bluuebunny/crossref_metadata_2025_split huggingface dataset:
TP6.1.5 The Importance of the Patient Voice in Metastatic Colorectal Cancer: A Qualitative Study
Authors: Chan Anthony , Ignatowicz Agnieszka , Mason James , Siriwardena Ajith 
Published: October 2021

Abstract

Aims
Colorectal cancer is the fourth commonest cancer in the UK with a third presenting with synchronous liver metastases. Although there is a large body of clinical cohort data, there is no research exploring patient perspectives of disease. This qualitative phenomenological study explores the lived experiences of patients following treatment for synchronous disease.

Methods
Qualitative interviews used pre-prepared prompts encouraging open dialogue and were transcribed for thematic analysis.

Results
Four major themes emerged.
(1) Experience of Cancer
The initial diagnosis was recalled in vivid detail, with delays perceived negatively particularly if clinicians were dismissive about their concerns. Caregiver participation was valued in consultations. Patients with recurrence perceived chemotherapy as a method of control.
(2) Patient Autonomy
Patients describe a paternalistic relationship with their clinician and were satisfied with their management despite any complications or recurrence. There was little perception of pathway equipoise with some questioning any real choice particularly those with a symptomatic bowel primary.
(3) Treatment Strategy
Patients preferred a bowel-first strategy as a method of control, perceiving the primary to continually seed the body with metastases. Chemotherapy offered little reassurance for disease control. Synchronous resection was preferred but the greater potential for complications was appreciated.
(4) Research
No patients expressed ethical concerns about potential studies randomising to different surgical strategies. However, patients would not want a liver-first strategy.

Conclusions
This is the first qualitative study exploring patient perceptions of metastatic colorectal cancer. The importance of the first consultation outlining management is emphasised as a simple but important message.
TP6.1.7 Systematic review and meta-analyses of cholecystectomy as a treatment of biliary hyperkinesia
Authors: Eltyeb Hazim A. , Al-Leswas Dhya , Abdalla Mutwakil O. , Wayman John 
Published: October 2021

Abstract

Aims
Biliary hyperkinesia is typically diagnosed in patients with biliary like pain and no evidence of gall stones on imaging modalities but who have had biliary scintigraphy scan (HIDA) that shows ejection fraction ≥80%. This study aims to identify whether the removal of the gall bladder can alleviate the symptoms associated with Biliary Hyperkinesia.

Methods
Systematic search following PRISMA guidelines was done from inception to January 2020 using PubMed/Medline, OVID, Embase, Cochrane database of systemic reviews, Cochrane central register of controlled trials, The Database of Abstracts of Reviews of Effects (DARE) and Cochrane library databases. Results were expressed as risk ratios (RR) for dichotomous outcomes together with 95% confidence intervals (CI) or mean differences (MD) or standardized MD (SMD) for continuous outcomes. A meta-analysis done using random-effect model in RevMan 5.4® software.

Results
Thirteen studies met the inclusion criteria and were included in the review. A total of 332 patients diagnosed with biliary hyperkinesia underwent cholecystectomy, of whom 303 (91.3%) reported symptomatic improvement RR 8.67 [95% CI 4.95, 15.16] P = 0.01. Six studies described abnormal histological features in 163/181 (90.05%) with high GB EF. RR 7.88 [95% CI 3.94, 15.75] P = 0.08. Chronic cholecystitis n = 155 (95%), cholesterolosis n = 7 (4.3%), and one showed features of acute cholecystitis.

Conclusion
Patients with typical biliary colic symptoms without gallstones and markedly high ejection fraction might benefit from having cholecystectomy to alleviate their symptoms.
TP6.1.9 Prolonged post-operative stay following emergency and elective laparoscopic cholecystectomies and its contributing factors
Authors: Lucocq James , Radhakishnan Ganesh , Scollay John , Patil Pradeep 
Published: October 2021

Abstract

Aims
Patients who undergo laparoscopic cholecystectomy (LC) for gallstone disease are a heterogenous population with many variables involved in their management. The aim was to identify the proportion of patients who have a prolonged post-operative stay (PPS; &gt;3days) following elective and emergency LC and the variables that most contribute to PPS.

Methods
We retrospectively collected data for all patients who underwent an elective and emergency LC across three surgical units from 2015 to 2020. Rates of PPS were compared between elective and emergency groups and variables associated with PPS were identified using multivariate logistic regression models.

