bluuebunny/crossref_metadata_2025_split huggingface dataset:
WP4.19 - The Emergency General Surgeon: what is their current operative role?
Authors: Wohlgemut Jared , Lee Matt , Peckham-Cooper Adam , Lockwood Sonia , Tierney Gillian , Moug Susan 
Published: September 2024

Abstract

Aims
Determine the current operative role of dedicated Emergency General Surgery (EGS) surgeons in the United Kingdom (UK) and the Republic of Ireland (ROI).

Methods
A live interactive online survey, designed and endorsed by ASGBI, was completed by attendees at two ASGBI conferences in 2023. The study was conducted according to CHERRIES and exempt from REC according to HRA. Consent was obtained from study participants, who were asked which surgeons usually perform the most common EGS operations in their hospital.

Results
The survey was completed by 156/371 eligible participants, of which 132 responses were analysed once duplicate responses (n=16), and non-UK/ROI respondents (n=8), were excluded. Participants included consultants (34%), surgical trainees (42%), and other doctors (23%), 61% were male and 39% were female, aged between 25 and 69.
The general surgeon on-call – or a dedicated EGS surgeon, where such service exists – operates on the majority of EGS pathology through an un-selected take. A surgeon with the relevant sub-specialty interest usually operates on emergency non-traumatic complex upper gastrointestinal or colorectal pathology. These include emergency colonic resections for cancer or inflammatory bowel disease, and operations for gastric volvulus, bariatric complications, and Boerhaaves. Acute cholecystectomy forms a major part of a dedicated EGS surgeon’s practice.

Conclusions
Dedicated EGS surgeons deliver a wide variety of operations, in addition to the peri-operative management of acute surgical patients. Future curriculum design and NHS workforce planning should reflect this service delivery pattern, should EGS become a recognised specialty interest.
WP6.10 - Factors Impacting Success in The Intercollegiate Membership of The Royal College of Surgeons Examinations
Authors: Small Sarah , McLaughlin Declan 
Published: September 2024

Abstract

Aims
We have witnessed within surgical training schools, that the attainment of the Intercollegiate Membership of the Royal College of Surgeons iMRCS examinations Part A and Part B continues to be one of the greatest challenges within core surgical training. This study aims to explore a trainee’s examination experience and factors influencing success and examination challenges.

Methods
A voluntary electronic survey including demographic factors, preparation specific approaches and adjuncts, challenges and barriers was sent to Northern Ireland core surgical trainees. Results were correlated with their examination outcomes. The results were collated using Microsoft excel software. Statistical analysis was completed using SPSS and thematic analysis of free text responses carried out.

Results
Twenty-seven trainees responded to the survey. The modal age category was 25-34 years with a male to female preponderance of 16 males to 11 females. English language was the first language of 60% of respondents. Statistical significance was demonstrated between age and first-time pass rate in the Part B. No statistical significance was demonstrated between first time pass rate and gender, English language, or background. Forty eight percent of those surveyed attributed personal attitude as a major contributor to success.

Conclusion
Those who undertook Part A closer to foundation training appeared to require fewer attempts to be successful in Part A, and the hours of preparation and study undertaken, correlated to feeling of preparedness. Part B success correlated to clinical experience.
WP6.16 - A comparison of post-rotation confidence levels over a year of surgical foundation year one doctors in a busy district general hospital
Authors: George Jayan , Savage Daniella , Brown Denise , Yeluri Sashidhar 
Published: September 2024

Abstract

Aims
Assess the confidence levels of foundation year one (FY1) doctors in managing surgical patients post-rotation. Identify areas where further support could be given to improve confidence levels.

