bluuebunny/crossref_metadata_2025 huggingface dataset:
BS O04 - Audit of outcome of SADIS- Results from a single Bariatric center
Authors: Kaur Mandeep , Haider Ijlal , Raslan Charef , Baruah Bedant , Javed Shafiq , Almerie Qutayba , Stewart Duncun , Darrien Jennifer , Kerrigan David
Published: November 2024

Background

SADIS- Single anastomosis Duodeno-ileal switch is a bariatric procedure that has been accepted widely as a bariatric procedure. Literature has shown that it gives good outcomes in terms of weight loss and resolutions of obesity related morbidity. There has been criticism about the nutritional deficiencies associated with SADIS. It is a technically challenging procedure, so it is not extremely popular in the bariatric world where sleeve is the most done procedure and RYGB is the gold standard.

Method

All the patients at our centre undergo MDT assessment. Based on the MDT discussion and the patient preference, the decision of surgery is made.

All the patients who underwent SADIS were included in the study

Primary aim:

Weight loss at 6 months, 1 year, 2 years and 6-10 years

ORM resolution at 6 months, 1 year, 2 years and 6-10 years

Nutritional deficiencies in the short term and long term.

Results

17 patients underwent SADIS. Average BMI 55, it is higher than the usual BMI cohort, saying that higher BMI patients were offered SADIS as compared to the lower BMIs, who were offered Sleeve, Bypass. The weight loss pattern followed by SADIS patients was more than bypass patients over 6 m, 1 y and 2 y. The SADIS patients had better sustained weightloss over 6-10 y. One crucial factor in patient profile is the ratio of psychological vs physiological co-morbidities is higher than the average; which corresponds to our findings of the feasibility study for bariatric surgery for BMI >65

Conclusion

SADIS gives good outcomes in terms of weight loss and resolution of co-morbidities. Long term results with SADI in terms of sustained weight loss are better than bypass. It did not lead to increased nutritional deficiencies.
BS O05 - Prevalence and Patterns of Iron Deficiency in Patients Living with Obesity: Insights from Bariatric Surgery Candidates
Authors: Carey Emily , O’Brien Abigail M , Ryan Odhrán K , Clifford Julie-Therese , Davis Cian E , Ahmed Ola S , Al-Mukhlifi Talal , Butt Waqas T , Fearon Naomi M , Heneghan Helen M
Published: November 2024

Background

Iron deficiency anaemia (IDA) is a recognised complication of obesity, and its associated co-morbidities. Iron deficiency has been implicated in immunologic dysfunction in obesity. However, the patterns of iron deficiency in people with obesity, independent of IDA, and its implications for patients with obesity remain unclear. This study aimed to investigate potential causes of iron deficiency, including relationship with glycaemic control and relationship with systemic inflammation. Relationship between iron deficiency and body mass index (BMI) was also considered.

Method

A retrospective review of a prospectively maintained database of consecutive patients undergoing bariatric surgery was performed. Pre-operative haematologic assessments were reviewed, and linear regression models were used to identify the associations of iron deficiency in patients with obesity. Statistical analysis was performed using SPSS.

384 consecutive patients over a 2-year time period were included in the analysis. 72.1% of patients were female and the mean age was 49.44±10.2. The mean weight of included patients was 144.1±31.02 kg, and the mean BMI was 50.66±9.61 kg/m2

Results

​2.45% of patients met the criteria for iron deficiency anaemia. However, 15.49 % had low serum iron(<9 mmol/L), 12.1% had low ferritin(<30mg/L), 1.38% had low transferrin(<2g/L), 15.17% had high Total Iron Binding Capacity(>71.6mmol/L), 37.93% had low transferrin saturation(<20%). High BMI was a significant predictor of low serum iron(β=-0.206, p=0.031). Dysregulated glycaemic metabolism(HbA1c and glucose) was not a significant predictor of iron deficiency. Baseline inflammation (elevated CRP) was associated with low serum iron(β=-0.320, p=<0.001) and low transferrin(β=-0.205, p=0.028).

Conclusion

Iron deficiency in patients with obesity is common, but not iron deficiency anaemia dependent. It does not appear to be linked to patients’ glycaemic regulation, as previously thought. Our findings suggest it may instead be attributable to the systemic inflammation caused by obesity.
OGC O04 - The role of capsule-sponge technology in Barrett's surveillance: A two-year experience
Authors: Hasan Mahmudul , Khan Saadia , Olejnik Hannah , McDonald Claire , Megson Tyler , Saha Arin
Published: November 2024

Background

Barrett's surveillance requires regular endoscopic and histological assessment of the oesophagus to reduce the risk of progression to oesophageal cancer. Capsule-sponge technology has been used in the assessment of reflux for some years, and is increasingly used as an adjunct or replacement for endoscopic surveillance of Barrett's. Current NICE guidance does not advocate complete replacement of surveillance with capsule-sponge assessment but notes the potential benefits of the technology and highlights the requirement for more evidence and research. This study aimed to describe two-year experience with capsule-sponge technology in the surveillance of Barrett's Oesophagus.

Method

All patients who were due for Barrett's surveillance from September 2022 to June 2024 were screened to see if they were appropriate for capsule-sponge assessment. Appropriate patients were approached and offered capsule-sponge assessment. Patients who were not appropriate, or declined, were offered standard endoscopic surveillance.

Capsule sponge assessment was performed using the CytospongeTM and sponges sent to Cyted for cytological analysis. All patients were entered onto a prospectively maintained database and monitored for progression of symptoms or development of gastro-oesophageal cancer.

