bluuebunny/crossref_metadata_2025_split huggingface dataset:
ThP3.14 - Four-Year Experience of Laparoscopic Transcystic common bile duct exploration at a District Hospital
Authors: Vrachni Vasiliki , Kontaxi Ourania , Andreou Alexandros 
Published: September 2024

Abstract

Aim
This study aims to assess the outcomes of Laparoscopic Common Bile Duct Exploration (LCBDE) as a single-stage procedure for symptomatic choledocholithiasis.

Methods
In this retrospective analysis we included 87 patients with high suspicion of common bile duct (CBD) stones, imaging proven choledocholithiasis or failed Endoscopic Retrograde cholangiopancreatography (ERCP). These patients underwent either LCBDE or CBD exploration under fluoroscopy between 2019 and 2023.

Results
Among the 87 patients selected for a single stage procedure, 59 underwent Laparoscopic transcystic CBDE. Successful CBDE was achieved in 40 cases (68%), with four patients after failed ERCP. In one case on table ERCP with rendez-vous technique was used to complete CBD clearance. Two of them needed complementary post operative ERCP to remove impacted stones. Most cases with unsuccessful CBDE, 19 in total (32%), was due to difficult cannulation of a narrow cystic duct. Three were managed with on table ERCP and five had post-operative ERCP. Six patients (7%) experienced unplanned readmissions, three with retained stones post-successful stone clearance and two after clear on table cholangiogram, who were managed with ERCP. Bile leak occurred in two cases and it was self-limited within 14 days. The mean hospital length of stay (LOS) was 5,3 days with a median LOS of 4 days.

Conclusion
Transcystic LCBDE, when surgical expertise and experience are available, is an effective and safe procedure for treating choledocholithiasis, providing comprehensive CBD clearance while avoiding the risks associated with ERCP.
ThP5.6 - Intraoperative blood transfusion and postoperative infective complications in patients who undergo pancreatoduodenectomy for malignancy
Authors: Jordan Caitlin , Rees Jonathan , Russell Tom , Aroori Somaiah ,   RAW Study Collaborators, Mavroeidis Vasileios K 
Published: September 2024

Abstract

Background
Prior authors have suggested that patients who receive an intraoperative blood transfusion (IOBT) are at increased risk of postoperative infective complications (transfusion-related immunomodulation). This study aimed to investigate whether pancreatoduodenectomy (PD) patients who received IOBT were more likely to develop an infective complication than those who did not.

Methods
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 from 8 countries, n=1484). Patients who received IOBT were identified and compared to those who did not. The primary outcome measure was the development of at least one postoperative infective complication, including: hospital acquired pneumonia, cholangitis, Clostridium difficile, intra-abdominal collection, liver abscess, sepsis of unknown origin, surgical site infection and urinary tract infection. The Mann-Whitney U test and Fisher exact test were used for statistical analysis.

Results
Blood transfusion data was available from 907 patients (61.1%). In total, 165 patients (18.1%) received IOBT. The median number of units given was two (range: 1-36, interquartile range (IQR): 1). Patients who received IOBT were similar to those who did not in terms of median age (68 vs 67 years, p=0.5), median BMI (23.8 vs 25.3 kg/m2, p=0.0001) and ASA grade (33.3% vs 34.5% grade &gt;II, p=0.8). These patients also had similar rates of preoperative diabetes (24.8% vs 20.9%, p=0.3), cardiac (41.2% vs 45.9%, p=0.3) and respiratory disease (7.9% vs 12.1%, p=0.01) compared to patients without IOBT. Transfused patients experienced more infective complications but this was not statistically significant (24.2% vs 17.6%, p=0.06).

Conclusion
In our multicentre study, there was a trend amongst patients undergoing PD who received IOBT to develop more infective complications. Blood transfusions should only be given when strictly indicated.
ThP6.2 - Benign and malignant biliary strictures encountered during single session laparoscopic cholecystectomy and bile duct exploration. Rationalising preoperative imaging and relying on routine cholangiography can optimise outcomes
Authors: Omran Asmaa , Al-Shaye Ahmad R A , Hayyawi Israa , Nassar Ahmad H M 
Published: September 2024

Abstract

Aim
To review causes, diagnostic features and operative strategies of biliary strictures discovered on routine cholangiography (IOC) during single session treatment of bile duct stones.

Methods
A prospective database of cholecystectomies and bile duct explorations spanning 30 years was analysed. Cross sectional imaging and ERCP play a limited role in patients with confirmed gall stones except in suspected malignancies.

