bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-BN04 Evaluation of Outcomes of Anti-reflux Surgery in a District General Hospital
Authors: Lim Jie , Dronamraju Shridhar , Nachimuthu Senthil 
Published: December 2021

Abstract

Background
Gastro-oesophageal reflux disease (GORD) affects up to 20% of the Western population, and is usually associated with presence of hiatus hernia (HH). Proton pump inhibitors (PPI) are the mainstay treatment, but half of PPI users have persistent symptoms. Anti-reflux surgery in the form of fundoplication surgery with HH repair can be considered in patients unable to tolerate or unwilling to persevere with long term medical therapy and those with severe sequalae of reflux, such as those with Barrett esophagus or non-healing erosive esophagitis. We aim to evaluate the outcomes and factors relating to surgical success of anti-reflux surgery.

Methods
We identified patients who had HH repair and fundoplication surgery from our prospectively maintained theatre database over a eight year period. Retrospective data collection was performed, inclusive of patients’ pre-operative investigations, intraoperative findings and postoperative patient outcomes. Chi Square and Mann Whitney U test were used to calculate the statistical significance. 187 cases were analyzed, involving only 167 unique patients as 14 patients had 1 redo surgery and 2 patients had 2 redo surgeries.

Results
Male to female ratio was 2:3. Median age was 59 years and median BMI was 29.1. 85% of cases were performed laparoscopically, which had the shorter median length of stay at 2 days. Pre-operative assessment of HH size with barium swallow had the highest sensitivity (82%) and specificity (75%). Large to moderate HH are more prevalent in female patients. Rolling HH are more associated with dysphagia and vomiting whereas sliding HH with reflux symptoms. Rolling HH are more likely to be repaired with an open approach and more likely to require hiatal mesh repair compared to sliding HH.

Conclusions
In the 96% of patients followed up, we successfully achieved symptom control in 94% of them. Although we were unable to find specific patient or surgical factors contributing to symptom recurrence or redo surgeries, we were able to identify certain pre-operative tests which can predict the difficulty of surgery. Larger scale case series would allow us to predict patient cohort at a higher risk of unsuccessful anti-reflux surgery.
P-BN06 Percutaneous cholecystostomy rates are increased following COVID-19 induced disruption to elective surgical pathways
Authors: Abdeen Bashar , Vulliamy Paul , English William , Bellam-Premnath Krsihna , Mansuri Ahmer , Mukherjee Dipankar 
Published: December 2021

Abstract

Background
The COVID-19 pandemic has led to major service disruptions, including the cessation of elective laparoscopic cholecystectomies (LC), causing delays in managing symptomatic gallstones. We hypothesised that this would lead to an increased need for percutaneous cholecystostomy (PC) for acute cholecystitis.

Methods
We performed a retrospective cohort study in a single NHS trust. We included all patients who underwent either LC or PC during the periods of March 1st – August 31st over the years 2019 and 2020. Patient data was obtained from prospectively maintained patient electronic notes. Data are presented as median and interquartile ranges for continuous data and the percentages for categorical data and compared with Mann-Whitney U-test and Fisher’s exact tests respectively.

Results
We observed a substantial reduction in the number of LC performed in 2020 (n = 99) compared to 2019 (n = 198), whilst the number of PC performed in 2020 (n = 35) was more than double that in 2019 (n = 17) (Fig.1). This increase in numbers persisted even after our LC service was restarted. Comparing the patients who underwent PC in both years, there were no significant differences in age (2019: 68 (45-76) vs 2020: 72 (57-81), p = 0.41), comorbidities (Charlson comorbidity index≥4: 10 (59%) vs 16 (46%), p = 0.56), or in-hospital mortality (2019: 2 (12%) vs 2020: 3 (9%), p = 0.99). As a proportion of all biliary interventions for cholelithiasis, PC increased from 8% (17/214) in 2019 to 26% (35/134) in 2020 (p &lt; 0.001).