Results
2769 patients were included in the study (median age, 53years(range, 13-92); M:F,1:2.7; emergency:elective,1:3.6) The rate of PPS was higher in the emergency versus elective group (25.1% versus 6.6%; p&lt;0.0001). Pain was one of the major causes in both groups. In the elective group, factors associated with PPS included cholecystitis (OR,1.96; p=0.008), previous gallstone related admissions (OR,1.48; p=0.008), pre-operative ERCP (OR,3.58;p&lt;0.0001), ASA (OR,1.82; p=0.001) and age (years) (OR,1.03;p=0.001). In the emergency group, factors associated with PPS include cholecystitis (OR,5.3;p&lt;0.0001), ASA (OR,1.96; p = 0.01) and pre-operative ERCP (OR,4.44;p=0.001).

Conclusions
The rate of PPS following laparoscopic cholecystectomy is significant, particularly in the emergency group. Although the possibility of PPS cannot be avoided, patient information regarding the possibility of PPS is important, particularly for those at risk. The risk factors for PPS should be used to guide surgical decision making and should be followed by targeted management of these patients including optimised pain relief.
TP6.2.4 Emergency colorectal resections: do colorectal surgeons achieve better outcomes than non-colorectal surgeons?
Authors: Wu Diana , Gartner Isabel , Henderson Nikola 
Published: October 2021

Abstract

Aim
Patients requiring emergency colorectal surgery in Tayside are managed by general surgeons who may or may not have subspecialist training in colorectal surgery. We investigated whether surgeon subspecialisation influences outcomes after emergency colorectal resections.

Methods
All patients undergoing emergency colorectal resections between 01/01/14 and 31/10/20 were included. Demographic, clinical, operative and outcome data were collected from hospital electronic records. Outcomes were compared for patients treated by colorectal versus non-colorectal surgeons. The primary outcome was 30-day post-operative mortality. Adjusted mortality was calculated using logistic regression. Secondary outcomes included rates of laparoscopic surgery, stomas, complications, readmissions and length of hospital stay. Categorical data were compared by chi-squared tests and non-parametric data by Wilcoxon tests.

Results
Of the 177 operations performed, 104 (58.8%) were performed by colorectal surgeons. Overall 30 day mortality was 5.1%, which was significantly lower for colorectal versus non-colorectal surgeons (1.0% vs 11.0%, p = 0.003), this remained significant after multivariate adjustment (Odds ratio 0.10, 95% confidence interval 0.01-0.86, p = 0.036). The proportion of laparoscopic cases was significantly higher for colorectal compared with non-colorectal surgeons (54.8% vs 4.1%, p &lt; 0.0001). There were no significant differences in stoma rates (76.0% vs 63.0%, p = 0.063), further procedures (5.8% vs 8.2%, p = 0.523), anastomotic leaks (1.9% vs 4.1%, p = 0.387), readmission within 30 days (12.5% vs 13.7%, p = 0.815) or median length of hospital stay (16 vs 18 days, p = 0.375).

Conclusion
Mortality rates at 30 days after emergency colorectal surgery are significantly lower for patients treated by subspecialist colorectal surgeons. This provides a strong argument for a subspecialist on-call rota.
TP6.2.5 Post-operative recovery following emergency laparoscopic cholecystectomy: a need to redefine the consent for emergency cholecystectomy
Authors: Lucocq James , Radhakishnan Ganesh , Scollay John , Patil Pradeep 
Published: October 2021

Abstract

Aims
Understanding the risks of emergency LC is necessary before patients can make an informed decision regarding operative management. Our primary aim was to provide a comprehensive analysis of the post-operative course of these patients.

Methods
Emergency LC performed for all biliary pathology across three surgical units between January 2015 and January 2020 were included. We followed each patient up for 100 days postoperatively and data was collected retrospectively. Data collected included demographic data, operative data, post-operative recovery, imaging, additional interventions and re-admissions.

Results
A total of 605 patients were identified (median age, 53 years (range 13-92); M:F, 1:2.7). 36.9% of patients had a complicated postoperative period, either suffering a significant complication, requiring prolonged post-operative stay (&gt;3 days), further imaging, additional interventions or re-admission. The rate of complication was 13.5% (including retained stones 3.5%; collections 3.8%; bile leaks 3.3%). The rate of prolonged post-operative stay was 25.1%. 16.2% required postoperative imaging and 6.1% required post-operative intervention.12.9% were re-admitted for assessment related to the LC. The rate of bile duct injury was 0% (0/605).