Cost implications, clinical outcomes and impact on endoscopy resource utilisation were measured.

Results

379 patients had Cytosponge assessment for Barrett's oesophagus. 34 (9%) required endoscopy for either an abnormal cytology or an inadequate sample. Cytosponge assessment picked up many pathologies including high-grade dysplasia, oesophageal carcinoma and ulceration or atypia. All patients who had a Cytosponge have been booked for endoscopy for their next Barrett's assessment (in keeping with current guidelines); none have presented with inter-test malignancy. Over the same time period, three patients have presented with oesophageal cancer who have only had endoscopic assessment. Utilisation of capsule-sponge technology has saved almost 350 endoscopies (700 points) over 21 months, or over 70 endoscopy lists.

Conclusion

Utilisation of capsule-sponge assessment for Barrett's oesophagus is safe and effective and can have a rapid and sustainable effect on reducing demand on endoscopy lists. The procedure is better tolerated than endoscopy, reproducible and may be a more accurate method of Barrett's surveillance than endoscopy alone.
OGC O06 - Socioeconomic Health Inequality in Oesophago-gastric Cancer in a Single Tertiary Centre: On Behalf of Greater Manchester OG Unit
Authors: Thomson Jack , Tarazi Munir , Farnworth Christine , Powell Arfon , Sultan Javed
Published: November 2024

Background

Oesophagogastric cancer (OGC) 5-year survival is poor (15%). Only 34% of patients are considered for potentially curative treatment, which is associated with a 41% chance of survival. In other cancer, deprivation is associated with poor outcomes. This study aims to determine the association between deprivation, tumour and treatment intent (TI), and 5-year all-cause mortality (M) in OGC.

Method

This retrospective cohort study analysed patients newly diagnosed with OGC (adenocarcinoma or squamous cell carcinoma) across Greater Manchester between January 2018 and January 2023. TI was defined as the treatment pathway, at completion of staging investigations, either curative (pathway to resection or definitive chemoradiotherapy) or palliative (best supportive care, palliative chemotherapy or radiotherapy). Statistical analysis encompassed methods such as binary logistic regression, Cox proportional hazards models and Kaplan-Meier survival curves with adjustments made for age, gender, and clinical stage. IMD scores were grouped from deciles into quintiles leaving 5 groups, with IMD1 representing the most deprived.

Results

3027 patients were included (2102, 69.4% males). Patients in IMD1 were diagnosed 4 years younger than in IMD5 (most affluent) (median age 70 (IQR=17) vs 74 (IQR=16), p<0.001). There was a higher proportion of deprived patients (32.9% IMD1 vs 15.3% IMD5, p<0.001). The proportion of stage 4b disease in IMD1 compared with IMD5 was not different (406 (40.7%) vs 174 (37.5%), p=0.081). The median survival was lower in IMD1 compared with IMD5 (0.81 vs 0.90 years, p=0.074). Following adjustment for confounders IMD1 was associated with a poorer overall survival when compared with IMD5 (HR 1.16, CI[1.02-1.32],p=0.020).

Conclusion

This study highlights a significant health inequality in the outcomes of OGC. Poorer outcomes in the most deprived group were independent of tumour stage, gender and age. Urgent measures to address socioeconomic health inequalities need to be instigated.
BN O03 - Pooled two-year results of the novel RefluxStop implantable device in management of gastroesophageal reflux disease in Germany: Retrospective analysis
Authors: Elshafei Moustafa , Lehmann Thorsten
Published: November 2024

Background

The most common gastrointestinal disorder globally is gastroesophageal reflux disease (GERD). Standard-of-care treatments for GERD are medical therapy, via proton pump inhibitors (PPIs), and traditional antireflux surgery (i.e., Nissen fundoplication). Unfortunately, PPI therapy is associated with medication irresponsiveness in up to 40% of cases and Nissen fundoplication results in significant rates of postoperative adverse events (AEs), such as postoperative dysphagia. Notably, patients with large hiatal hernia (>3 cm) are exceedingly difficult to treat with antireflux surgery. This report presents the clinical results of patients treated with an emerging technology, the RefluxStop device, in Germany at our two centers.

Method

Between July of 2021 and November of 2023, 158 patients were operated on with RefluxStop surgery. This procedure entails correction of a defunct antireflux barrier through cruroplasty (with hiatal hernia reduction, if necessary), limited (90-120°) esophagogastroplication to recreate the acute angle of His and gastroesophageal flap valve, and regional stabilization of newly constructed anatomy with implantation of the RefluxStop device in a fully invaginated fundic pouch. Clinical outcomes included GERD Health-Related Quality of Life (GERD-HRQL) score, PPI use, and perioperative AEs.

Results

Patients of mean age 49±13.3 years and male (51.3%) had hiatal hernia >3 cm (22.2%). At 20±7-month follow-up, the median (IQR) GERD-HRQL score improved by 90.9% to 2 (0-2) from a baseline of 22 (19-31.5) (p<.001). PPI use decreased by 96.3%. Preoperative dysphagia (n=18) resolved in all patients with five cases (3.2%) of new-onset dysphagia occurring, but none requiring postoperative dilation. Hiatal hernia recurred in two patients (1.3%) and was treated with device repositioning. Device migration presented in two patients (1.3%) from excessively tight suturing of the fundic pouch. One of these patients was converted to Toupet fundoplication.

