bluuebunny/crossref_metadata_2025_split huggingface dataset:
HPB P36 Good Medical Practice: Patient's right to the information - An audit of the patient's understanding and satisfaction with the information provided to the patients with acute pancreatitis
Authors: Khawaja Zeeshan , Jamal Zohaib , Zafar Nowera , Adnan Naqqash 
Published: November 2023

Abstract

Background
Acute pancreatitis is one of the important and common causes of abdominal pain presenting to the emergency surgical take. The incidence of pancreatitis in the UK is approximately 56 cases per 100,000 people per year. Due to variation in the causes, disease course, investigations and treatment, it may be confusing for the patient to fully understand all the information. NICE guidelines and good medical practice recommends ‘to give people with pancreatitis, and their family members or carers (as appropriate), written and verbal information in a way they can understand’.

Methods
The aim of this audit was to find out if adequate information as per the NICE guidelines was being provided to the patients and their family members, and to assess patients’ satisfaction in terms of the provided information. 30 patients who were admitted in the department of general surgery with acute pancreatitis were provided with a questionnaire containing 10 questions asking about the information provided to them about their condition by the healthcare professionals. At the end of the first cycle an intervention in the form of following leaflet was introduced and a re-audit was done:

Results
Overall, 60% of the patients were not satisfied with the information provided. None of the patients was provided written information and more than 90% were not explained condition with the help of a diagram. The other areas where the patients were not provided information were: investigations done (40%), treatment (60%), provision of verbal information (26%) and alcohol as the potential causes of the condition (27%). A re-audit was done the results of which are compared with the first cycle below:

Conclusions
This audit emphasized the need of a proper explanation of acute pancreatitis to the patients and their family members. It was also found that no leaflets were available for the patients. Results were shared in the surgical team group and a leaflet has been designed and distributed to every patient with acute pancreatitis.
Second Cycle: After the introduction of the leaflet, improvement has been seen in almost all the areas of the information provided to the patients. Overall, satisfaction has improved from 60% to 92% in the patients admitted with acute pancreatitis.
HPB P38 A Novel Ambulatory Pathway in the Management of Acute Pancreatitis
Authors: Fox Benjamin , Walters Mary , Peckham-Cooper Adam , Blencowe Natalie , Pathak Samir 
Published: November 2023

Abstract

Background
The incidence of acute pancreatitis has doubled over the last two decades, accounting for approximately 20,000 UK inpatient admissions yearly1. The Atlanta Classification defines three severity grades, with over 90% of patients “mild” or “moderate” severity2,3. Validated risk-stratification tools including the Harmless Acute Pancreatitis Score(HAPS), supported by NEWS score, and biomarkers including CRP, predicts up to 97% of patients who will run a “mild” disease course; and are therefore suitable for ambulatory care4. Currently, however, these ambulatory pathways don’t exist. The main aim of the study was to develop a safe ambulatory pancreatitis pathway to reduce hospital admissions.

Methods
The study consists of four phases. Phase 1 involved development of an evidence-based, safe ambulatory pathway, based on HAPS and augmented with clinical/biochemical predictors of severe disease, complications, or mortality (See Figure 1). Phase 2 involved a 4-week retrospective analysis of all patients presenting with acute pancreatitis using the evidence-based pathway described above. Subsequent Atlanta classification, as well as documentation of complications/requirement for escalated care confirmed suitability for ambulatory care. Phase 3 is currently underway and involves piloting the pathway, and Phase 4 will consist of refining the pathway based on clinical, economic outcome measures and stakeholder views.

Results
Phase 1: Following literature review, use of HAPS, a CRP&gt;100, neutrophils&gt;15x109/l and NEWS of 2 or more, were identified as the most reliable severity scoring tools in acute pancreatitis. NEWS of 2 or more is an independent predictor of increased complications and resultant mortality. CRP and neutrophilia both have 90% sensitivity in predicting a severe disease course.
Phase 2: 27 confirmed cases of acute pancreatitis were identified. Of these, five (alcohol-related in 3 and gallstone-related in 2) met the criteria for ambulatory care. Mean hospital stay was 6 days: no patients died, and none required escalation from ward-based care.

