bluuebunny/crossref_metadata_2025_split huggingface dataset:
EGS P29 Evaluating Compliance and Identifying Barriers to Timely Cholecystectomy in Gallstone Pancreatitis: A Retrospective Study
Authors: Salem Rola , Bush Alexander , Hale Emily , Poulton Theodore , Kostalas Marcos 
Published: November 2023

Abstract

Background
Gallstone pancreatitis is a common cause of acute pancreatitis. Timely cholecystectomy within two weeks of admission is recommended by the UK Pancreatitis Guidelines and NCEPOD to prevent recurrent pancreatitis and associated complications. This study aimed to evaluate compliance with these guidelines at a District General Hospital.

Methods
A retrospective analysis was conducted on all patients (n=92) admitted with acute pancreatitis between July 1st 2022, and January 31st 2023. Patient demographics, diagnostic methods, time to surgery, and relevant laboratory values (median amylase, median CRP) were collected and analysed.

Results
35% (n=32) of patients had gallstone pancreatitis. 26 were fit for cholecystectomy. 35% (n=9) were operated on within 2 weeks. Median time to surgery was 7 days and median CRP 133. There were no readmissions within 6 months. The delayed surgery cohort (n=17) had a median time to surgery of &gt;60 days, median CRP 29 and a 59% (n=10) readmission rate . 1 patient had three readmissions. Reasons for delay were: 2 pancreatic necrosis, 1 pregnancy, 1 pneumonia, 1 delirium, 2 bed pressure, and 10 no clinical reason. 5 patients are still waiting for surgery at the time of analysis &gt;6months.

Conclusions
Prior to the COVID-19 pandemic, compliance with UK pancreatitis and NCEPOD guideline was excellent (GIRFT) at our institution. Our findings are that most patients with gallstone pancreatitis are not being operated upon within two weeks. Delays result in hospital readmissions increasing resource use. Most delays were organisational rather than clinical. Patients who were ambulated for operative management within 2 weeks rarely were operated upon within this timeframe. Trust initiatives aimed at COVID-19 recovery prioritised early discharge and repurposed emergency ‘hot lists’ to reduce elective waiting lists. Interventions to increase emergency operating capacity are most likely to improve matters.
EGS P36 Scan every clinical appendicitis before operation. Can we prevent unnecessary operations in this era of CT?
Authors: Khawaja Zeeshan , Jamal Zohaib , Zafar Nowera , Adnan Naqqash 
Published: November 2023

Abstract

Background
Acute appendicitis is the most common abdominal surgical emergency in the world, with around 50,000 acute appendectomies performed annually in the UK. However, appendectomy has been associated with negative appendectomy rates (NARs) of 15%-39% in large series. On the other hand, CT scan is associated with radiations increasing the risk of cancer and considerable cost to the trust.

Methods
Notes of 25 patients admitted with suspicion of acute appendicitis were reviewed retrospectively by the auditors from their admission to the discharge from hospital and CT scan reports were evaluated.

Results
All of the patients seen by the surgical team had a CT scan to confirm the diagnosis of acute appendicitis before surgery. 15/25 patients had a diagnosis of acute appendicitis and all of the histology reports in these patients after the surgery confirmed the diagnosis. 10/25 patients had other diagnosis on CT despite clinical features suggestive of acute appendicitis. Colitis was the second most common cause of abdominal pain after acute appendicitis. 0% negative appendectomy rate was achieved when CT scan was done before the surgery.

Conclusions
This audit concludes that all the patients who present with the clinical suspicion of acute appendicitis should have a CT scan before the surgery to avoid the unnecessary operations however, an audit of 1 year or more would be more beneficial in formulating a clear picture and the development of guidelines.
EGS P41 The Acute Abdomen - An 'A to E' approach
Authors: Bonsi Theona , Alasmar Mohamed 
Published: November 2023

Abstract

Background
The acute abdomen is classified as a surgical emergency which requires prompt intervention or could otherwise result in mortality. A variety of surgical and medical conditions can cause the acute abdomen ranging from appendicitis to diabetic ketoacidosis. Due to the serious consequences of this condition, surgeons need to be efficient and systematic in their initial principle management. The Royal College of Surgeons, last provided a commissioning guide to Emergency General Surgery (acute abdominal pain) in 2014. These are the most up to date guidelines surgical trainees can refer back too.

Methods
We decided to create and advise an easy to follow ‘A to E’ method that trainees can follow.
A includes - A to E (airway, breathing, circulation, disability, exposure/examination), Analgesia, Antibiotics and Amylase
B focuses on blood tests
C discusses radiographic imaging (chest x-ray) and Computerised Tomography (CT) scanning.
D debates when it is appropriate to diagnose and discharge the patient
E discusses when to explore the surgical option

Conclusions
This review aims to provide a concise, memorable A to E approach whilst discussing specific aspects of diagnosis and management in the acute abdomen.
OGBN P01 Outcomes of Prophylactic Total Gastrectomy in Germline CDH1 Mutation Carriers
Authors: Jun Lim Hui , Roberts Geoffrey , Hardwick Richard H , Fitzgerald Rebecca C , di Pietro Massimiliano , O’Neill J Robert 
Published: November 2023

Abstract

Background
Hereditary diffuse gastric cancer (HDGC) is predominantly attributed to CDH1 [E-Cadherin] germline mutation and carries a cumulative lifetime risk of diffuse gastric cancer (DGC) of up to 70%. Definitive treatment remains prophylactic total gastrectomy (PTG) with an attendant risk of morbidity and reduced quality of life. Endoscopic surveillance following the Cambridge protocol is an alternative for selected patients, however, the impact on disease stage and long-term gastric cancer prognosis is not established. This study aims to evaluate clinical and histopathological outcomes following PTG in patients with germline CDH1 mutations with or without prior surveillance at a national HDGC referral centre.