Conclusion

This study shows that RefluxStop provides excellent effectiveness and safety outcomes. Quality-of-life improvements were particularly appreciated with a 90.9% reduction in GERD-HRQL score. With the added context of 22.2% of this pooled cohort composed of difficult-to-treat patients (i.e., hiatal hernia >3 cm), RefluxStop surgery provides favorable efficacy in real-world settings with such patients. As with any novel surgical procedure, training is paramount to optimizing surgical outcomes and minimizing unwanted AEs. Further study is required to bolster the evidence supporting this emerging technology.
HPB O05 - Changing paradigms in the management of severe acute pancreatitis: Focused multi-disciplinary working between surgeons and intensivists to mitigate organ failure in order to reduce mortality
Authors: Chatzipavli Viktoria , Tzamou Vasiliki , Main Norman , Szatmary Peter , Gilbert-Kawai Ned , Mann Kulbir
Published: November 2024

Background

Mortality was classically bimodal in severe acute pancreatitis and organ failure is the single most important factor in predicting outcome in severe acute pancreatitis. Initial interventions are supportive often requiring critical care. Subsequently treatments are required to manage necrosis and any organ recovery remains under threat. The outcomes and interventions from surgery and critical care are reviewed to determine how to balance organ failure and the need for necrosectomy in a modern multi-disciplinary tertiary care centre

Method

The Royal Liverpool provides a tertiary service to all patients with pancreatitis across Merseyside and North Wales. All patients that were transferred to critical care from 2018 – 2023 were analysed using the intensive care national audit and research centre database which contains information on organ failure. The patients with severe pancreatitis were then reviewed using electronic clinical notes and radiology images to determine clinical course and management.

Results

Of 134 patients, 48 (36%) were admitted locally, 85 (64%) transferred in, occurring 35% <2weeks, 29% 2-4weeks, 28% 4-6weeks and 8% >8weeks. 76 (57%) required necrosis intervention, 58 (43%) were conservatively managed. Mortality was 38% with 35% <4weeks, 22% 4-8weeks, 22% 8-12weeks, 22% >12weeks. No significant difference in mortality between conservative or interventional management (15 (45%) vs 18 (55%)) nor median age (58 vs 57.5 yrs). Survival related to number of failing organs (dead vs alive): nil organs: 10 patients vs 27 patients (20%vs32%), One: 11 vs 45 (22%vs45%), Two: 21 vs 9 (42%vs11%), Three: 8 vs 3 (16%vs4%), p<0.005.

Conclusion

Of patients deemed fit for ITU admission with necrotising pancreatitis, the classic paradigms of biphasic mortality no longer occur. Differences in mortality from intervention and age of patient has been negated by optimal ITU management for organ failure. For the initial phases and the intervention phases of management, ensuring degree of organ failure is key to survival. There is a significant change when two organs fail in mortality and this stresses the importance of holistic management. Our ITU promotes pancreas specific organ preservation measures of early enteral feeding, cessation/tailoring of antibiotics, early extubation/tracheostomy and most importantly multidisciplinary working
MS O01 - HPB Outcomes following Cholecystostomy Insertion for Acute Cholecystitis: A National Registry-based Study
Authors: Billur Aditya , O’Connell Robert M , O’Sullivan A W , Gall Tamara , McEntee Gerald , Conneely John
Published: November 2024

Background

Acute cholecystitis (AC) is a commonly encountered surgical emergency. In cases of severe AC or cholangitis, or in patients with significant comorbidities, percutaneous cholecystostomy (PC) may be employed. International data suggest PC is associated with significantly worse patient outcomes, but limited data exist in the Irish context.

Method

All patients with AC presenting to public hospitals in Ireland between January 2017 and July 2023 were identified using the National Quality Assurance and Improvement System (NQAIS). Data were collected on patient demographics including age, co-morbidities, length of stay/LOS, operative intervention, endoscopic intervention, critical care admissions, in-patient mortality, and readmissions. All patients managed with PC were identified, and their outcomes compared to patients managed without PC.

Results

In total, 20,886 patients were admitted with AC. 975 (5%) patients underwent PC and 19,911 patients (95%) were managed without percutaneous cholecystostomy. In comparison to non-cholecystostomy cohort, the PC cohort was older (median 72 v 58 years, p<0.001), less likely to be female (39% v 57% p<0.001), had proportionally longer LOS (<0.001), higher mortality rates (<0.001), were more likely to be admitted to critical care (<0.001), and more likely to be re-admitted to hospital within 30 days (<0.001).

Conclusion

Cholecystostomy insertion occurs in older patients with more comorbidities. These patients have higher in-hospital mortality rates, higher rates of critical care admission, longer LOS, and increased 30-day readmission rates.
MS O03 - HPB Vitamin D deficiency and Survival in Pancreatic Ductal Adenocarcinoma Patients Who Received Adjuvant Chemotherapy
Authors: Leung Shun Hay Prudence , Halle-Smith James , Roberts Keith
Published: November 2024

Background

It is proposed that vitamin D contributes to reducing inflammation and tumour size by binding to vitamin D receptors (VDR) of pancreatic cancer cells, which activates response pathway thus enhancing delivery of intracellular chemotherapy. As vitamin D is a fat-soluble vitamin, individuals with pancreatic ductal adenocarcinoma (PDAC) are at risk of being vitamin D deficient due to the high prevalence of pancreatic exocrine insufficiency (PEI). We investigated the relationship between vitamin D deficiency and survival outcomes of patients with PDAC.