Conclusions
This retrospective analysis has shown that almost a fifth of patients with acute pancreatitis, admitted on the acute on-call take, could be managed in an ambulatory fashion as per currently established severity scoring criteria. Development of the ambulatory acute pancreatitis protocol required an integrated approach from key stakeholders including the emergency general and pancreatic surgical teams and ambulatory care staff. Further prospective analyses of the pathway will be required to identify its patient-reported satisfaction and economic benefits.
HPB P39 Pre-operative Cardiopulmonary Exercise test as a Predictive tool for post pancreaticoduodenectomy intra-abdominal collection development. A Retrospective study
Authors: Hassan Ahmed , Taggarsi Meghana , Chong Thomas , Sultana Asmaa 
Published: November 2023

Abstract

Background
Cardiopulmonary Exercise Test (CPET) provides a non-invasive assessment tool for physiological fitness and peri-operative mortality in major abdominal surgery including Pancreaticoduodenectomy (PD). Post-operative complications including intra-abdominal collection could potentially delay adjuvant chemotherapy following PD. There is minimal evidence in the literature to link CPET derived variables to post PD complications. The aim of this study is to evaluate the role of CPET in predicting post operative intra-abdominal collection.

Methods
A retrospective single centre analysis of a prospectively maintained database from 2016 to 2021 for all patients who had PD was performed. Patient demographics, co-morbidities, and CPET variables were collected. Post-operative adverse events including Clavien-Dindo (CD) grade III intraabdominal collection, length of hospital stay and Readmission within 1 year were looked at. P value ≤ 0.05 was considered statistically significant.

Results
143 patients had PD during the study period. CPET was performed in 30 patients (21%). The patients’ age was 67 ±9 (Mean±SD). Forty patients (28.2%) had developed Intra-abdominal collection CDIII. In the CPET subgroup, Anaerobic Threshold (AT) ≤ 14 on CPET was a risk factor to develop intra-abdominal collection CDIII in univariate analysis (60% Vs 9%, Chi2, p 0.02) and multivariate analysis (HR 3.5, 95% CI 1.6-657, p 0.02). Another significant risk factor was a post-operative pancreatic leak (POPF) (40% Vs 22%, Chi2, p 0.04).

Conclusions
Patients who have Anaerobic Threshold ≤ 14 on CPET, are more likely to develop intra-abdominal collection requiring drainage after Pancreaticoduodenectomy. This group of patients will be less likely to start chemotherapy early.
HPB P40 Laparoscopic spleen-preserving distal pancreatectomy versus laparoscopic distal pancreatectomy with splenectomy: A systematic review and meta-analysis
Authors: Ghassemi Nader , Hajibandeh Shahin , Hajibandeh Shahab , Romman Saleh , Laing Richard , Bhatt Anand , Athwal Tejinderjit , Durkin Damien 
Published: November 2023

Abstract

Background
To compare outcomes of interrupted (IS) and continuous (CS) suturing techniques for Roux-en-Y hepaticojejunostomy and duct-to-duct choledochocholedochostomy.

Methods
A systematic search of electronic databases and bibliographic reference lists were conducted. All comparative studies reporting outcomes of IS and CS in hepaticojejunostomy and choledochocholedochostomy were included and their risk of bias were assessed using ROBINS-I tool. Overall biliary complications, bile leak, biliary stricture, cholangitis, liver abscess, and anastomosis time were the evaluated outcome parameters.

