bluuebunny/crossref_metadata_2025_split huggingface dataset:
HPB SO14 - Surprise Inside: Gallbladder Herniation in a Parastomal Hernia - A Rare Case Report and Management Insight
Authors: Olusola Siji , Jarman Tobias , Parmar Chetan , Kathirvel Manikandan 
Published: November 2024

Abstract

Background
Parastomal hernias are a common complication of stoma formation, affecting approximately 40% of patients within two years. Gallbladder herniation within a parastomal hernia is a rare phenomenon, with only 18 cases previously reported. Patients are typically elderly females, with the condition attributed to ageing factors such as loss of visceral fat and elastic tissue, liver shrinkage, and the increased length and loss of elasticity of the gallbladder mesentery. These factors contribute to visceroptosis of the gallbladder, increasing its mobility and the risk of herniation.

Method
We present the case of a 68-year-old female with a four-day history of severe parastomal hernia pain and swelling. She had an emergency left hemicolectomy and transverse colostomy in the right upper quadrant 10 years prior for ischaemic colitis and perforation. Her stoma was functioning well. Vital signs and biochemistry results were normal. On examination her hernia was severely tender but partially reducible. CT revealed a right upper abdominal parastomal hernia containing loops of colon and surprisingly the gallbladder with a long stretched cystic duct. There was no evidence of cholecystitis, bowel obstruction, or compromise within the hernial sac.

Results
With analgesia, the patient's pain improved, though her hernia remained irreducible. She was discharged after two days of conservative management and referred back to the hospital where she had the initial operation. On enquiry with that hospital it was reported that an elective parastomal hernia repair with completion right colectomy and end ileostomy was performed. The gallbladder was mobilised and reduced back into the peritoneal cavity, and the hernial defect was closed. The patient made an excellent recovery and was discharged home three days after surgery.

Conclusion
Cholecystic parastomal herniation is a very rare phenomenon and should be considered as a differential in similar cases. Management should be based on clinical presentation, radiological diagnosis, and a multidisciplinary team approach. No standardised classification or approach exists. We propose classifying gallbladder herniations as either being simple (without inflammatory sequelae) or complicated (with cholecystitis, gallbladder torsion, incarceration or perforation). Simple herniations, such as the case presented, can be managed electively with intra-operative reduction of the gallbladder sufficing. Complicated herniations during acute admissions indicate the need for emergency surgical intervention with combined cholecystectomy and parastomal hernia repair.
HPB SO19 - Comparison of perioperative outcomes of open (CUSA) versus laparoscopic (LOTUS) major hepatectomy – revisited. First evaluation of efficacy and safety of AEONTM stapler
Authors: Iqbal Affan , Baltatzis Minas , Stathakis Panagiotis , Siriwardena Ajit , Jamdar Saurabh , Sheen Aali J 
Published: November 2024

Abstract

Background
In 2019, preliminary data matching 40 cases demonstrated improved outcomes of laparoscopic major liver resections using the BOWA-LOTUSTM liver blade (Devon, UK). An updated and expanded comparison between open and laparoscopic major hepatectomies is presented as well as evaluating of an endovascular stapler AEON™ (Lexington Medical, Massachusetts, USA).

Method
January 2020 to June 2023 patients were identified from a prospectively maintained database. Propensity score matching analysis used R statistical tool in SPSS (IBM, New York, USA) to isolate matched open and laparoscopic cases. LOTUSTM ultrasonic energy device was used for parenchymal transection in laparoscopic cases and CUSA (Valleylab, Colorado, USA) in open procedures. AEONTM endovascular stapler was used from early 2021.

Results
86 patients constitute the study population after applying propensity score matching analysis in a 1:1 ratio. The median (range) age in the matched sample was 63 (27-83) yrs. Hospital stay (mean 7.8 v 14.7 days; p=0.025) and blood transfusion requirement (0 v 4 units; p=0.035) were all significantly improved when comparing laparoscopic to open. Comparison of the AEONTM stapler with Endo-GIA (Medtronic, MN, USA) showed no significant difference in any outcome measure, although AEONTM demonstrated (non-significantly) a reduced trend in operating time comparing all cases (56 v 69 mins; p=0.300) and laparoscopic (56 v 71 min; p=0.295).

