bluuebunny/crossref_metadata_2025_split huggingface dataset:
BN SO43 - The impact of dedicated “hot cholecystectomy lists” on rates of early cholecystectomy and its outcomes
Authors: Lo Tammy , Assaf Nazrin , Pandya Shraya , Owera Anas , Moussa Osama , Arhi Chanpreet 
Published: November 2024

Abstract

Background
Surgical management of gallstone disease is evolving with NICE guidelines emphasising on early cholecystectomy following an index admission with biliary symptoms. Despite an attempt at adhering to these recommendations, many centres find operating theatre capacity as a potential significant constraint to offer a same admission or early cholecystectomy. We assess the impact of a dedicated theatre capacity provided by a specialist upper gastrointestinal surgical team on rates of early cholecystectomy and its outcomes.

Method
A pathway for patients presenting with symptomatic gallstone disease was designed and implemented trust wide, with two theatre lists per week dedicated to performing “hot cholecystectomies”. Retrospective analysis was performed from a prospectively maintained database of patients with symptomatic gallstone disease admitted to a district general hospital over two equal (30 days) but chronologically independent time periods. Data was collected from prior and after service reconfiguration and analysed with descriptive statistics.

Results
19 patients (F:M ratio 0.82:1) were referred for the consideration of receiving a hot cholecystectomy. Nine of the 12 patients (75%) who were deemed to be suitable as per NICE guidelines underwent a cholecystectomy within the recommended time frame.
There was a significant difference in the number of admissions over the two time periods with a shorter time from index admission to surgery (median 62 days to 5 days (P&lt;0.01)); with correspondingly fewer re-admissions from 14 to 2 (P&lt;0.01) following service reconfiguration.

Conclusion
With adequate theatre resources together with surgical expertise, early laparoscopic cholecystectomy can be proved to be an effective and sustainable model for the management acute biliary disease. Continue ahead, we aim to improve our computer-based referral system which will be better suited to record referrals, and the patient pathway. This data will be developed into a dashboard, thereby keeping a contemporaneous record of acute admissions and their management; subsequently improving the number and quality of referrals.
BN SO46 - PANDORA's BOX- When anatomy trumps the pathology
Authors: Menon Sreelakshmi , Nair Vishnu , Menon Jay 
Published: November 2024

Abstract

Background
Obturator hernias are usually attributed to elderly females presenting with small bowel obstruction. We present a case of an elderly gentleman with severe Kyphoscoliosis presenting with small bowel obstruction. His past medical history included Ischaemic Heart Disease with stents in the coronary arteries and on dual antiplatelets. His Kyphoscoliosis precluded him from being able to lie flat on his back. The spinal deformity as revealed in the CT scans proved challenging to position him dsafely for surgery. The lack of access between costal margins and the pelvis meant that surgical access with Laparoscopy was going to be impossible.

Method
After initial resuscitation, he underwent CT scan of his Chest, abdomen and pelvis which revealed an obstructed Obturator Hernia on the left side with small bowel obstruction. The CT was also concerning for the Anaesthetists due to the challenge posed by the severe Kyphoscoliosis. After fibreoptic intubation, abdomen was accessed through a transverse muscle cutting incision, at the level of the umbilicus. The Obturator membrane was approached from above and the hernia was reduced. The obstructed small bowel was viable and the defect in the obturator membrane was closed with No1 Ethibond sutures. The abdomen was closed with mass closure.

Results
Patient had a smooth post operative period and was discharged home after 2 weeks. Obturator hernias are notorious for their occult presentation. Unless the patient is scanned with CT imaging, it is impossible to make the diagnosis although clinical signs like Howship- Romberg sign may be present with pain on internal rotation of the hip, as a result of irritation of the Obturator nerve. Obturator Neuralgia may be elicited with positive Hannington- Kiff sign, which is an absence of absent adductor reflux in the thigh.

