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Introduction: - Corona virus disease (COVID-19) is an emerging disease that threatens the biosecurity of all countries and spreading rapidly worldwide. Early diagnosis of the disease is essential because of high infectivity and mortality rates of COVID-19. Aims and objective: -The study was to observe and compare the clinical, biochemical and hematological proles between high dependency unit (HDU), Intensive care unit (ICU) and pregnant women with conrmed COVID 19 positive RT-PCR. Material and methods: - This study is conducted in COVID-19 dedicated Tertiary Care Hospital attached to RNT Medical College, Udaipur of Southern Rajasthan. Data of all patients with conrmed positive RT-PCR was collected during April 26, 2021 to May 31, 2021 from respective Lab Coordinator appointed for this purpose. SPSS statistics software was used for data statistics and mapping. Continuous variables were expressed as median and IQR (Inter Quarentile Range). Results:- Out of 428 patients 174 patients were in ICU, 235patients were in HDU and 19 patients were pregnant women. Mean age of 428 is 47.32 year ranging 18-86yrs. Among these 428 patients 267(62.38%) patients were males and 161(37.62%) patients were females. The biochemical, coagulation and hematological parameters such as Serum Ferritin, Lactate Dehydrogenase, C-Reactive Protein, Blood Sugar, D-Dimer, Prothrombin Time & INR, ESR, WBC, and Absolute Neutrophil Count were statistically signicant(p

Introduction: Covid 19 is the ongoing pandemic which has affected millions of people across the world. Till date the number of confirmed cases in India has crossed 70 lacs. The clinical symptoms vary from a mild flu like illness to a severe from leading to ARDS, CBC analysis is a widely available test which can prove helpful in stratifying patients with Covid 19 infection. Neutrophil to Lymphocyte Ratio (NLR), Platelet to Lymphocyte Ratio (PLR) and Ct values have been studied across the world as a screening tool for severity among patients with Covid 19 infection.Aim: This Study aims to analyze NLR, PLR ratio among Covid 19 patients and co-relate the severity of illness with viral load.Type of Study: Retrospective StudyMaterial and Methods: Records of 80 Positive patients of Covid 19 were analyzed. Demographic data was recorded on a pre designed proforma, along with laboratory parameters like CBC, NLR, PLR and Ct values.Results: Out of 80 patients analyzed, 61 were males and 19 were females. Hemoglobin ranged between 6.7 gm/dl to 15.7 gm/dl with a mean of 12.27 gm/dl. Total leucocytes count ranged from 2.9x 103/ cumm to 22.0x 103 /cumm with mean of 7.4 x103 /cumm. 5 out of 80(6.25%) patients had Leucopenia and 6 out of 80 (7.5%) patients had Leucocytosis. Platelet count ranged from 65000 to 6.39 lacs/cu mm. Thrombocytopenia was observed in 13 patients (16.0%), while thrombocytosis was seen in 2 patients (2.5%). Cycle threshold value ranged between 19.18 and 34.0 with a mean of 26.59. NLR was calculated and it ranged from 0.55 to 27.0 with 17 patients having NLR >3.3, 63 patients had a NLR less than 3.3. All 17 patients who had a NLR > 3.3 were males, 14 of them were > 40 years of age( 14/17) and rest 3 were between 20-40 years of age.11 patients had PLR > 180( i.e. 11 out of 80) and all of them also had NLR >3.3. Most of the patient had mild to moderate symptoms, only 14 out of 80 patients(17.5%) required ICU care during the course of illness and 11 of these (78.57%) patients had NLR >3.3 and PLR >180.Cycle threshold was 3.3 and PLR value of > 180 are sensitive markers in assessing the progression of disease. Ct value should not be considered as an important tool in monitoring the disease