Results
53/6140 patients (0.86%) had strictures on IOC.Malignant Strictures 27 (%)Benign strictures 26 (%)Females18 (66.6)12 (46)Age Median7262Emergency admission24 (88.8)15 (57.7)Presentation: Jaundice22 (81.5)15 (57.7)USS: GB Thick or contracted6 (22.2)4 (15.4)Bile duct dilatation16 (59.2)14 (53.8)Suspected CBD stones23 (85.2)24 (92.3)Preoperative imaging: MRCP1 (3.7)6 (23)CT6 (22.2)4 (15.4)ERCP1 (3.7)5 (19.2)Gall bladder conditionMucocele10 (37)3 (11.5)Acute/Empyema6 (22.2)4 (15.4)Contracted5 (18.5)9 (34.6)Cholangiography abnormality:Strictures + dilated ducts12 (44.4)22 (84.6)Dilated ducts/stones/no flow15 (55.5)4 (15.4)Bile Duct Exploration:Choledochotomy17 (63)10 (38.4)Transcystic5 (18.5)11 (42.3)NONE5 (18.5)5 (19.2)Choledochoscopy21 (77.7)20 (76.9)Biliary drains13 (48)18 (69)Stents9 (33.3)3 (11.5)Operative time (median)135 min135Open conversion1 Bilioenteric anastomosis0Morbidity4 (14.8)7 (26.9)Hospital stay median1413Postoperative ERCP11 (40.7)11 (42.3)Postoperative surgery322 year survival122

Conclusions
Careful clinical assessment and exclusion of risk of malignancy optimises preoperative imaging and maximise benefits of single session management of suspected CBD stones.
ThP6.10 - Overview of Necrotising Soft Tissue Infections' Risks and Outcomes
Authors: Pha Sai Yan , Asfour Aref , Christie Hannah , Burke Joshua , Peckham-Cooper Adam 
Published: September 2024

Abstract

Introduction
Necrotising Soft Tissue Infections (NSTI) are severe life-threatening conditions, which are increasing in incidence. Associated with high mortality and morbidity, NSTI’s are a significant burden to health care services globally. Identifying themes, risk factors and underlying causation is therefore of interest.

Methods
A retrospective data cohort study examining clinical data for all histologically confirmed NSTI cases in a single centre between 2012 to 2022 was conducted.

Results
73 confirmed NSTI cases were identified. Patient co-morbidities included the following:CasesDiabetic34Smoker16Post-op12IVDU8Trauma7Immunosuppressed6Bowel Perf5Cancer5
68 patients underwent urgent surgical debridement, with an average of 3.59 (Range 1-11) further surgical interventions required. Patients spent an average of 8.24 days (Range 1-42 days) in ICU, with a hospital stay of 44.02 days. (Range 7-180 days)
6(8%) patients died (5 within first week of presentation). Defunctioning stomas were performed in 24 patients during the admission and 32 patients underwent reconstructive surgery after recovery from the acute phase.
An array of causative organisms were identified with no clear delineating trends.NumberAnaerobes36Streptococcus35Staphylococcus20E Coli + Coliforms20Enterococcus15

Conclusion
NSTIs continue to increase in incidence and prevalence. The old surgical adage ‘You will see one NSTI in your lifetime is no longer true. Associated morbidity and mortality is significant and a focus on early recognition and prevention is vital. Further larger data sets are required to delineate clear trends and associated risk factors that can effect meaningful health care policy change.
ThP6.17 - ‘If it’s not documented, it didn’t happen’: an audit into surgical ward documentation and clinicians expectations in a district general hospital
Authors: Sadczuk Dominika , O’Neill Aoife , Fox Katherine 
Published: September 2024

Abstract

Introduction & Aims
There are guidelines published by the Royal College of Surgeons (RCS) on adult surgical ward round documentation. Locally, documentation is done on pre populated sheets containing blood results, antibiotics and VTE prophylaxis. We aimed to assess documentation in our unit against the RCS guidelines.

Methodology
We audited documentation for surgical inpatients over 1 week, looking at daily ward rounds (DWR), and initial consultant post take ward round (PTWR). Through an online survey, we established the minimum standards of documentation expected by doctors of varying seniority on a ward round within our unit.

