENERAL SESSION Chair: Professor Patrick Broe & Mr Ronan Cahill 28. A Profile of Head Injury Admissions to a Regional Trauma Centre in the West of Ireland P Owens, N Lynch, P O’Leary, MJ Kerin Department of Surgery, University Hospital Galway, Newcastle Road, Galway, Ireland Introduction: Head injuries represent a significant burden of care for surgical services in hospitals without on-site neurosurgical cover. In Ireland, approximately 12,000 such injuries occur yearly. Aim: This study reviews the characteristics of head injury admissions to a West of Ireland trauma centre. We aim to determine factors associated with prolonged length of stay (LOS) ([2 weeks) and to assess implications for hospital resources. Method: A review of patients admitted from 2008 to 2013 with a HIPE diagnosis of head injury was conducted. Demographic data including age, gender, LOS, mode of injury, alcohol use, radiological diagnosis, neurosurgical opinion, transfer and intervention were documented. Factors increasing LOS were identified using univariate analysis in SPSS. Results: 645 head injury patients were admitted, accounting for 4,050 inpatient bed-days. 331 (51 %) were 1 day admissions for head injury observations. 107 (17 %) patients had a LOS of 1 week or greater, representing 3,041 inpatient bed-days (mean: 28.4, range 7–341). Mechanical falls accounted for 53 % (n = 57). Alcohol intake was associated with 25 % (n = 27). Intra-parenchymal injury was diagnosed in 55 % (n = 59) and was associated with prolonged LOS, p = 0.021. Extraaxial haemorrhage occurred in 80 % (n = 86). Neurosurgical opinion was sought in 75 % (n = 81), with 14 % (n = 11) requiring neurosurgical intervention. This intervention group accounted for 695 (23 %) of inpatient bed-days. The prolonged LOS group were significantly older, 55.6 v 66.0, p = 0.013. Conclusion: Head injuries result in significant utilisation of inpatient bed-days. Prolonged LOS is associated with intraparenchymal injuries and increasing age. Improved strategies to reduce LOS in these patients are warranted.

29. A Prospective Cohort Study Examining the Parent Reported Improvements in Health Following Paediatric Adenotonsillectomy G Thong, K Davies, E Murphy, I Keogh Department of General Surgery, Galway University Hospital, Galway, Ireland Introduction: The clinical efficacy of tonsillectomy had been under question of late. A 2010 randomised controlled trial commissioned in the UK, cited cost as a major factor and recommended the use of medical management. Evidence supporting the clinical value of tonsillectomy versus medical management is lacking. Aims: We aimed to evaluate the symptomatic benefit reported by parents of children undergoing tonsillectomy.

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Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 Methods: We utilised the T14 Paediatric Throat disorders Outcome Test, a disease specific, validated questionnaire which assesses Patient Reported Outcome Measures (PROMs). We administered pre and post operative questionnaires to parents of children undergoing tonsillectomy. A control group of symptomatic children on the waiting list was also studied. Results: Currently, 42 parents of children undergoing tonsillectomy have filled questionnaires. These were well matched in age and gender with 37 children on the waiting list. A paired sample t-test was conducted to evaluate the impact of tonsillectomy on T-14 scores. At 8 weeks after surgical intervention, there was a statistically significant decrease in T-14 scores; t (19) = 17.17, p \ .004(two tailed). The eta squared statistic (0.87) indicated a very large effect size. Scores in the waiting list group did not change; t(17) = .369, p \ .000 (two tailed). Conclusion: Tonsillectomy is one of the most commonly performed surgical procedures worldwide. It is highly regarded by otolaryngologists and parents alike. This study provides significant evidence that tonsillectomy provides improvement in PROMs vs. watchful waiting. We consider tonsillectomy to be a procedure of considerable clinical benefit and a worthwhile allocation of expenditure.

30. Predicting the Length of Stay (LOS) of Acute Surgical Admissions at First Patient Contact A Stirling, K Brown, M Whelan, A Gillis, K Conlon, P Ridgway Department of Surgery, AMNCH, Tallaght, Dublin, Ireland

Introduction: In the current economic climate hospitals are under ever increasing pressure to streamline inpatient care. To optimise discharge planning, current guidelines dictate all patients should be assigned an estimated date of discharge (EDD) at admission. There is no European data on physician’s ability to do this. Aim: To assess physician accuracy in predicting the LOS of acute surgical admissions. Method: Electronic hospital records and ‘e-handover’ for all acute surgical admissions from July-December 2013 where reviewed retrospectively. Predicted LOS was calculated from EDD and date of admission and was compared with the actual LOS for each patient episode. Errors in predicting LOS were compared across diagnostic categories and clinical/demographic groups. Correlation between the number of co-morbidities and error in predicting LOS was sought. Results: A total of 814 patient episodes were analysed. LOS was predicted correctly in 15.4 percent (median error:1 day underestimation (IQR 0-4 days)). There was a significant difference in error across diagnostic groups (p = 0.002) and in the[65 group versus\65 group (p = 0.001). Male or female sex (p = 0.915) and operative versus nonoperative groups (p = 0.586) had no significant difference in error. There was statistically significant correlation between error in predicting LOS and the patient’s number of co-morbidities (p\0.001). Conclusion: While there is an acceptable level of accuracy in predicting LOS overall, advanced age and co-morbid status have been shown to significantly increase our error. Accurate estimation of LOS allows for comprehensive discharge planning which ultimately reduces LOS and consumption of healthcare resources.


31. Balancing the Normal Appendicectomy Rate with Perforated Appendicitis Rate in the Era of Advanced Imaging and Diagnostic Laparoscopy M Aremu1, B Meshekat2, M Salama1 (1) Department of General Surgery, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland; (2) Department of General Surgery, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland Introduction: The diagnosis of appendicitis is often challenging. Delayed or missed diagnosis can lead to perforation and associated morbidity. The management of patients with suspected appendicitis remains controversial. Early exploration may reduce perforation rate, but can lead to increased negative appendectomy. An appropriate balance between negative appendectomy and perforation rates should be obtained. Aim: To compare negative appendectomy rates and perforation rates in our institution. Methods: All patients who had undergone appendectomy during a 2 year period (Jan 2009–2011) were identified through HIPE and a retrospective review of patient records was conducted. Data were collected on patient demographics, type of operation (open/laparoscopic), and histological findings. Children were categorised as patients under age of 16 years. Those who had undergone elective interval appendectomy or had appendectomy as part of another operation were excluded from the study. The final histology result was used to determine negative and perforated appendectomy rates. Results: There were 650 appendectomies performed, 35 % (n = 230) in children (134 male and 96 female, age (3–16 years), and 65 % (n = 420) in adults (181 male and 239 female, age (16–88 years). Forty percent (n = 395) of the appendectomies were performed laparoscopically with 39 % (n = 255) being open. Sixteen percent (n = 105) of appendectomies returned as normal on histology, and 9 % (n = 61) had perforated appendicitis. Both perforated appendicitis (57 %, n = 35) and normal appendectomies (62 %, n = 65) were more common in adults. Conclusion: The rates of normal and perforated appendectomies were comparable to other studies. Adults are at higher risk of perforation and normal appendectomy.

32. Declining Operative Experience in Colorectal Malignancy; Adequacy of Oncologic Resection I Robertson1, G Elamin1, P Waters1, F Bennani2, W Khan1, K Barry1 (1) Department of Surgery, Mayo General Hospital, Castlebar, Mayo, Ireland; (2) Department of Pathology, Mayo general Hospital, Castlebar, Mayo, Ireland Introduction: With the advent of the national cancer strategy (NCS) in 2008, the management of rectal cancer has been centralised to eight hospitals in Ireland. At present colon surgery continues to be performed electively and emergently outside of designated specialist centres. Aim: The aim of this study was to analyse the adequacy of oncologic resections performed by a single surgeon over a 10 year period, pre and post implementation of the NCS. Methods: An analysis of a prospectively updated colorectal cancer database was performed of all cases during the study period. All histopathological reports for the individual resections were collated and analysed. Statistical analysis was performed using Minitab V.18 and p \ 0.05 considered significant. Results: There were 114 operations performed over 10 year period, 77 elective (68 %) and 37 (32 %) emergency procedures. Seventy-six

S233 (67 %) of these were performed pre-NCS and 38 (33 %) post-NCS. This represents a reduction of 50 % in operative procedures since 2008. The mean lymph node harvest recorded was 10 for both elective and emergency procedures over the 10 year period. The mean lymph node harvest pre-implementation of the cancer strategy was 8, compared to 17 post-NCS (p \ 0.05). Clear resection margins were achieved in 109 of 114 cases (96 %), with positive microscopic margins noted in five patients. Conclusions: These data have implications for surgeons performing colonic surgery outside of specialist centres. In this study, despite reducing operative exposure, the mean numbers of lymph nodes harvested have increased significantly, in keeping with improved reporting standards of histopathological reporting as directed by the National Cancer Strategy.

33. Diagnostic Needs of an Acute Surgical Service: A Single Centre Experience of Diagnostic Burden N Bambury, J Donaghy, K Mealy Department of Surgery, Wexford General Hospital, Wexford, Co. Wexford, Ireland Introduction: Discharge planning in the current economic climate has placed an increased responsibility on healthcare representatives to process patient admissions in a more efficient way. Aim: We aimed to look at the burden on services in a single centre over a 3 month period in order to identify radiological, endoscopic, and support services and also to identify how these factors impact length of stay. Methods: Data was collected prospectively between October to January 2014. Admission data was collected daily. Patients were grouped into 4 categories; abdominal, soft tissue, trauma and other. Information was collected on expected date of discharge, actual date of discharge, reasons for delay in discharge, radiological and endoscopic procedures carried out. Results: 276 patients were admitted over the 3 month period. 38 % of patients exceeded the EDD on admission. Average length of stay was highest in the abdominal category (3 days). 43 % of patients did not require any diagnostic or surgical intervention. Diagnostics including radiology and endoscopic evaluation were required in 43 % of patients. 14 % of patients underwent surgical intervention. 25 % of patients who had a delay in discharge were as a result of diagnostic delays. Conclusion: Identifying the factors underlying a delay in discharge enables a service to adapt to the current challenges in the healthcare sector to meet the expected date of discharge. The above results suggest that daily emergency radiological and endoscopic appointments would lower delay in discharge rates.

34. Enhanced Exercise Training is Associated with Early Discharge: A Case Control Study G Sheridan1, N Bhatt1, M Connolly1, A Gillis1, K Conlon1, S Lane2, E Shanahan3, P Ridgway1, S Kelly1 (1) Department of General Surgery, Tallaght Hospital, AMNCH, Dublin 24, Co. Dublin, Ireland; (2) Department of Respiratory Medicine, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland; (3) Department of Anaesthesia, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland Introduction: Pulmonary complications are a leading cause of morbidity, mortality and increased hospital stay following surgery [1].

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S234 Aim: To investigate whether early postoperative aerobic exercise, using a pedal exerciser, reduces postoperative respiratory morbidity and length of stay, and improves pulmonary function. Method: A prospective case control study with 60 patients (30 controls) who underwent major surgery, was conducted. Controls were case mix matched prospectively from a similar general surgical service not utilising postoperative exercise. Patients underwent a twice daily exercise programme using the pedal exerciser from days 2 to 4 postoperatively. Primary outcome measures were respiratory tract infection, deep vein thrombosis (DVT) and pulmonary embolus (PE). Secondary outcome measures were subjective breathlessness and length of stay postoperatively. Results: The rate of RTI was 43.33 % in the control group and 16.66 % in the cases (p = 0.024). None of the cases or controls suffered from a DVT or PE. The secondary outcome as measured by median length of stay in the control group was 11 ± 12.7 days whereas in the cases it was 8.5 ± 5.23 days (p = 0.023). The BORG score in the cases group showed a decline in the subjective breathlessness on postoperative day 4. Conclusion: Aerobic activity with a pedal exerciser significantly reduced the rate of postoperative respiratory tract infections, length of stay and the perceived breathlessness in the intervention group as compared to the controls. Reference 1. Lawrence VA CJ, Smetana GW et al (2006) Strategies to reduce postoperative pulmonary complications after noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med 144(8):596–608

35. Novel Nanogold SERS Based Photosensitizers as Optical Diagnostic Probes for Oral Cancer K Davies1, J Connolly2, P Owens2, Y Lang2, P Dockery3, M Olivo2, I Keogh1 (1) Department of Otolaryngology, UCHG, Newcastle, Co Galway, Ireland; (2) Department of Biophotonics, NUIG, Newcastle, Co Galway, Ireland; (3) Department of Anatomy, NUIG, Newcastle, Co Galway, Ireland Introduction: Despite significant advances in treatment modalities, 5 year survival in oral squamous cell carcinoma is less than 50 %. Clinical examination, white light endoscopy and histopathological analysis remains the gold standard for diagnostic surveillance of oral cancer, with a limited diagnostic accuracy of 55 %. Aim: We aim to report the use of novel nanogold SERS (Surface Enhanced Raman Spectroscopy) based photosensitizers as an optical diagnostic probe for oral cancer using an in vitro oral cancer cell line. Method: We constructed a multi-modal nanosensitizer by layering fluorescent photosensitizers (Hypericin, Chlorin E6) and a Raman reporter (DTTCI; 3,30 -diethylthiatricarbocyanine) onto multi branched gold nanoparticles. Nanosensitizers were also conjugated to tumour specific antibodies to confer cancer cell specificity. A number of cell lines were cultured in vitro with various concentrations of nanosensitizers. Cellular uptake and intracellular localization of nanosensitizers was assessed using confocal fluorescence microscopy and transmission electron microscopy. To demonstrate label free detection of nanosensitizer uptake, SERS spectra and large area scans were also examined. Data was collected using a WITEC Alpha 500 system using 785 nm excitation. Results: It was observed that nanosensitizers were taken up by tumour cells and internalized, they were found to localize primarily to lysosomes. Raman images were collected, enabling label free visualization of nanosensitizers uptake in cells.

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Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 Conclusion: While preliminary, results from this study suggest biocompatibility of these novel gold nanosensitizers in vitro and highlights its potential as multifunctional optical agents for cancer diagnosis.

36. Factors Determining Minimal Conversion Rates for Laparoscopic Cholecystectomy in the General Hospital Setting an 11 Year Audit of Surgical Activity TP Burke, P Waters, I Khan, RM Waldron, W Khan, K Barry Department of Surgery, Mayo General Hospital, Castlebar, Mayo, Ireland Introduction: Laparoscopic cholecystectomy has been considered a nonspecialist operation with a quoted incidence of conversion to the open procedure in the region of 5 % nationally. Recent studies have suggested that outcomes for the laparoscopic procedure are improved by specialisation. In recent years, practice initiatives have been implemented in our unit including provision of a pre-assessment clinic, day of surgery admission (DOSA) and ring fenced elective surgical beds. Aims: The aim of this study was to determine outcomes for elective laparoscopic cholecystectomy in a non-specialist unit with a historic policy of avoidance of intervention for the acutely inflamed gallbladder. Methods: An analysis of a prospectively updated database of all cholecystectomies performed by four general surgeons during 2003–2013 was conducted. Hospital databases, theatre registers and patient charts were used as data sources. Complication rates were recorded at monthly audit meetings during the study period. Results: 1,937 consecutive cholecystectomies were performed; 1,875 as elective laparoscopic procedures and 62 as planned open. The overall conversion rate recorded was 1.7 % (32/1,875). Conversion rates declined progressively from 8.3 % in 2003 to \2 % in each of the last 7 years of the study. Three deaths occurred in the planned open cholecystectomy group (4.8 %). One common bile duct injury was noted in the laparoscopic cohort (0.05 %). Other complications observed in this group included bile leak (0.48 %), bowel ischaemia (0.1 %) and haemorrhage (0.21 %). Conclusions: Laparoscopic cholecystectomy can be performed safely, effectively and in significant volume in the general hospital setting. Minimal conversion rates (\2 %) and low morbidity can be consistently achieved in parallel with focused practice policies.

SESSION 5: BREAST RESEARCH/ENDOCRINE SESSION Chair: Professor Tom Gorey & Mr Ray McLaughlin 37. Comparing Axillary Burden for Node-Positive Breast Cancer Patients Detected by Fine-Needle Aspiration Cytology with Those Detected by a Sentinel Lymph Node Biopsy: How Big is the Difference? MR Boland, I Daskalova, Z Al-Hilli, D Evoy, J Geraghty, J Rothwell, A O’Doherty, C Quinn, RS Prichard, EW McDermott Department of Surgery, St Vincent’s Hospital, Elm Park, Dublin 4, Ireland Introduction: Emerging evidence indicates that node-positive breast cancer (BC) patients with a low axillary burden may not benefit from axillary clearance (AC).

Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 Aim: To determine axillary nodal burden in patients with positive axillary ultrasound-guided fine needle aspiration cytology (FNAC) compared with those who had negative FNAC followed by a positive sentinel lymph node biopsy (SLNB). Methods: A retrospective study was performed involving all patients with BC between 2010 and 2012 who had pre-operative ultrasound guided FNAC. Nodal burden was examined in all patients who proceeded to axillary clearance. Patients who had pre-invasive/recurrent disease, neoadjuvant chemotherapy or who did not undergo axillary surgery were excluded. Results: 405 patients were eligible for analysis. 141 (35 %) had positive FNAC and 264 (65 %) had negative FNAC. Of the 264 FNAC-negative patients, 82 had positive SLNB (micro-metastasis, n = 15). The mean total number of lymph nodes (LNs) excised during AC in FNAC-positive patients was 26 vs. 23 in SLN-positive patients (Unpaired t-test; p \ 0.05). The mean number of involved LNs was 7.9 (range 0–47) in FNAC-positive patients vs. 2.8 (range 1–25) in SLN-positive patients (Chi square test; p \ 0.0001). 48 % of SLN-positive patients had only 1 involved LN, 23 % had 2, and 29 % had C3. 13 % of FNAC-positive patients had 1 involved LN, 12 % had 2, and 74 % had C3. Conclusion: FNAC positive patients have a higher axillary burden than FNAC negative patients with a subsequent positive SLNB. Over 70 % of the SLN positive patients may fulfill ACOSOG Z0011 trial criteria and may not require further surgery.

38. The Economic Impact of Breast Cancer Management D Joyce1, H Heneghan1, C Curran1, C O’Neill2, M Kerin1 (1) Department of Surgery, National University of Ireland, University Road, Galway, Ireland; (2) Department of Economics, College of Business and Economics, National University of Ireland Galway, University Road, Galway, Ireland Introduction: Breast cancer is the most commonly diagnosed invasive neoplasm in Irish women. Revolutionary diagnostic and treatment modalities employed in breast cancer management are associated with a significant economic burden. As such, it is important that policy makers have a clear understanding of the level and composition of costs, so that provisions can be made for cancer care in the future. Aim: To assess how changing practice patterns of breast cancer management over the last 18 years have affected the cost of treatment provision. Methods: A detailed profile of care pathways for all new patients treated for breast cancer at GUH in 1995/1996 and 2011/2012 was constructed. Differences over time, and in unit costs over the time period, were explored. Results: The overall cost of breast cancer management increased fourfold over the 18 year period, from a total expenditure of €1,314,741 in 1995/1996 (adjusted for currency change and inflation) to €5,620,567 in 2011/2012. The cost of an individual breast cancer patient’s care pathway rose from €6,541 to €9,983 in 2011/2012 (1.5fold increase). The greatest increases in cost were accrued through the increased use of adjuvant radiotherapy and other adjunctive therapies including Trastuzumab, Lapatinib and bisphosphonates. The introduction of the Oncotype Dx gene assay has also played a role in increasing expenditure. Conclusion: Widespread use of radiotherapy and targeted therapy in breast cancer has contributed to the increased cost of breast cancer management. Knowledge of the extent of increases will be pivotal in the planning of future services

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39. Contextualising the Significance of Isolated Spikes in Intra Operative Parathyroid Hormone (IOPTH) During Parathyroidectomy over a Twelve Year Period N Foley, MR O’Donovan, MA Corrigan, HP Redmond Department of Surgery, Cork University Hospital, Wilton, Cork, Ireland Background: Despite a relatively short half-life, IOPTH spikes can occur during parathyroidectomy due to inadvertent manipulation of the parathyroid gland. This may present problems with intra-operative data interpretation. Aim: To identify and contextualise the occurrence of IOPTH spikes during parathyroidectomy. Methods: Data was harvested from a prospective database maintained since 2001. This included basic demographics, preoperative calcium levels, preoperative and intraoperative parathyroid hormone levels, localisation studies and histopathology results. Statistical analysis was performed using SPSS (V20). Results: Calcium and PTH levels are presented in Table 1. IOPTH levels were significantly higher in patients with concordant pre-operative imaging (p = 0.013). In 34 (8.9 %) patients PTH spikes were seen during surgery. Of these 25 (71.4 %) had a reduction in PTH on further testing. 4 (11.8 %) patients had a further increase in PTH; of these 3 had a single adenoma and 1 had 3-gland hyperplasia. Conclusion: IOPTH monitoring is useful in the majority of cases, however it is important to recognise and interpret appropriately PTH spikes during surgery; most of these patients had a decrease on further testing and subsequent histology revealed an adenoma in the majority of cases. Age

IOPTH

Percent Pre-op reduction calcium in PTH

Post-op calcium

Single 59.9 (SD 275.6 (SD 65.85 gland 14.4, 321.5, (SD removed SEM SEM 20.5, (n = 306) 0.822) 18.4) SEM 1.17)

2.83 (SD 2.3 (SD 0.23, 0.28, SEM SEM 0.01) 0.02)

Multiple glands removed (n = 35)

2.74 (SD 2.3 (SD 0.23 0.27, SEM SEM 0.04) 0.06)

61.9 (SD 358.6 (SD 46 (SD 12.9, 409.3, 31.9, SEM SEM SEM 2.2) 69.2) 5.4)

40. Cystic Adrenal Lesions - The Tallaght Experience M Durand, E Mansour, A Gillis, M Sherlock, J Gibney, P Ridgway, K Conlon Department of Professorial Surgical Unit, Tallaght Hospital, Belgard Road, Dublin 24, Ireland Introduction: Cystic adrenal lesions are an uncommon finding, most frequently noted as ‘incidentalomas’ on axial imaging (CT; MRI). They are typically classified as pseudocysts, endothelial cysts, epithelial cysts, and parasitic cysts. These lesions may be associated with benign and malignant adrenal conditions. Therefore, management involves multidisciplinary input

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S236 with endocrine physicians and radiologists. Treatment includes adrenalectomy, which may be performed by laparoscopic or open technique. Aim: In this case series, we examine the clinical course of patients attending Tallaght undergoing adrenalectomy for cystic adrenal lesions between 2006–2013. Method: Patients who were recorded as having undergone adrenalectomy on the Hospital Inpatient Enquiry (HIPE) database, with preoperative or post-operative findings of cystic lesions between 2006–2013 were included. Pre-operative/intra-operative/post-operative data was yielded from chart, radiology and pathology report reviews, supplemented by information from Tallaght’s ‘TEAMS’ electronic discharge system. Results: Five patients (n = 5) with cystic adrenal lesions requiring adrenalectomy were identified. One patient presented with pain, whilst the remainder were so-called ‘incidentalomas’. All were managed with laparoscopic approach. Post-operative histopathological analysis confirmed two haemorrhagic pseudocysts, one endothelial cyst, one epithelial cyst and one cystic adrenal lymphangioma. Mean maximum lesion diameter was 54.6 mm (median = 55 mm). None of the lesions demonstrated malignant features. One patient suffered post-operative pneumothorax, requiring chest drainage. Clinical course was otherwise unremarkable for patients in this series. Conclusion: Cystic lesions of the adrenal glands remain a rarity. Despite the absence of malignant features in this series, it’s important that malignant potential is considered. As such, management should be with a multidisciplinary approach.