Conclusions
These results show how the cessation of LC service was directly related to increased numbers of invasive ‘damage control’ procedures for acute cholecystitis, emphasising the importance of maintaining COVID-secure surgical pathways. The numbers of PC remained high even after the restart of LC service, consistent with a ‘COVID shadow’ resulting from interruptions to elective services that impacts patient care for a prolonged period.
P-BN09 Management of isolated splenic vein thrombosis: Risks and benefits of Anticoagulation
Authors: Eltweri Amar M , Basamh Mohammed , Ting Ying Yang , Harris Mark , Garcea Giuseppe , Kuan Li Lian 
Published: December 2021

Abstract

Background
Isolated splenic vein thrombosis (iSVT) is a common complication of pancreatic disease. Whilst patients remain asymptomatic, there is a risk of sinistral portal hypertension and subsequent bleeding from gastric varices if recanalization does not occur. There is a wide variation of iSVT treatment, even within single centres. We report outcomes of iSVT from tertiary referral hepatobiliary and pancreatic (HPB) units including the impact of anticoagulation on recanalization rates and subsequent variceal bleeding risk.

Methods
A retrospective cohort study including all patients diagnosed with iSVT on CT scan abdomen and pelvis between 2011 and 2019 from two institutions. Patients with both SVT and portal vein thrombosis at diagnosis, and isolated splenic vein thrombosis secondary to malignancy were excluded. The outcomes of anticoagulation, recanalization rates, risk of bleeding, and progression to portal vein thrombosis were examined.

Results
Ninety-eight patients with iSVT were included; of which thirty-nine patients received anticoagulation (40%). The most common cause of iSVT was acute pancreatitis n = 88 (90%). The recanalization rate in the anticoagulation group was 46% vs 15% in patients receiving no anticoagulation (p = 0.0008, OR = 4.7, 95% CI 1.775 to 11.72). Upper abdominal vascular collaterals (demonstrated on CT scan angiography) were significantly less among patients who received anticoagulation treatment (p = 0.03, OR = 0.4, 95% CI 0.1736 to 0.9288). The overall rate of upper GI variceal related bleeding was 3% (n = 3/98) and it was independent of anticoagulation treatment. Two of the patients received therapeutic anticoagulation.

Conclusions
The current data support that therapeutic anticoagulation is associated with a statistically significant increase in recanalization rates of the splenic vein; with a subsequent reduction in radiological left-sided portal hypertension. However, all patients had a very low risk of variceal bleeding regardless of anticoagulation. The findings from this retrospective study should merit further investigation in large-scale randomized clinical trials.
P-BN31 Surveillance for Gallbladder polyps at a NHS District General Hospital – a retrospective analysis
Authors: Khan Sharib Ziya , Kotecha Sita , Rajain Sakshi , Ravi Krish 
Published: December 2021

Abstract

Background
Gallbladder polyps are encountered in 5% of ultrasound scans and continue to remain a dilemma in terms of management. Very few polyps progress to cancer. However, most cancerous polyps are usually found at an advanced stage. It is therefore important to identify the premalignant polyps. There is a lack of national consensus in UK for surveillance of gallbladder polyps. Many trusts in the UK either adopt the European guidelines or formulate local protocols. We aim to present our findings based on our local surveillance policy existent during the study period with a view to recommending new local guidelines.

Methods
A search from our radiology database being coded to gallbladder polyp identified patients. We identified 431 patients from 2017 – 2019 who had a total of 1014 scans. The data was collected from local hospital IT databases in terms of variables such as number of scans, polyp size, number of polyps, progression to surgery or discharge from surveillance and histology. The data was analysed on excel platform.

Results
Patient demographics revealed an incidence of 54% in females (males 46%) with an average age of 59.7 years. Pain was the dominant symptom prompting the first scan (48%). An average of 2.3 scans were performed per patient. 45% of the polyps were less than 5mm. Overall, 22% polyps demonstrated interval growth. Only 15% of polyps less than 5mm demonstrated interval growth and none required cholecystectomy. 6% patients proceeded to surgery mainly for symptoms (46%) compared to polyp progression (1.5%). No malignancy was identified in this study. 43% of patients with polyp diagnosis in primary care had no identified surveillance plan.