Background Recently, the laparoscopic or minimally invasive approach has become common practice for planned colorectal malignancies. Its use in the emergency setting is limited by various factors, including resource availability and surgical expertise. However, more recent evidence suggests a laparoscopic approach to colorectal emergencies, which is comparable with laparoscopic routine work, and often promising. In this study, authors have investigated the outcome of the laparoscopic approach in both benign and malignant colorectal emergencies. Method Retrospective analysis of prospectively collected data (theater records, histology database, and discharge records) over the course of 9 years. The standard surgical approach included conventional laparoscopic and single-port technique (single-incision laparoscopic surgery). The outcome variables included in the final analysis were: success of the minimally invasive approach, conversion rate, postoperative complications, return to theater, and mortality. Results A total of 202 (males, 110 and females, 92) emergency patients with a median age of 59 years underwent surgery between December 2009 and 2019. The mean operating time was 169 minutes and median American Society of Anesthesiology grade III. Single-incision laparoscopic surgery was used in 19 patients (9.4%). The conversion to open surgery was 12.3% (n=25). The majority of them had primary anastomosis (n= 132, 65.3%).The complications from most to least frequent were: CONCLUSION:: The favorable results obtained in this study underline the theme that with the availability of resources and expertise, it is possible to offer minimal invasive approach to emergency colonic pathology.

Introduction Squamous cell carcinoma is the most common variant of anal malignancy. Certain disease-related factors have been established in determining survival. These include tumour size, differentiation and nodal involvement. Other factors such as HIV status, human papillomavirus infection, smoking and socioeconomic disparity may have important roles, however few data are available on the UK population. We aim to correlate social deprivation and survival of anal cancer patients at a tertiary centre. Materials and methods All consecutive cases diagnosed with anal squamous cell carcinoma and treated as per local protocol between July 2010 and April 2017 were included. The pathological and demographical details were collected from a prospectively maintained database. Socioeconomic deprivation was defined for each postcode using the Index of Multiple Deprivation decile compiled by local governments in England. Survival was estimated using Kaplan–Meier analysis and Cox regression was used to investigate the effect of different factors on overall survival. Results A total of 129 patients with anal squamous cell carcinoma over a median follow-up of 43 months were included. Overall survival for the entire patient cohort was 87.7% (95% confidence interval, CI, 82.0–93.7%), 75.5% (95% CI 67.5–84.5%) and 68.9% (95% CI 59.7–79.6%) at one year, three years and five years, respectively. On multivariate analysis, Index of Multiple Deprivation and income do not significantly influence overall survival (p = 0.79, hazard ratio, HR, 1.07; 95% CI 0.61–1.63), (p = 0.99, HR=1.00; 95% CI 0.61–1.63), respectively. Increased risk of death was observed for male sex (p = 0.02, HR=2.80; 95% CI 1.02–5.50) and larger tumour size (p = 0.01, HR=1.64; 95% CI 1.12–2.41). Conclusion In contrast to US studies, there is little difference in survival between the least deprived and most deprived groups. We attribute this to equal access to intensity-modulated radiation therapy-based chemoradiotherapy. Thus, a highly effective treatment made available to all mitigates any survival difference between socioeconomic groups.