Method

Patients who had resected PDAC at Queen Elizabeth Hospital Birmingham between 2014-2020 were reviewed. Patients who died within 90 days of the operation were excluded. Patient demographics, pre-operative vitamin D levels, adjuvant chemotherapy (AC) details and survival outcomes were collected. Vitamin D deficiency was defined as the serum 25-hydroxyvitamin D (25(OH)D) level of less than 25 nmol/L.

Results

202 patients were identified, of whom 63 (31%) were vitamin D deficient. Among 151 patients who received AC, 48 (32%) were vitamin D deficient. Patient demographics were comparable between the AC and non-AC groups, except age, which was higher in the non-AC group (p<0.01)(Table 1).

OS and DFS were significantly reduced in patients with vitamin D deficiency compared to those with sufficient vitamin D levels (p< 0.05). This trend was also observed in the AC subgroup. However, no significant differences in OS and DFS were found between vitamin D deficient and sufficient patients in the non-AC subgroup (Table 2).

Conclusion

Vitamin D deficiency is associated with lower OS and DFS, particularly in patients receiving adjuvant chemotherapy (AC). The greater survival outcomes observed in the AC group suggests that vitamin D enhances chemotherapy efficacy. Further studies are required to explore the cellular interactions between vitamin D and PDAC.
MS O08 - HPB Biomarkers for risk stratification of Intraductal Papillary Mucinous Neoplasm of the pancreas: A systematic review
Authors: Birch-Ford James , Rowley William , Tarazi Munir , Stott Martyn
Published: November 2024

Background

Intraductal Papillary Mucinous Neoplasm (IPMN) of the pancreas is the precursor lesion from which pancreatic ductal adenocarcinoma (PDAC) arises in 10% of individuals. IPMNs may be associated with low-grade or high-grade dysplasia or an associated adenocarcinoma. Accurately determining low-risk from high-risk IPMN is crucial for early detection initiatives for PDAC, so treatment can be offered before invasive cancer in high-risk individuals but without causing harm to low-risk individuals. Currently, imaging forms the basis for stratification but this is costly, resource intense and is limited in accuracy. There is a need to develop biomarkers to improve the risk stratification of IPMN.

Method

A systematic review was conducted according to PRISMA-DTA guidelines by screening EMBASE, MEDLINE, CENTRAL and bibliographic reference lists for comparative studies. Studies were excluded if they were based on non-human subjects, not specific to IPMN, or determined IPMN from PDAC rather than low-grade from high-grade dysplasia in IPMN. Data extracted included study design, cohort demographics, specimen type, biomarker type, methodology for biomarker discovery, positive predictive value, negative predictive value, sensitivity, specificity or AUC value and were evaluated against the STARD checklist. Study quality was evaluated using the QUADAS-2 tool.

Results

We identified 1761 studies of which 88 were selected for analysis. Twenty-six studies identified biomarkers derived from serum/plasma, 25 from biopsy specimens, 18 from cystic fluid, 13 from radiological findings, 4 from pancreatic juice, 3 from clinical risk stratification and 1 urinary biomarker. Markers were based on proteins (43%), mRNA (1%), miRNA (14%), lncRNA (2%), DNA (16%), metabolites (1%), radiomics (19%), glycans (5%), inflammatory markers (5%) and clinical history (5%). We observed discriminatory values ranging from AUC 0.58-1, specificity 64-100% and sensitivity 56-90.9%.

Conclusion

This systematic review outlines the current evidence-base for potential biomarkers to determine low-risk from high-risk IPMNs of the pancreas. Current studies are limited by retrospective sample collection, limited cohort sizes and lack of external validation of candidate biomarkers. There is a need to develop and validate biomarkers in a longitudinal prospective cohort study of individuals undergoing IPMN screening with the ability to characterise low-risk to high-risk transformation which after external validation would be suitable for adoption into clinical practice.
MS O11 - HPB Laparoscopic vs open liver resections for hepatocellular cancer in a tertiary care hepatobiliary unit; outcomes of cases over 10 years
Authors: Sherratt-Mayhew Sam , Page Charles , Rehman Saad , Shah Tahir , Shetty Shishir , Papamichail Michail , Raza Syed Soulat , Roberts Keith , Chatzizacharias Nikolaos , Bartlett David , Marudanayagam Ravi , Sutcliffe Robert , Dasari Bobby V M
Published: November 2024

Background

Despite its established role in liver resection surgery, minimally invasive surgery is still not a favoured option in cases of hepatocellular cancer (HCC) due to perceived risks of intra- and post-operative surgical morbidity and poorer oncological outcomes. This study aims to look at the outcomes of liver resections performed for HCC cases over ten years comparing laparoscopic and open cohorts.

Method

A retrospective study including all liver resections for HCC cases performed in our tertiary care hepatobiliary unit between 2013 and 2022 (10 years) was conducted. Data on demographics, underlying degree of liver cirrhosis, types of liver resection and post-operative outcomes, including recurrence rates and resections margins were collected and reported using descriptive statistics. Survival analysis was performed with compared between these two groups with log rank test in GraphPad prism 10.

Results

200 liver resections performed for HCC were grouped into laparoscopic and open cohorts containing 147 and 53 patients respectively. 21 (40%) laparoscopic cases had background liver cirrhosis as compared to 24 (16%) in open cases. Major liver resection comprised 9% and 43% of all cases and one and five patients had Grade B/C PHLF in laparoscopic and open groups. All 8 (4%) cases with 90-day mortality were from the open group. Negative resection margins (68% vs 71%), local recurrence (51% vs 47%) and overall survival (75 months vs 67 months (p=0.29)) were similar in laparoscopic and open groups, respectively.