Methods
August 2022, December 2022 and April 2023 cohorts were surveyed following the end of their four-month rotation. Ten questions used Likert scales (1 to 5: not at all confident to very confident) to assess general surgical patient management. One question focused on education methods and one was an open question. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results
100% (10/10) August 2022 cohort, 38% (3/8) December 2022 and 80% (8/10) April 2023 cohort completed the survey.
Modal post-rotation confidence levels were mostly four and five across all cohorts.
August 2022 and December 2022 cohorts had a modal value of three for confidence in speaking with a patient’s family when a patient was dying.
August 2022 cohort had a modal value of three for confidence in speaking to a patient when their condition was unknown.
Common concerns of FY1 doctors were managing a deteriorating patient and being unable to contact a senior.
Most FY1 doctors felt that case-based discussion would be the preferred method to increase understanding of general surgery.

Conclusions
Confidence levels were high post-rotation and increased throughout the year. This could suggest that FY1 doctors are receiving a good understanding of general surgery by the end of their rotation. Further work needs to be done to target improvement in areas of lower confidence.
WP7.2 - The Role of a Frailty Team to improve Perioperative Care for ELLSA Patients
Authors: McCulloch Alison , Watson Hannah , Richmond Victoria , McCleary Andrew , Sturrock Claire , Martin Paul 
Published: September 2024

Abstract

Aim
Frailty assessment amongst emergency laparotomy patients is essential. The 8th NELA report highlighted that only 31.8% of patients who were frail and over 65 years received geriatrician input. Within our organisation, patients who undergo emergency laparotomy are included in the Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA). The consultant geriatrician led Surgical Acute Frailty Team (SAFT) works collaboratively with the emergency general surgery team and ELLSA specialist nurse to review ELLSA patients within our hospital. Our aim was to establish outcomes of ELLSA patients reviewed by SAFT.

Methods
Data collected routinely via Redcap as part of our organisation’s ELLSA was reviewed. All ELLSA patients aged ≥65 years admitted between November 2022 and November 2023 were included. Data included frailty assessment, discharge destination and 30 day mortality.

Results
152 patients aged ≥ 65 years underwent operative intervention as defined by ELLSA. 100% of patients had a documented Clinical Frailty Scale (CFS) score. 72 patients (47.4%) had a pre-operative frailty review. 68.4% of patients had their initial frailty assessment by a consultant geriatrician. 19.7% of patients were reviewed by frailty ANPs or clinical fellow. Only 7.9% of patients required care support on discharge. 30 day mortality was 17.1%.

Conclusions
Embedding a dedicated frailty team within our general surgery wards has been incredibly successful; frailty assessment is significantly above that of the 8th NELA report. The majority of ELLSA patients aged ≥65 years are discharged home independently. Collaborative working and early identification of frailty in ELLSA patients is essential to improve patient outcomes.
WP8.6 - Improved confidence levels with the introduction of a junior doctor led surgical handbook for first rotation foundation year one doctors
Authors: George Jayan , Brown Denise , Savage Daniella , Yeluri Sashidhar 
Published: September 2024

Abstract

Aims
Assess the confidence levels of general surgical foundation year one (FY1) doctors in managing patients at the start of their rotation in August 2022 and August 2023. Assess the impact of a surgical handbook on confidence levels at the start of the rotation.

Methods
Cohort one (August 2022) were asked to reflect on their confidence before their surgical placements. Cohort two (August 2023) were surveyed at the start of their rotation. A surgical handbook was given to cohort two pre-rotation. Ten questions used Likert scales (1 to 5: not at all confident to very confident). One question on education methods and one was an open question. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results
100% (10/10) cohort one and 100% (12/12) cohort two completed the survey. 83% (10/12) of cohort two had read the surgical handbook pre-rotation. 100% (10/10) who read the guide found it useful.
Modal confidence scores were higher across all 10 questions in cohort two in comparison to cohort one.
The lowest confidence levels in both cohorts were in speaking to a dying patient’s family.
The majority of FY1 doctors would prefer case-based discussions as their preferred method of learning.
A common concern of FY1 doctors was a lack of senior support.