Conclusion
Obturator hernias are typically seen in skinny old females. When presenting with small bowel obstruction, Obturator herniae are challenging both in terms of diagnosis as well as in management. In our case, the challenging anatomy posed greater risk to safe airway control. From surgical view, laparoscopy as a less invasive option was ruled out because of the restricted access. When anatomy is challenging, the Surgeon will be forced to think outside the box and consider access to the abdomen through incisions which are not routinely used. The preoperative imaging shows the challenge posed by the extreme spinal deformity.
HPB SO01 - Preoperative respiratory disease and outcomes of pancreatoduodenectomy performed for malignancy
Authors: Hammoda Mohammed , Yarwood Adam , Al-Sarireh Bilal 
Published: November 2024

Abstract

Background
Despite improvements to morbidity and mortality rates in recent decades, pancreatoduodenectomy (PD) remains a high-risk operation. Patients with pre-existing respiratory disease are likely to be at increased risk of developing postoperative complications but few prior studies have investigated this. This may be as few patients with significant respiratory pathology are considered appropriate surgical candidates. This study aimed to compare PD outcomes in patients with a prior respiratory condition to those without. The outcomes of interest were median length of stay (LOS), 30-day readmission, 90-day mortality, unplanned return to theatre rate and five-year survival.

Method
Data was extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study of outcomes of PD performed for pancreatic head malignancy (29 centres in 8 countries, n=1484). Pre-existing respiratory disease included a prior diagnosis of asthma, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, pulmonary embolism, asbestosis, obstructive sleep apnoea, pleural effusion, tuberculosis, pulmonary sarcoidosis, pneumoconiosis or hypersensitivity pneumonitis. The Mann-Whitney U test and Fisher exact test were used to compare the two groups.

Results
Out of a total of 1484 cases, 142 patients (9.6%) had a pre-existing respiratory comorbidity. Asthma and COPD both affected 4.2% of patients. All other included pathologies affected less than one percent of patients. 30-day readmission (8.5% vs 9.1%, p=0.1), 90-day mortality (1.4% vs 3.7%, p=0.2), and unplanned return to theatre rate (3.5% vs 5.1%, p=0.5) were similar between the two groups, however, median LOS was significantly longer in those with a prior respiratory disease (14 vs 13 days, p&lt;0.0001). Five-year survival was also higher in those without respiratory disease, but this was not quite significant (24.6% vs 32.5%, p=0.06).

Conclusion
In our multicentre study of patients with confirmed malignancy, PD patients with a preoperative respiratory disease had significantly longer length of stay. Five-year survival rates were slightly lower but this was not quite significant.
HPB SO04 - Assessing the risk factors for post-ERCP pancreatitis and procedure abandonment at a single centre in the UK
Authors: Carey Charles , Jaunoo Shameen 
Published: November 2024

Abstract

Background
Endoscopic retrograde cholangiopancreatography (ERCP) is a common procedure with many uses. Due to limited expertise and resources, opportunities to perform this procedure should be made as productive as possible and the risks of procedure abandonment should be minimised. ERCP is also associated with a risk of pancreatitis and other significant sequelae. This study aimed to assess the risk factors associated with early procedure abandonment and post-ERCP pancreatitis.

Method
The notes from patients who underwent ERCP between June and November 2023 were retrospectively analysed. Data regarding procedure completion and post-ERCP pancreatitis were collected. The rates of procedure abandonment and post-ERCP pancreatitis among various groups were statistically analysed using N-1 Chi-squared tests.

Results
176 patients were included in this study, of which 95 were female and 81 were male. 18 (10.2%) procedures were abandoned early and 11 (6.3%) patients suffered post-ERCP pancreatitis. 8 (7.8%) of the 103 patients aged over 70 had their procedure abandoned early and 1 (0.97%) suffered post-ERCP pancreatitis. 10 (13.7%) of the 73 patients aged below seventy had their procedure abandoned early and 8 (11.0%) suffered post-ERCP pancreatitis. N-1 Chi-squared analysis revealed that patients under 70 were more likely to suffer post-ERCP pancreatitis (P = 0.003) and females were more likely to suffer early procedure abandonment (P = 0.0330).