41. Dynamic Science - A Bibliometric Review of microRNAs in Literature MC Casey, N Miller, JAL Brown, MJ Kerin, KJ Sweeney Discipline of Surgery, School of Medicine, NUI Galway, Galway, Ireland Introduction: The onset of the digital age revolutionised the manner in which scientific knowledge is produced. With expanding scientific production and unprecedented access to information, the requirement of a means of assessing and analysing research output proves essential. Here we utilise bibliometric parameters, in conjunction with current theories of research evolution, to quantitatively analyse miRNA research yield from time of discovery in 1993 to December 2013, thus outlining the progression of a novel research field. Method: Data were retrieved from the Web of ScienceTM (WoS) Core Collection database, produced by Thomson Reuters. This database was searched utilising the terms ‘‘miRNA’’ and ‘‘microRNA’’ with the Boolean operators ‘‘OR,’’ and ‘‘NOT.’’ Publications of all languages and formats were accepted. Results: The number of items identified summates 26,177 publications. From time of first publication, yearly output increased exponentially, with 62 % of all items published within the years 2011 to 2013 (n = 16,348). The United States contributed most to the literature (n = 11,056), followed by the Peoples’ Republic of China (n = 5,584). 69 % of all published material were original articles (n = 18,111), with only 13 % review articles (n = 3,314). Of all research categories, biochemistry molecular biology comprised 24 % of publications (n = 6163), followed by oncology, representing 15.5 % of publications (n = 4070). PLoS ONE published miRNA material most prolifically (n = 1589), followed by Nucleic Acids Research and PNAS (n = 451). A total of 736,197 citations were identified, with PNAS publications cited most frequently (6 % total citations).

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Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 Conclusion: Considering the ongoing remodelling of scientific production, analysis of publication trends, citations and distribution patterns proves infinitely informative. Recognising the stage of development of a particular research field provides researchers with direction and guidance, both in current investigative goals and future endeavours. Current unprecedented access to scientific material and bibliometric tools provides an opportunity to analyse the dynamics of scientific landscapes, enabling the production of informed, targeted scientific outputs..

42. A Phenotype-Genotype Analysis: BRCA1 and BRCA2 Breast Cancer Susceptibility Gene Mutations R Mulligan1, T McVeigh1, R Irwin1, N Cody2, T McDevitt2, N Miller1, K Sweeney1, A Green2, MJ Kerin1 (1) Department of Surgery, Galway University Hospital, Galway, Ireland; (2) Department of National Centre for Medical Genetics, Our Lady’s Hospital for Sick Children, Crumlin, Dublin, Ireland Introduction: Germline mutations in BRCA1 and BRCA2 confer high cancer susceptibility. The type and position of the gene mutation influences disease phenotype. There may also be interplay between mutations and other genetic factors. Aims: This study aims to describe the relationship between genotype and disease phenotype in carriers of mutations in BRCA1 and BRCA2, and to identify potential genetic modifiers of disease risk. Methods: A longitudinal cohort study was undertaken. The study group includes all patients diagnosed with mutations in BRCA1 or BRCA2 between 2000 and 2013. Data regarding family history, specific mutation details and disease presentation were collected by chart review. DNA from affected and pre-symptomatic BRCA mutation carriers was extracted from whole blood, and genotyped for a variety of putative disease-modifying polymorphisms using Taqman-based PCR. Data was analysed using SPSS. Results: Sixteen variants were identified in BRCA1 in 60 patients(30 families). Twenty-seven variants in BRCA 2 were identified in 51 patients (32 families). Large genomic rearrangements accounted for the majority of BRCA1 variants (19 families) and frameshift mutation 8525delC was the most common pathogenic mutation in BRCA2. Pathogenic mutations in BRCA1 were more often associated with younger age of diagnosis compared to BRCA2 mutation, and more often associated with ovarian cancer and triple negative breast cancer. The polymorphism rs2981582 in FGFR2 gene was significantly enriched in affected carriers of the mutation compared to presymptomatic individuals (p = 0.002, Chi square test). Conclusion: Mutations in BRCA1 and BRCA2 confer differential cancer risks, and risk may be modified by genetic polymorphisms in FGFR2.

43. Impact of Retroperitoniscopic Approach on Adrenalectomy in Galway University Hospital TK Khani, D Bowden, J King, D Quill Department of Endocrine Surgery, Galway University Hospital, Newcastle Road, Galway, Ireland (i) Expertise in retroperitoniscopic adrenalectomy, available at our institution since 2009, represents an advance upon the open technique.

Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 (ii) To assess our experience of Adrenalectomy at Galway University Hospital from 2009 to 2014 (iii) Audit of prospectively collected data of a series of 24 adrenalectomies performed at GUH in the department of endocrine surgery. (iv) 24 patients underwent adrenalectomy between July 2009 and April 2014. A laparoscopic retroperitoneal approach was made in 17 cases. 2 cases were converted to open surgery. 7 were planned for open surgery. The age range was 35–80 years and tumour size ranged from 1.5–10.2 cm. Mean length of stay for laparoscopic approach was 3.5 days. In our series conversion rate was 2(12 %) and success rate was 88 %. Average length of stay for cases approached by Morrison’s incision, anterior (1), posterior (2) and converted cases was 9.7 days. Indications for surgery were; Phaeochromocytoma (7), Adrenocortical Adenoma (12), Adrenocortical Carcinoma (1), Myelolipoma (1), Metastatic Melanoma (1), Medullary Haemangioma (1), Adrenocortical Hyperplasia (1), Retroperitoneal GIST(1). 2 of 15 patients completed by the laparoscopic approach had complications; 1 paralytic ileus and 1 post-operative nausea and vomiting. Of the 9 open cases, 4 had complications post operatively. These were; pulmonary embolus, post-operative nausea and vomiting, post operative pain and nosocomial pneumonia. (v) Retroperitoniscopic adrenalectomy represents a safe and effective approach to adrenal surgery. Significant advantages in duration of hospital stay and complication rate are demonstrated, and should translate into a better patient experience and reduced costs for the institution.

44. Early Post-Operative PTH as a Predictor of Recurrent Primary Hyperparathyroidism in Patients Undergoing Minimally Invasive Parathyroidectomy Without Intra-Operative PTH Monitoring A Stroiescu1, DP McCartan1, D Evoy1, D Gibbons2, SJ Skehan3, EW McDermott1, RS Prichard1 (1) Department of Breast/Endocrine/General Surgery, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; (2) Department of Pathology, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland; (3) Department of Radiology, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland Introduction: Minimally invasive parathyroidectomy (MIP) has advantages over open parathyroidectomy for patients undergoing surgery for hyperparathyroidism due to single gland disease. The use of intra-operative PTH (IoPth) monitoring during MIP to define operative success remains controversial. Furthermore, the technology is expensive and not universally available. Aim: The aim of this study was to assess the role of percentage drop in early (day 1) post-operative PTH in predicting those at risk of recurrent disease in patients undergoing MIP without IoPTH. Methods: All patients undergoing MIP from 2008 to 2013 were included. Recurrence was defined as hypercalcemia occurring greater than 6 months post-operatively with elevated calcium prior to 6 months classified as persistent hyperparathyroidism. PTH levels were assessed on the first post-operative morning. Results: Over a 5-year period, 148 patients underwent a focused MIP with removal of a single parathyroid gland. Four patients (3 %) underwent re-operation within 6 months due to persistent symptoms (median PTH drop 9 %). Six patients (4 %) developed recurrent hypercalcemia within the follow up period with 4 undergoing further surgery (median day 1 PTH drop (56 %). The median drop in PTH in those who did not recur was 86 % (p \ 0.001 Kruskal–Wallis).

S237 Conclusion: These results concur with a recent study demonstrating that early post-operative PTH values correlate well with risk of persistent and recurrent disease. The optimal threshold for defining those at greatest risk of recurrence and who require close biochemical follow up has yet to be elucidated.

45. Exosomal Transfer of Micrornas as a Potential Path for Gene Therapy D Joyce1, C Glynn1, S Khan1, J Brown1, P Dockery2, M Kerin1, R Dwyer1 (1) Discipline of Surgery, Clinical Science Institute, NUI Galway, Galway, Ireland; (2) Discipline of Anatomy, NUI Galway, Galway, Ireland Introduction: MicroRNA-379 has recently been reported to have a potential tumour suppressor role in the breast cancer setting. Recent evidence suggests that protective microvesicles, called exosomes, have the capacity to transport miRNAs. This mechanism of intercellular communication has raised the potential to use exosomes as vectors in the gene therapy setting. Aim: The purpose of this study was to confirm miR-379 is a tumour suppressor and investigate the potential to engineer cells to secrete exosomes enriched with miR-379. Method: T47D breast cancer cells were transduced with a lentiviral vector containing red fluorescent protein (RFP), to induce stable expression of miR-379 (T47D-379) or a non-targeting control (T47DNTC). Mice received a subcutaneous injection of T47D-379 (n = 5) or T47D-NTC (n = 5) and tumour progression was monitored. In vitro, T47D-379 and T47D-NTC secreted exosomes were isolated, characterised, and miR-379 quantified. Transfer of RFP-labelled exosomes was visualised using confocal microscopy. Results: T47D-379 cells exhibited reduced tumour formation (2/5) in vivo compared to T47D-NTC cells (5/5), confirming a tumour suppressor role for this miRNA. In-vitro, isolated exosomes were visualized by transmission electron microscopy to be *100 nm in size, with Western Blot confirming expression of the exosomal marker CD63. Exosomes from T47D-379 cells demonstrated significantly higher levels of miR-379 than those from T47D-NTC. Using confocal microscopy, RFP labelled exosomes over-expressing miR379 were shown to be efficiently taken up by recipient cells. Conclusion: The data presented confirms a potent tumour suppressor role for miR-379. Breast cancer cells were successfully engineered to secrete high levels of exosome-encapsulated miR-379, raising exciting therapeutic potential in the cancer setting.

SESSION 6: UROLOGY SESSION Chair: Mr Kilian Walsh & Mr Garrett Durkan 46. PSA Testing: Whom, By Whom and How Often? O Adhmed, D Moran, P Daly, N Hegarty, D Galvin, K O Malley Department of Urology, Mater Misericordiae Hospital, Eccles St, Dublin 7, Ireland Introduction: PSA testing in Ireland has risen dramatically over the last two decades. Due to concerns in over-diagnosis and in overtreatment of prostate cancer, screening with PSA remains controversial. Current guidelines suggest that PSA testing should only be

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performed in well-informed men with a life expectancy of at least 10 years. Despite this, PSA testing in Ireland is unregulated and some inappropriate testing may occur. We report data relating to PSA testing of [10,000 patients from our institution. Aim: To characterise PSA testing in our institution over a 1 year period. Methods: Over 12 months from January 2013, patients undergoing PSA testing were identified from the clinical biochemistry and institutional database. Demographics, clinical indication and PSA level were recorded. Results: There were 13,147 PSA tests performed on 10,716 patients during this time period. Of these, 69 % were ordered by general practitioners, 6.6 % by the urology service and 3 % by the oncology service. Median age was 64 years (range 10–102). 31 tests were performed on female patients. A paucity of clinical data was noted for the majority of patients. Conclusion: The vast majority of PSA testing occurs in primary care. PSA testing often occurs without a clear clinical indication. There is a vast age range of patients undergoing and some PSA testing is inappropriately performed. Some regulation may need to be introduced to reduce the level of unnecessary PSA testing in Ireland.

47. Radical Prostatectomy Experience in the West of Ireland UM Haroon, J Forde, N Nusrat, K Walsh, G Durkan Department of Urology, University College Hospital Galway, Galway, Ireland Introduction: We assessed the outcome of radical prostatectomy (RP) performed by a single surgeon in a cohort of men attending RAPC in the west of Ireland. Methods: Between September 2010 and March 2014, patients who chose surgery were assigned to laparoscopic radical prostatectomy (LRP) or open radical prostatectomy (ORP) depending on pre-op D’Amico risk classification performed. Data were collected prospectively. Results: In total, 271 radical prostatectomies were performed. Pre-op characteristics and post-op outcomes are given in Table 1.

Table 1 LRP

ORP

147

124

57.7 (38–72)

60 (46–73)

0.0025

6.2 (1.5–19.9)

7.8 (2.5–40.9)

0.0001

6–7

146 (99.3 %)

94 (75.8 %)

8–10

1 (0.7 %)

30 (24.2 %)

Mean (range)

190 (130–265)

168 (110–250)

Transfusion rate Complications

2% 19 (12.9 %)

13.7 % 27 (21.8 %)

Clavien–Dindo I–II

16 (10.9 %)

25 (20.2 %)

Clavien–Dindo III–V

3 (2 %)

2 (1.6 %)

Number of patients

P value

Age (years) Mean (range) Pre-op PSA (ng/mL) Mean (range) Gleason grade

Operating time (min)

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0.0001

Table c continued LRP

ORP

P value

4 (3–18)

6 (4–17)

0.0001

T2

107 (72.8 %)

54 (43.6 %)

T3

40 (27.2 %)

70 (56.4 %)

Total positive

15.3 %

23.1 %

pT2 positive

9.6 %

15.7 %

pT3 positive

30 %

28.6 %

Length of stay (days) Mean (range) Pathological stage

Overall margin status

Conclusions: Careful selection of men for LRP and ORP based on pre-operative risk criteria results in optimal surgical outcomes.

48. Adrenal Sparing Radical Nephrectomy, Is There a Survival Benefit? M Burke1, GJ Nason1, BB McGuire2, NP Kelly1, DJ Galvin2, DW Mulvin2, GM Lennon2, DM Quinlan2, HD FLood1, SK Giri1 (1) Department of Urology, University Hospital Limerick, Dooradoyle, Limerick, Ireland; (2) Department of Urology, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland Introduction: Routine ipsilateral adrenalectomy was a component of the traditional radical nephrectomy. Aim: The aim of this study was to assess the impact of adrenal sparing radical nephrectomy (ASRN) on survival. Methods: A retrospective analysis was carried out on all radical nephrectomies carried out in two university teaching hospitals between 2000 and 2012. Tumour details were assessed from histopathological reports. Overall survival (OS) and cancer specific survival (CSS) data was collected from the National Cancer Registry of Ireland. Results: 579 nephrectomies were performed in the study period. The median age was 60.1 years (range 25–85 years). The median tumour size was 6.45 cm (range 1–20). 65.6 % (n = 380) patients underwent an ASRN. On univariate analysis, there were significant OS (p = 0.001) and CSS (p = 0.001) differences favouring ASRN. On multivariate analysis, after adjusting for age, gender, histology, grade, TNM status, tumor necrosis and IVC invasion, non adrenal sparing radical nephrectomy was associated with worse OS (p = 0.089) and CSS (p = 0.064). Conclusion: Adrenal sparing radical nephrectomy has been shown to impact survival and should be standard practice without preoperative evidence of adrenal invasion of tumour.

49. Comparative Analysis of Perioperative Outcomes in Laparoscopic Nephrectomy for T1 Renal Cell Tumours Versus T2 and Selected T3 Tumours E Bolton, D Hennessey, P Lonergan, A Thomas, A Walsh, F Darcy, T Lynch

Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 Department of Urology, St. James’s, Dublin, Dublin 8, Ireland Introduction: There remains little evidence supporting the use of laparoscopic radical nephrectomy (LRN) in large and locally advanced renal tumours (T2–T3a), but with increased experience and technique this is gradually evolving into practice. Aims: The aim of this study was to review our experience with LRN in these patients. Methods: Retrospective data was obtained for all patients undergoing LRN from July 2010 to July 2013. Peri-operative parameters assessed are age, gender, American Society of Anesthesiologists score (ASA), waist circumference, tumour and specimen size, histological subtypes, anaesthetic duration, operative approach and technique, surgery duration, blood loss, pre and post-operative renal function, complication rate and duration of hospital stay. Results: Of 147 patients undergoing LRN, 81 (55 %) of patients had T2–T3a tumours (Group 2). The remaining 66 (45 %) patients formed the T1 tumours; Group 1. Mean tumour size in this group was 15.2 cm. Only 3 patients required conversion to open. Overall, RCC was more common in males (95/147; 64.6 %), however overweight females were more likely to have T2–T3a tumours (20/32; 62.5 %; p = 0.0231). Patients with T2–T3a disease were more likely to have an ASA score of 3 (42/147; 28.6 %). In the majority of patients across both groups, LRN was completed using a 3 port approach (128/147; 89 %). There were no significance differences between groups in terms of mean anaesthetic duration, average surgical time, average estimated blood loss, complication rate and mean hospital stay. Conclusion: We recommend that LRN should be considered as firstline treatment in all patients eligible for surgical management of T2– T3a patients.

50. Patient Outcomes Following Open Partial Nephrectomy for Small Renal Tumours BM Barea1, BW Cham1, H Ghous1, JC Forde1, S Jaffrey1, E Rogers1, K Wlash1, GC Durkan1, N Nusrat Department of Urology, Galway University Hospital, Galway, Ireland Introduction: With improvements in modern imaging techniques the detection rate of incidental small renal masses (SRMs) has increased. Nephron sparing surgery offers similar oncological outcome as radical nephrectomy for SRMs whilst preserving renal function. Methods: Between January 2012 and January 2014, 35 open partial nephrectomies were performed. All data was collected prospectively. Results: Mean age of patients was 57 years (range 32–77). Regarding tumour position; 7 were upper pole, 12 inter-polar and 16 lower pole. Mean tumour size was 3.1 cm (range 5–7). Warm ischaemia time (WIT) was 0 min in 22 patients while the remaining 13 had a mean WIT of 12.8 min (range 5–15). No patients required ureteric stenting. Mean estimated blood loss was 410 ml (range 100–1,825). Mean operative time was 138 min (range 90–180). Median length of stay was 6 days (range 5–18). Post operative complications include pneumonia (n = 1), perinephric abscess (n = 1), urinoma requiring stenting (n = 2) and wound infection (n = 1). Histologically, there were 2 benign tumours and 33 renal cell cancers with all surgical margins negative. Pathological staging was as follows; 27/33 (81.8 %) were pT1 and 6/33 (18.2 %) were pT3. Renal cell subtype was as follows; 25/33 (75.7 %) clear cell type, 7/33 (21.2 %) papillary and 1 patient had chromophobe subtype. Fuhrman Grade was reported as Grade 1 in 6/33 (18.2 %), Grade 2 in 25 (75.7 %), Grade 3 in 1 patient and Grade 4 in 1 patient. On follow up, no patients had deterioration in renal function.

S239 Conclusion: Partial nephrectomy in appropriately selected cases offers good local oncological and functional outcomes.