Conclusion
The LOTUS liver blade continues to be associated with acceptable outcomes in laparoscopic liver resections. The AEONTM endovascular stapler was equivalent to other staplers with a trend towards a shorter operating time in liver transectional surgery.
HPB SO21 - Percutaneous Biliary Endoscopy for Managing Disease in Endoscopically Inaccessible Biliary Trees: A Single Unit Experience in the UK
Authors: Brown Oliver D , Jenkins Paul , Gafoor Nelofer , Aroori Somaiah 
Published: November 2024

Abstract

Background
Patients with a history of hepatobiliary surgery often require interventions for complications such as hepatolithiasis, recurrent disease, or anastomotic strictures. Access to the biliary tree in these, and other post-operative patients, is hindered by a diverted alimentary tract or comorbidities that preclude endoscopy or re-operation. While forms of biliary endoscopy have been used for many years in combination with ERCP, recent advances now allow for the combination of percutaneous radiological interventions with cholangioscopy. We share our early experiences and outcomes using percutaneous biliary endoscopy (PBE) to manage a challenging cohort of patients

Method
In our hospital trust, a multidisciplinary team consisting of Interventional Radiologists, endoscopy staff, and a Hepatobiliary Surgeon performed some of the first PBE procedures using the SpyGlass device in the UK. The biliary tree was accessed under ultrasound and fluoroscopic guidance, followed by tract dilation to admit a 12F sheath. This allowed use of the SpyGlass device, along with adjuncts such as electrohydraulic lithotripsy catheters, dilation balloon catheters, biopsy forceps, and biodegradable stents through the working channel. This combined approach enhances the rate of conclusive biopsy and benefits from both visual assessment and radiological navigation.

Results
To date, 9 PBE procedures have been performed on 7 individual patients. Indications have included strictured hepaticojejunostomy, hepatolithiasis, malignant and benign biliary strictures. The first two patients underwent two-stage treatment of their disease following concerns about the burden of their treatment, however procedural intent was achieved in all cases. To date, two patients have experienced complications. The first required ITU admission for inotropic support in the context of a septic shower and the second suffered cholangitis secondary to a post-procedural haemorrhage and intraductal thrombus, requiring traditional internal/external drainage.

Conclusion
PBE, with its adjuncts, offers a minimally invasive alterative to operative treatment, and improved conclusive biopsy rates in patients with endoscopically inaccessible bile ducts due to post-surgical anatomy or impassable strictures. With appropriate multidisciplinary collaboration, PBE could easily be adopted in most hepatobiliary centres where the required equipment is likely to be readily available
HPB SO27 - Reconsidering Routine Histopathological Examination of Gallbladder Specimens in Cholecystectomy: Optimizing Clinical Practice and Resource Management
Authors: Jamal Zohaib , Yu Zirong , Zafar Nowera , Li Damon 
Published: November 2024

Abstract

Background
Cholecystectomy, the removal of the gallbladder, is a common surgery performed globally. Routine histopathological examination (HPE) of gallbladder specimens post-surgery aims to detect pathologies like gallbladder cancer (GBC). GBC incidence varies by region and ethnicity, with higher risks in women and those over 65. Advanced GBC stages often require surgery, while early stages may only need cholecystectomy. Global HPE practices differ based on resources and GBC rates. This study evaluates the necessity of routine HPE by examining the selective processing of specimens suspected of GBC, ensuring patient safety while potentially optimizing resource use.

Method
This retrospective cohort study conducted at Redland Hospital, a district general hospital in Australia, investigated the necessity of routine histopathological examination (HPE) for excised gallbladder specimens. Adhering to routine HPE policy, the study encompassed all elective and emergency cholecystectomies performed from January 2023 to December 2023, excluding pediatric cases, concurrent surgical procedures, and those with suspected malignancy. Demographic data, surgery indications, intraoperative findings, histopathological results, and incidental gallbladder cancer (IGC) outcomes were analyzed. Pathology reports and case documentation were reviewed for cancerous pathology indicators.