Results
21 DWR and 21 PTWR entries were reviewed; 90% (n=19) contained the date and 95% (n=20) the name of the reviewing consultant. Time of review was documented in 29% (n=6) and 35% (n=7) respectively. 33% (n=4) DWR entries documented examination findings, compared to 8 40% (n=8) PTWR entries. 45% (n=10) PTWR contained the presenting complaint. 26 doctors completed the online survey; 100% thought date, time and examination findings were important. More senior doctors highlighted that drain status was a key part of ward round documentation.

Conclusions
Within our unit, there is poor adherence with the RCS ward round documentation guidelines. Juniors suggested this is because ward rounds are too fast paced, often on complex and comorbid patients. We plan to address our findings with an improved surgical admission proforma and an electronic handover to ensure all team members are up to date with patients’ admission details.
ThP8.6 - A real-world diagnostic algorithm for identifying carotid artery stenosis
Authors: Elkorety Mohamed , Khosravi Annie , Rosenfeld Kevin , Naseer Afifa , Sarin Sanjeev 
Published: September 2024

Abstract

Aim
Eighty-five percent of ischaemic strokes are caused by extracranial atheromatous lesions involving a narrowing of the Internal Carotid Artery so accurate and timely diagnosis is vital for management. The aim of this study was to correlate CT angiogram (CTA) and ultrasound doppler (US) derived measurements of carotid artery stenosis (CAS), with a view to identify those cases where second modality is required to reduce potential errors.

Methods
All consecutive carotid US and CTA examinations performed in 2021 and 2022 were included for comparison in this retrospective cohort study. Collected data was then reviewed and evaluated by a multidisciplinary team. North American Symptomatic Carotid Endarterectomy Trial (NASCET) and St Mary’s criteria were used to narrow down the percentage stenosis.

Result
There were fifty-one patients (102 carotid arteries) over this period who had both studies performed. Twenty-nine males and twenty-three females with a median age of seventy-three. Initial data analysis showed no discrepancy in ninety-one (90%) carotid arteries between both modalities. After MDT review, there were eight (7.1%) false positive results and three (2.9%) true positive (2 symptomatic & 1 asymptomatic). In three (2.9%) cases quantification was significantly inaccurate in the initial imaging modality because of heavily calcified vessels.

Conclusion
This study supports the use of US or CTA as a single modality in grading CAS. Heavily calcified vessels on the first test should be a ‘red flag’ for triggering further alternative imaging to reduce the risk of error. Persistent discrepancies even after the second modality will require a further modality e.g. enhanced magnetic resonance angiography.
ThP8.7 - Giant Cell Arteries: Diagnostics
Authors: Elkorety Mohamed , Naseer Afifa , Anton Jeny , Sarin Sanjeev 
Published: September 2024

Abstract

Aim
Giant cell arteritis (GCA) poses a risk of severe ischaemic complications such as irreversible blindness which mandates early recognition of condition. We aimed to evaluate effectiveness of ultrasound doppler (USD) in diagnosing GCA compared to temporal artery biopsy (TAB) and American College of Rheumatology (ACR) score.

Method
This retrospective study included patients with suspected GCA who had consecutive TAB and USD examinations performed over a course of three years (2017-2022) which was correlated with ACR score. The data was also analysed to assess further management.

Results
There were 64 patients over this period who had both studies performed (22 were excluded as they did not have TAB) with 64% having an ACR score ≥3. Twenty males and forty-four females with a median age of 77 years (IQR 84-67). Overall, 81% patients had a negative USD result. Comparing USD results with TAB gold standard, there was sensitivity of 63% and specificity of 84%. Comparing USD results with ACR as gold standard, there was sensitivity of 20% and specificity of 83%. Forty percent patients with negative doppler result were continued on treatment mainly due to improvement of symptoms in response to steroids.

Conclusion
US Doppler has high diagnostic specificity and low sensitivity which makes it time-efficient, cost-effective and allows for the implementation of fast-track management pathway for majority patients. In certain circumstances, as cases of low clinical suspicion and positive doppler result, an additional test (TAB) would be required to confirm the diagnosis and cases where clinical suspicion is high with negative doppler, TAB should be considered.
FP1.10 - Functional Outcomes of a Standard vs Modified Brooke Ileostomy – A Quality of Life Study
Authors: Bruce Nikki , Tallo Tracy , Duffy Norma , Robertson Isabel , Macdonald Scott , Thornton Michelle , Macdonald Angus 
Published: September 2024

Abstract

Aim
Previous studies have shown that IBD patients with a modified Brooke ileostomy, where there is retention of the ileocolic sphincter, may have improved stoma function by preserving a functional high pressure zone. This study aims to review functional outcomes through a patient-reported quality of life survey.