51. MiRNA Expression Profiling Across Progressive Grades of Prostate Cancer A Walsh1, C O’Rourke2, A Tuzova2, B Hayes3, J Hansen4, M Emmert-Buck4, S Finn3, T Lynch1, A Perry2 (1) Department of Urology, St James’s Hospital, Dublin 8, Ireland; (2) Department of Prostate Molecular Oncology, Trinity College Dublin, St James Hospital, Dublin 8, Ireland; (3) Department of Pathology, St James’s Hospital, Dublin, Dublin 8, Ireland; (4) Department of Pathology, National Cancer Institute, Bethesda, MD, USA Introduction: High-grade prostatic intra-epithelial neoplasia (HGPIN) is currently the only accepted precursor lesion of prostate cancer (PCa). Proliferative Inflammatory Atrophy (PIA) describes focal atrophic lesions, associated with chronic inflammation and is proposed as a further PCa precursor lesion. Supporting evidence comes from both morphological and molecular data (P53 mutations, chromosome 8 abnormalities, hypermethylation of GSTP1). We examined expression of microRNAs in PIA compared to HGPIN, benign and PCa tissue. Methods: Laser capture microdissection was performed on FFPE prostate tissue from 10 benign, 8 HGPIN, 4 PIA and 23 PCa samples. Expression profiling of 752 human miRNAs was performed by Exiqon miRCURY LNATM qPCR. Results: 21 microRNAs were differentially expressed in PIA vs benign prostate tissue (P \ 0.05 and fold change [1.5). Of these, 3 showed a similar expression pattern in PCa relative to benign tissue, indicating that these molecular events occur in early tumour initiation. Comparing PIA with tumour, 45 microRNAs were differentially expressed. 4 of these were also differentially expressed in PCa vs benign, suggesting that these aberrations occur during the transition from PIA to PCa. A similar stepwise progression was observed for HGPIN lesions. Notably, there was no overlap in the expression profile of PIA and HGPIN bar miR-205-5p, indicating divergent preinvasive lesions. miR-205-5p appears to be a driver in prostate carcinogenesis given its down-regulation at all transition points. Conclusion: This is the first report of microRNA dysregulation in PIA, distinct to that of HGPIN and benign tissue, supporting the hypothesis that PIA is a precursor lesion to PCa.

52. Should Trans-Peritoneal Template Biopsy Become The New Standard for Prostate Cancer Diagnosis? D Moran1, C McGarvey1, N Hegarty2, T Lynch2, K O Malley2 (1) Department of Urology, Mater Misericordiae Hospital, Eccles St, Dublin 7, Ireland; (2) Department of Urology, Mater Private Hospital, Eccles Street, Dublin 7, Ireland Introduction: The limitations of 12-core TRUS biopsy are well established. Its complication profile is also significant. Though transperitoneal template biopsy (TTP) requires additional resources, it may offer a more accurate histological diagnosis with a reduced infection rate. Aim: To evaluate the role of TTP biopsy in prostate cancer diagnosis.

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S240 Methods: Information on all men undergoing TTP was collected prospectively. Data included demographics, PSA and previous TRUS biopsy history, procedure details, TTP histology, subsequent treatments and procedure related complications. Results: Sixty-eight TTP biopsies were performed and data analysed. All (100 %) had at least one prior 12-core biopsy while 42/68 (62 %) had at least 2 previous negative biopsies. In 3/68 (4.4 %) a TTP was performed as part of active surveillance. Of those undergoing TTP, 33/68 (48.5 %) were upgraded in comparison to initial TRUS histology. Of these 33 patients 27 (82 %) had radical treatment for their prostate cancer. Complications included urinary retention (N = 1) and sepsis (N = 1). Conclusion: For patients considered high risk of prostate cancer, TTP results in a significant upgrading and potentially more accurate staging of disease compared to 12-core TRUS biopsy. The associated complication rate of TTP is low.

53. A 4-Year Audit of Practice in the Rapid Access Prostate Clinic in Beaumont Hospital T Aherne, LG Smyth, D O’Neill, S White, E Dunne, G Smyth, RE Power Department of Urology, Beaumont Hospital, Beaumont, Dublin, Ireland Background: The incidence of prostate cancer continues to rise in Ireland. As such, an evolution in the delivery of care is required to meet this growing demand in a timely and safe manner. In line with the standards set out by the National Cancer Control Programme Beaumont Hospital introduced a rapid access prostate clinic (RAPC) in 2010. This has offered high-risk patients timely access to tertiary urological services. Methods: Data were prospectively gathered on all referrals to the RAPC between January 2010 and December 2013 and tabulated in a standardized fashion. Data were analyzed using descriptive statistics. Results: A total of 1,058 patients with a mean age of 63-years were referred to the RAPC over the study period. The mean wait time from referral to consultation was 16.78 days with 72.75 % of patients evaluated within the 20-day target. The mean PSA at primary consultation was 9.1 ng/mL. Of those attending 54.46 % (n = 601) patients underwent TRUS biopsy of which 65.58 % (n = 394) revealed prostatic malignancy. Overall 346 referrals were received in 2013 as opposed to 164 in 2010. Biopsy rates ranged from 33.57 % in 2010 to 65.85 % of all patients in 2012 with 62, 64, 69 and 64 % of those referred for TRUS in respective years having a diagnosis of prostatic malignancy. Target review times were met in 93.92 % of referrals in 2010 falling to 51.41 % in 2012. Conclusion: Rapid access prostate clinics offer a high level of care to patients with prostatic disease. However, due to resource saturation timely intervention remains challenging.

54. Impact of Pulsatile Machine Perfusion of Organs Procured From Donors Aged 65 Years and Above, on the Waiting Time for the Elderly Patients in Need of Renal Transplant M Azhar, W Shields, J Zimmermann, D Hickey

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Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 Department of National Kidney and Pancreas Transplantation Unit, Beaumont Hospital, Beaumont, Dublin, Ireland Introduction: The Extended Criteria Donors(ECD) kidney transplants for the elderly patients, lead to similar outcomes as compared to the Standard Criteria Donors(SCD) transplants with added advantage of decreased waiting time and reduced complications and cost involved in dialysis. Aims: To compare the static cold storage (CSS) method versus hypothermic pulsatile machine perfusion (PMP) method of organ preservation and their outcomes. Methods: A retrospective analysis of two groups, each consisting of 20 transplant patients with donors’ age above 65 years, grouped on the basis of method of organ preservation at the time of procurement. These two methods included CSS using University of Wisconsin (UW) storage solution versus the hypothermic PMP (LifePort). Results: Median age was similar in both groups whereas the donor age was as old as 76 years in the PMP group. Post-transplant mean serum creatinine in the PMP group was 165 lmol/L at 1 month, 137 lmol/L at 3 months and 138 lmol/L at 1 year as compared to the CSS group where follow up serum creatinine was 186 lmol/L at 1 month, 192 lmol/L at 3 months and 180 lmol/L at 1 year. The incidence of delayed graft function was far reduced in the PMP group compared to the CSS group (15 vs 35 %). The one-year graft survival rate was better in the PMP group (100 vs 90 %). Conclusion: The PMP method of organ preservation has shown more favourable outcomes in transplanted recipients and can provide optimized organs even from elderly donors for potential elderly recipients on the waiting lists for renal transplant.

SESSION 7: VASCULAR SESSION Chair: Professor Stewart Walsh & Professor Sherif Sultan 55. The Development of a Multi-Modal Pro-Angiogenic for the Treatment of Critical Limb Ischaemia C Herron1, C Hastings1, F O’Brien1, C McDonnell2, G Duffy1 (1) Department of Anatomy, Tissue Engineering Research Group, RCSI, 123 St Stephens Green, Dublin 2, Ireland; (2) Department of Vascular Surgery, Mater Misericordiae University Hospital, Eccles St, Dublin 7, Ireland Introduction: A combination of pro-angiogenic agents is proposed to increase collateral vessel formation in critical limb ischaemia when compared to single agent use. The use of sophisticated drug delivery systems such as hydrogels to allow for a sustained release of the proangiogenic agents may help to augment their effects. Aim: To assess the efficacy in vivo of a novel combination of proangiogenic agents, desferrioxamine (DFO) and human mesenchymal stem cells (hMSCs) in a chitosan based hydrogel to increase collateral vessel formation in a hindlimb ischaemia model. Methods: 40 athymic mice underwent ligation of the common femoral artery to induce critical limb ischaemia. This was followed by injection with either chitosan gel alone, chitosan gel with DFO, chitosan gel with hMSCs or chitosan gel with DFO and hMSCs. Limb perfusion was assessed weekly via laser Doppler imaging and at 28 days histological analysis was undertaken and treatment and nontreatment limbs were compared for collateral vessel number. Results: Laser Doppler Imaging measures actual perfusion to the limbs. At day 28 animals who received chitosan gel alone had an average recovery of 54.86 %. This compares to a recovery of 28.65 % in the chitosan gel and hMSC group, 34.87 % in the chitosan gel with

Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 hMSC and DFO group. The recovery in the chitosan gel with DFO alone group was 37.13 %.Staining with CD31 antibodies to endothelial cells revealed increased blood vessels in the treatment limbs when compared to control. Conclusion: We have demonstrated a novel combination of proangiogenic agents in an in vivo model of critical limb ischaemia.

56. Impact of Neck Radiation Therapy on Atherosclerosis Disease Progression and Treatment of Extra-Cranial Carotid Arteries: Systematic Review and a Meta-Analysis K Bashar1, E Khierelseid1, D Healy1, M Clarke Moloney1, P Burke1, E Kavanagh1, S Walsh2 (1) Department of Vascular, University Hospital Limerick, Limerick, Ireland; (2) Department of Surgery, NUI Galway, Galway, Ireland Introduction: Extra-cranial carotid artery (ECCA) stenosis is a wellrecognised complication after radiation therapy for head and neck malignancies. These carotid lesions should not be regarded as benign and should be treated in the same manner as standard carotid stenosis. Previous studies have noted increased cerebrovascular events such as stroke in this cohort of patients. Aim: To evaluate the effect of radiation therapy on ECCA atherosclerosis progression and the benefits from regular surveillance and best medical treatment in those patients. Methods: Online search for observational studies and randomised clinical trials that reported on stenosis in ECCA in patients with neck malignancies who received radiation therapy (RT) comparing them to patients with neck malignancies who did not receive RT. Results: Eight studies were included with a total of 1,070 patients—596 received RT compared to 474 in the control group. There was statistically significant difference in overall stenosis rate in all eight studies (Pooled risk ratio = 4.08 [1.70, 9.78], p = 0.002) and high grade ([70 %) stenosis in six studies (Pooled risk ratio = 8.82 [3.46, 22.52], p = 0.00001), both being higher in the RT group. Analysis of the five studies that reported on low grade (\70 %) stenosis did not show significant difference (Pooled risk ratio = 2.38 [0.77, 7.34], p = 0.13). Conclusion: Severe ECCA stenosis is higher among patients who received RT for neck malignancies. Those patients should be closely monitored and screening programs should be considered in all patients who receive neck RT.

57. Risk Factors Associated With the Diagnosis of Abdominal Aortic Aneurysm in an Irish Screened Population W White1, S McHugh1, P O’Halloran1, B Murphy2, E Boyle1, M Allen2, P Naughton1, D Moneley1, A Leahy1 (1) Department of Vascular Surgery, Beaumont Hospital, Beaumont, Dublin 8, Ireland; (2) Department of Surgery, Connolly Memorial Hospital, Blanchardstown, Co. Dublin, Ireland Introduction: The question as to whether screening for abdominal aortic aneurysm (AAA) should be introduced and who should be screened is an ongoing source of debate. Some authors have recommended screening of high risk groups. Previous studies have attempted to identify what risk factors could be used to identify those in whom screening might be cost-effective.

S241 Methods: A pilot AAA screening programme was commenced and carried out over a 4 year period. Male patients over 60 years were contacted and invited to attend for duplex aortic ultrasound. Clinically significant AAA were referred from the screening programme to vascular surgery. Data collated was exported to SPSS version 20 for statistical analysis with p \ 0.05 considered significant. Results: Overall 1304 males underwent AAA screening. The mean age was 63.8 years. The majority (n = 1275, 97.8 %) did not have a clinically significant aneurysm (\3 cm). Of the remainder, 20 (1.5 %) had an AAA \4 cm, with 6 (0.5 %) AAAs 4–5.5 cm discovered. In total 3 (0.2 %) AAAs of size greater than 5.5 cm were noted. With regard to risk factors, previous histories of ischaemic heart disease (IHD) or cerebrovascular event (CVA) were significant predictors of having an AAA (p = 0.013, p = 0.011). Prior history of hypertension, hypercholesterolaemia, smoking or diabetes was not noted to have a statistically significant association. Conclusion: The efficacy of screening men aged 60 years or older and have a history of IHD or CVA should be evaluated in randomised controlled trials.

58. Late Dacron Patch Reaction after Carotid Endarterectomy M Alawy, M ElKassaby, M Zaki, W Tawfick, S Sultan Department of Vascular Surgery, Galway University Hospital, Galway, Ireland Introduction: Human tissue reaction to Dacron vascular prostheses is a recognized issue; Late fluid collection around an arterial prosthesis often leads to the suspicion of graft infection. Aim: We describe our experience with Late Dacron patch aseptic reaction after carotid endarterectomy (CEA). Method: A prospective data record was maintained for all patients who underwent CEA in our institution between 2002 and 2012. A total of 512 patients had CEA, 441 of them were identified with Dacron patch closure. Only seven patients returned with late Dacron patch reaction 1.4 % Results: All the seven patients had a complication-free postoperative period after original CEA, ranging from 1 to 7 years. Surprisingly, blood tests came with negative results regarding inflammatory markers. All culture and sensitivity tests from wound swabs and tissue during surgery were negative for bacterial growth except only one patient Staphylococcus aureus isolated from the sinus discharge. Postoperative pathological examination and cultures of the retrieved synthetic patch with the excised surrounding tissue revealed the same picture in all cases. Surprisingly there was no evidence of infection or any trace of pathogenic micro-organisms. Pathological specimens showed evidence of non-specific acute and chronic fibrosing inflammation and histiocytic reaction to foreign body with giant cells. Conclusion: Late reaction to Dacron patch after CEA is a rare but very hazardous complication. The incidence of this phenomenon is comparable to infection rates. Adoption of the eversion technique, whenever possible, or the use of Bovine patch could be a safer option when carrying on CEA.

59. A 13 Year Experience with Botox Treatment for Axillary Hyperhidrosis: Cost effectiveness and Quality of Life Analysis J Gibbons, E Nugent, N O’Donohoe, B Egan, M Feeley, S Tierney

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S242 Department of Vascular Surgery, Tallaght Hospital, Tallaght, Dublin 24, Ireland Background: Hyperhidrosis is a chronic autonomic disorder that can be debilitating and can lead to reduced quality of life (QoL). The use of Botox has provided a non-surgical option for the treatment of this disease and carries no major risks to the patient when compared to endoscopic thoracic sympathectomy (ETS). This study investigates the cost effectiveness of Botox therapy as a function of QoL in a centre with 13 years’ experience. Methods: Cost analysis was performed using the costs incurred in a single treatment. Data was collected on patients (n = 44) attending the clinic, mean age of 31.6 years (r = 7), mean duration of treatment 51.2 months (r = 39.2). The average duration between treatments was used for life cycle analysis for 1 year. Validated Dermatology QoL Index was used to measure improvement in QoL for patients before, and greater than 4 weeks after, treatment. Results: Cost analysis shows that the average 1 year cost for treatment is €852.85. At the time of assessment, symptoms had recurred on average 5 weeks earlier. For those with recurrence of symptoms, the improvement in QoL showed a mean 14.4/30 (r = 4.98) increase in QoL. Conclusions: Using the costs for 1 year and the validated QoL survey we calculated that the cost per point of improved QoL is €59.13 per year which is very reasonable considering the lack of significant complications when compared to the surgical treatment which even if uncomplicated the cost for ETS is over 24 times the cost of a single Botox treatment at €9,389.

60. Catheter Directed Thrombolysis of Iliofemoral Vein Thrombosis in an Irish Centre P Staunton, S McHugh, A Leahy, D Moneley, A Keeling, M Given, F McGrath, P Naughton, M Lee Department of Vascular Centre, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland Aim: To evaluate the practice of catheter directed thrombolysis of iliofemoral vein thrombosis in our centre. Methods: Data was collected retrospectively on all cases treated from 2006–2013. Outcomes were assessed using follow up out-patient consultation notes and via direct survey of patients. Results: Fifteen patients underwent intervention. Median age was 48 years, female to male 9:6. Mean duration of presenting symptoms prior to intervention was 7.4 days (range 1–17). Known risk factors included OCP (n = 2), SLE (n = 2), active carcinoma (n = 2), hypercoagulable state (n = 3), recent major surgery (n = 1). Diagnosis was made with Duplex (n = 12), CT abdomen (n = 2) or CT Venogram (n = 1). IVC filter was deployed pre-procedure in 14 cases. Procedures included tPa alone (n = 4), tPa with mechanical thrombectomy (n = 4), tPa with mechanical thrombectomy and aspiration (n = 7). Stenting was performed in 7 cases. Duration of tPa post bolus was procedural only (n = 4), 12–15 h post procedure (n = 10) or 24 h (n = 1). The overall re-intervention rate was 40 % (n = 6). One patient developed compartment syndrome post intervention. All patients were anticoagulated prior to discharge with grade 2 compression stockings. Mean follow up was 15 months (range 2–24 months). Post thrombotic syndrome has been reported by 2 patients. Follow up imaging showed patency in 13/15 cases, with evidence of non-occlusive common femoral vein thrombus in one patient at 21 months (asymptomatic).

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Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 Conclusions: Iliofemoral thrombosis should be considered a very different entity than infra-inguinal thrombosis and urgent percutaneous intervention should always be considered in acute presentations.

61. Fenestrated Stent Grafts for Treatment of Juxtarenal Aortic Aneurysm G Roche-Nagle, BB Rubin, G Oreopoulos, L Tse, J Jaskolka*, KT Tan*, TF Lindsay Department of Vascular Surgery, Department of Interventional Radiology* Toronto General Hospital Background: Fenestrated endovascular abdominal aneurysm repair (FEVAR) is increasingly being used for the repair of juxtarenal aortic aneurysms (JAAs). As a result of customized fenestrations, patency of vital side branches such as the renal arteries, superior mesenteric artery and the celiac artery can be maintained, whilst positioning the graft over these aortic side branches when repairing these aneurysms. This study aimed to evaluate the early experience technical feasibility and short-term results of FEVAR in treating JAAs. Methods and Results: Fenestrated stent-grafting was performed for 67 patients at high risk for open repair of JAA. The majority of the patients were male (54) and the average patient age was 75.3 years. FEVAR was performed with Cook (63) and Anaconda (4) custom devices. Seven four-fenestrated grafts, 34 three-fenestrated grafts, 23 two-fenestrated grafts and three one-fenestrated grafts were implanted. There were two mortalities within 30 days (3 %). 176 (96 %) visceral vessels were successfully accommodated with fenestrations, and 20 (100 %) visceral arteries with scallops. There was loss of two renal arteries and one celiac artery. In three cases, a type III endoleak occurred at a renal artery fenestration and there was one type 1b endoleak. Iliac leg occlusions occurred in three cases. Conclusions: Implantation of a fenestrated stent-graft incorporating the visceral arteries is technically feasible in high-risk patients with JAA and may be a viable alternative to current open methods.

SESSION 8: PLASTICS SESSION Chair: Professor Jack Kelly & Mr Alan Hussey 62. Complication Rates of Diep Flap Donor Site versus Elective Abdominoplasty: A Single Plastic Surgery Unit Experience F Sheil1, A Pabari2, A Mosahebi2 (1) Department of Student, RCSI, 123 St. Stephen’s Green, Dublin 2, Ireland; (2) Department of Plastic and Reconstructive Surgery, Royal Free Hampstead NHS Trust, Pond St., London NW3 2QG, UK Introduction and Aims: The DIEP flap has emerged as one of the preferred choices for autologous breast reconstruction. The donor site closure is similar to the standard abdominoplasty technique. The aim of this study was to compare complication rates between DIEP donorsite and elective abdominoplasty. Materials and Methods: All patients undergoing either a DIEP flap breast reconstruction (n = 92) or elective abdominoplasty (n = 109) between March 2011 and March 2012 were included in this study. Case notes of all patients were reviewed and patient demographics, co-morbidities and complications were recorded.

Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 Results: Seroma rate was three times higher in abdominoplasty group compared to the DIEP the group. There was no significant difference in the rates of infection, wound dehiscence, umbilical necrosis between the groups. Conclusions: There is no significant difference in complication rates of the donor site between abdominoplasty and DIEP flaps. The rate of seroma is lower in DIEP patients and patients undergoing DIEP flaps should be informed of this comparison.

63. A Comparison of Fibrin Sealant Versus Standard Closure in the Reduction of Postoperative Morbidity After Groin Dissection: A Systematic Review and MetaAnalysis K Bashar1, T O’Sullivan1, M Clarke Moloney1, SR WAlsh2 (1) Department of Vascular, University Hospital Limerick, Limerick, Ireland; (2) Department of Surgery, NUI Galway, Galway, Ireland Introduction: Groin dissection is a commonly performed procedure for patients with lower limb malignant conditions with an associated high complication rate. Numerous surgical strategies have been suggested to reduce morbidity. Aim: To systematically review one of those methods—the efficacy of Fibrin Sealant (FS)—in comparison to Standard Closure (SC) methods in reducing postoperative morbidity from groin dissection. Methods: A systematic search of the literature, study selection and data extraction using an independent screening process. Only randomised controlled trials (RCTs) comparing Fibrin Sealant to standard care in patients with malignant disease undergoing groin dissection reporting at least one outcome measure relating to postoperative complications were included in the review. Results: A total of 6 RCTs were included. There were no statistically significant differences in postoperative surgical site infection (SSI) rates between FS and SC. The overall incidence of wound infection in the FS group was 32 % (43/133) in comparison to 34 % (45/132) in the SC group. (Pooled risk ratio = 0. 0.94 [0.68, 1.32]; 95 % CI; P = 0.74). The incidence of seroma for the FS group (30/133) and the SC group (30/132) did not differ (Pooled risk ratio = 1.03 [0.67, 1.58]; 95 % CI; P Value = 0.90). The overall complication rates were similar between both groups. Conclusion: Based on the current evidence, fibrin sealant does not significantly reduce morbidity in patients undergoing groin dissection for the management of malignant disease when compared to standard closure techniques in use.