Results
Over the one-year study period from January 2023 to December 2023, a total of 266 gallbladder specimens were subjected to histopathological examination (HPE) post-cholecystectomy. Of these, 201 were female and 65 were male, yielding a male-to-female ratio of 3:1. Elective cholecystectomy was performed on 56.4% (150) of patients, while 43.6% (116) underwent emergency procedures. Laparoscopic cholecystectomy (LC) was the primary surgical approach, except for one case requiring conversion to an open procedure. None of the patients exhibited gallbladder carcinoma (GBC); however, 3.3% (9) displayed premalignant histopathological features in their specimens.

Conclusion
In conclusion, adopting a selective approach, where only gallbladder specimens with macroscopic abnormalities undergo histopathological examination (HPE), seems prudent, especially in regions with low gallbladder cancer (GBC) incidence. Our study, which revealed no cases of GBC, supports this approach. It not only reduces the risk of missing incidental carcinoma in clinically unsuspected cases but also proves cost-effective and reduces the histopathology department workload without compromising patient outcomes. Therefore, we advocate for routine macroscopic examination of gallbladder specimens for abnormalities before HPE submission, particularly in cholecystectomy patients with gallstone disease.
HPB SO32 - Outcomes Following Surgical Resection for Duodenal Adenocarcinoma – A Single Centre Experience
Authors: Sellappan Hari , Ghahramani Isabella , Fouad Mina , Arora Arvind , Zaitoun Abed , Gomez Dhanny 
Published: November 2024

Abstract

Background
Duodenal adenocarcinomas are rare cancers and their clinico-oncological management pathways tend to follow that of small bowel tumours. The aim of this study was to determine the outcomes of patients undergoing surgical resection for duodenal adenocarcinoma.

Method
Retrospective data of all patients who underwent surgical resection for duodenal adenocarcinoma between January 2008 to December 2023 were included. Collated data included demographics, clinico-pathological features and survival outcomes.

Results
Thirty-one patients were included, with a mean age of 65.7 (± 9.6) years and a greater proportion were male patients (58.1%). The predominant site of the primary tumour was at D2 section of the duodenum (58.1%). The majority of patients required a pancreatico-duodenectomy (80.6%) and 58.1% experienced minor morbidity (Clavien-Dindo I-II) while 22.6% experienced major morbidity (Clavien-Dindo III-V). There were 4 (12.9%) peri-operative mortalities.

Results
The median post-operative follow-up was 29.7 (IQR 61.5) months. Only 37.0% of patients received adjuvant chemotherapy while 13 patients (48.1%) experienced disease recurrence. The 3- and 5-year overall survival was 44.3% and 33.3%, respectively, while the disease-free survival at 3 and 5 years were 37.0% and 29.6%, respectively.
Patients who received adjuvant chemotherapy had a trend towards improved mean overall survival in comparison to patients who did not receive chemotherapy following surgery [80.3 vs 51.2 months; log rank 1.857, p=0.173]. Nevertheless, the median disease-free survival was similar between both groups [24.0 vs 26.0 months, log rank 0.016, p=0.901].
Patients who experienced major morbidity (Clavien-Dindo III-V) were significantly more likely to have a poorer median overall survival compared to patients with minor morbidity (Clavien-Dindo I-II) [72.1 vs 3.4 months; log rank 16.860, p&lt;0.001].

Conclusion
Major morbidity (Clavien-Dindo III-V) following surgery is associated with poorer overall survival. Patients who received adjuvant chemotherapy following surgical resection for duodenal adenocarcinoma may have a trend towards improved overall survival.
HPB SO34 - Inter-fascial/Wound Catheter with Local Anaesthetic Infusion vs Thoracic Epidural Analgesia in Hepato-biliary Surgery (HILA) – A Retrospective Cohort Study
Authors: Sellappan Hari , Charles Nina , Adiamah Alfred , Eastwood Joanne , Sanyal Sudip 
Published: November 2024

Abstract

Background
Thoracic epidural analgesia (TEA) offers effective pain control after open hepato-biliary surgery, however it is associated with several limitations that delay post-operative recovery. This study compared outcomes between inter-fascial/wound catheter with local anaesthetic infusion (IF/WC) and thoracic epidural analgesia (TEA) following open liver and biliary surgery in an enhanced recovery after surgery (ERAS) setting.

