bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP5.2.6 Adrenal Incidentalomas in Living Kidney Donors: A Dilemma?
Authors: Theodorou Chloe , Moinuddin Zia , Dellen David Van , Augustine Titus , Giuffrida Giuseppe 
Published: October 2021

Abstract

Aims
During donor multi-detector CT angiogram (MDCTA), incidental findings occur, commonly adrenal incidentalomas (AIs). These are usually benign and non-functional with an estimated incidence of 4%.1 These potentially limit organ donation due to the need to exclude malignancy. There is no consensus on the management of donors with AIs.1,2 This study aims to explore the incidence and clinical course of AI’s in living kidney donors.

Methods
We performed a single-centre, retrospective study on all prospective living kidney donors between November 2000 and September 2020. Patients with adrenal lesions during work-up were identified and further information was collected from electronic patient records.

Results
Six (1.09%) of the 546 donors during that period had an AI. All were small (&lt;4cm) and non-functional with benign radiographic features. Five (83.3%) proceeded to donation while 1 (16.7%) was unsuitable for donation due to complex vascular anatomy. Of the five donors that proceeded, 2 (40%) were contralateral and 3 (60%) ipsilateral AI’s to the side of nephrectomy. Of the 3 ipsilateral AIs, 2 (66.7%) underwent nephrectomy alone whilst 1 (33.3%) underwent a simultaneous nephrectomy and adrenalectomy. There was no evidence of malignancy or functional change in AIs post-donation.

Conclusion
The incidence of adrenal pathology in living donors is low and largely benign. These patients should not be excluded from donation. Such patients could benefit from open discussion regarding simultaneous adrenalectomy vs conservative management.
SP6.1.2 Colorectal Liver Metastases - Novel Assessment Tools for Resectability (The CoNoR Study): Results from an International Questionnaire of Hepatopancreatobiliary Surgeons
Authors: Parmar Kat , O'Reilly Derek , Jones Rob , Balaa Fady , Welsh Fenella , Renehan Andrew 
Published: October 2021

Abstract

Aims
Hepatic resection offers the only chance of cure for colorectal liver metastases (CLM), yet wide variation in resectability decision-making has been demonstrated. This study aims to evaluate the potential value of two novel assessment tools in aiding resectability decision-making: the LiMAx test (hepatic functional capacity) and HepaT1ca interactive pre-operative MR scan (MR-based volumetry and functional assessment).

Methods
This study utilises four workstreams: WS1 systematic review, WS2 international HPB interviews, WS3 international HPB online questionnaire, and WS4 online scenario-based survey to assess change in decision-making resulting from the novel tools. The WS3 questionnaire closed in January 2021; participation was increased by professional association endorsement (AUGIS, GBIHPBA, E-AHPBA, AHPBA, CHPBA, IHPBA).

Results
197 complete responses were received from 37 countries in 6 continents. The clinical scenario in which HPB surgeons found resectability decisions most challenging was post-chemotherapy downsizing, with &gt;90% of respondents agreeing that the following scenarios also present a challenge: recurrent disease post-liver resection, post-portal vein embolisation, and close proximity to major ducts/vessels. Substantial variation was demonstrated in the percentage future liver remnant at which surgeons preferred further investigation in all scenarios. &gt;90% of respondents felt the novel tools would be potentially useful in decision-making; wide-ranging free-text feedback was also provided.

Conclusions
The questionnaire lends support to the previously documented variation in resectability decision-making and confirms international HPB community support for investigation of these novel tools. Response analysis has facilitated the appropriate case selection to best assess their potential utility in the WS4 survey, due to launch this spring.
SP6.1.5 Morbidity following emergency and elective laparoscopic cholecystectomy for cholecystitis: a retrospective comparative cohort study
Authors: Lucocq James , Radhakishnan Ganesh , Scollay John , Patil Pradeep 
Published: October 2021

Abstract

Aims
A comprehensive comparison of post-operative outcomes between emergency and elective laparoscopic cholecystectomy (LC) for cholecystitis has not been conducted and the relative morbidity associated with emergency LC remains uncertain. Our aim was to evaluate the difference in early post-operative outcomes between emergency and elective LC for patients with cholecystitis.

Method
LC performed for cholecystitis across three surgical units between January 2015 and January 2020 were analysed retrospectively from multiple regional databases using deterministic records-linkage methodology. Rates of complications, further imaging, re-intervention, prolonged post-operative stay and re-admissions over a 100-day follow-up period were compared between emergency and elective groups using univariate and multivariate analysis.