Conclusion

Post-operative and oncological outcomes of liver resections for HCC were comparable in laparoscopic and open groups. Laparoscopic liver resections could be safely performed in patients with background liver cirrhosis.
MS O12 - HPB The efficacy of CA19-9 in predicting resectability and survival in pancreatic cancer patients with jaundice: A retrospective cohort study
Authors: Keyte Imogen , Turner Jessica , Halle-Smith James , Roberts Keith
Published: November 2024

Background

Carbohydrate antigen 19-9 (CA19-9) is the most utilised biochemical marker in pancreatic ductal adenocarcinoma (PDAC); shown to be related to resectability and prognosis. However, concurrent cholestasis, commonly seen in PDAC, can also elevate CA19-9, which may lead to unreliability and hence limit its efficacy in jaundiced patients, making management planning and prognostication more challenging. This study aims to investigate the impact of jaundice on the efficacy of CA19-9 in predicting resectability and survival in PDAC patients.

Method

715 patients undergoing attempted resection for PDAC between 2010-2023 were identified from a prospectively maintained surgical database for retrospective analysis. The ability of CA19-9 to predict resectability and survival in different bilirubin sub-groups was assessed using receiver operating characteristic and Kaplan-Meier curves. Existing adjustment methodologies were applied and the curves replotted to assess their effects on the predictive efficacy of CA19-9. Multivariate analysis was then utilised to screen other potentially predictive factors which could be incorporated in the future.

Results

Of the 554 (77.4%) patients who underwent resection, CA19-9 predicted resectability in the first three bilirubin subgroups: ≤21 µmol/l (AUROC:0.660, 95% CI:0.551-0.769, p=0.004), 21<x≤130 µmol/l (AUROC:0.689, 95% CI:0.595-0.784, p<0.001) and 130<x≤315 µmol/l (AUROC:0.710, 95% CI:0.614-0.807, p<0.001). However, CA19-9 did not predict resectability in patients with bilirubin levels >315 µmol/l (AUROC:0.579, 95% CI:0.452-0.707, p=0.222). CA19-9 was a significant predictor of overall survival in the non-jaundiced (p=0.048) cohort but did not predict survival in patients with bilirubin levels >21 µmol/l. Existing adjustment methodologies did not improve predictive efficacy of CA19-9 for resectability or prognosis.

Conclusion

These findings support the prospect of decreased ability of CA19-9 to predict resectability and survival in PDAC patients with jaundice. Further investigation is required to find a method of adjusting CA19-9 values based on jaundice to aid diagnostic and treatment decision making.
VS 01 - BN Chronic loop gastrojejunostomy volvulus masquerading as a Crohn’s stricture
Authors: Loh Alex Yuen Hua , Tase Arkeliana , Karim Seiver , Al-Fagih Othman , Jambulingam Periyathambi
Published: November 2024

Background

A video presentation of a case of chronic loop gastrojejunostomy volvulus masquerading as a Crohn's stricture.

Method

61 year old female with a previous loop gastrojejunostomy and subsequent ileocaecal resection for Crohn's related pyloric stenosis and terminal ileal stricture. Acute worsening of post-prandial pain and vomiting 5 years later, re-investigation revealed a stenosed gastrojejunostomy thought to be Crohn's related.

Results

Intraoperative volvulus of the gastrojejunostomy was demonstrated related to traction forces resulting in the migration of the duodeno-jejunal flexure to the right of midline. The gastrojejunostomy was revised to a Roux-en-Y configuration with relief of mechanical obstruction.

Conclusion

An ileocaecal resection may create unexpected traction forces
VS 03 - BN Laparoscopic Excision of Aortic Schwannoma
Authors: Shehata Zak , Satyadas Thomas
Published: November 2024

Background

This video presentation describes a laparoscopic approach to the excision of a large retroperitoneal cyst in a 39 year old female presenting with generalised abdominal pain. The patient had a background of Type 2 Diabetes, as well as a laparoscopic hysterectomy.

Method

The patient presented acutely with the above symptoms. CT and MRI both confirmed a large retroperitoneal cyst measuring 8x9cm. EUS was performed showed a thin walled cyst and a normal pancreas. FNA cytology was benign, hydatid serology was negative

Results

MDT decision was to go ahead with formal surgical resection. Laparoscopic excision of the cyst was performed, demonstrating that the pancreas was displaced anteriorly, with the coeliac axis displaced to the right. The cyst did not involve the pancreas or adrenal gland. Post operative histology found the cyst to be an aortic schwannoma.

Conclusion

This video demonstrates the complex retroperitoneal dissection that can be performed laparoscopically. The patient was discharged on post op day 8 with surveillance follow up
VS 10 - HPB Pancreas preserving total duodenectomy, How I do it
Authors: Hammoda Mohammed , Al-Sarireh Bilal
Published: November 2024

Background

Patients with duodenal polyps particularly patients with familial adenomatous polyposis syndrome (FAP) are at increased risk of developing duodenal cancer. Pancreas preserving total duodenectomy is an alternative to pancreaticoduodenectomy. Advantages over pancreaticoduodenectomy include: shorter operative time, fewer and safer anastomoses, allowing future endoscopic surveillance and preserving the entire pancreas with both exocrine and endocrine functions. The complication rate is comparable if not fewer than pancreaticoduodenectomy. Here, we present our standardised operative technique for this procedure.

Method

This a video presentation of the technique of this novel procedure. The video has been edited with added narrative comments on the different steps of the procedure.