Conclusions
Our study demonstrates a low incidence of polyp progression. We would recommend stopping annual surveillance after 2 years from the index scan for multiple small (&lt;5mm) polyps with little or no progression but continue with annual surveillance for polyps greater than 5mm. We would recommend reserving cholecystectomy for symptomatic polyps and polyps greater than 10mm. There is wide variation in surveillance practice particularly in primary care. We would recommend sharing the guideline widely with primary care for optimal surveillance.
P-BN42 Percutaneous cholecystostomy - A practice review
Authors: Li Wing Ching , Elboraey Omar , Kilani Mohammad Saeed , Pursnani Kishore Gopaldas , Rajendran Ilayaraja 
Published: December 2021

Abstract

Background
Percutaneous cholecystostomy (PC) is performed occasionally in a highly selected group of patients with variable outcomes. The World Society of Emergency Surgery (WSES) updated guidelines(2020) has recommended PC as a treatment modality in patients admitted with ‘acute calculous cholecystitis’(ACC) with who are not fit for surgery, including septic patients and those who show no improvement on conservative management within 48 hours. An audit was organised to review our patient selection for PC in the last 5 years in comparison to the latest WSES recommendations.

Methods
A retrospective observational study was conducted using a prospectively collected hospital database on patients who underwent PC between March 2016 and March 2021 in a teaching hospital. The patient cohort who underwent PC were compared and analysed against the set WSES guidelines.

Results
Some 23 patients were included. The median age was 82 years (range-61-90), with 13 females (56.5%) and 10 males (43.5%).19/23(82.6%) patients were at risk of sepsis on presentation, with two or more amber flag symptoms, whereas 4/23(17.4%) patients presented with confirmed sepsis. 19/23 (82.6%) were deemed unfit for surgery against 4/23 who were deemed fit based on the surgeons assessment. Patients unfit for surgery were treated with antibiotics following a diagnosis of ACC. The median time for patients to undergo PC from admission was 4 days. The 30-day mortality rate was 13 % (n = 3/23).

Conclusions
The study has demonstrated that our current practice for managing patients admitted with ACC and performing PC are mostly in line with the WSES guidelines. Considering individuals presentation and the surgeons clinical judgement into account, the practice was also likely impacted by COVID-19 the global pandemic. Further clinical studies may be required to determine specific patient groups who would benefit from PC.
P-BN52 Patient-reported outcome measures following fundoplication – lind and nissens - single centre, single surgeon results
Authors: Muthusami Anitha , Jayaprakash Sindoora , Jangan Akash , Sellahewa Chaminda , Akingboye Akinfemi 
Published: December 2021

Abstract

Background
Gastro-oesophageal reflux disease (GORD) affects approximately 10%-20% of adults in Western Countries. Surgery is indicated following failed medical therapy. This is recommended when GORD symptoms have a significant impact on the quality of life (QOL). A long term follow up is critical to authenticate outcomes following anti-reflux/hiatal hernia repair surgery. Objective information must be linked to the patient’s perception of the disease and the impact on the QOL. Our survey aims assess the long term patient’s satisfaction and the impact on QOL following standard Nissen’s and Lind’s fundoplication for GORD.

Methods
A single surgeon’s prospective database of laparoscopic and or open hiatus hernia repair and fundoplication with patient’s demographics since 2014 in a district general hospital was analyzed. These patients were contacted virtually between June and July 2021. Verbal consent was obtained, the patients were asked to answer questions from the GERD HRQL (AUGIS modified for use in National Hiatal Surgery Registry) for Hiatus Hernia (HH) or Gastro-oesophageal reflux disease (GORD) or both to assess postoperative symptoms relief, complications, and overall quality of life. The scoring scale was divided into two categories; no symptoms or mild–moderate symptom improvement and those with significant symptoms.

