bluuebunny/crossref_metadata_2025_split huggingface dataset:
BN SO42 - Our experience of Emergency Laparoscopic Fundoplication in a DGH
Authors: Khan Amnah Ilyas , Mostafa Omar , Sellahewa Chaminda 
Published: November 2024

Abstract

Background
Emergency presentation of hiatal hernias can be life-threatening and is associated with high morbidity and mortality rates. Elective Laparoscopic hiatus and paraoesophageal hernias are commonly performed with fundoplication. However, emergency cases are often repaired without an anti-reflux procedure. We present our experience of emergency Laparoscopic Hiatus/ Paraoesophageal hernia repair with fundoplication in a District General Hospital (Russells Hall Hospital, RHH).

Method
6 cases of diagnosed hiatus/ paraoesophageal hernia that underwent Emergency fundoplication from 2019-2024.

Results
The mean age of the patients was 74 (56-83). All patients had a pre-op CT scan to confirm the diagnosis. 4 patients (66%) had a Type 3 Hiatus hernia and 2 (33%) had a Type 2 classic paraosephageal hernia. All patients underwent Emergency Laparoscopic Hiatus / Para oesophagal hernia repair with fundoplication. 2 patients required mesh for the repair. The mean length of stay was 5 days (3-7). There were no intra or post-op complications and on follow up 1 patient had a recurrence of symptoms after 1 year requiring redo fundoplication.

Conclusion
The choice of operation is mainly based on the patient’s clinical condition, the complexity of the hernia and the surgeon’s experience. Our experience at RHH shows that Laparoscopic Hiatus/ Paraoesophageal hernia repair with fundoplication is safe and feasible in patients with emergency presentation.
HPB SO03 - Preoperative biliary drainage prior to pancreaticoduodenectomy for pancreatic head malignancy: Guidelines versus the reality
Authors: Hammoda Mohammed , Yarwood Adam , Al-Sarireh Bilal 
Published: November 2024

Abstract

Background
British guidelines currently advise against routine preoperative biliary stenting (PBS) unless patients have cholangitis or organ failure secondary to biliary obstruction. If stenting is required, self-expanding metal stents are advocated. Using a large multicentre cohort, this study aimed to investigate the proportion of patients who underwent PBS prior to pancreatoduodenectomy (PD) and describe the approach used.

Method
Data were extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study of outcomes of PD performed for histologically confirmed pancreatic head malignancy (29 centres from 8 countries, n=1484). Patients who underwent PBS were identified and the details surrounding this were obtained.

Results
1482 patients had data on use of PBS. 427 didn't undergo PBS, 1055 underwent attempted PBS. Of the latter, 989 had a stent placed successfully, 38 had PBS failed , and 28 had an external biliary drain . when PBS performed, Among 857 were primary endoscopically placed , 75 had percutaneously placed PBS having failed endoscopy , and 50 had a primary percutaneously placed PBS . 755 patients known stent material ( 66% were plastic, 34% metal). In 671 who had data regarding cytology from PBS known, 48% had cytology suggestive/diagnostic of malignancy, 25% had inadequate histology, and 28% did not send a cytology sample.

Conclusion
Despite guidelines advising against routine PBS, over two thirds of PD patients in our study underwent stenting. Despite guidelines advocating metal stents when PBS is necessary, two thirds of the stents deployed were plastic. Stent cytology has a low sensitivity for pancreatic head malignancy.
HPB SO08 - Safety of Robotic cholecystectomy as index training procedure – the UK experience
Authors: Stefanova Irena , Alkhatib Omar , Sheel Andrea , Alabraba Edward , Alibrahim Mohammad , Arshad Ali , Awan Altaf , Baron Ryan , Bhatti Imran , Bhogal Ricky , Dhakshinamoorthy Vijayanand Vijayanand , Diaz-Nieto Rafael , Dunne Declan , Frampton Adam E , Green Alexander , Hajibandeh Shahin , Hamady Zaed , Horgan Liam , Kissane Eleanor , Krishnan Sailakshmi , Kumar Rajesh , Lahiri Rajiv , Lam Shi , Liau Siong-Seng , Marangoni Gabriele , Moudghalya Shyam , Papadopoulos Georgios , Pencavel Tim , Picker Sarah , Ramsingh Jason , Riga Angela , Silva Michael , Soonawalla Zahir , Subar Daren , Sud Vikas , Upasani Vivek , Wong Vincent , Worthington Tim , Yeung Kai Tai Derek , Ahmad Jawad 
Published: November 2024

Abstract

Background
A recent large retrospective cohort study reported a higher risk of bile duct injury associated with robotic cholecystectomy when compared to the laparoscopic approach. Considering that most robotic training pathways, including the one followed in the UK, utilise robotic cholecystectomy as index training procedure, such findings mandate evaluation of the safety profile of robotic cholecystectomy in the UK to ensure its use as an alternative approach to laparoscopic cholecystectomy is not putting patients at risk. We aimed to conduct a multi-centre observational study to evaluate the safety profile of robotic cholecystectomy performed within the UK HPB Robotic training program.