64. Current Practice Patterns of Prophylactic Drains in Bilateral Breast Reductions: Scientific Evidence is Still Being Ignored C Sugrue1, N McInerney2, C Joyce2, MJ Kerin1, P Regan2 (1) Department of Surgery, University College Hospital, Galway, Galway, Ireland; (2) Department of Plastic and Reconstructive Surgery, University College Hospital, Galway, Ireland Introduction: Bilateral breast reduction (BBR) is one of the most commonly performed breast operations. Frequently done by Plastic and Breast surgeons, this surgical reduction improves the functional and aesthetic problems of symptomatic breast hypertrophy. Recent

S243 publications, aiming to improve BBR outcomes, question the role of prophylactic post-operative breast drains in BBR. Aim: Assess the current practice of prophylactic breast drains in BBR performed by Plastic and Breast surgeons in Ireland and the UK. Method: An 18 question survey was created evaluating multiple aspects of BBR practice. Irish and UK members of the Irish Association of Plastic Surgeons (IAPS), British Association of Plastic and Reconstructive Surgeons (BAPRAS), Society of Irish Breast Surgeons and Association of Breast Surgery (ABS) were invited to participate. Results were collected over 1 month by an online resource. Statistical analysis involved Student t test and Chi square test. Results: 211 surgeons completed the survey, 74.8 % (158/211) plastics surgeons and 25.2 % (53/211) breast surgeons. Plastics surgeons performed more BBR’s, with a mean of 29.3 ± 6.3, when compared to 19.3 ± 9.1 performed by breast surgeons (p = 0.001). 71.6 % (151/ 211) routinely used post-operative drains, for a mean 1.32 days. There was no difference in drain use between plastic and breast surgeons (p = 0.123) or for breast pedicle selection (p = 0.512). Drains were less likely used for day case BBR’s and were used significantly less by surgeons performing [20 BBR’s per annum (p = 0.020). Conclusion: Despite high quality evidence desmotrating minimal benefit from breast drains, they are still advocated. Surgeons performing BBR must be aware of current evidence, so surgical outcomes can improve.

65. Impact of the Formal Introduction of Guidelines on Key Performance Indicators in the Management of Cutaneous SCC A Granahan, A Collins, S O Neill, C Lawlor, S Carroll, T O’Reilly, C Morrison Department of Plastic and Reconstruction Surgery, St. Vincent’s University Hospital, Elm Park, Merrion Rd, Dublin 4, Ireland Introduction: Surgical excision remains the mainstay of treatment for cutaneous squamous cell carcinomas (SCC). At present no national guidelines exist. Aim: The aim of this audit was to develop standardised, evidencebased guidelines for the management of cutaneous SCCs and to evaluate the impact of the introduction of such guidelines on key performance indicators. Methods: The audit standard was developed following review of three independent internationally recognised bodies of literature (BAD, NCCN, CCA). A retrospective audit was conducted involving all patients who underwent surgery for cutaneous SCCs in the department of plastic surgery over a 12-month period. Current performance, specifically evaluating excision margins and follow-up protocols, was compared with the audit standard. A re-audit was subsequently undertaken following the formal introduction of evidence-based guidelines over a 1-month period. Results: One hundred patients were identified for analysis. The mean radial operative margin was 3.8 mm (0–15 mm) across all tumours, 4.2 mm (0–15 mm) for high risk and 2.6 mm (0–5 mm) for lower risk tumours. The overall clearance rate was 89 %, all of which were highrisk lesions. Within this cohort, positive deep margins were present in 9 % (n = 9) and the radial and deep margins were positive in 2 % (n = 2). Follow-up protocols were deemed adequate in 76 % of cases. Re-audit following the formal introduction of departmental guidelines improved the clearance rate to 95 % and the follow-up protocol to 97 %.

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S244 Conclusion: The formal introduction of standardised, evidence-based guidelines resulted in a significant improvement in key performance indicators in the management of cutaneous SCCs.

66. Composite Anterolateral Thigh-Tensor Fascia Lata Flap for Reconstruction of Complex Skull Defects M Azhar, B Kneafsey, N Ajmal Department of Plastics and Reconstructive Surgery, Beaumont Hospital, Beaumont, Dublin, Ireland Introduction: Skull tumours can result in complex defects involving dura, bone and soft tissue. Inadequate reconstruction can lead to life threatening complications such as CSF leak, meningitis and pneumocephalus. The antero-lateral thigh flap (ALT flap) is a versatile, composite flap which can be effectively used for composite skull defects. The versatility in the blood supply can be exploited to include skin, muscle, fascia or nerve in extended designs and as chimeric flaps. Aim: To present our experience of ALT flap in composite reconstruction of skull defects. Method: A retrospective analysis of 25 patients who underwent composite skull reconstruction using ALT flap. Patients with full thickness defects involving skin, soft tissue, bone and dura were included in the study; data was recorded from patient charts. Results: The median age of patients was 70 years. Lateral base of skull was the commonest site involved and some of these tumors were skin tumors which eroded into the ear, temporal bone, middle ear cavity and into the dura. The most common tumour pathology encountered was invasive squamous cell carcinoma. All the cases had had previous surgeries, ranging from 1–14 procedures (incomplete excisions or recurrences). During the ALT flap reconstruction, most flaps were raised as chimeric flaps and no bony reconstruction was performed in any of these patients. There was one flap loss, and only one case reported CSF leak which lasted for 3 weeks and resolved with conservative measures. Conclusion: ALT flap provided a reliable, robust and adequate reconstruction of the skull-base defects.

67. Patterns of Melanoma Recurrence Following a Negative Sentinel Lymph Node Biopsy E O Connell, P O’Leary, K Fogarty, HP Redmond Department of Surgery, Cork University Hospital, Wilton, Cork, Ireland Introduction: Sentinel lymph node (SLN) status is recognised as a prognostic indicator in melanoma. However, in the setting of a negative SLN there remains a high risk of disease recurrence. We aimed to analyse the predictors and patterns of recurrence following a negative SLN biopsy. Methods: We conducted a chart review of a prospectively maintained database. Melanoma patients with a negative SLN were identified and we performed statistical analysis on their respective demographics, tumour histology and follow-up data. Results: Of 246 patients studied, 43 (17.4 %) had a recurrence of melanoma at a median of 24 months following diagnosis (range 2–101 months). Recurrence was defined as any local recurrence,

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Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 regional spread or distant metastases. Distant metastases were the most common form of disease recurrence (56.7 %). 75.5 % of all recurrences occured in those with a primary tumour of Breslow’s thickness [2.1 mm. Favourable characteristics associated with lower risk of recurrence included being aged\55 years at diagnosis (20.1 vs 44.5 % [55 years; P \ 0.05) and female gender (19.1 vs 38.9 % in males; P \ 0.018). Median survival of 7 months was seen following disease recurrence (range 1–72 months). Conclusion: In the setting of a negative SLN biopsy there is a high risk of melanoma recurrence. Distant metastases were the most common form of recurrence. Predictors of increased risk of recurrence were increased age at diagnosis, male gender and increased tumour thickness.

SESSION 9: UPPER GASTROINTESTINAL AND CARDIOTHORACIC Chair: Professor Tom Walsh & Mr Chris Collins 68. An Enhanced Recovery Program Following Minimally Invasive Oesophagectomy Decreases Duration of Hospital Stay and Perioperative Morbidity with Improved Patient Outcomes P Carroll1, S Cushen2, A Griffith3, A Ryan2, T Murphy1 (1) Department of Surgery, Mercy University Hospital, Cork, Co. Cork, Ireland; (2) Department of Nutrition, University College Cork, Cork, Co. Cork, Ireland; (3) Department of Anaesthetics, Mercy University Hospital, Cork, Co. Cork, Ireland Introduction: Enhanced recovery programs (ERP) are multimodal perioperative pathways designed to achieve early recovery and improved outcomes for patients after colorectal surgery. Oesophagectomy has traditionally been associated with high perioperative morbidity and long hospital stays. Consequently ERP may have a role in improving outcomes post oesophagectomy however prospective studies and consensus guidelines are lacking. Aim: The aim of the study was to prospectively determine the impact of an ERP on perioperative and patient-reported outcomes post minimally invasive oesophagectomy. Methods: From January 2013 to March 2014 consecutive unselected patients undergoing minimally invasive oesophagectomy (MIO) were enrolled in a standardized multidisciplinary ERP including written patient education with daily treatment targets, pre-emptive analgesia and early structured mobilization and early enteral feeding protocols. Patients were commenced on jejunostomy feeding day one and were discharged on overnight enteral feeding for 1 month post surgery. Inhospital/30 day outcomes, patient-reported global quality of life (QOL) scores (EORTC C30) and nutritional outcomes were prospectively collected. Results: 25 patients underwent a MIO with an in-hospital/30-day mortality of 4 %. 76 % had an uncomplicated in-hospital stay. Median length of stay was 7 days (range 6–18). All patients were tolerating oral diet at discharge and no clinically significant weight loss occurred at 30 days (mean weight loss 3.7 %). 30-day re-admission rate was 8 %. Global mean QOL scores were not significantly reduced at 30 days compared to baseline (75 versus 69; p = 0.3). Conclusion: ERP after MIO is associated with reduced hospital stay, decreased perioperative morbidity, low readmission rates and improved nutritional and patient-reported outcomes.


69. Minimally Invasive Gastrectomy: Feasibility, Surgical and Oncological Outcomes of an Early Experience A Salih1, M Arumugasamy2, T Walsh1 (1) Department of Academic Department of Surgery, Connolly Hospital Blanchardstown, Dublin 15, Ireland; (2) Department of Surgery, Beaumont Hospital, Dublin 9, Ireland Background: Laparoscopic surgery is becoming the most favourable approach in many areas of the surgical practice. Recent reports have suggested comparable outcomes in cancer surgery. Aims: To evaluate our early experience of laparoscopic gastrectomy and compare our outcomes with the published series. Methods: A retrospective review of prospectively collected database for patients who underwent laparoscopic gastrectomy between May 2010 and December 2013. Results: A total of 42 laparoscopic gastrectomies were performed during the study period. Patents’ ages ranged between 47–92 years old (mean = 71.3), of which there were 67 % males (n = 28). Adenocarcinoma was confirmed in 90.5 % of the cases (n = 38). Two patients had high-grade dysplasia, one had a gastrointestinal stromal tumour and one patient underwent resection for benign gastric disease. The majority of the patients underwent total gastrectomy (n = 37, 88.1 %), while five patients underwent distal gastrectomy. Pathological staging post-operatively revealed an R0 resection in 91 % of the resected specimens (n = 38). The mean number of harvested lymph nodes was 17.5 lymph nodes. Clinical leak rate at the anastomotic site was 0 %, while one patient developed radiological leak, which was treated conservatively. One patient developed wound infection and one patient developed port site hernia. Conclusions: Laparoscopic gastrectomy for gastric cancer appears to be a safe and feasible procedure with comparable outcomes.

70. Minimally Invasive Ivor-Lewis Oesophagectomy Following Neoadjuvant Chemoradiotherapy for the Treatment of Oesophageal Cancer: First 30 Consecutive Unselected Cases P Carroll1, D Power2, S O’Reily2, F Vernimmen3, J Gilmore3, P MacEneaney4, A Griffith5, M Bennett6, TJ Browne6, M Buckley7, C Daly1, T Murphy1 (1) Department of Surgery, Mercy University Hospital, Cork, Ireland; (2) Department of Medical Oncology, Mercy University Hospital, Cork, Ireland; (3) Department of Radiation Oncology, Mercy University and Cork University Hospitals, Cork, Ireland; (4) Department of Radiology, Mercy University Hospital, Cork, Ireland; (5) Department of Anaesthetics, Mercy University Hospital, Cork, Ireland; (6) Department of Pathology, Mercy University Hospital, Cork, Ireland; (7) Department of Gastroenterology, Mercy University Hospital, Cork, Ireland Introduction: Trimodality therapy comprising of neoadjuvant chemoradiotherapy and oesophagectomy is an established treatment for resectable locally advanced oesophageal cancer. In an effort to reduce the morbidity associated with open oesophagectomy minimally invasive techniques have been developed, however concerns remain regarding feasibility, safety and oncological validity. We report the results of our first 30 consecutive unselected minimally invasive Ivor-

S245 Lewis oesophagectomies (MIO) following carboplatin and paclitaxel chemotherapy with concurrent radiotherapy (41.4 Gy in 23 fractions). Method: A prospective database of all MIO following neoadjuvant chemoradiotherapy between 2011 and 2014 was reviewed. The operative approach consisted of a laparoscopic mobilization of the stomach with formation of a gastric conduit, pyloroplasty, jejunostomy, thoracoscopic mobilization of the oesophagus with an en bloc 2-field lymphadenectomy and a thoracoscopic stapled high intrathoracic anastomosis. Results: The median age was 65 years (range 41–76) and 80 % were male. 80 % were adenocarcinoma and 20 % squamous cell carcinoma. There was one conversion to open thoracotomy. 70 % of patients had an uncomplicated post-operative course. 20 % were treated for atrial fibrillation and 13.3 % for pneumonia. There was one anastomotic leak. Median length of stay was 8 days (6–25 days). 30-day/in-hospital mortality was 3.3 %. 30-day post discharge readmission rate was 13.3 %. 93 % had a curative (RO) resection with an overall median lymph node yield of 30 (15–58 LNs). Conclusion: Minimally invasive Ivor-Lewis oesophagectomy is feasible and can be safely incorporated into the trimodality treatment of oesophageal cancer in an Irish healthcare setting with low morbidity and mortality with reduced hospital stay and excellent short-term oncological outcomes.

71. New-Onset Atrial Fibrillation Post-Oesophageal Cancer Surgery: Incidence, Management and Impact on Short and Long-Term Outcomes A Zaborowski1, O Mc Cormack1, S King1, L Healy1, C Daly2, N O’Farrell1, CL Donohoe1, N Ravi1, JV Reynolds1 (1) Department of Surgery, St James’ Hospital and Trinity College Dublin, St James’ Street, Dublin 8, Ireland; (2) Department of Cardiology, St James’ Hospital, St James’ Street, Dublin 8, Ireland Introduction: Atrial fibrillation is a common cardiac complication following surgery for oesophageal and junctional tumours. The full spectrum of risk factors, associations and implications are unclear. Aim: This study investigates the incidence of new-onset AF post surgery for oesophageal and junctional tumors, and its impact on inhospital and longer term oncologic outcomes. Method: All patients undergoing surgery for OJT at St. James’s Hospital from 2006 to mid-2013 were prospectively studied. The complication of AF was recorded, its management and resolution, association with other complications, and impact on in-hospital mortality and longer-term oncologic outcomes analysed. Results: 473 patients (mean age 63; 73 % male) underwent resection, 51 % 2-stage, 18 % 3-stage, 12 % transhiatal, and 19 % extended total gastrectomy. 96 (20 %) developed new-onset AF, in 18, 27, 29 and 14 % of 2-, 3-, TH and ETG cohorts, respectively (p = 0.05). Age, diabetes, neoadjuvant therapy and cardiac history predisposed (p \ 0.05) to AF, and AF was significantly (p \ 0.0001) associated with pneumonia, pleural effusions requiring drainage, and maximum CRP (p \ 0.05), but not anastomotic leak/conduit necrosis, or mortality. Amiodarone was the primary treatment in 63 % of cases, 1 % underwent cardioversion, and 96 % were in sinus rhythm on discharge. At a median follow up of 40 months (7–109), the median survival was 40 vs 53 months in the AF and non-AF cohorts respectively (p = 0.353). Conclusion: New-onset AF is common, occurring in approximately one in five cases. It is strongly associated with complications, principally respiratory sepsis and systemic inflammation. For most it resolves with no impact on oncologic outcomes.

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72. Objective Measurement of Gallbladder Volume Using Abdominopelvic Computed Tomography B O Connor1, S McWilliams2, P McLaughlin2, O O’Connor2, M Maher2 (1) Department of General Surgery, Mercy University Hospital, Grenville Place, Cork, Ireland; (2) Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland Introduction: Reporting of gallbladder volume (GV) or dilatation on CT is commonly subjective in nature. Knowledge and skill in the objective interpretation of relevant imaging by members of the surgical team is a crucial component of the provision of high quality care to our patients. Aim: To establish the normal GV in adults as measured on CT. The relationship between GV and age, gender, anthropometric parameters, the presence of cholelithiasis, and other biliary pathology (OBP) was examined. Method: 434 consecutive studies performed over a 6 month period were identified. Patients younger than 18 or post-cholecystectomy were excluded; patients with multiple studies had the first included. 347 studies were included; 325 were normal, 22 had OBP. GV was measured with semi-automatic image segmentation. Intra- and interobserver variability was examined with the intra-class correlation coefficient (ICC). Results: The median GV in normal subjects was 35.2 cm3 (25th centile: 22.5 cm3, 75th centile: 58.51 cm3). GV increased with age (r = 0.109, p \ 0.05), body mass index (r = 0.209, p \ 0.001), and body surface area (BSA, r = 0.233, p \ 0.001). There was no significant difference in GV by gender or due to cholelithiasis. GV was significantly increased in 22 patients with OBP compared to normal (p = 0.001). There was low intra- and inter-observer variability (ICC = 0.994 and ICC = 0.993, respectively, p \ 0.001). Conclusion: The median normal adult GV independent of gender is 35.2 cm3. Knowledge of the normal range for GV on CT may improve objectivity in reporting, aid in the diagnosis of OBP, and help us in determining the best management strategies for our patients.

73. Advanced Materials For Cardiac Regeneration (AMCARE): Improving Stem Cell Delivery to the Infarcted Heart Using Biomaterial Approaches A Hameed1, C Hastings1, E Roche2, F O’Brien1, C Walsh2, D Mooney2, G Duffy1 (1) Department of Anatomy, RCSI, St. Stephens Green, Dublin 2, Dublin, Ireland; (2) Department of Engineering and Applied Science, Harvard Univ/Wyss Institute, Cambridge, MA, USA Introduction: Cell delivery to the infarcted heart has emerged as a promising therapy, but is limited by very low acute retention and engraftment of cells. Aim: The hypothesis was that acute retention can be improved with a biomaterial carrier and the study compared several. Methods: Cells were quantified 24 h post-implantation in a rat myocardial infarct model in five groups (n = 8 per group); saline injection (current clinical standard), two injectable gels (alginate and chitosan) and two epicardial patches (alginate and collagen). For injectable groups 60 ll of saline or gel containing 400,000 human mesenchymal stem cells was injected intramyocardially in the infarct border zone. 400,000 cells were seeded on alginate or collagen

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Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 patches, and implanted on the epicardial surface at infarct border zone. At 24 h, retained cells were quantified with Xenogen imaging system. Hearts were perfused and sectioned to stain for retained cells. Results: All biomaterials significantly improved retention compared to a saline control, with 4.1 and 2.6-fold increases for chitosan and alginate injectables, and 14.2 and 19.3-fold increases achieved with collagen and alginate patches, respectively. Immunohistochemical analysis qualitatively confirmed these findings. Encapsulated/seeded cell survival was assessed in hypoxia/ischemia to further compare biomaterials. Conclusion: Injectable gels and epicardial patches were demonstrated to improve acute retention of cells when compared to a saline control. Injectable gels enable immediate myocardial delivery while epicardial patches facilitate superior retention and could potentially sustain cell delivery over extended periods. These biomaterial approaches should be considered for future cell therapy applications.

SESSION 10: PLENARY SESSION Chair: Professor Paul Redmond & Professor Kevin Conlon 74. Association of Prostate Cancer Susceptibility Loci with Disease Aggressiveness and Disease Specific Clinical Endpoints: A Single Centre Analysis with Long Term Follow Up J Sullivan, K Stratton, R Kopp, C Manschreck, J Eastham, K Offit, R Klein Department of Urology, Memorial Sloan Kettering, 1275 York Avenue, Manhattan, NY, USA Introduction: Genome-wide association studies (GWAS) have currently identified over 75 single nucleotide polymorphisms (SNPs) associated with prostate cancer (PrCa) risk. However, susceptibility loci have not been shown to discriminate men who will develop aggressive disease. Aim: To assess the frequency of a comprehensive selection of PrCa risk SNP’s within localised PrCa patients with respect to disease specific endpoints. Methods: We genotyped 1,355 individuals treated for PCa between 1988 and 2007 in our institution. Blood samples were prospectively collected and de-identified before genotyping and matched to clinical data with follow up to November 2013. Multivariate survival analysis was adjusted for gleason score, pathological stage and diagnosis age. We investigated associations between 60 SNPs and biochemical recurrence (BR), castration-resistant metastasis (CM), and PrCa–specific survival (DSS) using Cox proportional hazards models. Results: On univariate analysis, three SNPs were associated (P \ 0.05) with BR, four with CM, and one with DSS. Applying a Bonferroni correction for SNP volume (P \ 0.0008), the only significant association was between rs17632542 and PSA levels at diagnosis (P = 1.4 9 10-5). Five SNPs showed associations on multivariable analysis (P \ 0.05): rs13385191 (BR/CM), rs9284813, rs4857841,rs1894292 and rs1529276 (CM), although not after correcting for multiple testing. Conclusions: We demonstrated that rs17632542 in KLK3 is associated with PSA levels at diagnosis, confirming previous reports. No significant association we seen between risk variants and disease specific endpoints. This provides further evidence that PCa risk variants are equally prone to associate with both more and less aggressive disease.