Conclusions
Confidence levels were higher pre-rotation with the cohort that received the surgical handbook. Targeted case-based discussions may support increasing confidence through the rotation
ThP4.4 - Is it always just a Whipple? A not insignificant number of patients require a concomitant procedure at the time of pancreatoduodenectomy
Authors: Abdelmohsin Omar A M , Russell Thomas B , Labib Peter L ,   RAW Study Collaborators, Aroori Somaiah 
Published: September 2024

Abstract

Background
Some patients may need to undergo an additional procedure at the time of their pancreatoduodenectomy (PD). This study aimed to investigate the proportion of patients that this includes and to describe the additional procedures that these patients undergo.

Methods
Data were extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study (29 centres from eight countries, n=1484). The group that underwent a concomitant procedure was compared to the group that did not (chi-squared test).

Results
Out of 1484 PD patients, 79 (5.3%) underwent a concomitant procedure (seven excluded due to missing data). This was most commonly: right hemicolectomy (14, 17.7%), liver excision biopsy (12, 15.2%), appendicectomy (11, 13.9%), adhesiolysis (6, 11.4%), cholangioscopy (5, 6.3%), incisional/ventral hernia repair (5, 6.3%), diagnostic laparoscopy (5, 6.3%) and splenectomy (5, 6.3%). When those who underwent an additional procedure were compared to those who did not, length of stay (both 13 days, p=0.7), as well as rates of return to theatre (7.6% vs 4.9%, p=0.3), 90-day mortality (5.1% vs 3.6%, p=0.5) and five-year survival (38.0% vs 31.5%) did not differ significantly. However, 30-day readmission was significantly higher among those who underwent a concomitant procedure (16.4% vs 8.7%, p=0.02).

Conclusion
In our multicentre study of PD outcomes, 5.3% of patients underwent an additional procedure at the time of their Whipple. These patients more commonly had an unplanned return to theatre.
ThP4.9 - The role of preoperative nutritional assessment in postoperative outcomes of hepato-pancreato-biliary patients: A bicenter prospective observational study
Authors: Frountzas Maximos , Sotirakis Demosthenis , Karanikki Eva , Tsikrikou Iliana , Schizas Dimitrios , Toutouzas Konstantinos 
Published: September 2024

Abstract

Aims
Preoperative nutritional status of patients who undergo surgery due to hepato-pancreato-biliary (HPB) cancer has been considered as a prognostic factor of their postoperative course. The aim of the present study was to investigate the association of preoperative nutritional assessment with the postoperative morbidity and mortality in such patients.

Methods
Patients undergoing surgery due to HPB 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 Global Leadership Initiative on Malnutrition (GLIM) criteria and the Controlling Nutritional Status (CONUT) score. The present study was registered in ClinicalTrials.gov (NCT05795374).

Results
The present study included 66 patients with a mean age of 63 ± 12 years old. The high risk of malnutrition according to the GLIM criteria was associated with major (Clavien-Dindo≥3) postoperative complications (74% vs 32%, p=0.026) and increased 30-day mortality (80% vs 23%, p=0.021). Moreover, malnutrition according to the CONUT tool was correlated to increased 30-day mortality (66% vs 45%, p=0.016).

Conclusions
Preoperative malnutrition seems to be associated with higher rates of postoperative mortality and major morbidity in patients undergoing surgery due to HPB cancer.
ThP4.13 - To drain or not to drain?! Selective Abdominal Drainage Reduces Morbidity and Re-interventions in Laparoscopic Cholecystectomy and Bile Duct Exploration
Authors: Hayyawi Israa , Al-Shaye Ahmad , Omran Asmaa , Nassar Ahmad 
Published: September 2024

Abstract

Aims
To evaluate the indications and benefits of sub-hepatic drainage after laparoscopic cholecystectomy(LC) and bile duct exploration (LCBDE).

Methods
Utilisation of drains in a prospective database of LC and LCBDE was reviewed. The occurrence of postcholecystectomy bile leakage (PCBL) and abdominal collections was analysed.