Summary Background Radical surgery via total mesorectal excision might not be the optimal first-line treatment for early-stage rectal cancer. An organ-preserving strategy with selective total mesorectal excision could reduce the adverse effects of treatment without substantially compromising oncological outcomes. We investigated the feasibility of recruiting patients to a randomised trial comparing an organ-preserving strategy with total mesorectal excision. Methods TREC was a randomised, open-label feasibility study done at 21 tertiary referral centres in the UK. Eligible participants were aged 18 years or older with rectal adenocarcinoma, staged T2 or lower, with a maximum diameter of 30 mm or less; patients with lymph node involvement or metastases were excluded. Patients were randomly allocated (1:1) by use of a computer-based randomisation service to undergo organ preservation with short-course radiotherapy followed by transanal endoscopic microsurgery after 8–10 weeks, or total mesorectal excision. Where the transanal endoscopic microsurgery specimen showed histopathological features associated with an increased risk of local recurrence, patients were considered for planned early conversion to total mesorectal excision. A non-randomised prospective registry captured patients for whom randomisation was considered inappropriate, because of a strong clinical indication for one treatment group. The primary endpoint was cumulative randomisation at 12, 18, and 24 months. Secondary outcomes evaluated safety, efficacy, and health-related quality of life assessed with the European Organisation for Research and Treatment of Cancer (EORTC) QLQ C30 and CR29 in the intention-to-treat population. This trial is registered with the ISRCTN Registry, ISRCTN14422743. Findings Between Feb 22, 2012, and Dec 19, 2014, 55 patients were randomly assigned at 15 sites; 27 to organ preservation and 28 to radical surgery. Cumulatively, 18 patients had been randomly assigned at 12 months, 31 at 18 months, and 39 at 24 months. No patients died within 30 days of initial treatment, but one patient randomly assigned to organ preservation died within 6 months following conversion to total mesorectal excision with anastomotic leakage. Eight (30%) of 27 patients randomly assigned to organ preservation were converted to total mesorectal excision. Serious adverse events were reported in four (15%) of 27 patients randomly assigned to organ preservation versus 11 (39%) of 28 randomly assigned to total mesorectal excision (p=0·04, χ2 test). Serious adverse events associated with organ preservation were most commonly due to rectal bleeding or pain following transanal endoscopic microsurgery (reported in three cases). Radical total mesorectal excision was associated with medical and surgical complications including anastomotic leakage (two patients), kidney injury (two patients), cardiac arrest (one patient), and pneumonia (two patients). Histopathological features that would be considered to be associated with increased risk of tumour recurrence if observed after transanal endoscopic microsurgery alone were present in 16 (59%) of 27 patients randomly assigned to organ preservation, versus 24 (86%) of 28 randomly assigned to total mesorectal excision (p=0·03, χ2 test). Eight (30%) of 27 patients assigned to organ preservation achieved a complete response to radiotherapy. Patients who were randomly assigned to organ preservation showed improvements in patient-reported bowel toxicities and quality of life and function scores in multiple items compared to those who were randomly assigned to total mesorectal excision, which were sustained over 36 months’ follow-up. The non-randomised registry comprised 61 patients who underwent organ preservation and seven who underwent radical surgery. Non-randomised patients who underwent organ preservation were older than randomised patients and more likely to have life-limiting comorbidities. Serious adverse events occurred in ten (16%) of 61 non-randomised patients who underwent organ preservation versus one (14%) of seven who underwent total mesorectal excision. 24 (39%) of 61 non-randomised patients who underwent organ preservation had high-risk histopathological features, while 25 (41%) of 61 achieved a complete response. Overall, organ preservation was achieved in 19 (70%) of 27 randomised patients and 56 (92%) of 61 non-randomised patients. Interpretation Short-course radiotherapy followed by transanal endoscopic microsurgery achieves high levels of organ preservation, with relatively low morbidity and indications of improved quality of life. These data support the use of organ preservation for patients considered unsuitable for primary total mesorectal excision due to the short-term risks associated with this surgery, and support further evaluation of short-course radiotherapy to achieve organ preservation in patients considered fit for total mesorectal excision. Larger randomised studies, such as the ongoing STAR-TREC study, are needed to more precisely determine oncological outcomes following different organ preservation treatment schedules. Funding Cancer Research UK.