Method
A retrospective analysis of prospectively collected data from eleven centres participating in the UK robotic HPB training program was conducted. All adult patients undergoing robotic cholecystectomy for symptomatic gallstone disease or gallbladder polyp were considered. Bile duct injury, conversion to open procedure, conversion to subtotal cholecystectomy, length of hospital stay, 30-day re-admission, and post-operative complications were the evaluated outcome parameters.

Results
A total of 600 patients were included. The median age was 53 (IQR 65 - 41) years and the majority (72.7%; 436/600) were female. The main indications for robotic cholecystectomy were biliary colic (55.5%, 333/600), cholecystitis (18.8%, 113/600), gallbladder polyps (7.7%, 46/600) and pancreatitis (6.2%, 37/600). The median length of stay was 0 (IQR: 0-1) days. Of the included patients, 88.5% (531/600) were discharged on the day of procedure with 30-day re-admission rate of 5.5% (33/600). There were no bile duct injuries and the rate of conversion to open was 0.8% (5/600) with subtotal cholecystectomy rate of 0.8% (5/600).

Conclusion
This current study confirms that robotic cholecystectomy can be safely implemented to routine practice with a low risk of bile duct injury, low conversion to open surgery and low need for subtotal cholecystectomy.
HPB SO22 - Clinical outcomes following radical cholecystectomies, a single centre experience in review
Authors: Mohamed Eyas , Mascarenhas Chrystle , Arora Arvind , Zaitoun Abed , Gomez Dhanny 
Published: November 2024

Abstract

Background
Gallbladder carcinoma (GBC) is a rare disease with dismal prognosis. The majority of cases are identified at an advanced state that preclude curative approaches which would usually necessitate removal of the gallbladder with en-block wedge hepatectomy of segment 4b/5 as well as periportal lymphadenectomy. The purpose of this study was to analyze our outcomes for patients undergoing a radical cholecystectomy for suspected GBC.

Method
A retrospective analysis of patients who underwent radical cholecystecomies at Queen’s Medical Centre, Nottingham, UK between 1st January 2014 and October 2023 was performed. Patients with concomitant primaries, incidental GBC or completion liver resection following index cholecystectomy were excluded.

Results
41 patients were eligible for analysis, those were comprised of 13 males and 28 females with a median age of 67 (IQR 57-72) years. The incidence of malignancy on histology was 31.7% (GBC n=11, metastatic renal carcinoma n=1, metastatic melanoma n=1). Cystic margin assessment by frozen section was performed in 41% of cases.
In cases with confirmed gallbladder cancer, the median tumour size was 30mm, positive periportal lymph nodes were identified in two patients while R0 resection was achieved in all cases.
The median length of stay following surgery was 5 days (IQR 5-7) while Clavien Dindo complication grade ≥ III were experienced in 12% ( return to theatre for leak from repaired cholecysto-duodenal fistula n=1, IR drainage of post operative collection n=3, ITU stay for cardiac arrhythmia n=1).
The pathologies encountered in benign cases (n=28) were compatible with chronic cholecystitis (53.5%, n=15), concurrent chronic cholecystitis and adenomyomatosis (21.4%, n=6), xanthogranulomatous cholecystitis (10.7%, n=3), adenomyomatosis (7.1%, n=2), follicular cholecystitis (3.5%, n=1), benign GB polyps (3.5%, n=1).

