Operative reports at emergency inguinal hernioplasty may not be comprehensive enough to avoid later litigation

s / International Journal of Surgery 12 (2014) S13eS117 S97 Results: Of the 202 appendicectomies, 23 (11%) were histologically negative for appendicitis and there were 31 (15%) cases of perforated appendix. When comparing the “negative appendicitis” vs. “inflamed appendix” group, we found no significant difference between the frequency of raised WCC, NC, CRP. The sensitivity and specificity of each blood test for a diagnosis of acute appendicitis were as follows:WCC (62.6% and 52.2%), NC (72.6% and 43.5%), CRP (70.9% and 47.8%), and for 2 combined tests (70.9% and 43.5%). When comparing “perforated appendix” vs. “non-perforated” group, therewas a significant difference in the number of cases with raised CRP (p<0.05). CRP was 90.3% sensitive for perforated appendix. Conclusions: Inflammatory markers, including WCC, NC and CRP are not accurate enough to diagnose acute appendicitis. However, CRP alone is a sensitive marker for cases of perforated appendix. 1225: OPERATIVE REPORTS AT EMERGENCY INGUINAL HERNIOPLASTY MAY NOT BE COMPREHENSIVE ENOUGH TO AVOID LATER LITIGATION Mohamed Mohamud , Frances Parkinson, Andrew J. Beamish, Gethin Willliams, Brian Stephenson. Royal Gwent Hospital, Newport, UK. Introduction: Chronic groin pain (CGP) after inguinal hernia repair is a multi-factorial problem of variable incidence. Litigation for testicular injury and CGP accounts for up to 40% of claims with settlements averaging over V85,000. Methods: We scrutinised computerised surgeon-typed reports (ORMIS) of all emergency inguinal hernia repairs in a single DGH during 2013. We specifically sought clear description of spermatic cord handling and inguinal canal nerves. Results: All repairs (n1⁄4 27; all male; mean age 65; range: 25-93 years) were performed by surgeons in training using an open approach. The consent form uniformly described CGP as a possible complication. The majority (23/27; 85%) were primary hernias with well-described operative findings in all cases. Cord handling was documented in 19 patients (70%) and two underwent orchidectomy. The repair was augmented with prosthetic mesh in the majority of cases (89%) but the ilio-inguinal nerve status was described in only two patients. No report mentioned ‘seeking but not finding’ nerves. Conclusions: Surgeons in training seem to disregard documenting the status of nerves at urgent repair. Lawyers canbe forgiven for arguingnegligence (“post hoc, propter hoc”) if records omit observations on structures prone to ‘inadvertent’ damage. This should be emphasised to all trainees. 1288: THE DIAGNOSTIC VALUE OF INFLAMMATORY MARKERS IN PERFORATED APPENDICITIS Mohammad Eddama, Sara Renshaw , Konstantinos Fragkos, Georgina Bough, Latha Bonthala, Richard Cohen. University College