Results

This is a video presentation of the technique of pancreas preserving total duodenectomy in a patient with familial adenomatous polyposis syndrome to treat Spiegelman IV duodenal polyps.

Conclusion

The PPTD provides a feasible and probably favourable if not better alternative to classical pancreaticoduodenectomy particularly in patients with FAP syndrome.
AHP SO01 - Establishing Physiotherapy led Prehabilitation for patients undergoing major hepatobiliary surgery in a Regional Centre - A Service Improvement
Authors: Kindness Gemma
Published: November 2024

Background

Prehabilitation is increasingly on the agenda for major surgical patients and will be an essential service in an ageing population with increasing cancer prevalence. By 2040 5.3 million people in the UK will be living with cancer physical fitness can have an impact on both treatment options and survival rates. Prehabilitation has been mentioned in both the Major Conditions Strategy and the Long-Term Plan.

Currently within the trust, there are no established multiprofessional prehabilitation services. New funding allowed a service improvement project to develop a ‘model’ for a specialist physiotherapy prehabilitation pathway pilot in patients undergoing major hepatobiliary surgery.

Method

Patients undergoing major surgery complete Cardiopulmonary Exercise Testing, providing data indicating fitness levels and guides risk stratification. Patients deemed to be at high risk due to poor fitness, (anaerobic threshold 10.9 or below), were referred to the prehabilitation physiotherapist.

Patients attended a 1:1 assessment with a Physiotherapist, were provided with an individualised home exercise programme, including cardio-vascular and muscle strengthening. Weekly follow up virtual follow was provided.

Outcome measures taken at initial appointment included five sit to stand (5STS) time, Grip strength and EQ-5D. These were repeated before surgery, and after hospital discharge. Patients had the opportunity to provide feedback.

Results

Average improvement in all outcome measures was demonstrated. Outcome MeasuresPre-intervention averagePost intervention averageAverage changeEQ-5D Score8.17.30.8EQ-5D Health score687465 STS (seconds)14.711.5-3.1Grip (kg)29.831.31.5Sarcopenic 5 STS (seconds)20.913.1-7.9

Patient and staff feedback was positive, finding patients reported they felt prepared for the post operative period, and staff noted and increased in their patients preparedness.

It is too early to say if Prehabilitation has had an impact on hospital length of stay or post operative complications, though early results are promising.

Conclusion

Physiotherapy led prehabilitation is beneficial for patients undergoing major HPB surgery, demonstrating improvements in physical strength and fitness following an individualised home exercise programme with regular virtual support, especially those who have sarcopenia.
AHP SO04 - ''Effectiveness of a surgical wound care bundle for reducing surgical site infection after emergency abdominal surgery''
Authors: Saha Gobinda Chandra , Selim Abdur Rahman , Sikder Dhiman Kanti
Published: November 2024

Background

Surgical site infection (SSI) imposes a considerable financial burden to both hospital and patient by increasing the hospital stay, utilization of resources and readmission rates. This study compared the effectiveness of surgical wound care bundle concept with traditional ongoing wound care for reduction of SSI after emergency abdominal surgery.

Method

This cross-sectional analytical study was carried out with a total of 120 patients who underwent emergency abdominal surgery were included after taking informed written consent and divided into two groups: Group-A (n=60, surgical wound care bundle) and Group-B (n=60, traditional ongoing care). A detailed history and thorough clinical examination were carried out in each patient. Data were collected in separated case-record form and analyzed by SPSS 24.

Results

Mean age of Group A and Group B was 44.88 ±11.2 years and 44.82±13.3 years accordingly (p=0.391) with male majority in both groups (70% in Group-A and 80% in Group-B, p<0.292). Both groups were statistically similar regarding comorbidities, baseline laboratory parameters and pre-operative diagnosis (p>0.05).Group-B patients had higher frequency of SSI development compared to Group-A(43.3% vs. 15%, p-0.001). Besides, patients having traditional ongoing care had longer hospital duration than surgical wound care bundle (10.1±2.7 vs. 6.9±1.9 days, p<0.01). Though not significant, 30-day readmission rate was also higher in Group-B than Group-A (16.7% vs. 5%, p=0.075).

Conclusion

Surgical wound care bundle reduce surgical site infections in patients with emergency surgery. However, further multicenter studies are warranted.
AHP SO05 - First year experience of running a specialist pre-op clinic for patients undergoing a Whipple procedure that focuses on patient education and improving theatre utilisation
Authors: Clarke Hannah , Mcdonnell Declan , Takhar Arjun
Published: November 2024

Background

The Whipple’s pre-operative clinic was organised to ensure patients were fully aware of the impact of this operation. Additionally, it was implemented to reduce the risk of preventable theatre cancellations and unfilled operating theatre slots arising given the challenges currently faced in the current NHS climate.

The primary aim of the clinic is to improve education to ensure the patients are aware of what the procedure and aftercare entails. A secondary aim is to identify correctable issues in the pre-operative period which could prevent surgery from proceeding safely.

Method

The clinic ran over 12 months in the tertiary HPB centre at University Hospital Southampton. The clinic has two elements: a 30min video appointment with a specialist nurse for each individual patient to provide comprehensive information regarding the procedure This was followed by a checklist to ensure there was appropriate up-to-date imaging available, as well as a review of the latest blood tests and current medications.

Results

There were a total of 105 patients reviewed in the clinic. Due to this new service, 21 (20%) essential interventions were made. These included requesting or reviewing new imaging (n=14) correcting anticoagulation plans (n=2) and admitting patients for optimisation prior to surgery (n=2).