Conclusions
Although LC has the reputation of largely an uncomplicated procedure, our data illustrates the substantive morbidity associated with emergency LC. Patients should be counselled about the high morbidity rates. This involves patient education and will improve consent which should help decrease litigation. Surgeons should take a more selective and pragmatic approach when offering the procedure.
TP6.2.7 Routine examination of gallbladder specimens after cholecystectomy: a single-centre analysis of the incidence, clinical and histopathological aspects of incidental gallbladder carcinoma
Authors: Mauro David Di , Orabi Amira , Myintmo Aye , Reece-Smith Alex , Wajed Shahjehan , Manzelli Antonio 
Published: October 2021

Abstract

Aims
Gallbladder carcinoma is often found incidentally on histopathologic examination after cholecystectomy – this is referred as incidental gallbladder carcinoma (IGC). Routine vs selective histopathological assessment of gallbladders is under debate, this study evaluates the role of regular specimens’ examination, based on a single-centre analysis of incidence, clinical and histopathological aspects of IGC.

Methods
Patients who underwent cholecystectomy, between July 2010 and January 2020, were considered. Exclusion criteria were age under 18 and preoperative diagnosis of GB carcinoma. Demographic, clinical and histopathological data were retrospectively collected, continuous variables with a normal distribution were evaluated with Student’s t-Test and ANOVA.

Results
Some 5779 patients were included. The female/male ratio was 2.5:1. Chronic cholecystitis (CC) was the most common finding on specimens (99.3%), IGC was found in 6 cases (0.1%). In the latter group, there were 5 women and patients were older than those with benign disease – 73.7 ± 5.38 years vs 55.8 ± 0.79 years (p &lt; 0.05). In all the cases, the GB was abnormal on intraoperative inspection and beside cancer, histopathology showed associated CC and/or dysplasia. Upon diagnosis, disease was at advanced stage – one stage II, one stage IIIA, one stage IIIB, three stage IVA. Two patients are alive, three died of disease progression – median survival was 7 months (range 2-14).

Conclusions
In this series, ICG was rare, occurred most commonly in old adult women and was diagnosed at an advanced stage. In all the cases, the GB was abnormal intraoperatively, therefore macroscopic GB anomalies demand histopathological assessment of the specimen.
TP6.2.9 1224 Surgical Endoscopic Retrograde Cholangio-Pancreatography over three years. A single unit’s experience of service provision and delivery of clinical excellence
Authors: Smith Eleanor , Bowyer Eleanor , Nagendram Sathyan , Zeindler Jasmin , Singh Sukhpal , Veeramootoo Darmarajah 
Published: October 2021

Abstract

Aims
Endoscopic Retrograde Cholangio-Pancreatography (ERCP) is traditionally the domain of medical gastro-enterology. Our practice is exclusively surgeon delivered and therefore represents an alternative paradigm. The British society of Gastro-enterology (BSG) proposed key performance indicators in 2014 to evaluate standards of ERCP practice with focus on performance and safety against which we evaluated our practice.

Methods
The study period covers 3 years from September 2016 to August 2019. An analysis of prospectively collected data was performed. Performance of the individual surgeons and collective was collated and retrospectively analysed.

Results
The unit’s caseload for the 3 years period was 1224 procedures. Each surgeon’s share was similar, i.e. 454, 430 and 340 cases respectively (BCG 75 per annum). Most procedures were performed electively, some on emergency basis or within two weeks. Biliary duct stones were the most common indications for the procedure, followed by malignancy. Overall bile duct cannulation rate was 95.3%; and 91.8% for first ERCP (BSG &gt; 85%). CBD clearance was achieved in 80.6% cases, and stone clearance at first ERCP was 78.6% (BSG &gt; 75%). Successful stenting of extra-hepatic biliary stricture was achieved in 89.4% cases at first ERCP (BSG &gt; 80%). Overall complications rate was 6.2% and for level 1 & 2 cases 5.3% (BSG less than 6% is accepted standard).