Conclusion
Radical cholecystectomy remains the standard of care for suspected GBC however sufficient preoperative counselling is prudent given likelihood of benign disease on histology.
HPB SO24 - Recurrence Pattern of Pancreatic Ductal Adenocarcinoma based on Time-to-Recurrence: A 5-year Single-Centre Retrospective Study
Authors: Patel Agastya , Kitching Samuel , Barker Sharon , Lancellotti Francesco , Kadamapuzha Jacob , Satyadas Thomas 
Published: November 2024

Abstract

Background
A vast majority of patients with pancreatic ductal adenocarcinoma (PDAC) develop early disease recurrence, even after curative-intent surgical resection. Understanding the pattern of disease recurrence will enable identification of areas for improvement within the preoperative diagnostic and management algorithms for these patients. The aim of the retrospective cohort study was to compare the recurrence pattern of PDAC in patients with early (&lt;12 vs &gt;12 months) and very early (&lt;6 vs &gt;6 months) recurrence following surgical resection.

Method
A retrospective review of histologically confirmed pancreatic ductal adenocarcinoma patients who underwent pancreaticoduodenectomy (N=151) between 2015-2020 at a tertiary HPB centre was undertaken. All patients underwent CT and PET-CT for initial staging before resection. Initial recurrence after resection was identified through postoperative imaging and/or HPB MDT outcomes. Early recurrence (ER) was defined as recurrence within the first 12 months after surgery (n=78). Additionally, very early recurrence (VEM) was defined as recurrence within the first six months after surgery (n=46). Statistical analysis was performed using GraphPad Prism 8.0.

Results
In total, 117 (77.5%) of patients experienced recurrence, with a median recurrence-free survival of 11.3 (5.1-19.6) months. Patients with ER had significantly higher pathological T staging (p=0.01), greater margin positivity rate (p=0.01) and higher lymph node ratio (p=0.046), while those in VER had significantly larger maximum tumour diameter and number of involved lymph nodes (p=0.04) compared to their counterparts. Patients with ER (47.4 vs 31.5%, p=0.046) and VER (60.9 vs 30.5%, p&lt;0.001) had significantly greater rates of liver metastasis compared to their counterparts. There were no differences in loco-regional recurrence, peritoneal or pulmonary metastasis between the groups.

Conclusion
Approximately 20% of patients undergoing surgical resection for PDAC developed liver metastasis within six months of surgery. This raises concerns for the presence of micro-metastatic disease within the liver unidentified on preoperative imaging. Therefore, there is a need to enhance preoperative imaging and treatment algorithms to improve survival of patients with PDAC.
HPB SO28 - Pre-operative Biliary Drainage in Pancreatic Adenocarcinoma and its Effect on Surgical Oncological Outcomes
Authors: Shehata Zak , Subar Daren 
Published: November 2024

Abstract

Background
Pre-operative biliary drainage (PBD) in patients undergoing pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) has been associated with a significantly increased risk of serious complications. This retrospective study investigated if PBD has a significant effect on lymphovascular (LVI) or perineural (PNI) invasion compared to direct surgery (DS).

Method
Data was collected retrospectively from patients undergoing PD for PDAC from 01/01/2014 to 30/12/2022. Patients were grouped according to whether they received any form of PBD or not. Patients’ T and N stage, as well as lymph node ratio (LNR), R status, Mortality, disease free (DFS) and overall survival (OS) were recorded. The primary outcome measure was lymph node ratio.

Results
A total of 87 patients were identified (48 PBD group vs 39 DS group), with a mean age of 68. The median LNR was 0.2 in PBD vs 0.21 in DS Group (p=0.87). There was no significant difference in median DFS (310 days PBD vs 285 DS p=0.94) or median OS (513 days PBD vs 515 DS p=0.39). PBD was not associated with a greater incidence of LVI (67% PBD vs 69% DS p=0.8), or PNI (94% PBD vs 97% p=0.41). PBD did not have a significant effect on resection margin status (p=0.75).

Conclusion
Despite evidence in the literature on its effects on the rate of complications, PBD has not been shown to have an effect on LVI or PNI, disease progression, nor overall survival in our patient group.
HPB SO31 - A 3rd cycle quality improvement project on reducing unnecessary investigation, improves patient satisfaction and optimises cost-efficiency in a tertiary general surgical unit caring for patients with acute pancreatitis
Authors: Kwan Yi Xin , Teoh Yong Xuan , Carr Harry , Kanakala Venkatesh 
Published: November 2024

Abstract

Background
Acute pancreatitis (AP) is a serious and potentially life-threatening systemic disease. Guidelines recommend that a diagnosis may be established if the patient has any two of1:a typical clinical history/examinationserum amylase &gt;3 times the upper limit of normalRadiological (CT) evidence consistent with AP
Once established, further repeat amylase testing is not indicated and does not guide management, nor provide prognostic value2. Previous QIP cycles carried out in James Cook University Hospital (JCUH) between 2021-2023 showed that 47% of patients with established AP had repeated amylase done unnecessarily. Interventions were implemented in JCUH and re-evaluated.

