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Aim To improve the quality and completion of consent forms for patients undergoing emergency laparotomy. Methods A standard for emergency laparotomy consent forms, guided by recommendations from the National Emergency Laparotomy Audit (NELA) was established. This standard was used to score consent forms. Our initial audit of 20 consent forms scored an average of 41.9%. A template sticker, specific to emergency laparotomy, was created. This contains all of the information deemed important by our standard. The sticker allows the surgeon completing the consent process to simply tick off the individual components once discussed with the patient and apply it to the regular consent form. The stickers were introduced to all of those involved in consenting patients, and their use was strongly encouraged. Results Consent forms were collected and scored over the following 2-months. Of the 18 consent forms, 33% made use of the consent form sticker, with an average score of 65.2% (improvement of 23.3%). In analysing scores for both the pre- and post-intervention consent forms, we found a P value of < 0.0001. Conclusions The use of consent templates specific to surgical procedures improves the quality of consent forms and ensures that all possible complications are discussed with patients. The use of stickers for emergency laparotomy has improved the quality of our consent forms. With ongoing use, we aim to ensure that all patients undergoing this procedure are adequately consented. There remains room for continued improvement, and we believe ongoing exposure to these stickers will lead to an up-take in use.

Aim To assess consent forms for appendicectomy and ensure that patients are consented for an intraoperative finding of a normal appendix. Method Retrospective audit assessing consent forms (for mention of Normal appendix finding) for patients who underwent appendicectomy over a 2-month period. Results A total of 68 patients underwent appendicectomy. The age range of these patients was 3 to 84 years old (median 20 years). 58 of these procedures were performed laparoscopically. 23 (33.8%) of the consent forms have mention of a normal appendix. The remaining 45 patients (66.2%) had no mention of normal appendix on the consent form. In analysis of the operative notes, 7 patients had no intraoperative finding of macroscopic inflammation. Of these 7 patients, only 1 was consented for a normal appendix finding. Conclusion During the consent process for an appendicectomy, it is important to warn the patient (or caregiver) about the possibility of finding a normal appendix. The appendix is routinely removed regardless of the intraoperative findings (normal or inflamed). The patient should be made aware, as the appendicectomy may not result in the resolution of their symptoms, or further procedures may be required. This audit found that there is currently a deficit in consenting patients, undergoing appendicectomy, about the possibility of finding a normal appendix intraoperatively. A quality improvement project is currently underway, wherein a combination of departmental education and patient information booklets aims to improve consenting practices.

Background The aforementioned service provides specialist intestinal failure care to patients in Leicestershire and surrounding counties. Aim To study the epidemiology of IF cases referred to the service & review outcomes particularly the indications and delivery of parenteral nutrition (PN). To review catheter-related sepsis (CRS) rates and identify areas for improvement. Method Service data from January 2016 to November 2017 was analysed retrospectively. Descriptive and inferential statistical analysis was carried out. Chi-square/ Fisher Exact tests were used to identify significance on categorical data and non-parametric settling was used for qualitative data analysis. Results 365 patients were referred to the service from January 2016 to November 2017. 58% patients had grade I intestinal failure. 34% and 24% referrals were made by the colorectal and hepato-pancreato-biliary (HPB) units respectively. Gut rest (27%) and bowel obstruction (25%) were the most common indications for nutritional support. Duration of PN requirements varied greatly, but most patients (39%) patients required it for up to 7 days. Single lumen PICC line (64%) and cephalic vein (54%) were the most commonly used catheter and site of vascular access respectively. Chronicity of IF and number of vascular catheters required to provide PN were significantly associated with rates of CRS. Conclusions CRS was found to be statistically significantly associated with chronic IF and number of vascular access catheters required to provide PN. Cost implication and morbidity of CRS could be analysed further to identify other ways to provide safer and cost-efficient parental nutrition for patients with intestinal failure.

Background Amyand’s hernia, first described by Claudius Amyand in 1735, continues to remain a diagnostic & therapeutic challenge. By definition includes inguinal herniae that contain the vermiform appendix. Aim This up-to-date review aims to define and classify Amyand’s hernia and suggest appropriate management options in the current era. Aim to shed light on the value of pre-operative cross-sectional imaging and the use of laparoscopic surgery to provide a one stop solution. Method Published English literature was reviewed (1735–2021), using PubMed and Embase, combining the MeSH terms “hernia”, “inguinal”, “appendix”, “Amyand”, “low dose CT” and “laparoscopic herniotomy”. Most cited open access reviews, case series and case reports were chosen to provide a framework. A recent case is described with selected images (radiological, histology and intra operative). Results Since the original publication, by Claudius Amyand in 1735, there exists a gulf on this condition in the available British medical literature. Nearly 100,000 hernia repairs are performed in the UK annually. If Amyand’s hernia account for 1% of these (according to the most stated estimate), there should be a thousand Amyand’s herniae repaired annually in the UK alone. Unfortunately, the management options remain nonstandard. Conclusions Computerized tomography (CT) allows for pre-operative diagnosis and should be considered more often, even in children. Laparoscopic appendicectomy combined with a laparoscopic herniotomy is a safe one stop solution, in experienced hands, for paediatric patients.