Conclusion
Younger patients were significantly more likely to suffer post-ERCP pancreatitis while female patients carried a greater risk of early procedure abandonment. Younger patients should therefore have clear safety netting over the risks of pancreatitis during the consent taking process and may benefit from more rigorous post-procedure monitoring. The reasons underpinning why female patients were more likely to have their procedure terminated early should be explored in greater detail so that measures minimising this risk may be implemented.
HPB SO09 - Review of the management and the outcome of acute pancreatitis in a tertiary centre in the United Kingdom
Authors: Fouad Mina , Sonoo2 Prithvirao , Quraishi Samah , Ibrahim Oladeji , Elhofy Eman , Karrar Ahmed , Aigbokhae Osarumwese , Sanyal Sudip 
Published: November 2024

Abstract

Background
Acute idiopathic pancreatitis (IP) is a challenging condition in surgical practice. We undertook a prospective review of all patients presenting with idiopathic pancreatitis to identify the natural course of the disease.

Method
Fifty-nine patients were identified within a 12-month period from a prospectively maintained database. Patients were diagnosed with idiopathic pancreatitis (IP) following a standardised protocol excluding other causes of pancreatitis.

Results
Over one year, a total of 373 new patients with acute pancreatitis were admitted. IP constituted 15.8% of admissions; 15.2 % of which presented with severe pancreatitis. Average LOS for the index IP admission was 7.05 days, compared with 6.4 days for the rest of cohort. 8.47% with IP were re-admitted within 3 months of index admission, increasing to 13.6% over 12 months. Overall, 16.9% developed long term complications including pancreatic insufficiency or chronic pancreatitis over 12 months compared to 15.3% in the rest of AP cohort. The mortality rate was 3.4% and 12.1% in the IP and AP cohort respectively.

Conclusion
Idiopathic pancreatitis constitutes a larger burden than expected in a large prospective cohort of patients with AP. Patients with IP have a longer LOS and a high risk of long-term sequelae.
HPB SO15 - Developing protocol for managing diabetes after Distal pancreatectomy
Authors: Gulnaz Nadia , Buchanan Alex 
Published: November 2024

Abstract

Background
The incidence of new-onset diabetes mellitus (NODM) has been reported to be 18% to 39% after pancreaticoduodenectomy and 5% to 42% after distal pancreatectomy. Postoperative NODM is historically referred to as type 3c diabetes mellitus (DM). Postoperative HbA1c levels over 7% or 52 mmol have been identified as one of the independent risk factors for tumor recurrence and overall poor survival after cancer-related resections.
This study aimed to evaluate the current practice in glycemic monitoring of patients who had distal pancreatectomy and to develop a departmental protocol for Glycemic monitoring in the perioperative period.

Method
Electronic medical records of 74 patients were reviewed, of these, 61 patients who underwent distal pancreatectomy from Jan 2019 to Dec 2023 was included in the study. All patients with distal pancreatectomy were included irrespective of their pathological diagnosis. age or gender. Patients who died in the perioperative period or the ones who did not have distal pancreatectomy were excluded. (necrosectomy, drainage procedures, GIST, central pancreatectomy. Data analysis performed using Microsoft Excel

Results
The Age ranged from 24-86. 61 patients were included in the study where whereas male-to-female ratio is shown in the Pie Chart. 80% of the patients had investigations for glycemic status, Only 59% (36/61) had HBA1C done, additional 21% others had only glucose levels measured. 19.7% had no investigations to date.
This graph shows the current diabetic status of patient
The graph shows the variability in practice with no consistency.
Overall 36% of our patients have become diabetic or Pre-diabetic post distal pancreatectomy.

Conclusion
There is a lack of consistency in the follow-up of our patients regarding glycemic control. This calls for the development of a defined departmental protocol for the follow-up of our patients.
Every patient with pancreatectomy should have a glucose tolerance test/HBA1C pre-op in close liaison with the diabetic team. We made the following suggestions. HBA1C at 1 month post surgery in 1st clinic follow up.
HBA1C every 6 months thereafter or advice GP if they were to be discharged after benign disease surgery.
Information charts are to be made available to the ward base and added to the induction pack.
HPB SO25 - The impact of chest physiotherapy on post-operative recovery from open liver surgery: A quality improvement project
Authors: Tharmapathy Thaarabi , Edwards Tara , Sundaravadanan Senthil , Sethi Pulkit , Rees Myrddin , Welsh Fenella 
Published: November 2024

Abstract

Background
The incidence of postoperative pulmonary complications (PPCs) after open liver surgery is high. Risk factors include age, body mass index, ex- or current smoker, and chronic lung disease. Early postoperative chest physiotherapy (CP), an essential part of any enhanced recovery protocol (ERP), can reduce PPCs, length of stay and healthcare costs. This study evaluated the uptake of CP after open liver surgery and resultant outcomes, following a quality improvement (QI) intervention.