Results
LC were performed for cholecysitits in 962 cases (median age, 52 years; M:F, 1:2.7; emergency:elective; 1:3.9). Emergency cholecystectomy had higher rates of complication (15.8% versus 8.8%;p&lt;0.0001), prolonged post-operative stay (40.3% vs. 12.7%;p&lt;0.0001), post-operative imaging and intervention (19.1% vs. 9.4%;p&lt;0.0001) and readmission (11.1% vs. 7.0%;p=0.017). In the multivariate regression analysis, emergency LC was associated with prolonged admission (OR,5.7;p&lt;0.0001), complication (OR,2.97;p&lt;0.0001), post-operative imaging and intervention (OR,2.4;p=0.002) and readmission (OR,1.9; p = 0.06).

Conclusions
Despite current guidance, an emergency cholecystectomy remains a morbid procedure and we demonstrate increased risks of emergency LC versus elective LC. The increased risk of an emergency LC needs to be weighed up against the risk of further attacks from biliary pathology until elective surgery. Our data indicates that we need to readjust our selection criteria for the ‘emergency cholecystectomy patient’ and identify patients who will specifically benefit from earlier surgery.
SP6.1.7 Meta-analysis of procedural outcomes of laparoscopic-assisted endoscopic retrograde cholangiopancreatography in patients with previous Roux-en-Y gastric bypass surgery
Authors: Hajibandeh Shahab , Hajibandeh Shahin , Mansour Moustafa , Satyadas Thomas 
Published: October 2021

Abstract

Aims
To investigate the procedural outcomes of laparoscopic-assisted endoscopic retrograde cholangiopancreatography (ERCP) in patients with previous Roux-en-Y gastric bypass (RYGB) surgery.

Methods
We performed a systematic review in accordance with PRISMA statement standards to identify all studies reporting procedural outcomes of laparoscopic-assisted ERCP in patients with previous RYGB. The ROBINS-I tool was used to assess the risk of bias of the included studies. Fixed-effect and random-effects models were applied to calculate pooled outcome data.

Results
A total of 17 case series, enrolling 256 patients, were included. The mean age of included patients was 49. The mean procedure time was 137 minutes (95% CI 102-172). In terms of procedural success rates, the overall technical success was 95.3% (95% CI 92.5-97.5,I2=0%), papillary access success was 95.3% (95% CI 92.5-97.5,I2=0%), cannulation success was 95.3% (95% CI 92.5-97.5,I2=0%), sphincterotomy success was 96.1% (95% CI 93.5-98.1,I2=0%), and stone removal success was 95.9% (95% CI 92.4-98.4, I2=0%). Conversion to open was required in 4.7% (95% CI 2.5-7.6,I2=0%). In terms of complications, pancreatitis occurred in 4.7% (95% CI 2.3-8,I2=17%), cholangitis in 1.7% (95% CI 0.5 to 3.6,I2=0%), and perforation in 3.7% (95% CI 1.8- 6.3,I2=0%). The length of hospital stay was 3 days (95% CI 2-4).

Conclusions
Laparoscopic-assisted ERCP seems to be feasible, effective, and a safe method to access the biliary tract in patients with previous RYGB as indicated by high technical success rates and low complication rates. There is a need for comparative evidence regarding outcomes of laparoscopic ERCP in comparison with alternative treatment options.
SP6.1.11 The Effect of the Enhanced Recovery Programme for Liver Surgery on Long Term Survival
Authors: Arujunan Kalaiyarasi , Shugaba Abdulwarith , Uwadiae Harmony , Lambert Joel , Sgourakis Georgios , Subar Daren 
Published: October 2021

Abstract

Aims
The Enhanced Recovery Programme for Liver Surgery (ERPLS) has been shown to promote functional recovery and reduce hospital stay. However, its effect on long term survival has yet to be established. The aim of this study was to determine the effect of the ERPLS on 5-year patient survival.

Methods
This was a retrospective study of patients who underwent liver resection for colorectal liver metastasis (CRLM) between January 2011 and December 2016 at a regional hepatobiliary centre. The cohort comprised of 60 pre-ERPLS and 60 post-ERPLS patients. The primary outcome was 5-year patient survival. The secondary outcomes were length of stay (LOS), postoperative complications and 90-day readmission rates. Multivariate analysis was performed to identify independent predictors of overall survival.