Acute appendicitis is a common surgical emergency; however, its misdiagnosis resulting in negative appendicectomy is not uncommon. Novel diagnostic methods will help reduce the rate of negative appendicectomy. We hypothesise that the neutrophil-lymphocyte ratio (NLR) will increase upon peritoneal involvement by inflammation, as it does in severe disease.We conducted a retrospective analysis on prospectively collected data for all emergency appendicectomy patients during the study period. We studied blood results at the time of presentation, and histology of the removed appendices. Receiver Operating Characteristics were calculated to classify histologically normal versus inflamed appendices and moderate versus severe disease. Moderate disease was that confined to the sub-serosal layers, while severe disease involved the serosa and beyond.A total of 372 patients underwent emergency appendicectomy, 254 (78.4%) of which subsequently had acute appendicitis on histology. Sixty-five (25.6%) and 189 (74.4%) patients had moderate and severe disease, respectively. The median age was 27 years (range 16-84). In diagnosing acute appendicitis, the cut-off value of the NLR was 4.2, while the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 79.5%, 67.0%, 89.8%, and 47.5%, respectively. In identifying the moderate versus severe disease, the cut-off value was 9.7, while the sensitivity, specificity, PPV and NPV were 71.4%, 53.8%, 85.4% and 43.7%, respectively.Inflammatory markers are useful adjuncts to history, examination, and radiological investigations in making the diagnosis of appendicitis. However, due to low sensitivity and specificity, they cannot be used alone. Calculation of the NLR has no additional benefit over the neutrophil count in diagnosis, or in distinguishing moderate and severe disease.

Summary Background Closure of an abdominal stoma, a common elective operation, is associated with frequent complications; one of the commonest and impactful is incisional hernia formation. We aimed to investigate whether biological mesh (collagen tissue matrix) can safely reduce the incidence of incisional hernias at the stoma closure site. Methods In this randomised controlled trial (ROCSS) done in 37 hospitals across three European countries (35 UK, one Denmark, one Netherlands), patients aged 18 years or older undergoing elective ileostomy or colostomy closure were randomly assigned using a computer-based algorithm in a 1:1 ratio to either biological mesh reinforcement or closure with sutures alone (control). Training in the novel technique was standardised across hospitals. Patients and outcome assessors were masked to treatment allocation. The primary outcome measure was occurrence of clinically detectable hernia 2 years after randomisation (intention to treat). A sample size of 790 patients was required to identify a 40% reduction (25% to 15%), with 90% power (15% drop-out rate). This study is registered with ClinicalTrials.gov, NCT02238964. Findings Between Nov 28, 2012, and Nov 11, 2015, of 1286 screened patients, 790 were randomly assigned. 394 (50%) patients were randomly assigned to mesh closure and 396 (50%) to standard closure. In the mesh group, 373 (95%) of 394 patients successfully received mesh and in the control group, three patients received mesh. The clinically detectable hernia rate, the primary outcome, at 2 years was 12% (39 of 323) in the mesh group and 20% (64 of 327) in the control group (adjusted relative risk [RR] 0·62, 95% CI 0·43–0·90; p=0·012). In 455 patients for whom 1 year postoperative CT scans were available, there was a lower radiologically defined hernia rate in mesh versus control groups (20 [9%] of 229 vs 47 [21%] of 226, adjusted RR 0·42, 95% CI 0·26–0·69; p

Purpose The NHS Bowel cancer screening programme (NHSBCSP) aims to reduce colorectal cancer (CRC) cumulative mortality by up to 23 per cent; long-term outcomes at national level are not yet known. The purpose of this paper is to examine a local population of CRC patients of screening age for their characteristics and long-term survival in relation to their presentation, including through the NHSBCSP. Design/methodology/approach Retrospective analysis of a prospectively maintained CRC database for the years 2009-2014 in a single district hospital providing bowel cancer screening and tertiary rectal cancer services. Findings Of 528 CRC patients diagnosed in the screening age range, 144(27.3 per cent) presented through NHSBCSP, 308(58.3 per cent) electively with symptoms and 76(14.4 per cent) as emergency. NHSBCSP-diagnosed patients were younger (median 66 vs 68 and 69 years, respectively, p=0.001), had more often left-sided cancers (59(41.0 per cent) vs 82(26.6 per cent) and 24(31.6 per cent), respectively, p=0.001), more UICC-stage I (42(29.2 per cent) vs 49(15.9 per cent) and 2(2.6 per cent)), stage III (59(41.0 per cent) vs 106(34.4 per cent) and 20(26.3 per cent)) and less stage IV disease (8(5.6 per cent) vs 61(19.8 per cent) and 34 (44.7 per cent), respectively, pp Originality/value Patients diagnosed within the NHSBCSP have improved outcome compared to both symptomatic elective and emergency presentations. A reduction in overall cumulative mortality in order of 25 per cent may well be achieved, but continuing high levels of emergency presentations and undetected right-sided disease emphasise need for further improvement in public participation in the NHSBCSP and research into more sensitive and acceptable alternative screening methods.