Results
Ten comparative studies (2 prospective and 8 retrospective) were included which reported 1617 patients of whom 1186 patients underwent Roux-en-Y hepaticojejunostomy (IS:789, CS:397) and the remaining 431 patients underwent duct-to-duct choledochocholedochostomy (IS:168, CS:263). Although use of IS for hepaticojejunostomy was associated with significantly longer anastomosis time (MD:14.15 minutes, p=0.0002) compared to CS, there was no significant difference in overall biliary complications (OR:1.34, p=0.11), bile leak (OR:1.64, p=0.14), biliary stricture (OR:0.84, p=0.65), cholangitis (OR:1.54, p=0.35), or liver abscess (OR:0.58, p=0.40) between two groups. Similarly, use of IS for choledochocholedochostomy was associated with no significant difference in all categories compared to CS.

Conclusions
Interrupted and continuous suturing techniques for Roux-en-Y hepaticojejunostomy or duct-to-duct choledochocholedochostomy seem to have comparable clinical outcomes. The available evidence may be subject to confounding by indication with respect to diameter of bile duct. Future high-quality research is encouraged to report the outcomes with respect to duct diameter and suture material.
HPB P45 Assessment of quality of documentation for Laparoscopic cholecystectomy: a quality improvement project
Authors: Saeed Aziz Sarmad , Ibrahim Shalaby Amr , Mohamed Mohamed Saleem Noor , Khan Sumbel , Darrien Jennifer 
Published: November 2023

Abstract

Background
Laparoscopic cholecystectomy is one of the most common procedures carried out in a General Surgery unit both in emergency and elective theatres. Getting It Right First Time (GIRFT) and the Royal College of Surgeons England (RCS) have made best practice recommendations to ensure adequate documentation of laparoscopic cholecystectomy operation details for good clinical communication with colleagues and to aid in the review of operations after a patient complaint. This is a Quality Improvement Project (QIP) in a NHS Trust in West Midlands to assess the quality of documentation in view of the recommendations made by GRIFT and RCS.

Methods
Documentation including operative note, clinical noting, ward round entries, laboratory results, imaging records and clinical letters were reviewed for 100 consecutive laparoscopic cholecystectomies carried out during the month of May 2023 and assessed against a checklist based on recommendations made by GIRFT and RCS. Following the audit, a multifaceted intervention is planned, including teaching presentations and an electronic documentation template. A re-audit following interventions will be carried out in July, 2023.

Results
There was mixed compliance with GIRFT recommendations. Some recommendations, including indication for surgery, consent, WHO checklist, and surgeon details were followed in all cases. Documentation shortcomings included missing details on technique for pneumoperitoneum with 19% of operation notes failing to mention this detail ,intraoperative drug administration (54%), intraabdominal pressure levels (95%), Number of clips applied (66%), gall bladder retrieval method and port used for the purpose (38%), confirmation of port removal under vision (32%), hemostasis achievement (12%), fascia closure (26%), critical view of safety/safe view assessment (49%), anesthetist names (62%), and first surgeon's signature (41%).

Conclusions
We found significant shortcomings in documentation of patients undergoing laparoscopic cholecystectomy. This documentation needs improvement and standardization so that it meets the GIRFT and RCS Guidelines.
HPB P47 Torsion of a wandering gallbladder
Authors: Marchese Salvatore , Samra Benjamin , Bond-Smith Giles 
Published: November 2023

Abstract

Background
Gallbladder torsion is an uncommon cause of acute abdomen. Despite over 500 reports published since 1898, only 10 cases of wandering gallbladder have been reported.
In this anatomical variant (4-5% of the population) the gallbladder has no attachments to the liver. It is suspended only by the cystic duct and artery, which predisposes to twisting of the pedicle. Subsequent gallbladder necrosis can lead to rupture, peritonitis, sepsis and death (6%).
Patients are typically elderly females, above the age of 70. A palpable gallbladder is described in 54% of cases. We report a rare case of wandering gallbladder leading to torsion.

Methods
An 89-year-old lady presented to emergency department with abdominal pain associated with vomiting and bowel not opened for five days. A palpable mass was evident on the right lower side of her small abdomen.
Vital signs and lactate level were within normal range. Despite CRP was only moderately elevated on admission, it suddenly climbed to 504 within 24 hours.
An abdominal CT scan showed a distended thick-walled gallbladder with a large stone, reported as “consistent with chronic calculous cholecystitis”.