Results
There was no significant difference in the age (p = 0.960), gender (p = 0.332) and type of resection (p = 0.198) between both groups. ERPLS was not an independent predictor for overall survival (Gehan Wilcoxon Test, p = 0.828). There was no significant difference in the LOS (p = 0.874) and 90-day readmission rates (p = 0.349). Major postoperative complications (&gt;3a Clavien-Dindo classification) were significantly less in the ERPLS group (p = 0.02). On multivariate analysis, positive resection margins and major postoperative complications were independent predictors for overall survival.

Conclusions
ERPLS does not seem to have an effect on long term patient survival. However, it appears to reduce the rate of major postoperative complications. LOS and 90-day readmission rates were not influenced by ERPLS.
SP7.1.5 Common General Surgical Never Events: Analysis of NHS England Never Events Data
Authors: Omar Islam , Singhal Rishi , Wilson Michael , Parmar Chetan , Khan Omar , Mahawar Kamal 
Published: October 2021

Abstract

Background
There is little available data on common general surgical Never Events (NE). Lack of this information may have affected our attempts to reduce the incidence of these potentially serious clinical incidents. The purpose of this study was to identify common general surgical NE from the data held by the NHS England.

Methods
We analysed NHS England NE data from April 2012 to February 2020 to identify common general surgical NE.

Results
There was a total of 797 general surgical NE identified under three main categories of Wrong-Site Surgery (n = 427;53.58%), Retained Items Post-Procedure (n = 355; 44.54%), and Wrong Implant/ Prosthesis and (n = 15; 1.88%). We identified a total of 56 common general surgical themes - 25 each in the Wrong-Site Surgery and Retained Foreign Body category and 6 in wrong implants.
Wrong skin condition surgery was the commonest wrong-site surgery (n = 117; 27.4%). There were 18 wrong side chest drains (4.2%) and 18 (4.2%) wrong side angioplasty/angiogram. There were 7 (1.6%) instances of confusion in pilonidal/perianal/perineal surgeries and 6 (1.4%) instances of biopsy of cervix rather than colon or rectum.
Retained surgical swabs were the most common retained items (n = 165;46.5%). There were 28 (7.9%) laparoscopic retrieval bags with or without the specimen, 26 (7.3%) chest drain guidewires, 26 (7.3%) surgical needles; and 9 (2.5%) surgical drains. Wrong stents were most common (n = 9;60%) wrong implant followed by wrong breast implants (n = 2;13.3%).

Conclusion
This study found 56 common general surgical NE. Increased awareness of these common themes of NE may help reduce their incidence.
SP7.1.12 Could surgery under local anaesthetic be the default for Pilonidal Sinus Disease? A systematic review
Authors: Ali Kiren , Tahir Ahmed , Chien Siobhan , Komolafe Olusegun 
Published: October 2021

Abstract

Aims
Pilonidal sinus disease (PSD) is a significant cause of morbidity. The purpose of this systematic review and meta-analysis is to determine the totality of evidence regarding the effectiveness of Local Anaesthesia (LA) when compared to spinal or general anaesthesia in individuals undergoing definitive surgery for PSD.

Methods
A systematic review of literature was conducted. Studies included randomized controlled trials comparing LA with other anesthetics and non-randomized studies focusing on ambulatory procedure of excising pilonidal sinus aiming wound closure, all performed under local anesthetics. We used Cochrane risk of bias tool. The statistical analysis was done using Revman and Excel.

Results
Four original RCTs and 10 observational studies were included, with a total of 1801 patients. There was no significant difference in operative time between the groups Patients in the local anaesthetic group experienced less pain than those in other group, lower rates of anaesthetic related complications, early return to work and increased satisfaction. However, the mode of anaesthesia used had no relation with recurrence.

Conclusion
Our findings support the use of LA in adult patients undergoing definitive surgical treatment for PSD. We aggregate the published evidence to demonstrate clear benefits clinically, patients’ preference, and economic benefits. Patient selection, and adequate dose of local anaesthetic, is the key. In the context of the current COVID—19 pandemic, novel care pathways need to be developed in all medical fields, and we would propose that surgery for Pilonidal Sinus Disease under local anaesthesia should now be the default.
SP7.2.1 Simultaneous intestinal surgery does not increase complication or recurrence rates after complex abdominal wall reconstruction
Authors: Wallace Alison , Garner Jeffrey 
Published: October 2021

Abstract

Aims
To compare post-operative outcomes in patients undergoing elective complex abdominal wall reconstruction (CAWR) alone vs. CAWR plus simultaneous intestinal surgery.