Methods
This cohort study was conducted across two sites, one performing Standard Brooke Ileostomy (SBI), and the other Modified Brooke Ileostomy (MBI), as standard practice. Patients with diagnosis of colitis were identified from a prospectively collected database. A stoma activity log and a validated stoma Quality of Life survey (PRATO) was sent, with 23 responses obtained (14 MBI, 9 SBI). Activity log included bag emptying, hours of interrupted sleep, and number of visits to stoma nurse.

Results
For QoL survey (minimum score 20, max 80), patients with MBI scored higher (mean 55.36), compared to SBI (mean 48.22), (p=0.037).
Bag emptying over 24 hours was similar (MBI mean 5.71, SBI mean 5.86), as was bag emptying overnight (MBI mean 1 (range 0-3), SBO mean 1 (range 1-2).
MBI patients reported longer mean uninterrupted sleep (7.07 hours vs 5.43 hours (p=0.005)).
MBI patients required fewer stoma nurse visits in the first year (mean 5.3, median 5, range 0-13). SBI (mean 10.7, median 10, range 2-33).

Conclusion
A practice of Modified Brooke Ileostomy has comparable patient reported quality of life outcomes to a standard Brooke Ileostomy and performs better overall in terms of less interruption to sleep and lower disruption of daily life through hospital visits.
FP2.2 - Does preoperative nutritional assessment correlate with postoperative outcomes of patients undergoing surgery due to colorectal cancer? A bicenter prospective observational study
Authors: Frountzas Maximos , Kozadinos Alexandros , Lidoriki Irene , Theodoropoulos George , Toutouzas Konstantinos , Schizas Dimitrios 
Published: September 2024

Abstract

Aims
Preoperative nutritional status has been investigated as a risk factor for postoperative complications in patients undergoing surgery due to colorectal surgery. The aim of the present study was to investigate the predictive role of preoperative nutritional assessment in terms of morbidity and mortality in such patients.

Methods
Patients undergoing surgery due to colorectal cancer from March 2022 until March 2023 at two university surgical departments were included in the present study. Patients’ demographics and postoperative parameters, such as complications’ severity according to Clavien-Dindo classification and mortality, along with malignancy stage were reported. Preoperative nutritional assessment was conducted according to the Patient-Generated Subjective Global Assessment (PG-SGA) tool and the Geriatric Nutritional Risk Index (GNRI) tool. The present study was registered in ClinicalTrials.gov (NCT05795374).

Results
The present study included 159 patients with a mean age of 69 ± 12 years old. Severe malnutrition according to the PG-SGA tool was associated with advanced disease stage (66% vs 59%, p=0.006). In addition, the high risk of malnutrition according to the GNRI tool was correlated to major (Clavien-Dindo≥3) postoperative complications (19% vs 15%, p=0.026) and increased 30-day mortality (34% vs 9%, p=0.026).

Conclusions
Postoperative morbidity and mortality of patients undergoing surgery due to colorectal cancer seem to be associated with preoperative nutritional stratification, especially with the high malnutrition risk.
FP2.4 - Assessment of Outcomes Reported in Elective Colorectal Cancer Surgery Research for Elderly Patients: A Scoping Review
Authors: Bhattacharya Yagnaseni , Xavier Hepsi , Ramsay George , Poobalan Amudha , Brazzelli Miriam 
Published: September 2024

Abstract

Aim
This scoping review aimed to identify outcome measures for assessing the impact of elective colorectal cancer surgery on elderly patients, given their higher surgical risk and mortality rates. Conventional surgery-specific outcomes, like 5-year mortality rates, may not be appropriate, necessitating a focus on postoperative quality of life. The challenge lies in determining optimal outcomes to assess the effects of colorectal cancer resections in the elderly.

Methods
A comprehensive literature search of major electronic databases from inception to March 2023 was conducted. Studies exploring frail or elderly individuals with colorectal cancer undergoing elective surgery and reporting postoperative outcomes were included. Outcomes were classified as surgery-specific versus geriatric-specific and summarised using a narrative synthesis. The type and rate of surgery-specific outcomes were tabulated.