Results
The patient was urgently brought to theatre for a laparoscopy where a free-floating gallbladder was found at the right lower quadrant, distended and gangrenous, rotated around its vascular axis.
The surgery was converted to open due to lack of sufficient intra-abdominal space to accomplish the procedure. Her gallbladder was in the end successfully removed with no further concern and a washout of the peritoneal cavity was performed.
The subhepatic drain was removed on day 1 postoperative. She recovered uneventfully and was discharged 12 days later due to social issues.

Conclusions
Despite rarely encountered, gallbladder torsion should be considered in the differential of patients presenting with acute abdomen, especially in case of rapid deterioration.
Symptoms are nonspecific, as well as radiographic signs. A preoperative diagnosis is rarely made. If delayed, the condition may potentially become life-threatening.
Surgical exploration is thus warranted and, once recognized, cholecystectomy remains the only resolutive treatment.
HPB P48 Liver Abscess Secondary to Cocktail Stick Migration Following Accidental Ingestion
Authors: Attard Joseph , Das Debashish , Mullineux Joseph , Bhardwaj Neil 
Published: November 2023

Abstract

Background
Liver abscess formation following foreign body ingestion is rare. This may occur if the foreign body is lodged in the upper gastrointestinal tract and persists. Initial management consists of antibiotics with or without percutaneous abscess drainage. However, referral to the regional HPB unit may need to be considered to discuss foreign body retrieval, especially if it is located within the liver parenchyma itself, in order to treat persistent sepsis or prevent abscess recurrence in the future.

Methods
A 38-year-old gentleman, previously healthy, presented to the emergency department of a district general hospital with nausea, upper abdominal pain, and fever. He stated that he had accidentally ingested a piece of a wooden cocktail stick while eating some weeks back. Leucocytosis and raised inflammatory markers were present on bloodwork. Computed tomography revealed a 6 cm hypoattenuating lesion in the left lobe of the liver, which demonstrated features of a hepatic abscess on magnetic resonance imaging. Abdominal ultrasound visualised a 4 cm linear hyperechoic structure within the hypoechoic lesion, raising the suspicion of foreign body retention with abscess formation.

Results
The fever subsided, and symptoms resolved with antibiotics. Follow-up imaging revealed abscess resolution with foreign body persistence in the liver. He was referred to the regional HPB unit and underwent laparoscopy for foreign body removal. A fistulous communication between liver segment II and lesser curvature of the stomach was seen and disconnected using diathermy. Minimal pus was drained and the foreign body retrieved. The gastric perforation was sealed using a linear stapling device. A nasogastric tube was left in the stomach until the patient tolerated a liquid diet and discharged on the first post-operative day. He remains well on follow-up.

Conclusions
This case highlights that scrupulous history taking and imaging review are required for a timely diagnosis of foreign body retention.
HPB P49 Implementation of a standardised operation note template using the Getting It Right First Time (GIRFT) and Royal College of Surgeons of England (RCS) best practice guidance to improve the quality of laparoscopic cholecystectomy documentation
Authors: Goulder Lewis , Daniels Sarah 
Published: November 2023

Abstract

Background
Getting it right first time (GIRFT) in partnership with the Royal College of Surgeons of England (RCS) have published advice on aspects of surgery which should be documented in the laparoscopic cholecystectomy (LC) operation record. This is following calls to enhance the accuracy and value of operative records coupled with a lack of existing recommended minimal standards. Operation notes are fundamental for communication of patient care and in the review of operations following adverse events or patient complaints.

Methods
We reviewed 20 operation notes to assess adherence to the guidance. Some aspects of the guidance were omitted if expected to be documented elsewhere in the patient records, 28 of 32 points were reviewed. An operation note template was created and implemented then a further 20 operation notes were reviewed.