Results
Of the 93 patients, 85 (91.4%) underwent primary laparoscopic repair with 91 cases performed as elective procedure. 68 patients (73%) underwent a Lind wrap, 24 (26%) had a floppy Nissen’s and one was a dor procedure. Three patients with unrelated death were excluded from the analysis. We had 67 responders (74.4%), 56 answered the GORD questionnaire and 66 responded to the HH questionnaire.
84% patients with GORD and 85% of patients with HH had significant symptom improvement. 61 % and 55% suffered from significant gas bloat symptoms in each group. As for dysphagia; 77% had no - mild dysphagia and 23% had significant dysphagia and this was 79% and 21% in HH group.

Conclusions
Overall patients satisfaction and improvement in quality of life was 90% . Half of our patient experienced gas bloat syndrome, which had little effect on their quality of life. 20% had long term dysphagia and one third of the patients seem to continue to use PPI despite expressing a satisfactory clinical improvement. It appears that patient’s long term improvement on the quality of life was satisfactory from both Nissen’s and Lind procedure.
P-BN55 Results of the ARROW survey of anti-reflux practice in the UK
Authors:   The ARROW collaboration
Published: December 2021

Abstract

Background
Gastro-oesophageal reflux disease (GORD) affects 10-20% of the population. Lifestyle modifications and medications such as proton pump inhibitors are generally well tolerated, however a variety of surgical and endoscopic interventions may be more suitable for well selected patients. Despite national guidelines and evidence from trials there is lack of consensus regarding the best approach to antireflux surgery (ARS).
We designed a national audit (ARROW) to describe variation in UK clinical practice of ARS and adherence to clinical guidelines. Our audit was designed in two phases. First, a survey of national practice; Second, a prospective audit of adherence to available guidelines.

Methods
Survey questions were iteratively developed by the ARROW steering committee and an online tool was developed to gather survey responses and contact details for the audit phase. The final questionnaire consisted of 90 fields per surgeon and 57 fields per institution. Participants were enlisted through AUGIS, social media, personal contacts and the ROUX group of upper GI surgical trainees. The online tool was piloted in three centres. The protocol for the study was peer reviewed and published in Diseases of The Esophagus in January 2021

Results
Survey responses were received from 151 surgeons at 57 institutions with a median of 40 cases annually and 4 surgeons/institution. Surgeons perform a median of 12(range 0-75) NHS cases and 6(range 0-75) private cases. 150/151 NHS surgeons perform some form of fundoplication for ARS, 4 surgeons perform LINX™, 4 STRETTA™ and 49 roux-en-y bypass for GORD. Fundoplication procedures performed in the UK include Nissen (111/151), Watson (39/151), Toupet (72/151) and Dor (61/151). 104 surgeons adjust the wrap performed according to clinical symptoms, manometry or both. 20/57 centres had no access to a benign MDT to discuss ARS.

Conclusions
ARS in the UK lacks standardised approaches that can be reliably compared and therefore improved most surgeons perform less than 20 cases a year. Our survey revealed differences in which investigations are considered mandatory, which procedures are available to whom and with what variations, and available resources to facilitate shared decision making for patients with GORD and ARS surgeons. Our audit phase (begun in April 2021) will establish current practice, compliance with clinical guidelines and inform improvement projects and randomised trials in the future.
P-BN59 Danger is there, do we want to know about it? Routine intra operative cholangiography highlights dangerous biliary anatomy for safer cholecystectomy
Authors: ain Noor Ul , Bibi Saira , Tait Ian , Zino Samer 
Published: December 2021

Abstract

Background
Normal biliary anatomy is uncommon. Different classification for biliary anatomy has been described, with Huang Types A4 & A5 of great interest for laparoscopic cholecystectomy (LC) due to the proximity of aberrant bile duct to Cystic duct (CD). These types of dangerous anatomy might contribute to bile duct injury. This study aims to analyse the prevalence of dangerous biliary anatomy.