Method
The present QIP is a third cycle retrospective evaluation of the number of repeat serum amylase tests performed on patients with a diagnosis of AP, between 01/10/2023 to 21/01/2024. Of a total 1368 patients admitted, 63 patients (n=63) were identified for inclusion, by confirming their diagnosis of AP within their discharge letters. Data collection was completed by reviewing electronic notes and investigation results on our local investigations platform (WebICE). 1 year prior to data collection the intervention, a ‘pop-up', was implemented into WebICE to invite the clinician to consider if the repeat amylase test requested was clinically indicated before proceeding.

Results
Of the 63 patients identified, 100% had serum amylase tested on admission and were diagnostic in 62% of patients. 19 patients (30%) had amylase re-requested, a significant decrease from 47% in previous cycles. Among the patients with repeat amylases requested, 7 patients had amylase repeated twice. None of the documented indications to repeat amylase were clinically justified, with the most common indication being ‘for monitoring’. When comparing to cycles 1 and 2, we saw an improvement in the mean rates of amylase re-requesting from 2.4/patient, down to 1.37/patient in cycle 3 (Figure 1).
Figure 1 – Mean rates of repeat amylase per patient across all QIP cycles to date

Conclusion
Our simple intervention, a ‘pop-up’ in our investigations requesting platform, resulted in a significant improvement over previous cycles, reducing the burden on our laboratories, costs of our general surgical service and improving patient satisfaction during their admission. However, there are still repeated amylases being performed without clear indication or patient benefit. Further interventions should be considered including, increasing awareness among healthcare personnel and re-evaluating and enhancing the effectiveness of the pop-up reminder in our local requesting platform. Re-evaluation will be completed in 6-12 months’ time.
HPB SO33 - Transcriptomic characterisation of the diabetogenic pancreatic ductal adenocarcinoma phenotype
Authors: Stott Martyn , Hasoon Megan , Oldfield Lucy , Soul Jamie , Halloran Christopher , Costello Eithne 
Published: November 2024

Abstract

Background
New-onset diabetes mellitus (NOD) can manifest as a consequence of pancreatic ductal adenocarcinoma (PDAC), although not all PDAC patients develop NOD. For many patients, hyperglycaemia begins 3 years prior to PDAC diagnosis, with 30% of PDAC patients experiencing NOD by the time their cancer is diagnosed. The mechanisms underlying the onset of diabetes mellitus (DM) in PDAC and its consequences for disease development, detection and treatment are not well understood. The aim of this study was to characterise the transcriptomic differences between PDAC tumours that present with NOD compared to those that do not.

Method
Eight tumour samples from patients undergoing surgery for PDAC (4 without DM (HbA1c &lt;35), 4 with NOD (HbA1c &gt;65, within 3 years of cancer diagnosis) underwent single cell-RNA sequencing (scRNAseq) after taking intra-operative biopsies using Chromium 10X Genomics technology. Unique cell clusters were identified using CellRanger and cell types annotated using scATOMIC and singleR datasets. Manual annotation was undertaken when results were not agreeable after consulting the literature. Differential expression between groups was performed using DESeq2. Significant genes were identified as having a log2 fold-change &gt;1.5 and p&lt;0.05. Gene set enrichment was performed using Reactome. Analysis was conducted in RStudio.

Results
Single cell suspensions were created with a mean cell count of 1.2 million cells and a mean viability of 90%. PDAC cells and the full complement of tumour microenvironmental cells were recovered. Significant differential expression was seen in the PDAC cells themselves, CD4+ cells, macrophages, mast cells and fibroblasts. Cancer associated fibroblasts (CAFs) seemed not to differ. PDAC cells with NOD seemed to be enriched in MYC oncogenes whereas those without DM seemed to be enriched in KRAS mutations. There was a mixture of “basal” and “classical” transcriptional subtypes between the two groups.

