Results: mean 53.3% median 51%. Range 17-87%. Mean total laparoscopic simulator task time: Lowest 10% AST score¼ 1286 seconds, highest 10% ¼ 574 seconds Conclusions: Early results show the possibility in identifying those indi- viduals who excel on AST and laparoscopic simulator tests. More impor- tantly it can also identify those who might struggle in the technical aspect of surgical training due to their low performance in both tests. 0604 ACCURACY OF TIME-KEEPING IN THE SURGICAL PATIENT PATHWAY AND ITS IMPACT ON OPERATING THEATRE UTILISATION Suraya Zainul-Abidin, Maha Shariff, Zacharia Silk, Shubhanan Upadhyay, Rehan Rajput, Haig Gulian. Imperial College Business School, London, UK Introduction: Optimal operating theatre scheduling plays a crucial role in maximising quality and cost-effectiveness of surgical care. Theatre data management systems are designed to capture real-time patient data per- taining to the surgical pathway, influencing case-scheduling and resource management. Aim: To assess the accuracy of data captured by theatre staff using Thea- treManTM (Trisoft) and its impact on efficient theatre utilisation. Methods: Independent observers recorded the timings of 7 key steps in the patient pathway for 38 randomly selected operations at a major Lon- don Teaching Hospital. The results were compared with data recorded on TheatreManTM and analysed using the student T-test. Results: Recorded anaesthesia and operation ‘start' times were significantly earlier than observed ‘start' times (p¼0.0000 and p¼0.0010). Recorded operation ‘finish' times were significantly later than observed ‘finish' times (p¼0.0069). Total operative time was overestimated by a mean of 6.1 minutes per case (S.D 11.2 mins, 95% CI: 2.4 to 9.8 mins), leading to over- estimation of theatre utilisation by 4.2% over a 12 month period. Conclusion: Benchmarked times for surgeon-specific-procedure were found to be inaccurately recorded. The cumulative impact of this resulted in an actual utilisation of 65.8% over twelve months as opposed to the 70% perceived utilisation in this hospital. 0607 EXPLORING THE OPINIONS OF HEALTHCARE STAFF REGARDING KEY BARRIERS TO EFFICIENT OPERATING THEATRE UTILISATION Zacharia Silk, Maha Shariff, Suraya Zainul-Abidin, Rehan Rajput, Shubhanan Upadhyay, Haig Gulian. Imperial College Business School, London, UK Introduction: An increasing demand for NHS services requires effective utilisation of existing resources in all areas of healthcare, especially oper- ating theatres. It is well recognised that an 'empty theatre' has a significant impact upon the surgical patient pathway, and contributes to increasing financial burden on hospital and NHS budgets. Aim: To explore and establish the reasons for sub-optimal operating theatre utilisation from the perspective of key healthcare staff. Methods: A range of individuals from the medical, nursing, administration and management teams were identified and interviewed using a semi- structured questionnaire. Theoretical saturation was achieved after 14 interviews. The interviews were transcribed, 246 codes were identified and thematic analysis was undertaken to determine our results. Results: Seven key themes emerged as being central to inefficient theatre utilisation. These were: cancellations; ineffective scheduling; lack of resources; inter-professional relations and communication; staff motiva- tion; bureaucracy and documentation; poor pre-operative planning. Conclusion: A number of complex, inter-related factors influence effective utilisation of the operating theatre, ranging from systems issues to more intangible aspects. Increasing physical capacity and human resources alone are insufficient to optimise theatre utilisation. What is required is a paradigm shift in organisational culture and working practices. 0608 RADIOLOGICALLY INSERTED BIODEGRADABLE (SX-ELLA) OESOPHAGEAL STENTS TO TREAT DYSPHAGIA DUE TO BENIGN OR MALIGNANT OESOPHAGEAL STRICTURES Ewen Griffiths, Catherine Gregory, Jeremy Ward, Kishore Pursnani, Robert Stockwell. Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK Introduction: Biodegradable (BD) oesophageal stents have only been available commercially since 2008 and previous published research is limited. Our aim was to review the use of BD stents to treat dysphagia in benign or malignant oesophageal strictures. Methods: Patients were identified from a prospective interventional radiological database. Results: 18 BD SX-ELLA stents were inserted in 13 males and 3 females. The median age was 68 (range 54-80). Indication for BD stent was dysphagia from benign strictures (n¼ 6), or in patients due to have neoadjuvant chemotherapy awaiting oesophagectomy (n¼ 7), radical chemo-radio- therapy (n¼ 4) or palliative chemotherapy (n¼1). Median dysphagia score before stent insertion was 3 (range 2-4) compared to 1 post stent insertion (range 0-2). There was a statistically improved dysphagia score after stent insertion (p¼ 0.001). Technical success was 94% and clinical success was 76%. 6 patients required subsequent metallic stent insertion. In the neo- adjuvant chemotherapy group, 4 patients had irresectable disease and 3 patients were unfit for surgery. Conclusion: BD stents provide good dysphagia relief for the life time of the stent. However, the reintervention rate is high after the stent dissolves. Patients with severe dysphagia who are potential surgical candidates require careful re-staging. 0613 NOVEL TECHNIQUE OF RECONSTRUCTING THE INGUINAL LIGAMENT USING RECTUS FEMORIS FASCIA Alasdair Bott, Shaheel Chummun, Rory Rickard. Derriford Hospital, Plymouth, Devon, UK Introduction: We describe a technique of reconstructing the inguinal ligament using rectus femoris fascia. A 62-year-old man presented with massive bilateral abdominal wall hernias, six years after developing bilateral inguinal hernias. In the interim, he had undergone six unsuccessful hernia repairs, with wound breakdown on one occasion healing by secondary intention. MRI showed attenuation of both recti and absence of the remainder of the musculoaponeurotic abdominal wall anterior to both mid-axillary lines. The right inguinal ligament had been destroyed. The missing inguinal ligament was reconstructed using a 4cm wide strip of vascularised rectus femoris fascia pedicled on the anterior superior iliac spine. This was transposed to cover the external iliac vessels, and sutured to the pubic tubercle. Care was taken to avoid compression of the vessels. The musculoaponeurotic abdominal wall was reconstructed with two 20 x 20cm sheets of StratticeTM (porcine acellular dermal matrix) and an overlying sheet of ProleneTM mesh, sutured to the lateral abdominal wall muscles and to both inguinal ligaments. The cutaneous abdominal wall was closed with an abdominoplasty technique. There was no hernia recurrence 6 months post-operatively. Conclusion: This is a novel technique for the reconstruction of the inguinal ligament. 0618 THE ASSOCIATION BETWEEN WHO SURGICAL SAFETY CHECKLIST AND ANTIBIOTIC PROPHYLAXIS IN ELECTIVE MESH REPAIR OF INGUINAL HERNIA Tou Pin Chang, Rebecca Oates, Maria Takhreem, Robert Brown, Simon Galloway. University Hospital of South Manchester NHS Foundation Trust, Manchester, UK Aims: The aim of this study was to examine the impact of WHO Surgical Safety Checklist (SSC) completion on provision of antibiotic prophylaxis in elective mesh repair of inguinal hernia. Methods: We conducted a prospective study on 100 consecutive elective inguinal hernia mesh repairs over 8 months. We reviewed patient's operative notes, anaesthetic charts and SSC sheets for documentary evidence of compliance to National Patient Safety Agency (NPSA) recom- mendations and hospital antibiotic guidelines. Results: The SSC was completed in 64 patients (64%). Antibiotic prophy- laxis was provided in 52 patients (52%) and of these, 50 (96%) were given the recommended antibiotics within 30 minutes of induction of anaes- thesia. Of those with SSC completed, a significantly higher percentage Abstracts / International Journal of Surgery 9 (2011) 547–582 553 ABSTRACTS