Results
52.5 % of 6140 patients had drains. PCBL occurred in 43 (1.3%). 20 leaks had choledochotomy LCBDE; 16 before drain removal (10 settling spontaneously, 3 requiring ERCP, 3 relaparoscopy). All 4 occurring after drain removal required percutaneous drains (PCD) or ERCPs. 12 leaks had transcystic explorations; 10 before drain removal (8 settling spontaneously, 1 ERCP, 1 PCD) and 2 after drain removal (1 settled, 1 needed ERCP). 11 PCBLs had LC only; 9 still had drains (6 settled, 1 PCD, 1 ERCP, 1 relaparoscopy) and 2 after drain removal needing relaparoscopy and ERCP. Drains allowed early detection and spontaneous resolution in 24 patients (55.8%) and early detection and intervention prevented serious morbidity in 11 (25.6%). 7 of 8 PCBLs after drain removal required reintervention.
2915 (47.5%) had no drains. 6 had PCBL (0.2%); 5 needing multiple reinterventions; 3 PCD, 2 ERCPs and 3 relaparoscopies.
Drains caused complications in six patients (0.18%); one retracted into the abdomen needing relaparoscopy, two drain site infections and 3 had significant pain disappearing when drains were removed.
Collections other than PCBL occurred in 19 patients; 8 with drains and 11 after drain removal. They were treated conservatively (9), by PCD (8) or relaparoscopy (2).

Conclusions
Careful selective abdominal drainage after advanced biliary surgery allows early detection of collections, minimising morbidity and reintervention.
ThP5.1 - The Influence of the COVID-19 Pandemic on the Complexity of Laparoscopic Cholecystectomy
Authors: Zubair Farhan , Di Rollo Domenic , Nassar Ahmad H M , Khan Khurram S 
Published: September 2024

Abstract

Aim
The operative difficulty of Laparoscopic Cholecystectomy (LC) varies widely. This can affect the operative time, complications, post-operative course and ultimately patient outcomes. The COVID-19 pandemic caused substantial delays in the definitive management of gallstone disease. The aim of the present study was to compare the intraoperative difficulty grading of post COVID-19 pandemic LCs with previously published data.

Methods
This comparative study analyses a prospectively maintained database of all LCs performed by two biliary surgeons in a single centre between August 2022 to January 2024. Clinical and intra-operative findings including operative difficulty grading using the Nassar scale were recorded. This data was then compared to the previously published data from a single surgeon spanning 29 years (n=5,391).

Results
149 patients were included; the median age was 56 years (IQR 45-66). 88 (51.1%) were female. 71 (47.7%) LC’s were completed as part of an emergency admission. The median Scottish Index of Multiple Deprivation was 5 (IQR 3-7). 45 (30.2%) underwent LC alone, 63 (42.2%) also received an operative cholangiography and 41 (27.5%) underwent common bile duct exploration. Grade 1 LC (4.8% vs 33.2%, p&lt;0.001) were significantly less prevalent than grade 4 LC (37.4% vs 14.2%, p&lt;0.001) in the post pandemic period when compared to the previous published data.

Conclusion
The present study suggests that LCs are more challenging post pandemic. The contributing factors are likely diverse, but extended waiting times and multiple emergency admissions leading to delays in definitive management are presumed to play significant role. Urgent attention is warranted to establish biliary pathways that guarantee timely and definitive management of gallstones for patients.
ThP5.5 - Outcomes Of Laparoscopic Common Bile Duct Exploration And Laparoscopic Cholecystectomy; A Single Centre Review From A District General Hospital In Northern Ireland
Authors: Winter Jonny , Ainley Paul , Gudyma Jaroslaw , Eltayeb Omer 
Published: September 2024

Abstract

Aim
Laparoscopic cholecystectomy with laparoscopic common bile duct exploration is a one-stage therapeutic option for patients presenting with choledocholithiasis. This is a review of outcomes for patients who underwent this procedure in a district general hospital setting in Northern Ireland over a two-year period.

Method
This is a retrospective review of prospectively collected data concerning all patients who underwent laparoscopic cholecystectomy and laparoscopic common bile duct exploration between October 2021 and October 2023. Data were reviewed to include pre-operative liver function, pre-operative imaging, rate of conversion to open procedure, length of stay, and readmission rate due to complications.