Results
Of 1366 identified citations, 16 studies focused on geriatric-specific outcomes and 66 exclusively on surgery-specific outcomes. Nine of the 16 ‘geriatric-specific outcome’ studies reported discharge destination, with home discharge being predominant. Postoperative delirium ranged from 8.2% to 18.1% in six studies. Four studies explored geriatric syndromes and three analysed activities of daily living. Three studies reported a significant improvement in quality of life. The 66 ‘surgery-specific outcome’ studies assessed mortality (N=61); length of stay (N=40); postoperative complications (N=47); readmission (N=18); reoperation (N=16); and survival (N=42).

Conclusion
Geriatric-specific outcomes are underreported, despite their importance in guiding patient management. Elderly patients require adequate information about their recovery after surgery to manage their lives better. Future research must address this gap to improve care for the elderly undergoing elective colorectal cancer surgery.
FP3.2 - Pre-Treatment Neutrophil–Lymphocyte/ Lymphocyte-Monocyte Ratios: Are They Useful Prognostic Biomarkers In Locally Advanced Rectal Cancers?
Authors: Chaudhury Madhu P , Lim William , Manatakis Dimitris , Mitchell Peter J , Kearsey Chris C 
Published: September 2024

Abstract

Aim
Examining the relationship & outcome between pre operative Neutrophil:Lymphocyte Ratio, Neutrophil:Monocyte Ratio & Lymphocyte:Monocyte Ratio in a cohort of locally advanced complex pelvic tumours, involving the rectum, where the patients underwent resection with curative intent.

Methods
The retrospective data collected from 2013 to 2022. Cases where rectum resection was not involved were excluded. The Kaplan-Meier curve was employed to estimate the survival function, with overall survival defined as the duration from the date of the first surgery to the date of death from any cause. The final data input point was last attendance at the hospital or the date of death. Disease-free survival was calculated and disease recurrence was determined based on a combination of radiological, histopathological, and/or endoscopic results.

Results
The data encompassed 72 cases. The male-to-female ratio was 1:0.85. Kaplan-Meier curves were used to calculate over-all disease free survival. Our results from Neut:Lymph ratio did not show any significant correlation in overall survival and disease free survival. For Neut:Monocytes ratio, all cases in our cohort had high ratio but this comparison was not published elsewhere for our comparison. Finally, for Lymph:Monocytes, when compared to Gawiński’s data, our disease free survival was found to be significant at p&lt;0.0425 suggesting that the likelihood of recurrence is high. Our overall survival did not have any significant findings.

Conclusions
In all cancer cases, the neutrophil-to-monocyte ratio consistently showed high averages, raising the question of whether this ratio could potentially serve as a more effective biomarker. The analysis remains a work in progress with further variables to compare.
FP3.5 - Colonoscopy post diverticulitis – Compliance with ACPGBI guidance in a single centre audit
Authors: Castelhano Rute , Helmy Naderadel , Linzell Aoife , Davies Emma 
Published: September 2024

Abstract

Introduction
For decades the management of acute diverticulitis (AD) has included endoscopic evaluation to exclude malignancy. In complicated AD, the incidence of colonic neoplasia is between 7.8%-10.9% (1-5) so interval colonoscopy remains mandatory. However, in uncomplicated AD, the incidence is low, 1.6%-1.9% (1-5), therefore the routine colonoscopy may be unnecessary in this group. This audit aims to assess our single-centre compliance with the ACPGBI guidance of colonoscopy post-diverticulitis.

Methods
A retrospective single-centre audit enrolled 120 patients with CT-confirmed diverticulitis over 18 months. Patient identification involved on-call handover sheets or PACS reports containing "diverticulitis" or "complicated diverticular disease." Patient scans were reviewed, and their management was studied.

Results
Number Number Uncomplicated Surgery 0 (Hinchey 1A+1B) No surgery 90 (75%) Colonoscopy 71 (59%) No colonoscopy 19 (16%) Surgery 15 (12.5%) Complicated (Hinchey 2 or greater) No surgery 15 (12.5%) Colonoscopy 11 (9.2%) No colonoscopy 4 (3.3%) Total 120
3.3% of complicated diverticulitis did not undergo colonoscopy due to patient choice, comorbidities or frailty. Among the 82 patients who underwent colonoscopy, there was no detection of CRC, resulting in a 0% detection rate.

Conclusion
In this 120-patient cohort, the incidence of colorectal cancer was 0%, which is in keeping with the published data. 78.9% of patients with uncomplicated diverticulitis underwent colonoscopy, which may have been unnecessary. The use of faecal immunochemical testing may be beneficial as an adjunct to avoid endoscopy in this group, whilst taking into consideration individual risk factors such as age, clinical suspicion of malignancy or concerning features on imaging.