Method
The project design involved two audit cycles: cycle 1 (C1) and cycle 2 (C2), each of five months duration, of consecutive patients undergoing open liver surgery, before and after a QI intervention (intensive preoperative patient education, poster campaign, increased engagement with physiotherapists regarding the importance of timely CP. Patients undergoing laparoscopic resections were excluded. Outcome measures included whether patients received postoperative CP at all, if so on which post-operative day (POD), for what duration, patient location, incidence of PPCs, and the length of postoperative stay. Statistical analysis was performed using (r 4-4.1) software, using the Chi-squared or Fisher’s Exact test.

Results
Despite more smokers/ex-smokers in C1(24%) versus C2(8%,p=0.04), only 18/50(36%) C1 patients received CP on POD1, versus 20/36(57%) in C2(p=0.07). Sixteen(32%) C1 patients received no postoperative CP, versus 7(19%) in C2(p=0.19). There were non-significant decreases in PPCs in C2(8%), versus C1(20%)(p=0.13). Three of four patients developing pneumonia in C1, and both those in C2, had no POD1 CP. Wards with higher physiotherapist:patient ratios had more POD1 CP: in C1 12/19(63%)[6/31(20%), p=0.001], and C2 14/15(93%)[6/20(30%) p=0.0001]. Median hospital stay was unchanged (4 days).

Conclusion
This QI project shows that even with an established enhanced recovery programme, the provision of postoperative chest physiotherapy is not universal. However, it can be improved with an education programme for both healthcare workers and patients.
HPB SO35 - Outcomes of Transcystic Laparoscopic Common Bile Duct Exploration at the time of Laparoscopic Cholecystectomy in patients with small common bile duct diameter
Authors: Winter Jonny , Ainley Paul , Gudyma Jaroslaw , Eltayeb Omer 
Published: November 2024

Abstract

Background
Laparoscopic Cholecystectomy with Laparoscopic Common Bile Duct Exploration (LC+LCBDE) is a single stage therapeutic option for management of choledocholithiasis. There have been limited publications regarding the feasibility of transcystic LCBDE in patients with small (≤8mm) common bile ducts (CBD). This study seeks to examine the outcomes for patients with small ducts who underwent LC+LCBDE via a transcystic approach (LCBDE-t) in a district general hospital over a thirty-month period.

Method
Prospectively collected data regarding all patients who underwent LC+LCBDE-t over a period from January 2022 to June 2024 was retrospectively reviewed. Data including indication for surgery, CBD diameter, length of stay, complication rate, and readmission rate were determined from Electronic Care Records. Data were analysed using Microsoft Excel.

Results
76 patients were identified. CBD diameter (almost all as measured at pre-operative Magnetic Resonance Cholangiopancreatography [MRCP]) ranged from 3.5mm to 8mm (average 6.32). One patient required conversion to open surgery due to difficulties with the LC element of the operation. Median postoperative length of stay was 1 day (range 0-32 days) and readmission rate was 5.33%. Five patients experienced a complication beyond Clavien-Dindo Grade II, with the most serious two being a bile leak and a postoperative bleed, both of which required further surgery. One patient required subsequent Endoscopic Retrograde Cholangiopancreatography (ERCP) for retained CBD stones.

Conclusion
LCBDE is a safe and effective management option for patients in the setting of choledocholithiasis with small CBD diameter. Small CBD should not necessarily be a deterrent to consideration of transcystic LCBDE as a therapeutic option in appropriately selected patients.
HPB SO43 - Meta-analysis of completion pancreatectomy for local recurrence of pancreatic cancer after the index pancreatectomy
Authors: Evans Daisy , Hajibandeh Shahab , Hajibandeh Shahin , Athwal Tejinderjit 
Published: November 2024

Abstract

Background
Poor prognosis post-resection of pancreatic cancer is owed to a high rates of cancer recurrence (approximately 80%) despite complete surgical resection being achieved. The role of surgical re-resection in patients with recurrent pancreatic cancer is unclear. Several studies have reported survival benefit of repeat pancreatectomy for selected patients with local recurrence in the remnant pancreas after the index pancreatectomy. We aimed to conduct a comprehensive systematic review and meta-analysis of best available evidence to evaluate survival outcomes of completion pancreatectomy for locally recurrent pancreatic cancer following index pancreatectomy.