75. Diminished P38 Signalling in M1-Polarised Macrophages in Response to Bacterial Stimulation N Foley, JH Wang, HP Redmond Department of Academic Surgery, Cork University Hospital/ University College Cork, Cork, Ireland Introduction: Macrophages are divided into subpopulations based on their functional phenotypes. Classically activated (M1) macrophages are induced by IFN-c and LPS, while alternatively activated (M2) macrophages are induced by IL-4 or IL-13. Aim: We established M1 and M2 macrophage polarisation profiles in vitro. We then stimulated these cells with gram-positive and gramnegative bacteria. Following this we examined the MAPK signalling pathway. Methods: Peritoneal and bone marrow-derived macrophages were harvested from C57BL/6 mice. Cells were exposed to polarizing stimuli (M1–LPS and IFN-c, M2–IL-4) for 18–24 h. Polarised cells were further stimulated with heat-killed Staphylococcus aureus and Salmonella typhimurium. Inflammatory cytokine production was assessed by FACScan analysis. Western blot analysis was carried out for the p38 and NF-jB signalling pathways. Results: At baseline M1-polarised macrophages were characterised by high levels of pro-inflammatory cytokines, whereas when cells were exposed to heat-killed bacteria, M1-polarised macrophages were found to have significantly lower levels of pro-inflammatory cytokines compared with naı¨ve and M2-polarised macrophages. We further found substantially attenuated p38 phosphorylation in M1polarised macrophages stimulated with both gram-positive and gramnegative bacteria when compared with naı¨ve and M2-polarised macrophages. Conclusion: M1 macrophages are expected to produce higher levels of pro-inflammatory cytokines than naı¨ve or M2 macrophages; however, we have found an endotoxin tolerance-like phenomenon when M1 macrophages are exposed to bacterial stimulation. Furthermore, the markedly suppressed p38 phosphorylation observed in M1-polarised macrophages after bacterial stimulation may play a key role in this unexpected finding.

76. Secretion of Exosome-Encapsulated MicroRNAs by Basal Breast Cancer Cells in Vitro D Joyce1, C Glynn1, J Brown1, E Holian2, P Dockery3, MJ Kerin1, R Dwyer1 (1) Department of Surgery, National University of Ireland Galway, University Road, Galway, Ireland; (2) School of Mathematics, Statistics and Applied Mathematics, National University of Ireland, Galway, Ireland; (3) Discipline of Anatomy, National University of Ireland Galway, Galway, Ireland Introduction: Exosomes are membrane-derived vesicles that are actively secreted by cells, and have been implicated in cell-to-cell communication through the transfer of genetic material. Recent reports suggest exosome-mediated trafficking of microRNAs between cells. Aim: To identify the panel of exosome-encapsulated microRNAs secreted by basal breast cancer cells in vitro. Methods: Two basal breast cancer cell lines, MDA-MB-231 and BT20, were cultured in exosome-depleted media for 48 h and secreted exosomes isolated. The presence of exosomes was confirmed by

S247 Transmission Electron Microscopy (TEM) and Western Blot analysis. Global microRNA array analysis of exosomes was performed to identify the panel of miRNAs secreted, and targets of interest were further analysed using RQ-PCR. Confocal microscopy was employed to investigate transfer of fluorescently-labelled exosomes between cells. Results: TEM analysis of secreted exosomes revealed vesicular bodies of 40–100 nm in size. Immunoblotting confirmed the presence of the exosome-associated protein CD63. MicroRNA array analysis of exosomes targeting 2089 miRNAs revealed secretion of 394 miRNAs by the MDA-MB-231 cells, and 382 miRNAs by the BT-20 cells. 329 miRNAs were common to exosomes from both cell lines, while a small selection were unique to each cell line exosome-mediated transport of miR451a and miR744-5p was validated using RQ-PCR. Confocal microscopy revealed uptake of fluorescently-labelled exosomes by recipient cells. Conclusions: A distinct panel of miRNAs are selectively packaged into exosomes and secreted by basal breast cancer cells. This transfer of functional miRNAs between cells may play an important role in intercellular communication in the tumour microenvironment.

77. Efficacy of a Laparoscopically Delivered Transversus Abdominis Plane Block Technique During Elective Laparoscopic Cholecystectomy; A Prospective Double Blind Randomised Trial G Elamin1, P Waters1, H Hamid1, H O’Keeffe1, M Duggan2, R Waldron1, W Khan1, K Barry1, I Khan1 (1) Department of Surgery, Mayo General Hospital, Castlebar, Mayo, Ireland; (2) Department of Anaesthetics, Mayo General Hospital, Castlebar, Ireland Introduction: The management of post-operative pain is paramount in order to facilitate the delivery of day case surgical programme. In recent years, the complexity of such procedures carried out has increased to include laparoscopic cholecystectomy (LC). Aim: The aim of this study is to evaluate the impact of laparoscopicassisted four-quadrant transversus abdominis plane (TAP) block versus peri-portal local anaesthetic wound infiltration in managing postoperative pain. Methods: A prospective, randomized, double-blinded trial was performed on patients undergoing elective LC. Patients were randomised using computerised ‘‘random number table’’ into a Test group which received laparoscopic-assisted TAP block with bupivacaine with periportal saline injection and a Control group which received a laparoscopic-assisted TAP block with saline and peri-portal bupivacaine. All patients received concomitant intra-peritoneal instillation of Bupivacaine in the gallbladder bed. Postoperative pain scores were recorded using visual analogue scores (VAS) at rest and during coughing and recorded at dedicated time points. Post-operative analgesic regimens were standardised. Statistical analysis was carried out using GraphPad Prism V.5 with p \ 0.05 considered significant. Results: Eighty patients, (70f, 10m) have been enrolled with 40 patients randomised to each group. Age, ASA score, operative time and BMI were comparable between both groups. No adverse events were encountered with the administration of TAP blocks. VAS were significantly reduced in the Test group at 1, 3 and 6 h at rest (p = 0.025, 0.03, 0.007) respectively. VAS was significantly reduced at 1, 3 and 6 h during coughing (p = 0.026, 0.02, 0.03) respectively. There was no statistical difference in post-operative analgesic requirements between both groups (p = 0.17).

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S248 Conclusions: This analysis has confirmed the therapeutic benefit of laparoscopically delivered TAP blocks in elective LC. This has now facilitated a policy of ambulatory LC in our unit.

78. Exosome-Encapsulated MicroRNAs Secreted by Colorectal Cancer Cells: Mediators of Intercellular Cross-Talk in the Tumour Micro-Environment C Clancy, J Brown, E Holian, M Joyce, MJ Kerin, RM Dwyer Discipline of Surgery, School of Medicine, National University of Ireland, Galway, Ireland Introduction: Exosomes are membrane-derived vesicles that have been recognised as important mediators of inter-cellular communication. Recent studies suggest exosomes transfer microRNAs to recipient cells, although the specific microRNAs packaged and secreted are unknown. Identifying microRNAs contained within exosomes secreted by colorectal cancer cells (CCCs) may provide valuable insight into the methods by which CCCs influence surrounding cells and promote tumorigenesis. Aim: Isolation and characterisation of the microRNA signature of exosomes secreted by CCCs. Methods: CCCs were cultured in exosome-free media and secreted exosomes isolated at 48 h. Transmission electron microscopy (TEM) and Western Blot were performed to visualise and characterise exosomes. microRNA was extracted from exosomes using the mirVanaTM kit and array based analysis was performed using the miRCURY LNATM microRNA array (Exiqon, Denmark). Targets of interest were validated by RQ-PCR. Transfer of red-fluorescent protein labelled exosomes between cells was visualised using confocal microscopy. Results: Exosomes secreted by CCCs were successfully isolated and visualised as vesicles approximately 100 nm in size. Protein extraction and Western Blot analysis revealed exosome-associated protein CD63. Of 2083 potential targets 300–350 microRNAs were found to be selectively packaged and secreted by separate CCC lines. Targets detected at high levels were validated with RQ-PCR, and included microRNAs with well described roles in the pathogenesis of colorectal cancer (miR-10b, miR-135a). Confocal microscopy confirmed transfer of exosome-encapsulated microRNAs between cell populations. Conclusion: CCCs actively secrete a panel of exosome-encapsulated microRNAs which are taken up by recipient cells. This has potentially important implications in the pathogenesis of colorectal cancer.

79. Circulating Fibrocytes in Crohn’s Disease: Novel Biomarker of Disease Severity S Sahebally1, M Kiernan1, J Burke2, C Dunne1, R O’Connell3, S Martin4, JC Coffey1 (1) Department of GEMS, University of Limerick, Castleroy, Limerick, Ireland; (2) Department of Surgery, University Hospital Limerick, Dooradoyle, Ireland; (3) School of Medicine and Medical Science, UCD, Dublin, Ireland; (4) Centre for Colorectal Disease, St Vincent’s Hospital, Dublin 4, Ireland Background: Fibroblasts are key mediators of fibrosis in Crohn’s disease (CD) but their origin remains contentious 1. Circulating

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Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 fibrocytes (cFC) are mesenchymal progenitor cells that are recruited to sites of inflammation, where they differentiate into fibroblasts. Aim: We aimed to characterise the role of cFC in CD using flow cytometry (FCM). Methods: Following ethical approval and informed consent peripheral blood samples were obtained preoperatively and at 4/52 postoperatively from CD patients undergoing intestinal resection (n = 13), baseline CD patients (n = 5) and healthy controls (n = 10). A FCMbased-technique was optimized to characterise cFC levels by staining for CD45 and Col-1. cFC were expressed as a percentage of the total WBC pool. Data was analyzed using SPSS v19. Patients were categorized as (1) CDAI \150 (n = 5), (2) CDAI 200–450 (n = 12) and (3) CDAI [450 (n = 1) and cFC were compared between these groups using a one-way ANOVA. Results: cFC were significantly elevated in active CD compared to controls (6.46 ± 1.19 vs. 1.97 ± 1.04 %, P \ 0.001). Following resection, cFC levels dramatically reduced to below normal levels (6.46 ± 1.19 vs. 1.72 ± 1.2 %, P \ 0.001). In addition cFC were higher in active CD when compared to baseline CD (6.46 ± 1.19 vs. 2.54 ± 0.22 %, P \ 0.001). Mean cFC levels also differed significantly between groups one (2.3 %), two (6 %) and three (8 %) (P \ 0.001). Conclusions: cFC are increased significantly in patients with active CD and correlate with disease severity. Levels return to below normal following resection. These findings point to cFC as a novel biomarker of disease severity in CD.

80. Microbes and the Mucus Gel Layer in Ulcerative Colitis: the role of Mucolytic and Hydrogen Sulphide Producing Bacteria H Earley1, G Lennon1, A Balfe1, A Lavelle2, C Coffey3, D Winter2, R O’Connell2 (1) Department of Medicine and Medical Sciences, UCD, Belfield, Dublin 4, Ireland; (2) Department of Colorectal Disease, St Vincent’s University Hospital, Dublin, Ireland; (3) Department of GEMS, Limerick, Ireland Introduction: Changes to the constituents of the colonic microbiome occur in ulcerative colitis (UC) and are accompanied by alterations in the mucus gel layer (MGL). Hydrogen sulphide (H2S) producing and mucolytic bacteria have been implicated in this process. Mucolytic bacteria degrade mucin, impairing the mucus barrier, while at elevated levels H2S is toxic to coloncytes. Aims: To determine the abundance of the mucolytic Akkermansia muciniphila and H2S-producing Desulfovibrio and Bilophila wadsworthia in the colitic colon. To correlate results with changes to the MGL and markers of inflammation. Methods: Paired mucosal brushings and biopsies were obtained from a cohort of 20 patients with active colitis and healthy controls and 14 patients with quiescent colitis. Bacterial counts were determined using RT-PCR. Histological scores were determined using H&E and HID-AB stains. Statistical analysis was performed using SPSS. Results: A. muciniphila and H2S-producing bacteria were more abundant in health compared to active and quiescent UC. A positive correlation existed between bacterial load and percentage sulphation. There was a negative correlation between bacterial counts and inflammation. Conclusion: Differences exist in the relative proportions of mucolytic and H2S-producing bacteria between health and UC. These data suggest that A. muciniphila are an integral part of the mucosa associated microbiota and play a role in the maintenance of the integrity

Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 of the MGL. Together alterations in the abundances of these bacteria contribute to the overall dysbiosis in UC. Further research is needed to delineate the role of other mucolytic species in the pathogenesis of UC.

81. The Role of the TNFSF15 Gene in Surgical Diverticulitis T Connelly, A Berg, L Harris III, D Brinton, S Deiling, W Koltun Department of Colon and Rectal Surgery, HMC Penn State, Hershey, PA, 17033, USA Introduction: TNFSF15 is an immunoregulatory gene associated with inflammatory bowel disease. Aims: (1) To determine if single nucleotide polymorphisms (SNPs) associated with TNFSF15 are associated with diverticulitis requiring surgery (D-S). (2) To determine functional consequences of this SNP in tissue from D-S patients vs controls. Methods: A test group of 21 D-S patients and matched healthy controls were genotyped for 5 TNSF15 SNPs. The significant SNP, rs7878647, was confirmed in 34 new D-S patients and matched controls. To determine mRNA expression, rtPCR was performed on full thickness sigmoid specimens from 13 control patients (2 dysmotility/2 FAP/6 colorectal cancer/1 endometriosis/2 HNPCC) and 34 D-S patients. Paired diseased and non-diseased tissue was available from 11 D-S patients. Statistics used were Wilcoxon rank sum, two sample t and signed rank tests. Results: The homozygous GG genotype for rs7878647 was found in 60 % of D-S patients vs 11 % of healthy controls (p = .003). An overall 7.59 upregulation of TNFSF15 mRNA was demonstrated in all D-S tissue versus control tissue (p = .004). Although still elevated when compared to controls, TNFSF15 mRNA expression in GG genotype tissue was markedly decreased versus AA/AG genotypes. No significant difference in expression in diseased versus nondiseased tissue from the same patients was found (p = .08). Conclusions: (1) SNP rs7878647 is associated with diverticulitis requiring surgery. (2) TNFSF15 mRNA expression is significantly upregulated in diverticulitis affected tissue. (3) This upregulation is attenuated in patients with the rs7848647 GG/risk genotype. (4) Lack of differential expression in paired diseased and nondiseased tissue from individual patients suggests a global effect in the sigmoid of diverticulitis patients.

82. Lipopolysaccharide (LPS)-Induced Tolerisation Contributes to an Altered Metastatic Potential in Colorectal Cancer Cells D Hechtl, JH Wang, HP Redmond Department of Academic Surgical Research, Cork University Hospital, Wilton, Cork, Ireland Introduction: Endotoxin tolerance, a well-known phenomenon, whereby cells stimulated with LPS show reduced responsiveness to repeat stimulations, has been extensively investigated in immune cells. Inflammation increases the incidence of tumour recurrence and metastases despite curative surgery in colorectal cancer. LPS, which binds to Toll-like receptor 4 (TLR4), plays an essential role in initiating the immune response and in subsequent tolerisation. This interaction between LPS and TLR4, may act as a ‘double-edge sword’ due to effects on tumour cell adhesion, migration and invasion.

S249 Aim: To investigate whether LPS pre-stimulation colorectal cancer cell lines induces tolerisation, thus leading to an altered metastatic potential in these cells. Methods: Human metastatic and non-metastatic colorectal cancer cell lines (SW620 and SW480) were pre-stimulated with different concentrations of LPS to induce tolerisation as determined by their cytokine profile. Non-tolerised and tolerised cell were further assessed for their viability and proliferation. Results: Pre-stimulation of SW480 and SW620 cells with LPS resulted in reduced interleukin-8 and vascular endothelial growth factor release in response to LPS re-stimulation, confirming that LPS pre-stimulation induced tolerisation in these cells. Moreover, LPStolerised SW480 and SW620 cells displayed enhanced cell proliferation, indicating an altered metastatic potential after the induction of LPS tolerisation. Conclusion: These results suggest that endotoxin/LPS stimulation and tolerisation plays a significant role in colorectal cancer cell behaviour and survival in a septic environment, providing further evidence for the concept of immunogenic carcinogenesis.

83. Differential Abundance of Mct1 in the Human Colon N Fearon1, L Ryan1, D Collins1, G Stewart2, A Baird2, D Winter1 (1) Department of Surgery, St Vincent’s University Hospital, Elm Park, Dublin, Ireland; (2) School of Veterinary Medicine, University College Dublin, Belfield, Dublin, Ireland Introduction: Butyrate, a short-chain fatty acid, is produced by fermentative bacteria in the colon, and is the primary energy source for colonocytes. It is transported across the colonic epithelium by monocarboxylate transporter 1 (MCT1). Optimal butyrate transport is imperative for maintenance of gut health. Aim: To investigate for differential regional expression of MCT1 in the human colon and for variation in butyrate flux across the colonic epithelium. Methods: Western blot studies and immunohistochemistry were used to detect expression of MCT1 transporters in the human colon. Butyrate flux studies were carried out by mounting fresh human colon samples in using chambers. Bidirectional flux was investigated using radiolabelled butyrate (C14) and Papp determined by using a scintillation counter. Results: Western blot studies revealed a 45 kDa protein in the colon. There was stronger expression in the ascending colon compared to the descending colon (p \ 0.01, n = 3). Immunohistochemistry showed a stronger expression of MCT1 in the proximal colon compared to the distal colon. Butyrate flux was bidirectional and was significantly greater in the ascending colon compared to the descending colon (p \ 0.05, n = 6). The known butyrate inhibitor Resveratrol inhibited flux. Conclusion: These results suggest differential expression of MCT1 in the human colon, which may reflect variation in bacterial populations in the colon.

84. Cartilage Repair in a Rabbit Model: Development of a Novel Subchondral Defect and Assessment of Early Cartilage Repair Using Rabbit Mesenchymal Stem Cell Seeded Scaffold M Neary, V Barron, F Barry, F Shannon, M Murphy

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S250 Department of REMEDI, NCBES, NUI Galway, Ireland Aim: To develop a novel subchondral defect in a rabbit model to assess the biocompatibility and early cartilage repair using a rabbit mesenchymal stem cell (rMSC)-seeded proprietary scaffold. Methods: In vitro optimisation of the rMSC-scaffold seeding technique was performed, and cell attachment, viability and distribution were analysed using Live/Dead assays and SEM imaging. Bovine explant models assessed scaffold fixation methods. A pilot rabbit study assessed scaffold fixation in a chondral defect model. Following this, a novel subchondral model was developed. Using a preclinical rabbit study, the surgical reproducibility of creating the subchondral defect was compared to that of well-characterised osteochondral defect, and tissue repair was examined using 4 test groups of empty osteochondral defect (n = 6), empty subchondral defect (n = 6) cellfree scaffold (n = 6) and rMSC-seeded scaffold (n = 6). Briefly, a subchondral defect was created in skeletally mature rabbits on the medial femoral condyle using an electrical drill and polyester scaffolds were press-fit into place. After 28 days, the joints were harvested, decalcified, embedded, sectioned at 5-micron intervals and stained with toluidine blue. Results: The subchondral defects were created with the same reproducibility as osteochondral defects. On gross examination, more degenerative changes were seen in untreated groups. Higher quality tissue repair was achieved in both cell free and cell-seeded scaffolds, with more organised repair, chondrocytes and Type II collagen (hyaline cartilage). Conclusion: A novel reproducible subchondral defect was successfully created. Results suggest improved cartilage repair and less joint degeneration in scaffold/rMSC treated groups.

SESSION 11: EVIDENCE BASED MEDICINE/ META-ANALYSIS SESSION Chair: Mr Ronan Waldron & Mr Diarmuid O’Riordain 85. Ratios Derived from an Array of Standard Hematologic Indices Predict Oncologic Outcomes in Colon Cancer J Hogan, J East, G Samaha, S Polinkevych, W MacKerricher, S Walsh, J Calvin Coffey Department of General Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland Background: The interaction between inflammation and cancer is well established. Surrogate markers of systemic inflammation such as the neutrophil/lymphocyte ratio, may be associated with long-term oncological outcomes. This study aimed to characterize the relationship between several ratios derived from haematologic indices using a classification and regression tree analysis. Methods: Hematologic white cell ratios were established for all patients undergoing colonic cancer resection (N = 436) with curative intent in a regional cancer center. The optimal ratios associated with overall survival were established in a training set (n = 386) using a classification and regression tree technique (CRT). The association between ratios and overall survival was assessed in a separate test set (n = 50). Within the test set, two groups were generated based on each ratio (above and below the cut-off point identified in the training set). The association between ratios and overall survival was assessed using a stepwise cox proportional hazards regression model. Results: The following ratios (identified by CRT) were associated with adverse overall survival in the test set; (a) neutrophil to

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Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 lymphocyte ratio (NLR) greater than 3.4 (HR 3.4, p \ 0.001) and (b) white cell count lymphocyte ratio (WLR) greater than 5.28 (HR 4.1, p = 0.03). Conclusions: This is the first study to apply recursive partitioning in determining the relationship between hematological ratios and overall survival in colon cancer. Haematologic ratios were predictive of oncologic outcome.