Method
Retrospective cohort data of all open liver and biliary surgery between August 2023 to February 2024 that used inter-fascial/wound catheter with local anaesthetic infusion (IF/WC) or thoracic epidural analgesia (TEA). Baseline characteristics were similar in the combined IF (n=17) and WC (n=7) group vs TEA (n=39) group. Technical failure rates were 12.5% in the IF/WC group vs 20.5% in the TEA group, p=0.509.

Results
Vasopressor requirement immediately post-surgery decreased by 32.7% in IF/WC vs TEA group [8.3% vs 41.0%, p=0.005], whereas none in the IF/WC group required vasopressor beyond 24 hours [0 vs 25.6%, p=0.010]. Length of critical care stay reduced by 1.5 days [1.79 vs 3.28 days; 95% CI 0.28-2.70, p=0.016] while length of hospital stay reduced by 2.6 days [5.79 vs 8.41 days; 95% CI 0.72-4.52, p=0.022] in the IF/WC vs TEA group. Admission cost reduced by £3941 per patient in the IF/WC vs TEA group [£10323 vs £14265; 95% CI 661-7222, p=0.019].

Conclusion
Inter-fascial/wound catheter with local anaesthetic infusion (IF/WC) is an effective, safe and cost-saving alternative to thoracic epidural analgesia (TEA) with significant decrease in post-operative vasopressor requirements, and length of critical care and hospital stay.
HPB SO39 - Incidence for the need of blood transfusion for Laparoscopic Cholecystectomy :Is a group and save always needed ?
Authors: Jeelani Sarah Masroor , BintulHuda Yusma , Ip Ignatius , Shrivastava Abishek , Malik Izzah , Broder Ephraim , Owera Anas , Moussa Osama , Arhi Chanpreet 
Published: November 2024

Abstract

Background
Major bleeding is rare but among the most serious complications of laparoscopic surgery. As low as 1.3% of patient undergoing laparoscopic cholecystectomy may require a blood transfusion. We propose that not all patients undergoing laparoscopic cholecystectomy require a valid group and save sample, as the risk of bleeding is minimal.

Method
Health records of 458 patients who underwent cholecystectomy at our two hospital sites were reviewed for blood transfusion up to 30 days post-operatively. This review included elective and emergency procedures from January 2023 till March 2024. Demographics and surgical outcomes, including preoperative Haemoglobin (Hb) levels, need for transfusion, reason for transfusion and amount of units transfused were recorded. We analysed nominal values in proportions and percentages.

Results
Average pre-operative Hb levels were 13.38 g/dl. 7 patients required peri-operative blood transfusion. Three patients requiring transfusion had conversion to open cholecystectomy. Three patients requiring transfusion underwent emergency procedures. Time to transfusion ranged from 2 hours-5 days. All patients requiring transfusion were at our main hospital site (Watford General Hospital). Our yearly cost of ordering routine group and save sample throughout the audit period was £12,824

Conclusion
Routine group and save is not required prior to Laparoscopic Cholecystectomy. In case transfusion is required sufficient time to process a group and save samples is present. High risk patients i.e those with known haematological malignancies, coagulopathy, concurrent use of blood thinner, higher ASA grades can be identified and selective blood grouping performed.
HPB SO44 - From Electives to Career-Changing: A Cross-Sectional Survey exploring the impact of International Medical Electives in Hepato-Pancreatic-Biliary Surgery Unit
Authors: Al-Rubaye Rawan , Al saoudi Tareq , Issa Eyad , Isherwood John , Garcea Giuseppe , Dennison Ashley , Bhardwaj Neil 
Published: November 2024

Abstract

Background
International medical graduates (IMGs) are crucial in addressing NHS workforce shortages, representing one-third of staff. Reliance on IMGs is likely to continue. Electives offer IMGs a valuable opportunity to overcome work culture and clinical skills challenges, difficult to address through PLAB tests alone. These experiences can aid in passing the exam. Entering a new culture and service can be daunting; electives help build confidence by increasing familiarity with the NHS and UK medical traditions. This survey was designed to gain insight into IME experiences, the educational value perceived by participants, and their influence on personal growth and career direction.