Transanal endoscopic microsurgery (TEM) is a minimally invasive technique that is increasingly being used to treat early rectal cancer (T1/T2). We studied the outcomes of TEM for rectal cancer at our institution looking at the indication, recurrence rate, need for further radical surgery, 30-day and 12-month mortality and complication rate. We performed a retrospective analysis of prospectively collected data of cases between 2008 and 2012: 110 TEM procedures were performed during this period: 40 were confirmed rectal cancers and 70 were benign. We analysed the data for the 40 patients with confirmed rectal cancer. Thirty (75 %) of the subjects were male with a mean age of 71 ± 10 years (range 49-90 years) and 19 (48 %) patients were ASA 3 and 4. Nineteen (48 %) of cancers were pT1, eighteen (45 %) were pT2, two (5 %) were pT3 and one was yPT0. Mean specimen size was 66 ± 20 mm (range 33-120 mm) with a mean polyp size of 41 ± 24 mm (range 18-110 mm). The mean cancer size was 24 ± 13 mm (range 2-50 mm). Average distance from the anal verge was 70 ± 37 mm (range 10-150 mm), and the mean operating time was 72 ± 22 min (range 40-120 min), with an average blood loss of 28 ± 15 ml (range 10-50ml). Median hospital stay was 2 ± 1 days (range 1-7 days). Complete excision (R0) was achieved in 37 (93 %) patients. Minor post-operative complications included urinary retention in two and pyrexia in three patients. There were no 30-day or 12-month mortalities. Mean follow-up was 13 ± 11 months, range (3-40 months) Local recurrence occurred in two (5 %) patients, both underwent redo TEM. Twelve (30 %) patients underwent laparoscopic radical resections (seven AR and five APER) post-TEM. Post-operative histology confirmed pT0N0 in 7/12 patients. Three were lymph node-positive (T0N1), one was pT3N1 and the fifth was pT3N2. TEM is associated with quicker recovery, shorter hospital stay and fewer complications than radical surgery. It is a good alternative to radical surgery in early rectal cancer, especially for high-risk patients. Recurrent tumours can be treated with redo TEM.

Single-port access (SPA) offers cosmetic advantages in addition to the well-recognised benefits of conventional multi-port laparoscopic (CL) surgery, and can be carried out using standard straight instruments. We report the outcomes of our early experience with SPA colorectal resections in comparison with CL surgery. We compared the following data, patient characteristics, operating time, morbidity, operative mortality, length of hospital stay and tumour variables, of patients who underwent SPA right, left, sigmoid and total colon resections, as well as high anterior resections and panproctocolectomies, with that of patients who underwent equivalent conventional laparoscopic (CL) operations. The 40 SPA and 78 CL patients studied underwent surgery between February 2008 and September 2011. There was no difference between the SPA and CL operations, as regards the patient’s sex (55.0 vs. 62.8 % males, p = 0.411), comorbidity (ASA I 10.0 vs. 12.8 %; ASA II 57.5 vs. 59.0 %; ASA III 32.5 vs. 25.6 %; ASA IV 0 vs. 2.6 %, p = 0.722) and body mass index (26.2 vs. 28.0 kg/m2, p = 0.073). However, SPA patients were younger (mean age 54.1 vs. 64.8 years, p = 0.001), and malignancy was a less common indication for surgery (25.0 vs. 71.8 %, p