Methods
All patients undergoing elective CAWR over a 10-year period in our unit were identified from a prospectively maintained database and divided into those who had concomitant intestinal surgery (resection, ileoanal-pouch formation, stoma reversal, etc) and those who did not. Simple adhesiolysis, cholecystectomy and gynaecological procedures were not classed as ‘intestinal surgery’. Differences between groups were determined using the paired-t test and the (n-1) Chi-squared test.

Results
59 patients underwent elective CAWR, 16 with intestinal surgery and 43 without. The two groups had similar baseline demographics with no significant differences in age, BMI, sex or hernia size. The commonest post-operative complications were pneumonia (33.9%) and wound infections (25.4%) but there were no significant differences in any complication between groups. There was zero 30 and 90 day mortality in either group. The mean operating time in the intestinal group (IG) was significantly longer compared to the CAWR-only group (5.4 +/- 1.3hrs vs 4.1 +/- 1.8hrs, p = &lt;0.05). There was no statistically significant difference between groups in rates of surgical site occurrence (37.5% IG vs 55.81% CAWR-only), mesh infections (0% IG vs 6.98% CAWR-only) or recurrent hernia (6.24% IG vs 9.30% CAWR-only) over a median follow up of 3.0 (0.1-7.8) years.

Conclusion
Performing simultaneous intestinal surgery during complex abdominal wall repair is safe and does not increase the risk of recurrence or mesh infections in a specialist abdominal reconstruction unit.
SP7.2.5 Robotic incisional/ventral hernia repair is feasible approach compared to laparoscopic repair: a systematic review
Authors: Imsirovic Anja , Bagga Rahul , Khan Mansoor , Singh Krishna , Sains Parv , Sajid Muhammad S 
Published: October 2021

Abstract

Aims
Robotic incisional/ventral hernia repair (R-IVHR) is gaining popularity due to higher safety as well as feasibility profile. The objective of this study is to present a systematic review exploring the role of robotics compared to laparoscopic approach in the management of incisional/ventral hernia.

Methods
A systematic review of all types of comparative studies until January 2021 published on Embase, Medline, PubMed, PubMed Central and Cochrane databases reporting the clinical outcomes in patients undergoing either R-IVHR versus Laparoscopic (L-IVHR) was performed.

Results
A total of 8289 patients in 7 studies were included. There was minimal heterogeneity (Tau2 = 0.29, chi2 = 9.10, df, I2 = 45 %) among included studies for the variables of recurrence rate and post-operative complications, but statistically significant heterogeneity (Tau2 = 1.05, chi2 = 132.81, I2 = 96 %) was observed for the duration of operation. In the random effects model analysis using the statistical software Review Manager, statistically the R-IVHR prolonged the duration of operation (Standardized mean difference, 2.24; 95% CI, 1.37, 3.11; z = 5.06; P = 0.00001) but the post-operative complication rate (OR 0.63; 95% CI, 0.30, 1.34; z = 1.20; P = 0.23) as well as the recurrence rate (OR 0.63; 95% CI, 0.14, 2.74; z = 0.62; P = 0.53) were similar.

Conclusion
R-IVH repair is feasible and safe, but the duration of operation is significantly longer. Major multi-center randomized controlled trial is mandatory to assess the long terms outcomes and cost effectiveness before the routine use of R-IVHR.
SP7.2.6 Where is the nerve? Review of operation note documentation practice for inguinal hernia repair
Authors: Farquharson Barnaby , Sivarajah Vernon , Mahdi Shareef , Bergman Henry , Jeyarajah Santhini 
Published: October 2021

Abstract

Introduction
Careful identification and management of inguinal nerves during inguinal hernia repair is important to avoid iatrogenic injury. Documentation of this practice informs postoperative clinical management. We set out to investigate how often surgeons identify inguinal nerves and document findings and management in operation notes.

Methods
Retrospective review of operation notes at single District General Hospital (DGH). Operation notes analysed for documentation of identification and intraoperative management (preservation vs sacrifice) of the inguinal nerves: iliohypogastric, ilioinguinal and genital branch of genitofemoral nerve. Data including baseline characteristics of each patient, hernia characteristics, and primary operating surgeon ascertained for subgroup analysis.