A total nine all day theatre lists were saved as a direct result of this clinic. Costing of each theatre is estimated at £12,000. Five (5%) patients had their surgeries cancelled in advance and all theatre slots were subsequently re-allocated. Four (4%) patients had interventions which directly prevented an on the day cancellation.

Conclusion

These results show that there are significant benefits from running a specialised pre-operative Whipple’s clinic. Multiple interventions have led to improving patient safety, optimising theatre utilisation and improving patient experience.
AHP SO08 - Weekend physiotherapy pilot for patients on hepatobiliary enhanced recovery pathways: Examining the impact of a 7-day service
Authors: Wilkinson Hannah , Turner Catherine
Published: November 2024

Background

Enhanced recovery after surgery (ERAS) is a safe, multi-disciplinary, evidenced-based approach to optimise the perioperative management and outcomes after hepatobiliary (HPB) surgery. Despite the adoption of the ERAS mobilisation protocols to improve recovery time, one limitation is a traditional 5-day service model (Monday-Friday). This can result in an inequality of service provision for those patients operated Thursday or Friday and lead to increased length of stay (LOS) in hospital. Mobilisation across 7 days can ensure improved compliance with ERAS mobilisation protocols, better continuity of care, facilitate improved outcomes and timely discharge from hospital.

Method

Data was collected pre-introduction of the 7-day physiotherapy service from May-October 2022. During November 2022 – April 2023 a 7-day physiotherapy service was piloted. This service included 1 qualified physiotherapist and 1 non-qualified physiotherapist on Saturday and Sunday. This 7-day service provided continuity of care for patients from intensive care or post-anaesthesia care unit to the ward, facilitating discharges and accelerating return to independence. Data was collected during the 7-day service as well as 6 months post intervention (May 2023-October 2023). Acceptability of the intervention was assessed among the HPB multi-disciplinary team (MDT) using a survey consisting of 5 qualitative questions.

Results

The table illustrates that a reduction in mean LOS was seen in all 4 HPB surgeries that follow ERAS protocols during the 7-day physiotherapy service. It was also shown that 6-months post intervention (returning to a 5-day service) all 4 HPB ERAS surgeries mean LOS increased. To determine the acceptability of the 7-day physiotherapy service, 22 members of the MDT responded to a survey (5 consultants, 4 physiotherapy staff, 4 sisters, 5 staff nurses, 1 nursing assistant, 2 healthcare assistants). All 22 members of the MDT agreed that a 7-day physiotherapy service was acceptable and improves recovery.

Conclusion

A 7-day physiotherapy service has shown to reduce mean LOS in comparison to a 5-day physiotherapy service within HPB ERAS pathways. From an MDT perspective the 7-day physiotherapy service was also deemed to be beneficial and improves patient recovery.
EDI&S SO03 Replacing Single-use Chloraprep with Low Carbon Cost-effective Surgical Skin Preparation: A QI Project for Sustainability in Surgery
Authors: Sivananthan Mathoorika , Joseph Moyenda , Nip Lawrence , Sabato-Ceraldi Serena
Published: November 2024

Background

Operating theatre waste accounts for approximately 50% of all hospital waste produced in the NHS [1] and two-thirds of carbon contributions come from single-use items [2]. With a major goal of the NHS being net-zero, surgeons have a collective responsibility for reducing the carbon footprint through eliminating single-use equipment and plastic waste such as Chloraprep wands. The aim of this quality improvement project was to introduce the use of chlorhexidine solution poured into reusable gallipots and applied using reusable sponge-holders into local practice, which is more environmentally friendly, significantly cheaper and is the first-line skin preparation recommended by NICE [3].

Method

Chloraprep use in consecutive operations performed by the trust in a month before and after the intervention was retrospectively collected and categorised based on specialties. The intervention was a series of local oral presentations, leaflets and posters to highlight the benefits of chlorhexidine solution over Chloraprep. The change in percentage of Chloraprep use in all cases completed in 1 month pre- and post-intervention was retrospectively collected and analysed. Further qualitative data was obtained through pre- and post-intervention surveys.

Results

There was a reduction in use of Chloraprep across all specialties targeted by the intervention, with 27% of cases pre-intervention and 24% of cases post-intervention using Chloraprep. The highest percentage reduction was seen by the local upper gastrointestinal surgery team (37%). The percentage reductions in the cases using Chloraprep 10 days post intervention were general surgery 9%, upper GI 3%, colorectal 1% and vascular 6%. The pre- and post-intervention surveys also showed a decrease in Chloraprep use from 94.1% to 80% and corresponding increased use of swabs and antiseptic solution. 100% of the responders agreed with using the sustainable option.

Conclusion

The educational intervention has proven to be effective in achieving the aims of this project. Critical analysis of the literature has shown no difference in surgical site infection rates between the two options [2]. However, there is a need for high quality trials that directly compare the clinical effectiveness of both methods of application. We hope to encourage surgeons and theatre staff to opt out of using Chloraprep and consider the use of swabs dipped in chlorhexidine alcohol solution. Thus, we recommend the re-usable low carbon low-cost alternative method and encourage efforts to promote sustainability in surgery.
BS SO02 - A systematic review to summarise and appraise the reporting of surgical innovation: A case study in robotic Roux-en-Y gastric bypass
Authors: Huttman Marc , Smith Alexander , Robertson Harry , Purves Rory , Biggs Sarah , Dewi Ffion , Dixon Lauren , Kirkham Emily , Jones Conor , Ramirez Jozel , Scroggie Darren , Pathak Samir , Blencowe Natalie
Published: November 2024

Background

Robotic Roux-en-Y gastric bypass (RRYGB) is an innovative alternative to the laparoscopic approach, however its clinical benefits are uncertain. The Idea, Development, Exploration, Assessment and Long-term follow-up (IDEAL) framework was developed to improve the evaluation of surgical innovations alongside their adoption into clinical practice. Studies investigating the benefits of RRYGB have been published, however the reporting quality and robustness of literature has not been assessed. The aim of this systematic review was to summarise and appraise the reporting of RRYGB as a case study of a surgical innovation in relation to the IDEAL framework.