Method
A cross-sectional survey was sent to 26 IMGs who completed an IME rotation in the HPB department at University Hospitals of Leicester NHS Trust since 2019. The survey included quantitative and qualitative questions to gather demographic details, insights into experiences, educational values gained, and career impact. Medical education and HPB surgery experts evaluated the survey for content validity and alignment with learning outcomes.Conducted via Google Forms®,recruitment emails were sent anonymously with weekly reminders for four weeks to ensure high response rates. Quantitative data were analysed using descriptive statistics, and qualitative data underwent thematic analysis.

Results
18 out of 26 participants (62.2%) responded. Ages ranged from 23-30, with 61.11% between 23-25 years. The gender split was 61.11% male and 38.89% female. Most (66.67%) were medical students during their elective, while 33.33% were Foundation Doctors. 72% of respondents are preparing for or have taken GMC registration exams, with 44% are already fully registered. The survey revealed overall positive responses, highlighting the welcoming and educational environment. However, participants suggested improving the induction program and providing a more defined daily schedule for elective students. These insights offer opportunities to enhance an already valuable program.

Conclusion
The study revealed a successful international medical elective program in the HPB department. Most respondents found the experience met their expectations, achieved learning objectives, and positively influenced their careers. All participants were satisfied and would recommend the elective, with 94% considering NHS careers. The program provided effective teaching, mentorship, and hands-on clinical experience for most participants. Many have begun or completed GMC registration, indicating lasting impact. This initiative is valuable in attracting and preparing IMGs for the NHS and should be replicated across the UK, with a structured program and ensuring necessary exposure and guidance.
HPB SO60 - A Re-Audit: Radiological Investigations In Patients Diagnosed With Gallstone Disease
Authors: Anis Iman , Sousseing Makeda Kingue , Gondavakuru Lesleen , Rai Anil , Al-Fagih Othman , Munasinghe Aruna 
Published: November 2024

Abstract

Background
Gallstones disease is very commonly encountered in general surgery and often detected by different modes of imaging.
NICE guidance advises offering liver function tests and ultrasound where gallstones are suspected. MRCP and EUS are then considered if gallstones have not been detected. However, ultrasound is not always offered first line in patient cases, for varying reasons.
This retrospective audit aims to assess the different radiological investigations used in gallstones against NICE guidance and the reasons behind this.

Method
Data was collected from a cohort of 108 patients over a 2 month period, all diagnosed with gallstones. The data collected included information regarding their demographics and imaging used to diagnose gallstones, as well as the reasoning when the first line investigation was not used. These results were then presented at the local general surgery CGM, findings were also communicated to doctors within the hospital. The audit was then repeated a year later with a similar cohort of patients, to compare findings.

Results
Mean age of patients decreased from initial audit to reaudit periodFemale preponderance in both audit and re-audit cyclePatients more likely to have imaging when abdominal pain present AND deranged LFTs as opposed to just one of the twoComparing total number of scans: less patients are undergoing CT scans (44 in audit period vs 31 in re-audit period)- 30% decreaseDecrease in number of patients having CTAP as first mode of scan (38 in audit period vs 21 in re-audit period). Total of 45 % drop.

Conclusion
While ultrasound scan is the first line radiological investigation where gallstones are suspected, it is not always the first to be used. This is for a plethora of reasons, including:Differing clinical judgment/ diagnostic uncertaintyDifferent clinicians/ specialities booking investigationsUnawareness of NICE guidanceLogistical delay in ultrasounds
However, it does appear there has been improvement in adherence to NICE guidance between first and second cycle. Other modes of awareness will be implemented to further improve this, including publishing further guidance about NICE protocol within the trust so this is more easily accessible to doctors.