Results
A total of 100 patients were included in the analysis. Identification of any of the inguinal nerves (generic - “nerve”) was documented in 17% of operation notes. Documentation of named individual nerves in operation notes was limited. No documentation of intraoperative management of inguinal nerves found in 83% of operation notes. Preservation of the inguinal nerves (generic - “nerve”) was recorded in 8% and sacrifice recorded in 9% of cases. Subgroup analysis revealed similar incidence of documentation of identification and management of inguinal nerves across grades of primary surgeon, with overall incidence low for all grades.

Conclusion
This study has revealed a lack of appreciation of the importance of documentation of identification and intraoperative management of inguinal nerves in operation notes. Further consideration of the potential implications of poor documentation would be beneficial to improve standards.
SP8.1.1 Ultrasonic versus electrocautery dissection in modified radical mastectomy for breast cancer: A Systematic Review and Meta-analysis
Authors: Suliman Amna , Latif Ahmed , Giono Ilaria , Doddi Sudeendra , Uhercik MIchal , Kasem Abdul 
Published: October 2021

Abstract

Aims
Electrocautery (EC) remains the dominant dissection tool in modified radical mastectomy (MRM) for breast cancer. However, ultrasonic dissection devices (UDD) have emerged as popular alternatives on the basis that their mechanism of action limits tissue damage resulting in decreased blood loss, seroma formation and post-operative drainage. A systematic review and meta-analysis was performed to compare surgical outcomes for EC versus UDD in MRM surgery.

Methods
MEDLINE, EMBASE, PubMed and the Cochrane Database were searched and a comprehensive systematic review and meta-analysis performed according to PRISMA guidelines, comparing EC versus UDD in MRM for breast cancer. Outcomes of interest were post-operative drainage, incidence of seroma, intra-operative blood loss and operative time. Meta-analysis was performed using a random effects model to aggregate the data. Odds ratios (OR) were used as the summary statistic for dichotomous data and mean difference (MD) for continuous data. Data heterogeneity was assessed using the I2 statistic.

Results
Nineteen eligible peer-reviewed studies were analysed involving 1501 patients, UDD:744 EC:757. We demonstrated that in MRM, UDD significantly reduced post-operative drainage (MD = 312.26, 95% confidence interval (CI): 102.59-521.93, p = 0.004); seroma (OR = 0.51, 95% CI: 0.39-0.68, p &lt; 0.00001) and intra-operative blood loss (MD = 111.68, 95% CI: 84.56-138.8, p &lt; 0.00001) with no significant difference in operative time between the two techniques (MD = 0.32 (11.3-11.94), p = 0.96.

Conclusion
Using UDD in MRM for breast cancer presents significant advantages in decreasing post-operative drainage, seroma and intra-operative blood loss, without lengthening operating time compared to EC. It therefore appears favourable, however further cost-effectiveness analysis would be beneficial to guide selection.
SP8.1.4 Design features of the EPR-integrated Southampton Breast Cancer Data System (SBCDS), with timeline structured whole-of-life records on 20,000 sequential cases since the 1970s
Authors: Rahman Fatima , Hales Alan , Cable David , Rew David 
Published: October 2021

Abstract

Introduction
The digitisation of the electronic patient record (EPR) provides transformative opportunities for data visualisation. The synchronised timeline and iconographic interface permits the whole-of-life display, navigation and interpretation of all documents and reports of each and every EPR on a single screen, thus substantially facilitating clinical research.

Methods
Since 2010, we have conceived, programmed and iterated a radical interface, UHS Lifelines, within our Trust EPR using agile methodology. It is live for &gt;2.5M record sets, and enriched with cellular pathology records back to 1990. We have integrated this interface into a unique, HTML-enabled, dynamic and continually updated database for the recording of treatments and pathologies of all cases of breast neoplasia from our current and historic record sets.

Results
As of January 2021, our data system contains ∼20,000 sequential whole of life records of patients with breast neoplasia, including ∼15,000 locally diagnosed and ∼ 5,000 externally referred cases. The unique Cancer Lifetrack timelines displays the disease course of every case from primary diagnosis, through loco-regional recurrence, to distant metastasis, other morbid cancers and cause of death, where relevant. An integral data mining system permits a wide range of analyses.

Conclusions
We believe our Breast Cancer Data System to be the first-in-class exemplar of a new and proven approach to clinical data visualisation. It permits near-instantaneous oversight and real time updating of every patient record in the system. We recognise its potential application for the whole-of-life study of all chronic diseases of childhood and adulthood as the model is more widely adopted.