Introduction Oncological outcome from Extra-Levator Abdomino-Perineal Excision of low rectal cancers (ELAPE) have been shown to be superior to those achieved by conventional APER. However, it usually requires some form of pelvic floor repair due to the larger defect, and it has been suggested that ELAPE carries a higher morbidity particularly in view to pelvic floor complications. We examined results and outcomes from ELAPE and APER in our institution. Method All non-restorative excisions of primary low rectal cancers in a single colorectal unit between 2009 and 2014 were retrospectively examined, using data from healthcare records, pathology records and administrative databases. End points for analysis included duration of hospital stay following index surgery, rates of immediate (≤ 30 days) and late post-operative complications, re-admission rates, re-interventions and perineal hernia rates. Results A total of 44 patients underwent non-restorative excision of a rectal cancer (26 ELAPE and 18 APER), with a median follow up period of 30 months. There was no difference between the groups for age, gender, BMI, and rates of pre-operative neo-adjuvant treatment. However, there were more UICC stage III cancers in the ELAPE group compared to APER (5/26 [19.2%] vs. 11/18 [61.1%], p = 0.035). The median length of stay was similar in both groups (7.5 days, p = 0.44), and there was no difference between ELAPE and APER for early complication (12/26 [46.2%] vs. 7/18 [38.9%], p = 0.632), re-intervention (12/26 [46.2%] vs. 3/18 [16.7], p = 0.078), readmission (8/26 [30.8%] vs. 1/18 [5.6%], p = 0.071), and perineal hernia rates (1/26 [3.8%] vs. 1/18 [5.6%], p = 0.474). However, late perineal complications were more common in ELAPE (17/26 [65.4%] vs. 2/18 [11.1%], p Conclusion ELAPE appears to have no increased short-term morbidity compared to conventional APER, but late complication rates are higher. This may be, in part, explained by tumour factors, use of neo-adjuvant treatment and the use of mesh for reconstruction in this group. Selective use of ELAPE for non-restorative excision of a rectal cancer is advised, and the role of flap reconstruction may need to be considered in more patients. Disclosure of interest None Declared.

Introduction The role of local excision for early rectal cancer continues to be a topic of debate due to high local recurrence rates. The quality of local excision is an important factor determining risk of local recurrence. Small T1 (Sm1 and Sm2) tumours can be adequately treated with trans-anal excision using specialised techniques such as trans-anal endoscopic microsurgery (TEM) or trans-anal endoscopic operation (TEO). Current practice dictates radical surgery (RS) for all other rectal tumours to achieve acceptable oncological outcomes. Method A retrospective analysis of prospectively kept data from a single centre case series of patients treated with TEM for early rectal cancer. We analysed data for patients who had rectal preservation without subsequent RS, and were followed up with regular clinical examination, blood tests, CT chest/abdomen/pelvis and MRI rectum. All local excisions were approved by the local MDT and performed by 2 trained consultant colorectal surgeons. Results Sixty eight patients underwent TEM for early rectal cancer between June 2009 and August 2013, 25 patients went on to have RS and 1 TEM was converted intra-operatively to RS. Forty two patients (61.8%), 31 males (73.8%), were followed up with rectal preservation. The mean age was 74 years (S. D =/- 9.8) and ASA grades of patients: ASA I 2.4%; ASA II 35.7%; ASA III 54.8%; and ASA IV 7.1%. The median height of tumour was 7cm (range 1–15), operative time was 90 min (range 30 – 320), and in all cases blood loss was minimal. Median length of stay was 2 days (range 1–17). Median tumour size was 20mm (range 2–50) and the pathological stage was T1 in 20/42 (45.2%) (Sm1 5/20[25%], Sm2 8/20[40%], Sm3 7/20[35%]), T2 in 17/42 (40.5%) and T3 in 3/42 (7.1%) patients. Two patients (4.8%) had no residual tumour following neo-adjuvant therapy/polypectomy. The TEM specimen contained lymph nodes in 6/42 cases (14.3%), positive in 2/42 (4.8%). The overall local recurrence rate was 9.5% (4/42 unfit or unwilling for RS, 2 with involved margins). The local recurrence rate with clear margins was 5.3%. Recurrence rate for T0, T1, T2 and T3 disease was 0% (0/2), 0% (0/19), 6.2% (1/16) and 33.3% (1/3) respectively when excluding recurrences with positive margins. The median length of follow up 17 months (range 3–60) and rectal cancer specific mortality was 2.4% (1 patient unfit for radical surgery with T3 disease). Conclusion This case series demonstrates a very low recurrence rate in contrast to most of the published series. We believe the technique and quality of surgery is an important factor contributing to local recurrence following local resection. We propose that further studies should be considered for identifying additional patients in whom rectal preservation can be safely offered. Disclosure of interest None Declared.