Conclusions
We performed a high volume of safe and effective ERCPs with low risk of complications in line with national standards. ERCP has become an exclusive therapeutic tool in surgical management of gall stones disease and biliary malignancy.
TP6.2.18 Initial experience with routine postoperative nasal high-flow oxygen as part of enhanced recovery following oesophagectomy for cancer
Authors: Nnaji Martin , Koshy Renol , Priest Oliver , Beardsmore Duncan , Jagadesham Vamshi , Bouras George 
Published: October 2021

Abstract

Introduction
Pulmonary complications occur in up to 38% of patients undergoing oesophagectomy and are associated with significant risk of mortality. Nasal high-flow oxygen (NHFO) has previously been shown to reduce respiratory complications following major abdominal surgery, however, its use in oesophagectomy has not previously been assessed. We report our results using NHFO routinely as part of our enhanced recovery protocol (ERP) in consecutive patients undergoing oesophagectomy for cancer at a single tertiary referral centre.

Methods
We recently incorporated routine postoperative NHFO following oesophagectomy as part of our ERP at Royal Stoke University Hospital. We conducted a prospective study of patients undergoing surgery between November 2019 and September 2020. The primary outcome measure was complications related to delivery of NHFO. Secondary endpoints included rates of pulmonary complications and mortality within 30 days of surgery.

Results
Fifty patients underwent oesophagectomy during the study period. The median age was 66 years (range 43-78 years) and male to female ratio was 4:1.Majority (49/50) of patients underwent 2-stage oesophagectomy while one underwent 3-stage oesophagectomy. All patients received postoperative NHFO. There were no complications related to NHFO. The 30-day overall pulmonary complication rate was 30%.Of these, 28% developed pneumonia,4% pulmonary embolism,and 2% pleural effusions requiring drainage. There were no deaths within 30 days of surgery.

Conclusion
Routine postoperative NHFO in consecutive patients undergoing oesophagectomy is safe and feasible with lower pulmonary complication rates than previously reported, leading to better overall outcomes. The value of NHFO in oesophagectomy requires further evaluation in a randomized clinical trial.
TP7.2.5 Surgeon measured radiological pelvic measurements as a patient selection tool for laparoscopic rectal resection – an aide in early learning curve
Authors: Gavrila A D , Deans A J , Dhruva Rao P K 
Published: October 2021

Abstract

Introduction
Rectal resections are considered one of the most technically demanding laparoscopic procedures. This study reviews one unit’s rectal cancer resections to determine whether pelvic dimensions measured by the surgeon could aide patient selection for laparoscopic resections.

Methods
A prospectively maintained database was used to identify rectal cancer resections between April 2015 to March 2018 and patient demographics, BMI, height of tumour and operative details were in extracted. Anteroposterior (Coccygio-pubic) and transverse (interspinous) distance were measured retrospectively on linked Axial & Saggital views on staging CT scans. Tumour dimensions in the respective planes were recorded and relative proportions of tumour to pelvic dimensions calculated. These were correlated to operative approach.

Results
Our cohort comprised of 70 patients (42 men) with a median BMI of 27 and mean age of 71. While 6 operations were planned as open procedures, 64 were attempted laparoscopically. Of these, 55 were completed laparoscopically and 9 were converted (16%). There was no correlation between gender and operative approach (p = 0.2). Mean BMI for laparoscopic group 28.7 and converted group 30.0 which was not statistically significant (p = 0.32). Conversion was more likely for low tumours (89%). Median tumour to pelvic area proportion was 0.14 laparoscopic compared to 0.03 for open and 0.03 for converted suggesting that bulkier tumours are more likely to need conversion.

Discussion
None of previously identified factors such as gender and BMI predicted conversion in our cohort individually. Tumour size relative to pelvic dimensions is a simple measure a surgeon could use to guide patient selection.
TP7.2.13 Clinical characteristics and outcomes of acute pancreatitis following spinal surgery: a systematic review
Authors: Jayasinghe Ravindri , Ranasinghe Sonali , Jayarajah Umesh , Seneviratne Sanjeewa 
Published: October 2021

Abstract

Aims
Acute pancreatitis (AP) is a rare post-operative complication of spinal surgery. This study reviews the current evidence on clinical characteristics and outcome of AP following spinal surgery.

Methods
A systematic search was performed on English articles published up to May 2020 using PubMed, Scopus, EMBASE, LILACS and Cochrane databases. Data on clinical characteristics, risk factors and outcomes were extracted and analysed.