Method

Systematic searches for primary studies evaluating totally RRYGB were undertaken. Their IDEAL stages were determined using a standardised algorithm. Information pertaining to study characteristics, governance/ethical factors, patient selection, demographics, surgeon expertise/training, technique description and outcomes were extracted. A narrative summary was formulated, with descriptive statistics and data arranged chronologically. All methodology was done in accordance with PRISMA guidance.

Results

Fourty-seven studies published between 2005-2024 were included: case report (n=1), case series (n=11), non-randomised comparative (n=28) and retrospective analysis of registry databases (n=7). IDEAL stages were assigned as follows: stage 1 (n=1), stage 2a (n=6), stage 2b (n=40), stage 3 (n=0), stage 4 (n=0). There was a lack of sequential progression through IDEAL stages as time progressed since the inception of RRYGB. There was incomplete and inconsistent reporting of governance, ethics, patient selection criteria, surgeon expertise/training and technique description. Outcomes were heterogenous and rarely corresponded to progress through the IDEAL model of surgical innovation.

Conclusion

Reporting of RRYGB literature correlated poorly with IDEAL recommendations. This indicates poor reporting quality of available literature, impeding the ability for surgeons to draw meaningful conclusions from available evidence. This also complicates patients’ ability to take part in shared decision-making and give informed consent. Future studies should report findings in a structured way using IDEAL guidance or a similar reporting standard. This will ensure future research is transparent, robustly designed, prospective, uses COSs and follows an ethos of incremental learning. This may reduce research waste and the premature adoption of surgical innovations, ensuring their safe introduction into clinical practice.
BS SO04 - Intragastric Balloons - are they for the long term?
Authors: Hammett Felix , Foley Sinead , Asarbakhsh Mariam , Salih Tamir
Published: November 2024

Background

Intragastric balloons are a bridging therapy to bariatric metabolic surgery. When sufficient weight loss to facilitate surgery is not achieved, a second balloon may be considered. Traditionally, balloons were used for 6 months prior to removal. The COVID-19 pandemic limited patient interactions and treatment duration was doubled.

We assessed outcomes (weight loss trends and safety) in patients with severe obesity undergoing sequential balloon treatment. The study period accounts for changes in balloon protocol instigated during the pandemic, addressing a current literature gap.

Method

Consecutive patients who underwent balloon treatment between May 2014 and February 2023 were identified. Only patients deemed fit enough for potential adjuvant bariatric surgery at presentation were included in the study. Outcomes recorded included: weight and BMI at 3-monthly intervals until balloon removal, progression to surgery and morbidity.

Results

45 patients were identified. Median BMI on balloon insertion was 62kg/m2.

Median weight loss with the first balloon was 15.2kg (8.8% weight loss). 11 patients (24.4%) had a second balloon, with median weight loss of 3.3kg (1.9%).

22 patients (48.8%) met criteria for surgery, only one had multiple balloons.

Weight loss was observed during the first three quartiles of balloon treatment, however median 2kg was gained during months 9-12.

16 (35.6%) first balloon patients had complications. 2 (18.2%) second balloon patients had complications. Median time from insertion to complication was 14 days.

Conclusion

The present study concludes that, although not associated with increased complication risk, sequential IGB use as a bridging treatment to definitive bariatric surgery does not significantly contribute to weight loss in super obese patients. Optimal treatment is achieved with a single IGB, although weight loss is not uniform across a 12 month treatment period and weight gain can result after 9 months.
BS SO08 - Prospective audit of weight loss and resolution co-morbidities of various bariatric surgeries and Comparisions of weight loss and ORM resolution between bypass and sleeve-1 years follow up- Audit outcomes from Jan 2019-2023
Authors: Haider Ijlal , Kaur Mandeep
Published: November 2024

Background

Bariatric surgery is the gold standard in managing bariatric patients. There are various bariatric surgeries that have been approved. Sleeve gastrectomy is the most common procedure to be done globally. RYGB is considered the gold standard surgery as it gives the best weight loss and comorbidity resolution. OAGB is now a well-established procedure. Other procedures which are offered to the patients are duodenal switch and SADIS.

Method

We prospectively analysed the patients who underwent bariatric surgery at our center. All the bariatric surgery patients were included.

Aim

To calculate EBWL at 6 m, 1 year Resolutions of obesity related morbidity Comparision of the outcomes between Sleeve and Bypass

Results

1024 patients underwent bariatric surgery. All the patients undergo MDT discussion and the decision of choice of surgery is made based on MDT discussion and patients' preference. For the first 6 months both sleeve and bypass fair equal in terms of weight loss and resolution of comorbidities. Subsequently weight loss is better with bypass. It is also better sustained with the bypass. Resolution of comorbidities is the best within the first 6 months post-surgery.

Conclusion

There is a direct relationship between weight loss and resolution of co-morbidities. These patients are under follow up for outcomes at 2 years. Results will be published at the time of conference presentation