PTH-348 THE OUTCOME OF AN ENHANCED RECOVERY PROGRAMME APPLIED TO MINIMALLY INVASIVE CYTOREDUCTIVE SURGERY T Bullen*, C Selvasekar, G Punnett, R Fish, PE Fulford, MS Wilson, O Aziz, AG Renehan, ST O’Dwyer. Department of Surgery, The Christie Hospital, Manchester, UK 10.1136/gutjnl-2015-309861.1234 Introduction Pseudomyxoma peritoneii (PMP) is a rare neo- plasm arising from the appendix, characterised by disseminated peritoneal mucinous tumour and progressive accumulation of mucinous ascites. For established disease, treatment by cytore- ductive surgery (CRS) and heated intra-peritoneal chemotherapy (HIPEC) is the accepted standard of care. 1 Through a UK national treatment centre, we increasingly identify patients with localised extra- appendiceal mucin without evidence of diffuse dissemination of disease (referred to as LAMN II tumours). 2 We developed a programme of risk-reducing cytoreductive surgery (RCRS) and HIPEC, initially by open surgery (period 1); subse- quently by laparoscopically assisted CRS and HIPEC (period 2); and more recently adding an enhanced recovery protocol (ERP) (period 3). 3 Here, we describe key outcome measures through this evolution. Method Using a prospective database we recorded patients undergoing RCRS and HIPEC between 2003 and 2014; Opera- tive time and length of stay and morbidity graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) were recorded. Results Sixty patients with LAMN II appendiceal tumours had RCRS and HIPEC: There was no difference in the demographics or ASA grade. There was no mortality in all groups. Conclusion We demonstrate that the combined approach of lap- aroscopic CRS with HIPEC and ERP in patients with localised LAMN II tumours is associated with very low morbidity and short hospital stay, desirable criteria for a risk-reducing pro- gramme. There were no complications due to ERP. Disclosure of interest None Declared. REFERENCES 1 Chua TC, Moran BJ, Sugarbaker PH. Early and long-term outcome data of patients with pseudomyxoma peritoneii from appendiceal origin treated by a strat- egy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Clin Oncol. 2012;30(20):2449–56 2 McDonald JR, O’Dwyer ST, et al. Classification of and cytoreductive surgery for low-grade appendiceal mucinous neoplasms. Br J Surg. 99(7): 987–92 3 Fish R, Selvasekar C, et al. Risk-reducing laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for low-grade appendiceal mucinous neoplasm: early outcomes and technique. Surg Endosc. 28(1): 341–5 PTH-349 USE OF METHYLENE BLUE TO IDENTIFY URETERS UNDER FLUORESCENCE DURING LAPAROSCOPIC AND OPEN COLORECTAL SURGERY 1 T Yeung*, 1 D Volpi, 1 G Nicholson, 2 N Buchs, 2 C Cunningham, 2 R Guy, 2 R Hompes, 2 I Lindsey, 2 B George, 2 O Jones, 1 B Vojnovic, 1 F Hamdy, 1 N Mortensen. 1 University of Oxford; 2 Oxford University Hospitals, Oxford, UK 10.1136/gutjnl-2015-309861.1235 Introduction Iatrogenic ureteric injury is a serious complication of colorectal surgery. Fluorescence image guided surgery (FIGS) is an expanding field and can potentially make operations safer for patients and prevent inadvertent ureteric injury. Intrave- nously administered methylene blue is excreted renally and con- centrated in the urine. It is fluorescent at 660nm and can therefore be used to locate ureters intraoperatively using fluores- cence enabled cameras and laparoscopes. The aim of this study is to assess the use of methylene blue under fluorescence to identify ureters during laparoscopic and open colorectal surgery. The primary objective is to compare ureter identification using white light versus fluorescence in each patient. The secondary objectives are to quantify the level of flu- orescence at different time points following administration of methylene blue and to work out the optimum time to visualise the ureters. Method All adult patients undergoing either laparoscopic or open colorectal surgery were considered for inclusion into this study. Exclusion criteria were pregnancy, significant renal or hep- atic impairment, and patients taking SSRIs with a risk of devel- oping serotonin syndrome. Between 0.25 – 1 mg/kg of methylene blue was administered intravenously during the opera- tion. Background and peak fluorescence were measured at multi- ple time points during the procedure, using custom-made fluorescence-enabled laparoscopes and open cameras that could detect fluorescence at 660 nm. Results 8 consecutive patients undergoing colorectal surgery were recruited into this study, of which 6 were laparoscopic and 2 were open procedures. Out of 11 ureters, 10 were successfully visualised under fluorescence (example shown in image below). The mean time to peak fluorescence was 14.5 min after intrave- nous methylene blue injection. There was a low background sig- nal, and the mean signal to background ratio was 2.74. Fluorescence could be detected up to 75 min after injection. This technique was considered useful in 4 patients: in one case, the ureter was more medial than initially thought, in another case, the ureter was not seen on white light but was seen under fluorescence, and in two cases, the ureters were traced from the pelvic brim all the way to the kidneys. There were no complica- tions after administration of methylene blue. Abstract PTH-348 Table 1 Shows the short-term outcomes between the groups Open CRS (n = 34) Laparoscopic CRS (n = 26) TRP TRP (n = 6) ERP (n = 20) Length of stay: days (median) 7–18 (10) 5–10 (6.5) 4–15 (6) Days on CCU (median) 1–6 (2) 0–2 (1) 0–4 (1) Operative time: Hours (median) 5.9–8.7 (7.0) 8.2–10.1 (8.8) 6.9–11.5 (8.5) Number of complications (NCI CTCAE Grade 3 and 4) 2 0 1 Abstracts A562 Gut 2015;64(Suppl 1):A1–A584