86. Conversion from a Laparoscopic to Open Colorectal Cancer Resection is Associated with Adverse Oncological Outcomes: A Meta-Analysis C Clancy, DP O’Leary, J Burke, JC Coffey, MJ Kerin, E Myers Department of Surgery, School of Medicine, National University of Ireland, Galway, Ireland Introduction: Laparoscopic colorectal cancer surgery is oncologically equivalent to open surgery. There is no consensus however on the impact of conversion from laparoscopic to open resection on disease free and overall survival. Aim: The primary aim of this study was to perform a meta-analysis assessing the long term oncological outcomes associated with conversion. Methods: A comprehensive search for published studies examining outcomes following conversion from laparoscopic to open colorectal cancer resection was performed adhering to PRISMA statement guidelines. Only randomised controlled trials and prospective studies were included in the final analysis. Each study was reviewed and data extracted. Random-effects methods were used to combine data. Results: 15 studies met the inclusion criteria with a total of 5,293 patients for analysis. 4,391 patients had a completed laparoscopic resection, 902 were converted to an open resection. The average conversion rate was 17.9 ± 10.1 %. Completed laparoscopic surgery favours lower 30 day mortality (OR 0.134, 95 % CI 0.047–0.385, P \ 0.0001), lower long term disease recurrence (OR 0.543, 95 % CI 0.421–0.701, P \ 0.0001) and lower overall mortality (OR 0.481, 95 % CI 0.391–0.593, P \ 0.0001). Conversion is more likely to occur with males (P = 0.011), elevated BMI (P = 0.004) rectal cancer (P = 0.017), locally advanced tumours (P = 0.009) and lymph node positive disease (P = 0.009). Conclusions: These data suggest conversion from a laparoscopic to open colorectal cancer resection is associated with adverse perioperative and long term oncological outcomes.

87. The Impact of Mechanical Bowel Preparation in Anastomotic Leakage after Rectal Surgery: A MetaAnalysis D Courtney, J Burke, M Kelly, F McDermott, D Winter Department of Surgery, St Vincent’s University Hospital, Elm Park, Dublin, Ireland Introduction: Anastomotic leakage is a feared complication post colorectal resection with significant morbidity and mortality. Numerous factors impact on this incidence including patient factors, peri-operative management and operative techniques. The role of mechanical bowel preparation (MBP) in reducing this complication prior to rectal surgery has not been well investigated.

Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 Aim: The objective of this review was to establish whether MBP reduces the risk of anastomotic leaks post-proctectomy. Method: A systematic review of all publications relating to MBP in the context of rectal resections and its complications was performed. Meta-analysis using pair-wise comparison was performed. Primary outcomes were the incidence of anastomotic leakage with and without MBP. Secondly we assessed associated morbidity and mortality with its use. Results: Three studies were included, reporting on 740 patients. 56 % (n = 416) were male. Mean age was 63.5 years. Although not statistically significant, there was a trend towards an increase in anastomotic leakage in those without MBP (8.0 % with MBP vs. 10.2 % without, OR 1.286, 95 % CI 0.684–2.417, p = 0.435). Overall morbidity was similar (38 % with MBP vs. 39 % in those without MBP, OR 0.998, 95 % CI 0.472–2.110, p = 0.995). Interestingly mortality was higher in those who did not receive MBP (though not statistically significant). Conclusion: This review observed a trend towards increased morbidity and mortality where MBP is utilized prior to rectal resection. However, there remains insufficient published data to categorically prove this. Therefore appropriately powered studies are required to definitely validate this.

88. The Practice of Emergency Department Thoracotomies: Rational and Perils

S251 (1) Department of Vascular, University Hospital Limerick, Limerick, Ireland; (2) Department of Surgery, NUIG, Galway Introduction: A number of ‘proof-of-concept’ trials suggest that remote ischaemic preconditioning (RIPC) reduces surrogate markers of end-organ injury in patients undergoing major cardiovascular surgery. There are currently no studies with clinical outcomes as primary endpoints. Aim: To evaluate the effect of RIPC on clinical outcomes following cardiovascular surgery. Methods: Randomised clinical trials of RIPC in major adult cardiovascular surgery were identified by a systematic review of electronic abstract databases, conference proceedings and article reference lists. Clinical end-points were extracted from trial reports. In addition, trial principal investigators provided unpublished clinical outcome data. Results: In total, 23 trials of RIPC in 2200 patients undergoing major adult cardiovascular surgery were identified. RIPC did not have a significant effect on clinical end-points (death, peri-operative myocardial infarction (MI), renal failure, stroke, mesenteric ischaemia, hospital or critical care length of stay). Conclusion: Pooled data from pilot trials cannot confirm that RIPC has any significant effect on clinically relevant end-points. Heterogeneity in study inclusion and exclusion criteria and in the type of preconditioning stimulus limits the potential for extrapolation at present. An effort must be made to clarify the optimal preconditioning stimulus. Following this, large-scale trials in a range of patient populations are required to ascertain the role of this simple, cost-effective intervention in routine practice.

Y AlJabi1, T Aherne1, J Clerkin1, P Staunton1, S McHugh1, Professor Arnold Hill2, Mr Peter Naughton1 (1) Department of Vascular Surgery, Beaumont Hospital, Beaumont, Dublin, Ireland; (2) Department of General Surgery, Beaumont Hospital, Beaumont, Dublin, Ireland Background: Emergency Department Thoracotomy (EDT) is a controversial resuscitative intervention characterized by poor survival rates. Aim: We sought to critically appraise the literature available on emergency thoracotomies to discuss indications, rationale and outcomes. Methods: An extensive review of the literature was carried out in both online medical journals and through the Royal College of Surgeons in Ireland library. All relevant papers published in the last 30 years were included for analysis in this study. Results: Emergency department thoracotomies are associated with a poor prognosis, offering little benefit particularly in blunt trauma. In addition, this intervention carries a high-risk of occupational exposure to transmissible blood-borne diseases. Conclusion: Overall, EDTs are only justifiable in the presence of a well-staffed, trauma-themed, operating theatre in the vicinity of the emergency department, as in the case of a number of level 1-trauma centers world-wide. Patients should be transferred to the operating room for resuscitative thoracotomy where indicated. Emergency thoracotomies as a ‘heroic measure’ should be abandoned in nonsalvageable patients.

89. Remote Preconditioning and Major Clinical Complications Following Adult Cardiovascular Surgery: Systematic Review and Meta-Analysis D Healy1, K Bashar1, M Clarke Moloney1, S Walsh2, The Remote Preconditioning Trialists’ Group (?)

90. Network Meta-Analysis Assessing Survival Outcomes for the Different Surgical Approaches for Synchronous Colorectal Liver Metastasis M Kelly1, G Spolverato2, T Pawlik2, D Winter1 (1) Department of Surgery, St Vincent’s University Hospital, Elm Park, Dublin, Ireland; (2) Department of Surgery, Johns Hopkins, Baltimore, USA Introduction: Traditionally, patients with synchronous colorectal liver metastasis (CLM) had resection of the colorectal primary with adjuvant chemotherapy prior to considering CLM resection. In recent years, there has been a shift towards simultaneous and liver-first approaches in selected patients. Aim: To evaluate the current literature and to compare overall survival outcomes for all three surgical approaches. Methods: A systematic review comparing three approaches was performed. Evaluated endpoints included 5-year overall survival, 30-day mortality, and post-op complications. Pair-wise and network meta-analyses (NMA) were utilized to compare the overall survival, with a random effects model assuming variation between the studies. Analysis of variance was used to analyze the complication rates. Results: Eighteen studies were included, reporting on 3,605 patients. 2,439 patients (67.7 %) had colorectal-first resection, 1,033 patients (28.6 %) had simultaneous resections, and 133 patients (3.7 %) had liver-first resection. NMA and pair-wise meta-analysis of the 5-year overall survival did not show significant difference between the three surgical approaches. NMA of the 30-day mortality among the three approaches also did not observe statistical difference. From analysis of variance, the post-operative complication rates of all three approaches were comparable (p = 0.5093). Conclusion: This study observed no clear statistical surgical outcome or survival advantage of any one of the three surgical approaches.

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S252 There remain considerable differences in the management of synchronous CLM patients without standardized reporting in the literature. Adequately powered prospective comparative trials are required to properly assess for superiority of a surgical approach in CLM.

91. Laparoscopic Cholecystectomy in Acute Cholecystitis: Who Should Have Immediate Surgery? R Lyons, P Waters, MJ Kerin Department of Surgery, UCHG, GUH, Galway, Ireland Introduction: Cholelithiasis is a very common presentation to emergency department worldwide. Despite a trend towards immediate laparoscopic cholecystectomy, the option of best medical management with a delayed laparoscopic cholecystectomy still exists. However readmissions with further episodes of cholecystitis and complications, necessitating hospital admission are frequent. This increases the cost to the health service. Aim: To identify factors that may indicate which patients are likely to represent to hospital while awaiting interval surgery. Methods: Review of all patients presenting with acute cholecystitis who underwent laparoscopic cholecystectomy in a 4 year period. Stratify into three groups, one who had emergency, immediate laparoscopic cholecystectomy at admission, one who had delayed laparoscopic cholecystectomy and a final group who had recurrent admissions while awaiting their delayed cholecystectomy. A review of patient demographics, radiological and haematological results was undertaken. Results: 100 patients underwent an emergency laparoscopic cholecystectomy during the first admission, 104 people underwent a delayed laparoscopic cholecystectomy and 75 people had readmissions while awaiting the interval surgery. Those that underwent emergency surgery had a mean age of 48 years, mean length of stay in hospital was 6 nights compared to 17 nights in the readmission group. 86 % had ultrasound at admission and all had haematological investigations. All groups had elevated white cells, inflammatory markers and abnormal liver function tests. Conclusions: Readmissions with complications related to cholelithiasis while awaiting interval cholecystectomy is common, leading to increased morbidity and costs. It is therefore beneficial to identify any factors that may help identify these patients at time of initial presentation.

92. Predicting Length of Stay in Emergency Surgical Admissions Remains Challenging MR Boland1, I Reynolds1, F Alquraish2, M Quirke2, N McCawley1, ADK Hill2, DA McNamara1 (1) Department of Colorectal Surgery, Beaumont Hospital, Beaumont, Dublin, Ireland; (2) Department of Surgery, Beaumont Hospital, Dublin 9, Ireland Introduction: The National Surgery Programmes emphasise the importance of estimated discharge dates (EDD) to assess predicted length of stay for each patient to facilitate planning and patient care. However there is little evidence that surgeons accurately predict length of stay on an individual patient basis.

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Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 Aims: To correlate predicted LOS by EDD on surgical signouts with actual LOS and to assess if common presenting symptoms are associated with more accurate estimated discharge dates. Methods: Admitting SHOs were requested to prospectively record EDD in a consecutive series of emergency surgical admissions over a 6 month period in a tertiary hospital using an electronic signout. Patient characteristics and actual LOS were validated at the end of the 6 month period. Presenting symptom complex was classified into 11 categories. Accuracy of predicted and actual LOS was compared using Pearson’s correlation co-efficient. Results: There were 1,040 emergency surgical admissions over a 6 month period with complete data available on 520 patients. Predicted LOS was accurate in 94 (18.9 %) patients but generally correlated well with actual LOS (Pearson’s correlation co-efficient = 0.87). Predicted LOS was more often overestimated (n = 295, 56.6 %). The most common presenting symptom complex was abdominal pain in patients under age 50 yet correlation with actual LOS was poor (Pearson’s correlation co-efficient = 0.47) when compared with other presenting symptoms. Conclusion: Prediction of LOS following emergency surgical admission by surgical SHOs is imprecise, even in common conditions. Use of historic LOS data by age and condition may improve accuracy in predicting discharge date.

93. Investigate Outcome Variables in the Timing of Acute General Surgery S Beecher, DP O’Leary, R McLaughlin, MJ Kerin Department of Surgery, University Hospital Galway, Newcastle, Galway, Ireland Introduction: Centralization of hospital services results in increased pressure on general surgical departments. Greater demand for access to emergency theatres leads to a longer time to theatre (TTT) for patients. Aim: Investigate the impact of increased demand on acute surgical key performance indicators. Methods: A retrospective review of an electronic prospectively maintained database was performed between 1/1/12 and 31/12/13. Data gathered included type of operation performed, TTT and length of stay (LOS). Statistical analysis was performed using SPSS 20.0. Results: There were 11,016 general surgical admissions. 6,355 patients were admitted through the emergency department. 2,884 underwent surgery in the emergency theatre. 2,165 cases were performed on weekdays. 900 were performed outside of 9 a.m. to 5 p.m. Mean LOS for those admitted at the weekend was shorter than for those admitted on a weekday (10.1 vs 12.7 days) (p = 0.017). Mean TTT was also shorter for those admitted at the weekend (15.6 vs 24.9 h) (p \ 0.000). Mean TTT was shorter for those operated on out of hours compared to those operated on between 9 a.m. and 5 p.m. (17.7 vs 28.3 h) (p \ 0.000). Mean operation duration was longer for those operated on out of hours (143 vs 101 min) (p \ 0.000). Conclusion: There is increased demand for access to the emergency theatre when all surgical teams are on site. When the full team is present, this leads to a shorter mean operation duration. The opening of a second dedicated emergency theatre during normal working hours may result in shorter LOS, shorter TTT and shorter operation durations.


94. Enterobius Vermicularis Infestation in the Setting of Acute Appendicitis in a Paediatric Population: Annual Incidence and Predictive Factors C Fleming, D Kearney, P Moriarty, P Redmond, E Andrews Department of General Surgery, Cork University Hospital, Wilton, Cork, Ireland Introduction: Enterobius Vermicularis (EV) is an important finding in appendectomy specimen, most commonly seen in paediatric cases. The role of this pinworm in the aetiology of appendicitis is controversial. We sought to identify the annual incidence of EV infestation in a paediatric population undergoing appendectomy for clinically suspected acute appendicitis and identify subjective predictive factors for EV. Methods: This study was performed in a University Teaching Hospital. We identified all paediatric appendectomies performed at our institute from January to December 2012 using prospectively maintained operating theatre logbooks. In-hospital Histopathology database, medical notes and operative findings were reviewed for each patient and relevant data recorded. Statistical analysis was performed using IBM SPSS, version 21. Results: In total 184 paediatric appendectomies were performed for clinically suspected acute appendicitis. Demographics included: mean age 11.2 years (3–16), gender 1M:1F. 56 % of procedures were completed laparoscopically and 44 % open. The negative appendectomy rate was 15 % (n = 27). The annual incidence of EV infestation in appendicectomy specimen from a paediatric cohort was 7 % (1 in 14). In specimen containing EV, a negative appendicectomy rate of 69 % was seen, this was statistically significant compared to negative appendicectomy rate for non-EV containing specimen (p \ 0.001). Possible factors to predict EV infection at presentation did not show statistical significance [apyrexia (p = 0.54), normal neutrophil count (p = 0.23) and eosinophilia (p = 0.24)]. Conclusion: EV is seen in 7 % of appendicectomy specimen. These patients have a significantly higher negative appendicectomy rate. Thus, EV is an important differential for right iliac fossa pain in paediatric patients.

SESSION 12: UROLOGY SESSION Mr Eamonn Rogers & Mr Patrick O’Malley 94. Cystic Renal Masses: Concordance Between Radiological and Pathological Findings J Costelloe1, E Bolton1, M Quinlan1, D Galvin1, G Lennon1, D Quinlan1, I Murphy2, D Mulvin1 (1) Department of Urology, SVUH Dublin, Elm Park, Dublin 4, Ireland; (2) Department of Radiology, SVUH, Elm Park, Dublin 4, Ireland Introduction: Characterization of cystic renal masses hinges on the I– IV Bosniak system. Lesions that are multi-loculated, demonstrate enhancement, wall thickening/nodularity (Bosniak 2F, 3, 4) are often managed surgically due to an association with malignancy. CT remains the gold standard for characterisation, but US and MRI are also useful in evaluating indeterminate lesions. Aims: This study assesses concordance between radiological and pathological findings for cystic renal masses. Method: Data was retrospectively collected on patients who required radical nephrectomy for radiologically diagnosed complex cystic

S253 renal masses over 5 years. Each US, CT and/or MRI was reviewed by a radiologist who graded lesions according to the Bosniak Scoring System. Pre-operative Bosniak classification was compared with surgical pathology. Results: 36 complex cystic renal masses were identified by US, CT and/ or MRI. The patient cohort consisted of 20 males and 16 females with a mean age of 65 years, (range 35–81 years). There were 6 Bosniak 2F, 16 Bosniak 3 and 14 Bosniak 4 lesions on imaging. Final pathology showed cystic renal cell carcinoma (RCC) in 22 patients, 2 benign renal cysts and solid malignancy in 12 patients. 28/36 (78 %) were found incidentally during evaluation for unrelated diseases. 30/36 (83 %) were clear cell RCC, 2/36 (6 %) papillary RCC, 1/36 (3 %) collecting duct and 1/36 (3 %) chromophobe RCC and 2/36 (6 %) benign. 94 % of Bosniak category 2F, 3 and 4 masses were malignant. Conclusion: The use of the Bosniak classification system preoperatively highly correlated with the presumed benign or malignant nature of the lesion.

95. Validation of Selection of Patients for Active Surveillance in Prostate Cancer: A Retrospective Study S Elamin, N Davis, P Sweeney Department of Urology, Mercy Hospital, Cork, Cork, Ireland Introduction: There are a substantial proportion of men that may have been considered as potential candidates for active surveillance (AS) that have aggressive tumour features at radical prostatectomy (RP). Therefore, accurate identification of patients with truly indolent cancer at the time of prostate cancer (PCa) diagnosis remains challenging. Aim: To compare the histopathology of patients that underwent RP for low grade disease with their original histopathology from (TRUS) biopsy. 2. To determine disease free survival based on biochemical recurrence (i.e. PSA level). Method: A retrospective study was performed on all patients that underwent RP in our institution between 2008 and 2012 (n = 245), 59 (25 %) met the AS criteria using: John Hopkins, University of California. Results: 52 patients (88 %) met the inclusion criteria of at least one protocol. 16 patients (28 %) were eligible for AS based on all studied criteria. Twenty-five patients (42 %) were upgraded compared to 12 patients (20 %) who were upstaged. Seventeen patients (28 %) met John Hopkins, criteria: Only 3/17 patients(17 %) were upgraded and 2/17 patients (11 %) were upstaged. Fifty-two patients (88 %) met University of California, criteria: Twenty-four (46 %) were upgraded and 12 (20 %) were upstaged based on their final histopathology specimen. 6. Two patients (3 %) had PSA failure. Conclusion: AS is an established protocol however, our findings demonstrate that significant variations exist in the ability of different AS criteria to predict pathologically insignificant PCa at RP. Standardisation of AS protocols should be introduced if patients with PCa prostate cancer are to receive an optimal management.

96. Review of Prostate Ca in the Over 70’s in Our Institution UM Haroon1, J Forde1, T McHale2, F Sullivan3, G Durkan1

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S254 (1) Department of Urology, University Hospital Galway, Galway, Ireland; (2) Department of Anatomic pathology, University Hospital Galway, UHG, Galway, Ireland; (3) Department of Radiation Oncology, University Hospital Galway, UHG, Galway, Ireland Introduction: Rapid Access Prostate Cancer (RAPC) clinics have been introduced in Ireland to improve diagnostic and treatment pathways in prostate cancer (PCa) for patients under 70 years of age. Aim: We analysed patients over 70 years of age diagnosed with PCa in our institute. Methods: A retrospective analysis of patients undergoing a TRUS biopsy in our institution during 2011 was performed. Data relating to demographics, histology, PSA readings, radiology findings and subsequent treatment pathways were recorded. Results: In total, 1,229 patients underwent a TRUS biopsy of the prostate. Overall, 44 % of patients were diagnosed with PCa with 36.2 % of these over 70 years of age. Mean age was 75.4 years (range 71–88). Median PSA was 11.45 ng/mL (range 2.1–1,025). Gleason grade was as follows; 36 % Gleason 6, 31 % Gleason 7, 23 % Gleason 8, 8 % Gleason 9 and 2 % Gleason 10. Regarding imaging, 67 % patients underwent MRI, which showed T2 disease in 69.3 %, T3 in 35.7 %. Nuclear bone scan was performed in 68.7 %, showing metastatic disease in 14.4 %. Regarding treatment; 54.6 % had definitive radiotherapy (79 % external beam radiation therapy (EBRT), 13.2 % had combined EBRT/brachytherapy and 7.8 % brachytherapy alone), 25 % opted for active surveillance/watchful waiting and 20.4 % hormonal treatment alone. No patient over 70 had any surgical intervention. Conclusions: A significant proportion of patients diagnosed with prostate cancer are over 70 years of age with majority referred for definitive treatment in the form of radiotherapy. There is a case for the age limit of the RAPC to be raised to facilitate these patients.