Method
A systematic search of electronic data sources and bibliographic reference lists were conducted. Proportion meta-analysis model was constructed to quantify 1- to 5-year survival after pancreatic re-resection for locally recurrent pancreatic cancer. Random-effects modelling was applied to calculate pooled outcome data.

Results
Fifteen retrospective studies were included reporting a total of 250 patients who underwent completion pancreatectomy for locally recurrent pancreatic cancer following their index pancreatectomy. Completion pancreatectomy was associated with 1-year survival of 70.6% (95% CI 65.0%-76.2%), 2-year survival of 38.8% (95% CI 28.6%-49.0%), 3-year survival of 20.2% (95% CI 13.8%-26.7%), and 5-year survival of 9.2% (95% CI 5.5%-12.8%). The between-study heterogeneity was insignificant in all outcome syntheses.

Conclusion
Repeat pancreatectomy for local recurrence of pancreatic cancer in the remnant pancreas following the index pancreatectomy is associated with acceptable overall patient survival. We recommend selective re-resection of such recurrences in younger patients with favourable tumour size and location. Our findings may encourage conduction of better-quality studies in this context to provide stronger evidence.
HPB SO49 - EUS guided biliary drainage prior to pancreaticoduodenectomy - The Leeds experience
Authors: Findlay Alasdair , Pathak Samir , Pine James , Young Alistair , Shapey Iestyn , Huggett Matthew , Paranandi Bharat , Smith Andrew 
Published: November 2024

Abstract

Background
Biliary obstruction is a common manifestation of biliary tract cancer. Decompression is indicated if patients develop systemic illness due to the obstruction or to facilitate chemotherapy. Stent insertion via ERCP is the current first line decompressive technique, although in certain situations such as duodenal/ampullary obstruction, is not always feasible. When ERCP has failed, our centre has implemented using lumen apposing metallic stents (LAMS) delivered by the HOT AXIOS™ system to create a draining choledochoduodenostomy. Our aim is to report on our experience of carrying out pancreaticoduodenectomy after biliary drainage has been achieved with this technique.

Method
All patients who underwent biliary drainage with a LAMS and then surgical resection of a biliary tract cancer were identified from a prospective database. Both procedures were carried out at St James’s Hospital, Leeds, between June 2018 and May 2024 by expert gastroenterology and pancreatic surgical consultants. Procedural and inpatient notes were retrospectively reviewed. The primary outcomes were the assessment of technical feasibility of pancreaticoduodenectomy and of perioperative complications, classified by the Clavien-Dindo (CD) system. Secondary outcomes were the safe and clinically effective (defined as &gt;50% reduction of serum bilirubin within 7 days) application of LAMS.

Results
Thirteen patients were identified with a median age of 69 (51-81), twelve requiring drainage due to jaundice and one due to cholangitis. Duration to resection was median 68 days (12-377). Surgical resection was successful in all thirteen patients, in seven cases the surgeons commented on fibrosis due to the stent, with one qualifying that this was no more than a conventional biliary stent. Postoperatively five patients had no complications, one CD grade 1, five CD grade 2 and one CD grade 5. There were no significant post endoscopic complications and 10 patients demonstrated clinical effectiveness of the LAMS.

Conclusion
ERCP is the current first line method of drainage in malignant biliary obstruction. Technical success is reliant on unimpeded access to the bile duct. The HOT AXIOSÔ system circumvents this reliance by delivering a LAMS in a single stage forming a draining choledochoduodenostomy. Our centre’s experience suggests that it is a safe and effective method of biliary drainage which does not impede surgical resection. Additionally, it is not associated with the risk of post procedural pancreatitis. Our experience justifies further large-scale studies into this technique with consideration for its use not only when ERCP is not possible.