Methods
Prospectively collected data for all patients who underwent laparoscopic cholecystectomy was analysed. All LC were performed by single surgeon or under his direct supervision, between 01/07/2020 and 20/08/2021. Index admission and single session management of cholelithiasis disease with routine Laparoscopic cholecystectomy + intra operative cholangiography (IOC) +/- LCBD exploration were standard practice.

Results
Laparoscopic cholecystectomy was performed in 137 patients. Mean age was 56y (17-84). 62% were females. 66% of Laparoscopic cholecystectomies were emergency.
IOC was performed in 92% of cases. Abnormal biliary anatomy was found in 54% : Huang A1 - 48%, A2 - 29%, A3 - 12%, A4 - 9.7% and A5 - 0.7%.
Dangerous anatomy (A4 and A5) was found in 10.5%, 78 % were females. Female with dangerous anatomy were younger than males 49 y, 60y respectively. Nassar difficulty grading for dangerous anatomy was as follows: G2 28%, G3 42% and G3 28%
Abnormal cholangiogram was found in 48%, due to filling defect in 58%, no contrast flow into duodenum in 4%, Cystic duct stone in 4%, and short CD in 8%. CBD stones were treated using transcystic approach in 92% of cases. No intra-operative or post operative complications were recorded for patients with dangerous anatomy.

Conclusions
This study demonstrates that dangerous biliary anatomy, that could lead to bile duct injury is relatively common, occurring in 10.7% of LCs. Routine intra-operative cholangiography highlights these high-risk variations in biliary anatomy and may prevent inadvertent bile duct injury in such cases.
P-BN61 Optimal timing of laparoscopic cholecystectomy for admitted acute cholecystitis patients
Authors: Lucocq James , Scollay John , Patil Pradeep 
Published: December 2021

Abstract

Background
The Tokyo 2018 guidelines support emergency laparoscopic cholecystectomy (ELC) for acute cholecystitis (AC) over delayed laparoscopic cholecystectomy (DLC) for mild cholecystitis, substantiated by a lower total length of stay. The supporting studies are limited by small sample sizes, and clinically relevant findings may have been missed. The aims of the present paper were firstly, to compare the peri- and post-operative course following emergency and delayed LC for AC.

Methods
All patients who underwent ELC and DLC for AC following hospital admission between January 2015 and December 2019 were included in the study. Pre-operative, operative and post-operative data over a 100-day follow-up period were collected retrospectively from multiple databases using a deterministic records-linkage methodology. Patients were splint into groups based on previous admissions and outcomes were compared between ELC and DLC. Multivariate logistic regression models were then used on the entire cohort to adjust for other variables and to determine the impact of ELC versus DLC. Complications of the category Clavien-Dindo ≥2 were considered.

Results
In the group with no previous admissions (n = 630), DCL patients had lower rates of intra-/post-operative complications (8.0%vs.17.9%;p&lt;0.001), lower rates of re-admission (6.6%vs.12.2%;p=0.04) and longer total length of stay (6dvs.5d;p=0.03). In patients with previous admissions (n = 181), DCL had lower rates of intra-/post-operative complications (14.1%vs.25.5%;p=0.06) but there was no significant difference in length of stay (13dvs.12d;p=0.81). The ELC group had a significantly lower admission CRP, ASA and age (p &lt; 0.001). In the multivariate logistic regression models, ELC was positively associated with subtotal/conversion to open (OR,1.94;p=0.01), drain insertion (OR,2.54;p&lt;0.001), bile leak (OR,2.38;p&lt;0.001), post-operative imaging (OR,1.83;p=0.01), longer post-operative stay (OR,7.26,p&lt;0.001) and readmission (OR-1.9;p=0.01).

Conclusions
DLC, once the period of active inflammation has settled, offers superior post-operative outcomes, including lower rates of complication, re-admission and post-operative length of stay; however is associated with longer total length of stay. DLC is only advised where the risk of re-admission is minimised (i.e surgery six weeks following the episode) and relies on the management of surgical waiting lists.