97. The Clinic-Pathological Characteristics of Prostate Cancer in an Irish Subpopulation with a Serum PSA Less Than 4.0 ng/Ml FO Kelly, B McGuire, R Flynn, R Grainger, TED McDermott, J Thornhill Department of Urological Surgery, Tallaght Hospital, AMNCH, Tallaght, D24, Ireland Background: Prostate specific antigen (PSA) has been used as a biomarker for prostate cancer (CaP) for the last 20 years. Traditionally, a serum PSA\4 ng/ml has been used as a general cut-off. There is evidence to demonstrate that men with a normal serum PSA can develop prostate cancer. The aim of this study was to investigate the clinico-pathological features of prostate cancer in a non-screened Irish cohort with serum PSA \4 ng/ml. Methods: A retrospective analysis was performed of all patients who underwent radical retropubic prostatectomy (RRP) in a tertiary referral unit over a 10-year period (2000–2010). Clinico-pathological characteristics were collated including those from trans-rectal ultrasound-guided (TRUS) prostate biopsies and radical prostatectomy specimens. Results: Between 2000–2010, 651 men underwent RRP, with 43 (6.6 %) having a PSA \4 ng/ml. Median PSA was 3.2 ng/ml (range 0.8–4.0). Nineteen (44.2 %) had palpable disease. Following prostatectomy, 28 (65.12 %) had Gleason 6 disease, 14 (32.56 %) had Gleason 7 disease and 1 (2.32 %) had Gleason 8 disease. Five

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Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 (11.63 %) patients were upgraded on final histopathology. Six (13.95 %) patients had pathological evidence of extra-capsular extension on final pathology. Three (6.98 %) patients experienced biochemical recurrence and received salvage radiation therapy after a median of 24 months. Median follow-up was 106 months (range 36–158). Twenty (46.51 %) patients had a first-degree family history of prostate cancer. Conclusions: Our study emphasizes that this cut-off is inappropriate and that no specific level of PSA can be used. Management decisions need to be individualized based on index of suspicion with concomitant counselling and rectal examination.

98. Prevalence of Extended Spectrum Beta Lactamase Producing Enterobacteriaceae in the Urology Patient Population: A Prospective Audit J De Marchi1, P O’Malley2, A Shah1, D Bouchier-Hayes2, L Joyce3 (1) Department of Medical Administration, Beaumont Hospital, Beaumont, Dublin 9, Ireland; (2) Department of Urology, Galway Clinic, Doughiska, Co. Galway, Ireland; (3) Department of Surgery, Galway Clinic, Doughiska, Co Galway, Ireland Introduction: Extended spectrum beta-lactamase (ESBL) producing bacteria play a significant role in the urology patient where procedures such as trans-rectal ultrasound guided (TRUS) biopsies increase patient exposure to enterobacteriaceae. Few studies have examined the colonisation rate in the pre-operative healthy patient. Aim: This study aims to add to identify colonisation risk factors, compare ESBL prevalence among differing patient populations, and provide a local audit of antimicrobial resistance patterns. Methods: 150 Rectal swabs were taken pre-operatively from participants and directly plated onto MacConkay and ESBL BrillianceTM plates. Grown isolates were then identified and antimicrobial susceptibilities determined. Participants were simultaneously asked to complete a questionnaire about exposure to proposed risk factors. Results: Rectal swabs from each of the three sample populations were collected (50 each). Fluoroquinolone resistant enterobacteriaceae, including ESBL producers, were identified in each group (endoscopy n = 7 with 2 ESBL, TRUS biopsy = n = 4 with 2 ESBL, and urology n = 8 with 3 ESBL) but with no statistically significant difference in frequency. Uni-variant analysis showed none of the proposed risk factors (History of previous prostate biopsy, recent hospital admission, recent infection, recent antibiotic use, age, race, and foreign travel) affected ESBL colonisation rate. Backwards binomial log regression (multivariate) of all independent variables again showed no significant effect. Conclusion: No significant risk factors for ESBL colonisation have been identified at this time. As such, recommendations on TRUS biopsy antibiotic prophylaxis cannot be made on individual patient characteristics and should continue to follow a protocol based on local susceptibility and resistance patterns.

99. Post-Chemotherapy Retroperitoneal Lymph Node Dissection in the Management of Metastatic Testis Cancer: The 16-Year Experience in an Irish Setting S Considine1, R Heaney1, R Casey2, R Conroy3, J Thornhill1

Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 (1) Department of Urology, Tallaght Hospital, Tallaght, Dublin 24, Ireland; (2) Department of Urology, Colchester General Hospital, Colchester, Essex, UK; (3) Department of Biostatistics, RCSI, St Stephen’s Green, Dublin 2, Ireland Introduction: Post Chemotherapy Retroperitoneal Lymph Node Dissection (PC-RPLND) is an important tool in the management of advanced testis cancer, particularly Non Seminomatous sub-types. Aim: We present the 16-year experience with this surgery in a single Irish tertiary referral centre, and compare our results to the major speciality centres worldwide. Methodology: All patients undergoing PC-RPLND for the treatment of metastatic testis cancer between January 1996 and December 2011 were included. Medical records were reviewed and up to date follow up obtained from primary referral centres, patient’s GPs and individual patient interview by phone. Results: 78 patients were identified for inclusion. The mean age at diagnosis was 29 ± 7.7 years. 63 % of patients suffered from NSGCT. All patients underwent pre-operative chemotherapy, of which 92 % received BEP based regimes. The resection template utilised was bilateral in 28 %, unilateral in 42 % and suprahilar in 21 %. Complete abdominal remission was achieved in 98 %. Additional procedures were required in 43 % of patients. Histology of RPLND specimen showed teratoma in 42 % and active cancer in 13 %. Median follow up was 101 months. 7 patients relapsed, while overall 5-year survival was 95.2 % (4 deaths). Histology of RPLND specimen showed residual teratoma in 42 % and active cancer in 13 %. Conclusions: In this series we have shown comparable results and outcomes of PC RPLND compared to major international centres. Given the low numbers of patients requiring this surgery in Ireland, we advocate a single centre of excellence be established to ensure optimal patient outcomes.

100. Cancer Specific and Overall Survival of Patients Undergoing Preoperative Renal Artery Embolization Prior to Radical Nephrectomy for Renal Cell Carcinoma NP Kelly, GJ Nason, L Walsh, E Redmond, MJ Burke, A Aslam, HD Flood, SK Giri Department of Urology, Limerick University Hospital, Dooradoyle, Limerick, Ireland Introduction: Preoperative renal artery embolization (PRAE) prior to radical nephrectomy (RN) for renal cell carcinoma (RCC) has theoretical potential for prevention of tumour emboli due to intraoperative handling of tumour. However use of PRAE has not been widely adopted. In our institution, PRAE has been available and utilised since 2009. We aimed to assess the medium-term oncological outcome of patients who underwent PRAE prior to RN for RCC. Methods: A retrospective review of demographic, peri-operative, interventional data and medical notes was conducted on all patients undergoing RN in our hospital from January 2009 to December 2012. ANOVA and Chi square tests were used to compare data. Cancer specific survival (CSS) and overall survival (OS) data was calculated using Kaplan–Meier curves and a p-value of 0.05 was considered statistically significant. Results: 55 RN were performed during the study dates. 16 patients underwent PRAE. There was no difference in the age profile of the

S255 patients (63.63 ± 8.2 vs 62.28 ± 12.2 years, p = 0.689). Tumours subjected to PRAE were larger (9.06 cm ± 1.9 cm vs 5.89 cm ± 2.98, p \ 0.001) and of a higher stage (p \ 0.001) than those that did not. Patients who had embolization were more likely to have locally-advanced disease (p \ 0.01). There was no difference demonstrated for CSS or OS between the two groups of patients at 1 year (p = 0.974, p = 0.804), 3 years (p = 0.974, p = 0.622) or 5 years (p = 0.974, p = 0.622). Conclusions: Our data has shown that despite having larger and more advanced tumours, PRAE is not associated with an inferior survival. Prospective randomised studies are necessary to further validate this work.

101. Testicular Pain Requiring Surgery: An Audit of Patients Undergoing Scrotal Exploration in Our Lady of Lourdes Hospital Drogheda T Subramaniam, C Reilly, S Fahy, B Meshkat, HK Perthiani, S El Masry Department of Surgery, Our Lady of Lourdes Hospital, Drogheda, Co Louth, Ireland Background: While radiological investigations may aid in diagnosis of testicular-torsion, scrotal exploration remains the only definite method and allows for simultaneous treatment without further delay. An overcautious approach to acute testicular pain may lead to excessive negative exploration rate, while high reliance on radiology and delay to theatre may lead to high testicular loss rate. Aims: To audit our hospital testicular exploration rate. Method: All patients who underwent emergency scrotal-exploration during December 2009 to December 2013 were identified through the theatre logbook, and a retrospective review of their medical records conducted. Data were collected on patient demographics, duration of symptoms, time of presentation (day/night) any radiology findings prior to exploration, intraoperative findings and histology where available. Day hours were defined as 8 a.m. until 8 p.m. Results: There were 75 emergency scrotal-explorations performed during the period, with 61 % (n = 46) being done at night. Imaging was performed on 24 % (n = 18) of patients prior to surgery. The primary operating-surgeon was consultants in 18.7 % (n = 14) and registrars in 82.3 % (n = 61). The mean age of the patients was 15.6 years (range 3–59). In 53.3 % (n = 40) of explorations, testicular-torsion was confirmed, of which 28.2 % (n = 11) had unilateral-orchidopexy and 71.8 % (n = 29) had bilateral-orchidopexy. In 7.5 % (n = 3) of torsions a non-viable testis was confirmed and orchidectomy was performed. Exploration resulted in diagnosis of torted-cyst-of-Morgagni in 18.7 % (n = 14) of cases, and epidydimo-orchitis in 28 % (n = 21). Conclusion: Scrotal exploration rates are appropriate in our hospital with high pickup-rate of pathology, low reliance on radiology and very low testicular loss rate.

102. Active Surveillance Experience on FavourableRisk Prostate Cancer in HSE West S Gnanappiragasam1, J Forde1, M Moloney1, S Kiely2, K Walsh1, G Durkan1

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S256 (1) Department of Urology, University College Hospital, Galway, Ireland; (2) Department of Urology, Limerick Regional Hospital, Ireland Introduction: Active surveillance (AS) is a management strategy for addressing the widely acknowledged problem of overtreatment of clinically indolent prostate cancer. We present our experience with AS in the HSE West region. Methods: A total of 180 patients have been enrolled on the AS program between August 2010 and February 2014. All data was collected prospectively in a secure database. Results: Mean age of patients enrolled was 64.4 years (range 54–75). Median PSA at enrolment was 7.01 ng/ml (range 2.8–14.4). The mean follow-up was 32 months (range 3–36). In total, 85 % of patients had a repeat biopsy within 1 year with 30 % having another biopsy at 3 years. Overall, 65.3 % of patients remain on AS. In the remainder; 24 % of patients were removed from AS for definitive treatment, 8.2 % of patients are now on watchful waiting, 2.5 % of patients self discharged from the program and one patient died of cardiovascular disease. The prostate cancer specific survival rate is 100 %. Indications for removal from AS and referral for treatment were; upgrade of disease on repeat biopsy (64 %), PSA progression (26 %) and 10 % of patients made a decision proceed with definite treatment despite still being eligible. Regarding definitive treatment; 64.2 % of patients have been for referred for external beam radiotherapy, 28.8 % for brachytherapy, and 7 % for surgery. Conclusion: Our findings to date support active surveillance as a valid strategy for early, localised prostate cancer.

SESSION 13: TRAINING AND EDUCATION Dr Dara Byrne & Ms Carmel Malone 103. One Year Review of Emergency Abdominal CT Scans Performed in a University Hospital M Kelly1, A Heeney1, C Redmond2, J Costelloe1, J Dodd2, D Winter1 (1) Department of Surgery, St Vincent’s University Hospital, Elm Park, Dublin, Ireland; (2) Department of Radiology, St Vincent’s University Hospital, Elm Park, Dublin, Ireland Introduction: The role of computed tomography(CT) in acute abdominal illnesses has increased significantly in recent years. However, there remains a considerable variation in indications for scanning. In addition, the improved quality of CT has resulted in an increased detection of incidental findings. While some have clinical significance, many are trivial with appreciable investigatory cost implications. Aim: To evaluate the prevalence of incidental findings detected on CT-scans and the need for further diagnostics to complete the investigation. Methods: We performed a retrospective review of all emergency abdominal CT scans at a tertiary referral hospital from 1st January 2012 to 31st December 2012. We audited the volume of ‘‘incidentals’’ and the recommended investigations. Results: During the study period, there were 1,155 abdominal CTscans performed in an emergency setting. The main indications for scanning included abdominal pain 69.1 % (n = 799), vomiting 9.8 % (n = 114), altered bowel habit 16 % (n = 139), and blunt trauma 3.45 % (n = 40). 21.9 % (n = 253) had significant incidental findings detected. The most common incidental pathologies were hepatobiliary (n = 72), adrenal (n = 50), and gynaecological

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Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 (n = 41). Recommended follow-up diagnostics by radiology department included 62 targeted abdominal ultrasounds, 34 targeted pelvic ultrasounds, 29 gastroscopies, 27 targeted magnetic resonance imaging, 25 targeted CTs, 12 colonoscopies, 7 cystoscopies and 4 endoscopic ultrasounds. Conclusion: CT use has increased significantly in recent years. Though some studies have observed a decline in admission rates with its use, there has been an increased detection of incidental findings. Though many of these findings are benign and warrant no intervention, others require significant surveillance or investigation with considerable cost.

104. Medical Students: Attitudes Towards Basic Surgical Skills and the Undergraduate Curriculum D O Connor1, G Browne1, N Lynch1, M Kerin1 Department of Surgery, NUI Galway, Clinical Sciences Institute, Galway, Ireland Introduction and aim: Undergraduate surgical education has undergone significant change in the last decade. This study aims to investigate the attitudes of medical students towards surgical skills and investigate whether these attitudes are mirrored in surgical curriculum delivery. Methods: An internet based survey of medical students currently on clinical attachment in NUI Galway was carried out. Students were surveyed with the use of a 20 point questionnaire which included demographic data and a 5-point Likert scale. Results: There were 129 respondents of whom 82 were female and 47 male. 122 and 117 of respondents either agreed or strongly agreed that medical students should learn how to scrub and learn basic surgical skills (BSS) respectively. 109 and 116 believe that learning scrubbing and BSS, respectively, in a simulated environment contributes to efficient transference of those skills to the operating theatre. 59 respondents reported being formally taught to scrub, while 30 had been taught surgical skills. When asked about the optimum time to learn these skills C75 % selected their third medical year. Conclusion: The results demonstrate an appetite amongst students for an early introduction to basic surgical skills and techniques. A significant number of students had received formal training in scrubbing and basic surgical skills. This may reflect both the introduction of special study modules (SSMs) into the curriculum and also the foundation of the NUIG Surgical Society. The results also suggest that early introduction to surgical skills may be a helpful adjunct in encouraging surgery as a career choice.

105. Patients Attitude Towards Surgeons Attire in Our Lady of Lourdes Hospital Drogheda B Meshkat, G Bass, M Matcovici, Z Farnez, C Buckley, O Al Saffar, P Gillen Department of Surgery, Our Lady of Lourdes, Drogheda, Ireland Introduction: A doctors competence and professionalism is often judged on the basis of attire. Our Lady of Lourdes (OLOL) is a leading Irish hospital in the implementation of bare below the elbows (BBE) policy, however surgical attire is not standardised and there is great variability in attire worn on wards. Aim: To evaluate patients attitude towards surgeons attire in OLOL.

Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 Methods: A prospective survey of adult surgical in-patients was conducted from October 2013 to February 2014. A twelve-question questionnaire was used as data-collection-tool, using a five-point Likert-scale to assess patients response to each question. Data were collected on patient demographics, level of trust and confidence based on different surgical attire, and patients perception of different attire worn by surgical teams. Results: There were 150 completed surveys during the study period with a male-to-female ratio of 44 to 56 % respectively. The mean patient LOS was 4.7 days (range 1–22). The most commonly represented age group was 30–40 years (18 %), with a comparable spread among all age groups. Surgical scrubs were considered more appropriate attire by patients compared to shirt and tie with white-coat (p = 0.039) which was in-turn found more appropriate compared to short-sleeve-shirt and no tie (p = 0.01). Shirt and tie with white-coat and scrubs had equally positive effect on patient trust in 63 % of responders, and significantly higher positive effect on trust compared to short-sleeve-shirt and no tie (p = 0.01). Conclusion: A policy of scrubs only rather than short-sleeve-shirt with no tie should be considered for BBE compliance.

106. Planning and Development of a Clinical Research Database: An Illustrative Example for Clinicians C Gormley1, J De Marchi2 (1) Department of Research, RCSI, 123 St. Stephen’s Green, Dublin 2, Ireland; (2) RCSI, The Galway Clinic, Doughiska Rd, Galway, Ireland Introduction: Data collection and its management are central to clinical research, whether it be large multi-centre trials or single surgeon audits. Most surgeons are involved in data management during their research career, whether they recognise the technical phases and techniques they use to manage the data or not. Lack of adherence to best practices in the planning, development and maintenance of databases is a common cause of database disuse and ultimate failure as data management tools. Aim: This paper seeks to provide a brief yet comprehensive outline of the processes involved in clinical data management. These are discussed in a stepwise manner using our recently established database for major colorectal surgery as a practical example. Method: The techniques of software selection, database design, case report form creation and data entry are briefly discussed at an introductory level. We look at the use of data limitation tools, clinical classification systems and the importance of an audit trail in reducing data error and variation. Results: Using the aforementioned principles and processes of data management, we successfully established a working colorectal surgery database. This database includes a plethora of demographic, physiological and operative data attributes on 317 major colorectal resections with particular emphasis on the clinical application of risk prediction models (e.g., POSSUM, P-POSSUM, CR-POSSUM and ACPGBI scoring systems) to this dataset. Conclusion: Data management is of paramount importance in current clinical practice, and this paper details the necessary principles for successful database construction. Category: Training and Education.

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107. The Evolution of General Paediatric Surgery Provision and Training in Ireland: What’s Being Done and What More Do We Need to Do? B O Connor, E Andrews Department of Surgery, Cork University Hospital, Wilton, Cork, Ireland Introduction: The future of the provision of non-specialist general paediatric surgery (GPS) in the Republic of Ireland has been a point of discussion in the literature for over 15 years now. Aim: To review the literature and reports from relevant governing bodies to assess attitudes to the provision of GPS in Ireland and ascertain if progress has been made in improving the care of children needing GPS in this time period. Method: We performed a literature search of the PubMed database and also searched the relevant organisation’s websites for articles relating to the provision of GPS in the Republic of Ireland. Publications were compared, paying particular attention to any changes in attitude, concerns, service provision and surgical training during this time period. Results: In the Republic of Ireland, 21 (47 %) acute hospitals perform elective and or acute GPS with 3 (7 %) providing elective day case surgery only for children over 5 years of age. The majority of higher general surgical trainees would not be willing to provide a GPS service as a consultant. Despite an awareness of the impending problem over many years, changes in general surgical training or appointments of an appropriate number of adequately trained general surgeons have not occurred. Conclusion: Comprehensive dialogue needs to be opened between governing bodies, surgical trainers and trainees to plan for general paediatric surgical service provision going forward. It is clear that there is a need for a comprehensive national audit of all GPS in the Republic of Ireland.

108. Acute Surgical Admissions not Requiring a Surgical Procedure: Can We Improve Efficiency? D Collins1, G Kelliher2, D Kavanagh1, K Mealy2, FB Keane2 (1) Department of Surgery, Tallaght Hospital, Dublin, D24, Ireland; (2) Department of National Clinical Programme in Surgery, RCSI, Ireland Introduction: In 2013 the National Clinical Program in Surgery published the Model of Care for Acute Surgery. This highlighted the need to understand the emergency surgical workload in order to improve efficiency and help direct resources and staff appropriately. With recent improvements in ambulant care, surgical patients not requiring intervention could be treated in the community. However, the volume and pathology encountered in this patient cohort is largely unknown and potentially unpredictable. Aim: To analyse acute surgical admissions not requiring a surgical procedure based on available HIPE data. Methods: The data used was provided from the HIPE system and validated by the ESRI from their 2012 data set.

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Results: In 2012, 46,172 patients were admitted under a surgical service but did not undergo a surgical procedure. This accounted for 76,862 bed days used (BDU) with an average length of stay (AvLOS) of 2.75 days. The most common pathologies are detailed in the table below. Interestingly, many of these patients could be treated in the community with close outpatient follow up. Conclusion: The majority (60.2 %) of acute surgical admissions do not require a surgical procedure. Understanding the volume and pathology of acute surgical admissions should help to direct workforce planning, patient flow and ultimately patient care.

Pathology

BDU

AvLOS

Num Pat

Abdominal pain

11141

2.32

7713

Cellulitis

8996

3.33

2287

Gallbladder disease

6831

4.55

2149

Urological

4973

2.68

2718

Diverticular disease

2000

3.47

639

Gynaecological

1847

1.786

1459

Head Injury

1614

1.81

1829

Pancreatitis

1353

3.094

438

SBME Programme SIMMED School SimSurgery SSM Transitioning

Level of Expertise Number of Participants Second Level Undergraduate

23 23

Final Year

621

Intern Training

Intern

596

Respiratory Emergencies

SpR

12

All participants rated training sessions as C4 on a 5-point Likert scale for both effectiveness of learning and acceptability

Conclusion: High fidelity manikin based simulation is an effective learning tool whose versatility allows for education and training of all levels in common medical emergencies.