Conclusion
Differences between diabetogenic PDAC and non-diabetogenic PDAC have been observed at the transcriptional level. Diabetogenic tumours seem to be promoted by MYC oncogenes and be more inflammatory than non-diabetogenic tumours. These findings require validation which will be done on independent samples using spatial transcriptomics to allow endocrine-exocrine crosstalk to be determined. Understanding the molecular pathways in diabetogenic pancreatic tumours could enhance future strategies to detect PDAC earlier and to target diabetes-associated vulnerabilities for therapeutic purposes.
HPB SO38 - Assessing current pancreatic cancer reporting practice against the PACT-UK Synoptic Reporting Template: An initial clinical audit
Authors: Patel Agastya , Edy Elbert , Lancellotti Francesco , Kadamapuzha Jacob , Satyadas Thomas 
Published: November 2024

Abstract

Background
In the last decade, the incidence of pancreatic cancer has increased by 9% in the UK. The gold standard for initial assessment of pancreatic cancer (or even peri-ampullary cancer) resectability is pancreatic-protocol CT scan. The PACT-UK project introduced a synoptic template for pancreatic cancer to standardise CT reporting practice across UK and enable consistent reporting of pertinent aspects of resectability status such as vascular involvement of the tumour. The aim of this audit is to assess the quality of current CT reports received by a tertiary hepato-pancreato-biliary (HPB) unit against the standards set out by PACT-UK.

Method
A retrospective analysis of 66 patients who underwent pancreatic resection between September 2023 and May 2024 at a tertiary HPB centre was undertaken. Patients were excluded from the analysis if they underwent resection for benign pancreatic pathology, were diagnosed with pathology other than peri-ampullary cancer or did not have a formal report of their CT scan. Initial CT scans performed at presentation and if available, subsequent up-to-date staging scan prior to surgery were assessed against the PACT-UK reporting template, in accordance with their guidance. The audit was registered with our clinical audit team (no. 11643).

Results
In total, 42 patients with peri-ampullary cancers were included in this audit. All patients had a reported CT scan on presentation. Additionally, 24 patients had a reported staging CT scan. The compliance (i.e. more than 90% information available) with PACT-UK reporting standards was 0% for initial presentation scans and 4.2% (n=1) for staging scans. The only staging scan with &gt;90% compliance was reported using the PACT-UK template. Majority (more than 80%) of CT scan reports lacked information on aspects such as pancreatic duct size, predicted tumour type and radiological stage, variant vascular anomalies, and arterial/venous involvement.

Conclusion
This audit highlights the substandard quality of current CT reporting for peri-ampullary cancer. There is an urgent need to adopt a structured and dedicated reporting template to address the issue. Utilising a template such as the one developed by PACT-UK will help ensure that relevant information is formally reported to facilitate optimal decision-making at MDT meetings, and assist surgeons in operative planning and oncologists in assessing treatment response.
HPB SO40 - Implementation of Biodegradable Stents in HPB and Transplant Surgery: A Systematic Review to assess adherence to the IDEAL framework
Authors: Hall Lewis , Fox Sebastian , Sarodaya Varun , Halle-Smith James , Roberts Keith , Smith Andrew , Pathak Samir 
Published: November 2024

Abstract

Background
Biodegradable stents are a novel device in HPB and liver transplant surgery, to potentially mitigate anastomotic dehiscence. The IDEAL (idea, development, exploration, assessment, long-term study) framework provides a formal method of evaluation for novel surgical procedures. This study explores adherence to the IDEAL guidance for the adoption of biodegradable stents in HPB and liver transplant surgery and explores governance procedures, patient selection, technique description, quality assurance measures, and outcome reporting.

Method
A systematic review of PUBMED, MEDLINE and Embase databases identified studies investigating use of biodegradable stents in HPB and liver transplant surgery. Data extracted included: study characteristics, governance procedures, patient selection, technique description, surgeon expertise, and outcome reporting.Where studies reported an IDEAL stage, it was recorded, and where not recorded, a validated tool was used by these authors to assign a stage to included studies.

Results
Of 736 records screened, nine studies were included (seven in pancreatic surgery and two in liver transplant). The biodegradable stent reported most often was the Archimedes™ stent (AMG Int., Winsen-Germany; six of nine studies). All studies failed to implement the IDEAL framework. Eight studies were classified retrospectively as IDEAL 2a and one as IDEAL 1. Five of nine studies detailed ethical approval. Patient selection and technique description were heterogenous. No studies reported surgeon expertise and outcome reporting was varied.

Conclusion
To date, the IDEAL framework has not been adhered to in the adoption of biodegradable stent use in HPB and liver transplant surgery. Study design, technique description, and outcome reporting were heterogenous. Any further work should endeavour to adhere to the IDEAL framework when reporting.