Introduction Ileoanal pouch surgery is still being done as an open procedure in many centres in spite of advancement of skills in laparoscopic colorectal surgery. There is plenty of evidence to show the early advantages of laparoscopic colorectal surgery but we believe that even the long term outcomes are likely to be better for pouch surgery. Single port laparoscopic ileoanal pouch surgery through the stoma site is a very attractive option. Method All patients undergoing restorative proctocolectomy or completion proctectomy and ileoanal pouch surgery since 2011 were included. Retrospective analysis performed from a prospectively collected database after confirmation by reviewing patient case notes. All operations were performed laparoscopically by using a multichannel single port device through ileostomy site. Specimen removed from the port site and 20 cm J pouch anastomosed to the anal canal. Results A total of 14 patients (M:F –7:7) with a median age of 27 years (range 17–52 years) underwent single port laparoscopic Ileal pouch anal anastomosis. Their median BMI was 25.75 (range 19.5–40) with a median ASA of 2 (range 1–3). The procedure was completed laparoscopically through the stoma site in all patients except two who required suprapubic incision for division of anorectal junction. The median operating time was 230 mins (range 130–420 mins). The median hospital stay was 4 days (range 3–10). All the patients started taking normal diet by day 2 and stoma started functioning at a median of day 2. Two patients had readmission within 30 days due to stoma related complications. Median interval of reversal of ileostomy was 11 weeks (range 5–20 weeks) with one patient still awaiting reversal as it was done recently. Median stool frequency was 4/24 h, one patient had recurrent pouchitis which settled with probiotics. All patients are satisfied with their recovery, pouch function and continence. Conclusion Ileoanal pouch surgery can be done safely as a single port laparoscopic procedure through the ileostomy site with very good pouch function. Open surgery with long incision is not required for these patients as better results can be achieved by single port laparoscopic surgery. Disclosure of interest None Declared.

Introduction A study to assess the impact of the introduction of the National Bowel Cancer Screening Programme (BCSP) on the workload of a colorectal unit in a medium-size general hospital covering a population of 400,000, and to compare it to the initially projected figures. Methods We used the BCSP database, hospital episode statistics and the locally held colorectal cancer Multi-Disciplinary Team (MDT) database to identify all patients with newly diagnosed colorectal cancer diagnosis between April 2007 and November 2012. Demographic data, pathological data, MDT outcomes and treatment details were examined. Results During the study period of 66 months, a total of 194 patients with screening-detected colorectal cancer were referred to the local MDT (mean 32 cases per annum). Of these, 144 patients had a cancer resection (74.2%, mean 24 cases per annum). The remaining 50 cases included unfit patients as well as those with metastatic disease at presentation and patients with polyp cancers not requiring resection. Furthermore, there was an increase in numbers seen from 2010 onwards, coinciding with the increase in the screening age limit to 75 years. Conclusion This study measures the effect of the national BCSP on the surgical workload and quantifies the proportion of patients requiring surgery. It was projected that 33 people per annum newly diagnosed with colorectal cancer would be referred from the BCSP centre to the local MDT 1 ; this study confirms this projection. Disclosure of Interest None Declared. Reference BCSP Publication No. 3 (2008): Guidance for public health and commissioners.