110. Global Rating Scale (GRS) Under the Microscope S Shaharan1, D M Ryan1, O Traynor1, D Buckley2, P Neary2

109. From The ‘‘Jes’’ To The ‘‘Res’’ - Delivering High Fidelity Manikin-Based Simulated Scenarios To All Levels Of Expertise G Browne, T McVeigh, P O’Connor, MJ Kerin, Dr Dara Byrne Department of Surgery, Galway University Hospital, Galway University Hospital, Galway, Ireland

Introduction: High fidelity manikin-based simulation is a versatile tool for teaching, learning and assessing technical and non-technical skills. Matching the learning objectives to the needs and expertise of the learner leads to a rich learning experience regardless of their level of experience. Aims: The aim of this study was to describe our experience in delivering training in common medical emergencies using high fidelity manikin-based simulation to second level, undergraduate students and postgraduate medical trainees. Methods: Our 6year experience in simulation-based education(SBE) at intern level has transferred to undergraduate and postgraduate medical education. Currently we deliver: SIMMED School (Transition year students); SIM-Surgery Special Study Module (SIMSSM, 4MB); transitioning programme (5MB); intern education and training; and a respiratory emergency management programme for registrars, all using multimodal simulation techniques. The emergency scenarios in the high fidelity manikin based simulation are the same for all groups: anaphylaxis, hypovolaemia, sepsis etc and the assessment tools used are the same; DOPS (Direct Observation of Procedural Skills) and NOTTS (non-technical skills for surgeons). Results: Since 2009, 1275 students have been trained using simulation-based education.

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(1) Department of Surgical Affairs, RCSI, 121 St Stephen’s Green, Dublin 2, Ireland; (2) Department of Surgery, AMNCH, Tallaght, Dublin 24, Ireland Introduction: Objective Structured Assessment of Technical Skills (OSATS) remains the classic assessment tool for open surgical skills. It consists of a procedure-based checklist and Global Rating Scale (GRS). It is labour intensive due to its dependence on expert observers. Aim: We aimed to assess the feasibility and reliability of the GRS in scoring basic suturing skill and compare it with an automated objective tool. Method: Consultants, surgical trainees and medical students were recruited for this study. Subjects performed simple interrupted suturing on bench models. Time to completion of task was recorded. Video recordings were assessed by 2 independent blinded experts using the modified GRS (mGRS) relevant to the suturing task. Subjects’ performances were also assessed by PatriotTM electromagnetic motion tracker with a sensor attached on the subjects’ index finger to track the hand motion. The metric generated from the raw data was total path length (TPL). The reliability of mGRS was assessed using Cronbach’s alpha for internal consistency and kappa for inter-rater agreement. Correlation between mGRS and TPL was established using Spearman analysis. Results: The internal consistency of mGRS was good with alpha 0.97. The inter-rater agreement was optimistically fair for each component with kappa between 0.2–0.3. There is a strong correlation between path length, ‘‘time and motion’’ and ‘‘flow of operation’’. Conclusion: The mGRS is reliable in assessing basic suturing skills. However, to achieve a good inter-rater agreement is difficult despite the most ideal setup. The PatriotTM device could potentially eliminate human element in providing an objective assessment tool.


111. The Use of Cross-Platform Smartphone Messaging Technology to Aid Vascular Patient Care R Murphy, S McHugh, E Murphy, A Leahy Department of Vascular Surgery, Beaumont Hospital, Dublin 9, Dublin, Ireland Introduction: Mobile technology available through smartphone usage continues to expand, with the potential for incorporating app technology into daily practice. We describe the usage of a commonly utilised social group messaging application ‘‘WhatsApp MessengerTM’’ in the daily care of acute surgical inpatients in a tertiary centre. Aim: To examine smartphone possession among doctors. To explore usage of messenger applications, and explore messaging trends. Method: WhatsApp Messenger TM is a cross-platform mobile messaging app, allowing users to exchange group messages without SMS. As a pilot study surgical interns in a tertiary vascular unit downloaded WhatsApp Messenger TM and utilised it over 3 months. The chat conversation was analyzed to extract trends in conversation topics. Results: With regard to usage, a total of 1,128 WhatsApp messages were sent over the time period. 32 % were updates on jobs completed, 23 % related information about the scheduling of team activities, 19 % of messages communicated clinical questions. 16 % of messages related to the delegation of clinical jobs that were to be committed. 11 % of messages discussed meeting up for breaks. A surge in message activity was noted on days where the team were post take. Conclusions: WhatsApp Messenger TM and other smartphone communication applications can facilitate communication in a hospital setting, with the potential to improve quality of patient care. Better patient handover can be facilitated and all members of the team can be kept up to date on team activities. This is especially relevant on days where the team is post take.

SESSION 14: ORTHOPAEDIC II SESSION Mr Michael Leonard & Mr Bill Curtin 112. Trauma Centre Experience with Air Ambulance Service 2013: A Retrospective Study J Gibbons, O Breathnach, J Quinlan Department of Orthopaedic Surgery, Tallaght Hospital, Tallaght, Dublin 24, Ireland Introduction: Helicopter emergency medical services (HEMS) are now in use worldwide to provide potentially life-saving pre-hospital care. This study examines the cases from the HEMS provided to Tallaght hospital and examines dispatch criteria with the aim to determine the best allocation of this service. Methods: From the aero-medical service log there was a cohort of n = 48. Using Google Maps, times to hospital by air and estimated road-time were compared. Using internationally recognised categories for trauma-related dispatch criteria for HEMS each case was evaluated. Results: Of the 48 cases (35 male, 13 female; age: 41.7 years [r = 23.6]), 43 were trauma cases. 12 patients were discharged without speciality input, 7 died within the first 24 h. The majority of cases admitted, 80 %, were orthopaedic. The average length of stay 9.3 days (r = 9.9). 11 required operative management, 5 ICU management, 3 insertion of chest drain, 1 cardiac angiogram.

S259 Of the dispatch criteria used, prolonged time to hospital by road was the most frequent criteria met, 79.2 % Other criteria examined: Mechanism of Injury 60.4 %, Need for ATLS 58.3 %, Inaccessible 43.8 %, patient age 31.3 %. Analysis of the transport time revealed— mean distance by road: 83.4 km (r = 45.2), mean air-transport time: 69.4 min (r = 19.9), difference between air-transport and estimated road-time: 51.7 min faster by air. Conclusions: This is a retrospective study of 1 year, of a single hospital’s experience with HEMS. Further research is needed in order to identify a general set of criteria with the highest sensitivity and specificity so as to develop a better algorithm for HEMS dispatch.

113. Tibial Plateau Fractures: Long Term Outcomes Following Operative Repair A Nic an Riogh, GN Solayar, FJ Shannon Department of Department of Trauma and Orthopaedic Surgery, Galway University Hospitals, Galway, Ireland Introduction: Tibial plateau fractures are complex peri-articular injuries of the proximal tibia. Depending on the severity of the fracture tibial plateau fractures can be treated either conservatively or with operative management. Aims: We analysed the long-term functional and radiological outcome following surgical treatment of tibial plateau fractures (minimum 10 years). Method: We performed a retrospective review of all patients who underwent operative management of tibial plateau fractures from the time radiological records were initiated till 2003. Patients were identified using theatre logbooks. We excluded patients who did not have complete records from the time of injury. 70 patients were identified during this time—30 females and 40 males. All fractures were classified according to the Schatzker classification. Schatzker type 2 was the commonest pattern. Patients were followed up with questionnaires and x-rays of the knee. Long term functional (HSSKnee), patient satisfaction and radiological (Ahlb ‘‘ck’’) scores were obtained and analysed. Results: 25 % of patients had radiographic evidence of osteoarthritis at their last follow up. 8 % of patients subsequently underwent a total knee replacement on the ipsilateral side. HSS scores ranged from 15 to 92. 83 % of patients were satisfied with their primary operation. Conclusion: The long term results following operative management of tibial plateau fractures remain good.

114. Halo Vest versus Cervical Collar in Conservative Management of Stable Isolated Atlas Fractures P O Sullivan1, T Fahey2, C Marks1 (1) Department of Neurosurgery, Cork University Hospital, Wilton, Cork City, Ireland; (2) Department of Division of Population Health Sciences, RCSI Medical School and HRB Centre for Primary Care Research, 123 St. Stephen’s Green, Dublin 2, Ireland Introduction: Non-operative management of stable isolated atlas fractures includes both halo vest (HVI) and rigid cervical collar immobilisation (CCI). In practice, HVI is more inconvenient for

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S260 patients and associated with more complications than cervical collars. No comparison of important outcomes between the two modalities exists in the literature. Aim: To review existing literature to compare outcomes between the two methods of stable atlas fracture treatment. Methods: Using PRISMA guidelines, we performed a comprehensive electronic database search (from inception to end-2012) and systematic review of studies of stable isolated atlas fractures treated nonoperatively, looking at radiographic fracture union, pain, function at follow-up and complications of therapy with either HVI or CCI. Primary authors were asked to provide incomplete or missing data. Data analysis and presentation were performed using Review Manager Version 5.2. Results: 12 retrospective studies of a total 119 cases were identified for review. 73 cases (61 %) underwent rigid CCI while 46 (39 %) had HVI. 114 (96 %) achieved radiographic fracture union at 3 months. Non-union occurred in 2 (4 %) patients treated with HVI and in 1 (1 %) elderly patient treated with CCI. The single reported pin-site infection was treated successfully with antibiotics. 18 patients in total (9 %) had significant pain at follow-up; there were no adverse neurological outcomes. Heterogeneity of data reporting prevented comparison of outcomes between HVI and CCI. Conclusion: This review confirms that external cervical immobilisation effectively treats stable isolated atlas fractures. There is no evidence in favour of HVI over CCI.

115. Upper Limb Surgeons: So You Think You’re Funny! a Study of Nominative Determinism in Orthopaedics P Mc Quail, L Murphy, J Kelly, K O’ Shea Department of Trauma and Orthopaedics, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland Introduction: Nominative determinism describes how names can influence and determine life choices. Recent research demonstrates that nominative determinism can play a role in career choices and patient’s health. Aim: To ascertain whether a sub-speciality interest is an indirect marker of your usage level of humour, that is, are those specifically interested in the humerus more humorous by nature. Method: The ‘Richmond Humor Assessment Instrument’ (RHAI) was issued to Orthopaedic Surgeons of Specialist Registrar and Consultant grade in a variety of sub-specialities. A focal assessment of Upper Limb surgeons was performed at the annual meeting of the Irish Hand Surgery Society. A comparative analysis was performed. Results: 120 Questionnaires were issued with a 58 % response rate. Orthopaedic surgeons with a sub-speciality interest in upper limb surgery had an average score of 64/80 on the RHAI. The sub-specialities found to be the least characteristically comical were Foot and Ankle surgeons and Spinal surgeons, scoring averages of 40 and 38/80 respectively. Conclusion: Orthopaedic surgeons with a sub-speciality interest in the humerus/upper limb demonstrate high levels of humour usage on a daily basis. This was statistically significant when compared to their colleagues in Spinal and Foot and Ankle surgery.

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116. A CT Evaluation of 200 Normal Ankles to Determine the Optimal Anatomical Position when Inserting Syndesmotic Screws O Carmody1, M Kennedy2, C Kennedy3, M Dolan3 (1) Department of Orthopaedic Surgery, Temple Street University Hosp, 202 Beechwood Court Apartments, Stillorgan, Ireland; (2) Department of Trauma and Orthopaedic Surgery, Cappagh National Orthopaedic Hospital, Cappagh, Dublin, Ireland; (3) Department of Trauma and Orthopaedic Surgery, Cork University Hospital, Cork, Ireland Introduction: Classical AO teaching recommends that a syndesmosis screw should be inserted at 25 to 30 degree angle to the coronal plane of the ankle. In practice accurately judging the 25/30 degree angle can be very difficult. Aims: To determine the ideal anatomical landmarks for placement of a screw across the ankle syndesmosis. Methods: The CT scans of 200 normal ankles which had been performed as part of CT angiograms were retrospectively examined. The centroid of the fibula and tibia in the axial plane 15 mm proximal to the talar dome was calculated. Since a force vector between the centroid of the fibula and the tibia in the axial plane should not displace the fibula relative to the tibia, a line connecting the two centroids was therefore postulated as the ideal syndesmosis line. Where this ideal line passed through the lateral border of the fibula, and through the medial malleolus was then noted. Results and Conclusion: The ideal syndesmosis line was shown to pass through the fibula with in 2.5 mm of the lateral cortical apex of the fibula, and the anterior half of the medial malleolus in 100 % of the ankles studied. The results support the concept that in the operatively-reduced syndesmosis, the anterior half of the medial malleolus can be used as a reliable guide for aiming the syndesmosis drill hole, provided that the fibular entry point is at or adjacent the lateral fibular apex. The screw should also remain parallel to the tibial plafond in the coronal plane.

117. Plotting Fibular Length for Children with Leg Length Discrepancy Using CT Scanogram NP McGoldrick, K Olajide, J Noel, P Kiely, DP Moore, P Kelly Department of Trauma and Orthopaedic Surgery, OLCHC, Crumlin, Dublin 12, Ireland Introduction: Current understanding of normal lower limb growth and growth prediction originates in the work of Anderson et al. published in the 1960s. There now exist several clinical and mathematical methods to aid in the treatment of leg length discrepancy, including the timing of epiphysiodesis. Early research in this area provided limited information on the growth of the fibula. It is now well recognized that abnormal growth of paired long bones may evolve into deformity of clinical significance. Existing work examining fibular growth used plain film radiography only. Computed Tomography (CT) scanogram is now the preferred method for evaluating leg length discrepancy (LLD) in the paediatric population. Aim: To use CT Scanogram to evaluate fibular growth, and thus calculate normal growth velocity, which may aid in determining the timing of epiphysiodesis.

Ir J Med Sci (2014) 183 (Suppl 5):S201–S261 Method: CT Scanograms for children presenting to our unit between 2009 to 2013 for investigation of LLD were retrospectively analysed. Scanograms for children aged between 7 and 18 years of age were included. Mean fibular length, taken as the average distance from epiphysis to epiphysis, was calculated and plotted against time in years. A linear regression model was subsequently analysed. Results: 400 children were included in calculations (46 % girls [n = 184], 54 % boys [n = 216]). Mean fibular length for both boys and girls at each year was determined and plotted against time. Conclusion: CT Scanogram may be used to calculate fibular growth in children presenting with leg length discrepancy.

118. Childhood Obesity as a Risk Factor for Upper Extremity Fractures A Abdulkarim, A Moriarty, E Sheehan Department of Orthopaedic Surgery, Midland Regional Hospital, Tullamore, Offaly, Ireland Introduction: There is no clear data regarding the degree of obesity and the risk pertaining to upper extremity fracture. Methods: We prospectively collected data on 280 children and adolescents between 2 to 19 years of age who presented to hospital with upper extremity trauma. We determined BMI and BMI-for-age percentiles for each patient. Fracture types were classified and the management was recorded. Any complications were recorded in follow up visits from the outpatient department. The associations among the BMI class and specific upper extremity fractures were estimated using multiple logistic regression models and expressed with odds ratios (ORs) and 95 % confidence intervals (CIs) using multivariate analysis to adjust for patient demographic variables. Results: Children of both genders with a BMI above the 85th percentile for their age group had an increased OR of an upper extremity fractures (OR 1.24, with 95 % CI 1.11–1.34) compared to children of the same age below the 85th percentile. The association was strongest in boys between the ages of 5- to 13-year-old. Boys with raised BMI were more likely to require operative management than their normal weight peers (P \ .05). Conclusions: Our study found that children with a BMI above the 85th percentile for their age were at increased risk of a more severe upper extremity fracture compared to children with a lower BMI. The raised BMI group was a risk factor operative management of their fracture.

119. The Availability of Accessible and Good Quality Information on the Internet for Patients Regarding Rotator Cuff Tears D Dalton1, E Kelly2, D Molony2 (1) Department of Surgery, Galway University Hospital, Galway, Ireland; (2) Department of Orthopaedics, Waterford Regional Hospital, Ardkeen, Waterford, Ireland An era of joint decision making between the physician and patient is emerging. Patients are increasingly looking to the internet for healthcare information. It is imperative that this information is pertinent to the patients and is written at an appropriate level for

S261 individuals to understand. There are a variety of treatments for chronic rotator cuff tears. Patients should be aware of the risks and benefits of each. We examined the quality of information available for patients online. We examined 125 websites identified from searching the term ‘‘rotator cuff tear’’ in the 5 most popular internet search engines. We assessed readability by measuring the Flesch Reading Ease Score, Flesch Kincaid Grade Level and Gunning Fox Index. Quality of the websites was measured using the DISCERN instrument, and the JAMA benchmark criteria and the presence of HON certification was established. There were 59 individual URLs analysed. Overall the quality was poor with the mean DISCERN score being 39.47. Furthermore the mean reading grade level was over 9, the recommended level being 6. HON certification did correspond to significantly worse readability scores (p = 0.004) but did not correlate to improved DISCERN scores. Those who satisfied more of the JAMA benchmark criteria did have significantly better DISCERN scores (p \ 0.001). Online patient information regarding rotator cuff tears is of a low standard with many cases written at too high a level for the general population. There are qualitative instruments which surgeons must be aware of in order to identify the best resources to direct patients to.

120. Standardised Consent: The Effect of Patient Information Sheets on Information Retention K Clarke, P O’Loughlin, J Cashman Department of Orthopaedics, MMUH, Eccles St, Dublin 7, Ireland Introduction: Informed consent embodies the ethical principle of autonomy in the surgical patient. Timely, effective communication is essential to this decision-making process. Variability can lead to confusion amongst patients and can expose the surgeon to risk in an increasingly litigious environment. Aim: to evaluate the use of a standardised consenting process and assess pattern of information recall following provision of patient information sheets. Methods: One hundred participants were randomly selected from OPD to participate in this prospective audit. Mean age was 41 years. Each participant was consented to undergo wrist MUA and K-wiring using a standardised BOA consent form. A 22-item questionnaire was completed based on the information provided. Fifty patients received written take-home information. Each questionnaire was repeated 1 day later to determine which aspects of consent were best retained. Results: 5 % of patients recalled all potential risks of surgery initially discussed (average score 4/10). This increased to 52 % with prompting (average score 8/10). Pain and compartment syndrome were least well remembered (4 and 2 % respectively). Patients who received written information were significantly more likely to recall all potential complications 24 h later compared with those who had not (10 vs. 2 % respectively, p = 0.02). In particular, arthritis, neurovascular injury and infection were significantly more likely to be remembered with provision of written information (p = 0.01). Conclusion: Consent remains challenging even with a standardised process. Information retention improves significantly with the use of patient information sheets. We advocate the use of standard consent sheets and provision of patient information sheets for commonly performed procedures.

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Abstracts of the Irish Society of Urology, 25-26 September, 2014, Killarney, Ireland.

Abstracts of the 62nd Annual and Scientific Meeting Science for Healthy & Active Ageing. October 9-11, 2014. Galway, Ireland.

Abstracts of the 33rd European Peptide Symposium, August 31-September 5, 2014, Sofia, Bulgaria.

The 10th Max Grob Memorial Lecture--Zurich, September 5, 1991.

Dale and the development of pharmacology. Lecture given at Sir Henry Dale Centennial Symposium, Cambridge, 17-19 September 1975.

The ninth Sir George Pickering memorial lecture. Ambulatory monitoring and the definition of hypertension.

Abstracts of the 53rd Annual Meeting of the European Society for Paediatric Endocrinology (ESPE), September 18-20, 2014, Dublin, Ireland.

Centenary Award and Sir Frederick Gowland Hopkins Memorial Lecture. Protein folding, structure prediction and design.

Creating a gold standard surgical procedure: the development and implementation of TVT : Ulf Ulmsten Memorial Lecture 2014.

David Streeten Memorial Lecture presented at the 24th International Symposium on the Autonomic nervous System.

Abstracts from the FEBS EMBO 2014 Conference, 30 August-4 September, 2014, Paris, France.

Abstracts of the Irish Society for Rheumatology, Autumn Meeting 2013, 19-20 September, 2013, Co.Meath, Ireland.

Abstracts from the 2014 ISDE World Congress, September 22-24, 2014, Vancouver, Canada.

Abstracts of the Interdisciplinary Symposium on Osteoporosis 2014, April 23-26, 2014, New Orleans, LA.

Abstracts of the Interventionell Radiologisches Olbert Symposium IROS 2014, January 16– 18, 2014, Salzburg, Austria.

THE GORDON WILSON MEMORIAL LECTURE.

ISOO Symposium, June 26-28, 2014, Miami, Florida.

The Gordon Wilson Memorial Lecture.

Masahiro Iio Memorial Lecture.

The challenges of anaesthesia for the next decade: the Sir Robert Macintosh Lecture 2014.

THE GORDON WILSON MEMORIAL LECTURE.

The Gillies Memorial Lecture 1975.

Abstracts of the 23rd Sylvester O’Halloran Perioperative Scientific Symposium, March 6-7, 2015, Limerick, Ireland.

Sixth International Symposium on Biomechanics and Medicine in Swimming. Liverpool, 7-11 September 1990. Abstracts.