Results
106 patients were included in the review. The average length of stay was 2.7 days (with a median of 1 day) and readmission rate was 7.5%. 87.7% of patients had deranged liver function tests on the morning of surgery, and 100% had proven choledocholithiasis on cross-sectional imaging prior to proceeding to theatre. Only two patients required conversion to open cholecystectomy. No patients developed postoperative pancreatitis. The complication rate was 11.3%, with most complications being of Clavien-Dindo Grade I or II.

Conclusions
Laparoscopic common bile duct exploration at the time of laparoscopic cholecystectomy represents a safe and effective method for management of choledocholithiasis. It can be considered as an alternative to endoscopic retrograde cholangiopancreatography as a therapeutic option in an appropriately selected patient group.
ThP5.8 - Familial hepatocellular carcinoma: a model for studying preventive and therapeutic measures
Authors: Weledji Elroy 
Published: September 2024

Abstract

Aims
Limited attention has been given to the role of primary genetic factors in hepatocellular carcinoma (HCC) especially as familial clusters of HCC are mostly described in areas of endemic hepatitis B virus (HBV) infection. The aim of the study was to review the literature on familial hepatocellular carcinoma (FHCC) and give evidence to suggest that FHCC may be a good model for studying preventive and therapeutic measures for HCC

Methods
Electronic searches of the Medline (PubMed) data base were performed to identify original published case studies on familial HCC.

Results
16 case studies on FHCC were reported between 1965-2016. Even in the presence of HBV infection, FHCC seemed statistically unlikely to occur by chance. Genetic contributions may explain healthy and unhealthy HBsAg carriers, the male sex being predominantly affected, and HBV being directly oncogenic and causing HCC in the absence of cirrhosis in the younger patients. The highest risk of HCC occurs when a hereditary component is acting in concert with environmental factors such as HBV infection through epigenomic alterations. A family history of HCC increases the risk of FHCC independently of hepatitis due to a multifactorial inheritance including DICER 1 germline mutation and altered liver zonation. Epigenetic studies on monozygotic twins with HCC will identify the susceptible loci which can be used therapeuticallym. FHCC is a prognostic factor for improved survival in early resectable tumours with no/minimal cirrhosis.

Conclusions
HCC lacks a strong hereditary component but HCC-prone families of the familial type may provide a powerful model for studying preventive and therapeutic measures.
ThP6.3 - Is routine histopathological analysis required following cholecystectomy?
Authors: Mohanraj Gearry , Tibude Ameya , Gajdhar Aniq , Madhok Brijesh 
Published: September 2024

Abstract

Aims
To identify incidental gall bladder cancers (IGBC) in elective cholecystectomy specimen. Preoperative presentations were observed to see if a selective approach can be adopted when requesting histopathological examination (HPE) following elective cholecystectomy.

Methods
Retrospective data was gathered for all patients undergoing cholecystectomy in 2022 at a single university teaching hospital. Histology reports and preoperative presentations were analysed. The total sample size was 505.

Results
Within the 505 patients, six operations did not occur, and five other patients underwent pancreaticojejunostomy. In the remaining 494 patients who underwent successful cholecystectomy 130 were males. Two (0.4%) patients were found to have IGBC (poorly differentiated adenocarcinoma). Both were females aged 57 and 75 years with grossly thickened gall bladder at operation. One patient underwent portal lymphadenectomy and segmental liver resection whilst the other patient was commenced on palliative chemotherapy.

Conclusions
We found very low incidence of IGBC following routine elective cholecystectomy. This is particularly rare in young patients (&lt; 50 years) found to have a thin-walled gallbladder on ultrasound examination or at laparoscopy. Hence routine HPE following elective cholecystectomy does not seem necessary. We recommend requesting HPE if any mucosal abnormality is identified on inspecting the specimen after removal or if the gallbladder is thick-walled at laparoscopy or preoperative imaging, or patient is over 50 years of age. In the absence of level 1 evidence, such a pragmatic approach appears safe, cost-effective, and offers good use of valuable resources.