Results
Initially, the mean completeness of guidance items was 39%. 6 of the 20 operation notes documented that the ports were inserted under direct vision; 8 documented that a critical view of safety was achieved; 13 documented the spillage/non spillage of bile or stones; 16 documented removal of ports under direct vision and none included all aspects of the post-operative plan. Following implementation of the template, compliance improved across all items.

Conclusions
There is scope to improve the documentation of LC, particularly in areas linked to common intraoperative and postoperative complications. Implementation of a standardised operation note template is an effective way of improving the documentation of laparoscopic cholecystectomy.
HPB P53 Readmission rate after laparoscopic cholecystectomy in a tertiary HPB Unit
Authors: Scoffield Julie , Dorrian Emmet , Kirk Gareth 
Published: November 2023

Abstract

Background
Laparoscopic cholecystectomy comprises a large portion of benign biliary surgery, and is increasingly performed safely as a daycase. The aim of our study was to determine the rate of unplanned readmission to hospital or unscheduled contact with medical services following discharge after laparoscopic cholecystectomy, along with the reasons for seeking medical advice.

Methods
Patients were identified retrospectively from our HPB Unit's operative database. All patients were included (daycases and inpatients) who underwent laparoscopic cholecystectomy in our unit in the calendar year 2019. Patients were excluded if they also had a CBD Exploration, or if their operation was converted to an open procedure. All patients' records were reviewed in detail on the Northern Ireland Electronic Care Record to capture readmissions, A&E attendances and contact with Out of Hours GP service within 30 days of discharge from hospital following operation.

Results
273 patients were admitted for planned cholecystectomy under 7 Consultant Surgeons. 257 had their operation completed laparoscopically (5.86% conversion rate). The overall daycase rate was 66%. 39 patients (15%) sought unplanned medical advice within 30 days of discharge. 15 patients (5.8%) contacted Out of Hours. A further 9 patients (3.5%) went to A&E. Most of these had pain or wound problems. There were 15 (5.8%) readmissions to hospital: 3 within 48 hours; with abdominal wall haematoma, constipation and pneumonia. The remainder (day 4-29) had mostly pain, vomiting or umbilical wound infection. Median length of stay was 3 days.

Conclusions
Our early readmission rate was low and in line with local guidance of &lt;10%. Most patients seeking unplanned advice had pain or wound problems. Further work looking at counselling patients regarding postoperative pain and wound care may reduce the total readmission rate and unscheduled contact after discharge. Readmission was not dependent on the age or size of the patient, or on whether the operation was carried out as a daycase or inpatient.
HPB P55 An audit of the quality standards for Laparoscopic Cholecystectomy. Compliance with the AUGIS standards (AUGIS: Association of Upper Gastrointestinal Surgery of Great Britain and Ireland)
Authors: Khawaja Zeeshan 
Published: November 2023

Abstract

Background
Laparoscopic cholecystectomy, which is a minimally invasive operation, is one of the most common surgical procedures in the UK and worldwide. Indications for LC include acute or chronic cholecystitis, symptomatic cholelithiasis, biliary dyskinesia, acalculous cholecystitis, gallstone pancreatitis, and gallbladder masses or polyps. The purpose of this audit was to assess and compare the outcomes after LC with the standards published by the association of upper GI surgeons (AUGIS) and to formulate measures to improve services at Royal Albert Edward Infirmary.

Methods
A data of 56 patients who underwent cholecystectomy was analysed retrospectively by two different auditors. All patients who underwent both open and laparoscopic cholecystectomies were included in this study.

Results
Our results showed that the majority of the patients (40/56) were females. Only 3 patients had open cholecystectomy while the rest of the 53 patients had LC. 67% (38/56) were done as a day case and discharged home the same day after surgery. None of the patients had an emergency and thus timely management of the disease in terms of surgery within the first 7 days of presentation. 7/56 patients were readmitted with different complications. No bile duct injuries were recorded.

Conclusions
Our hospital was found out to be compliant with only ⅙ criteria assessed. This study concludes that there is a need to improve outcomes in all domains especially the easily reversible factors such as day case rates and readmission due to complications.