Results
Eleven papers meeting the inclusion criteria which included a total of 306 (23.02%) patients developing AP out of 1,329 patients undergoing spinal surgery were included (mean age= 14.17 years). Of the 11 studies that specified symptoms (n = 55 patients) abdominal pain (43.6%), nausea and vomiting (32.7%) and abdominal distension (7.27%) were the commonest symptoms. The mean duration from surgery to onset of symptoms was 6.15 days (range:1-7). Almost all (n = 10, 90.9%) were treated non-operatively. Of the complications mentioned (n = 306 patients), glucose intolerance (25%), peritonitis (2%), pseudocyst (2%), and fluid collection (2%) were the commonest. Of the studies mentioning associated factors (n = 22 patients) prolonged fasting time (13.6%), intra-operative blood loss (9.09%), gastroesophageal reflux disease (9.09%), age &gt;14 years (9.09 %), low BMI (9.09 %), and anterior/combined approach (9.09%) were the commonest associated factors for AP. A total of 2 deaths (n = 2/306, 0.65%) were reported.

Conclusion
Although uncommon, AP remains an important post-operative complication of spinal surgery due to its associated morbidity and mortality. Avoiding major risk factors including prolong fasting and minimizing intra-operative blood loss may help reduce the incidence of AP in patients undergoing spinal surgery.
TP7.2.14 Long Term Outcome of Patients with Minimally Symptomatic Diverticular Stricture
Authors: Jayawardena P A , Hany T S , Peris M R 
Published: October 2021

Abstract

Aims
Minimally symptomatic diverticular stricture poses diagnostic and management dilemma for the Colorectal Surgeon. Long term outcome, risk of missing a cancer and complications are not well documented in the literature. This study aims at assessment of outcomes of patients with minimally symptomatic diverticular stricture who were treated conservatively.

Methods
Retrospective chart review of all patients with confirmed diverticular stricture on endoscopy and imaging scans who had minimal or mild symptoms over a 6-year period from January,2014 to June,2020 in a large tertiary referral hospital. Search methods included diverticular disease with stricture using ICD10 code K57 and K56.6. Outcome measures included complications while on conservative treatment including missed cancer, any subsequent surgery and complications including stomas.

Results
29 patients fitted the inclusion criteria, 18 females with median age 75(43-92). Median follow up was 32.5 months (8-93). All had endoscopic and CT imaging confirmation of diverticular stricture. Repeat investigations were recorded as 16 endoscopies in 9 patients and 30 CT scans in 14 patients during follow up. Four patients had at least one episode of diverticulitis; only one underwent emergency surgery at 5 years from diagnosis. 2/29 (6.9%) patients presented with diverticular perforation requiring Hartmann’s procedure. One patient (3%) had elective sigmoid resection with average duration of follow up 29 months (11.5-59) months. There were no missed diagnosis of cancer and no mortality due to diverticular disease.

Conclusions
In this patient population, diverticular stricture runs a relatively benign course with few complications or surgical intervention during follow up.
TP7.2.15 Superior Mesenteric Artery Syndrome Managed with Laparoscopic Duodenojejunostomy: Case Series and Review of the Literature
Authors: Saber Hatem , Shaalan Ramy , Kahlin Carl , Elhoofy Ahmed 
Published: October 2021

Abstract

Aims
Superior Mesenteric Artery (SMA) Syndrome is a rare disorder which may be managed surgically when conservative management fails. We present a case series of six patients who underwent laparoscopic duodenojejunostomy in our tertiary centre for treatment of SMA Syndrome. The aim of our case series is to assess and present our outcomes in comparison to the limited available literature on the topic.

Methods
Retrospectively, we identified all patients who underwent laparoscopic duodenojejunostomy for SMA Syndrome in our tertiary university centre’s surgical database between December 2016 and July 2019. Data collected included demographics, presenting symptoms, co-morbidities, pre and post-operative Body Mass Index (BMI), operative approach, operative blood loss, operative duration, length of hospital stay, clinical and radiological results, in hospital/30 day complications, mortality and post operative follow up outcomes.

Results
We identified six patients, 1:5 male to female ratio, with a median age 18 years of age (range 17-31 years). All patients had refractory symptoms after a minimum of two months (range 2-5 months) of conservative management and subsequently underwent laparoscopic duodenojejunostomy. Median hospital stay was 7 days and no in hospital/30 day post operative mortality or complications were identified. Follow up data showed no recurrence of symptoms and a BMI median increase of 10.2 (range 8-13.6) at a median follow-up of 18 months (range 12-30 months)

Conclusions
Laparoscopic duodenojejunostomy is a safe treatment option for SMA syndrome and should be considered when patients do not respond to conservative management.