Methods
Retrospective review was performed of clinicopathological outcomes for germline CDH1 mutation carriers who underwent PTG at Addenbrooke’s Hospital between January 2006 and May 2023. Indication for surgery of clinical stage 1 tumours was guided by patient preference, multiple visible lesions and increasing number of signet ring cell (SRC) foci. Endoscopic surveillance was offered to cases with no concerning endoscopic lesion and low number of SRC foci. Patients with confirmed DGC (≥stage 2) at diagnosis were excluded. Standard PTG procedure was open TG with D1 lymphadenectomy and preservation of posterior vagus with D2 lymphadenectomy and truncal vagotomy in selected cases.

Results
48 patients underwent open PTG with D1 (93.8%) or D2 (6.2%) lymphadenectomy. PTG was deferred in 18 patients (37.5%) with median of 3 pre-operative surveillance endoscopies over 22 months (5 to 61 months). Median post-operative length of stay was 7 days (6 to 12). Major morbidity was observed in 1 case (2.1%) with no post-operative mortalities. Final stage was pT1aN0M0 in 43 patients (89.6%) and pT0N0M0 in 5 patients (10.4%). No lymph node metastases were observed and complete gastric mucosal resection was achieved for all. The 5-year estimated overall and disease-specific survival were 100% with median follow-up of 7 years.

Conclusions
PTG remains a robust and effective treatment for patients with pathogenic germline CDH1 mutations who are appropriate surgical candidates. There was no increase in final stage following surveillance in a dedicated specialist service and this remains a safe alternative in selected cases. For patients choosing to proceed with PTG following comprehensive pre-operative counselling, this can be undertaken with low morbidity in a specialist centre. Further long-term data are needed to determine the impact of surgery and endoscopic surveillance on survival, functional outcomes and quality of life.
OGBN P02 Longer term symptom control following revision anti-reflux surgery: a cohort of 379 patients
Authors: Krishnan Sailakshmi , Falk Gregory 
Published: November 2023

Abstract

Background
Symptom recurrence after primary hiatus hernia surgery is an established problem and revision anti-reflux surgery may be indicated in select cases of recurrence after primary surgery. Previous studies on this subject are of small number and often lack objective measures. Our aim is to review the long term post operative outcomes and assess the impact of revisional anti reflux surgery on symptom improvement and quality of life measures.

Methods
A prospectively maintained single-surgeon database of revisional hiatus hernia surgery from 1992 to 2022 was retrospectively evaluated. The results of the pre operative assessments were collated to identify the symptomatic, anatomical and physiological indications. Validated scoring systems including GIQLI, Visick, Dakkak and Reflux Symptom Index scores were compared pre-operatively and post-operatively. Post-operative GIQLI scores were measured in the first 12 months (short term), 12 to 36 months (medium term) and after 36 months (long term) in order to obtain a trend in patient reported outcomes. Questions assessing heartburn, dysphagia, and regurgitation were analysed to determine progress of these specific symptoms.

Results
The dataset consisted of 379 patients, of whom 59% were female. The average age at the time of first revisional surgery was 59 years (range 19-91). Laparoscopic surgery was performed in 90% of primary operations compared to 68% of revision operations. There was overall improvement in outcomes as demonstrated in this table. Additionally, evaluation of symptoms specific questions of the GIQLI showed a statistically significant improvement in dysphagia scores in the long term category (p = 0.0210).

Conclusions
There is a global improvement in long term control of reflux and dysphagia symptoms following revision hiatus hernia surgery showed. However, volume regurgitation symptoms were not shown to be consistently improved post operatively. This may be due to an underlying motility disorder in these patients or the potential of dysmotility caused by revision surgery from injury to the vagus nerve. Caution should be exercised when considering revision anti reflux surgery in this patient cohort.
OGBN P05 Specialist Nurse-Led Reflux Clinic – Streamlining the pathway to specialist care for gastro-oesophageal reflux disease
Authors: Adwan Hussamuddin , Davis Heather , Aburrous Mohamed , Maitland Louise , Goldsmith Louise , Penhaligon Hannah , Clarke Michael 
Published: November 2023

Abstract

Background
Gastro-oesophageal reflux disease (GORD) is a common condition that can have a significant impact on patients’ quality of life and be associated with serious complications. Our institution offers daycase laparosopic anti-reflux surgery to patients with severe GORD or those refractory to medical management. However, the referral pathway is often prolonged, due to multiple investigations under gastroenterology or the long waiting list for outpatient appointments. A nurse-led reflux clinic (NLRC), with surgeon oversight, was therefore developed to facilitate earlier access to secondary care assessment and investigation, thus aiming to reduce the ultimate time to consultant surgeon decision making.

Methods
A standardised electronic ‘tick box’ proforma was developed for completion by the upper GI nurse specialists, incorporating common and atypical symptoms, Eckardt score, ‘red flag’ symptoms, weight, comorbidity, investigation results and free-text. Appropriate further investigations were selected and a clinic outcome was coded electronically to generate an electronic patient letter, thus requiring no secretarial support. Surgeon oversight was provided by the lead investigator and following completion of investigations (e.g. oesophageal physiology) patients were booked to the next available Consultant Upper GI surgeon clinic. Data on patient satisfaction was collated using a validated questionnaire and referral times also recorded.

Results
64-referrals to the NLRC between September 2021 and September 2022. Median waiting time to first appointment was 10 weeks (range 2.7 - 28.4) and 32 weeks to decision making (range 4.4 - 87.1). This was compared with 31-referrals prior to November 2020 with median waiting time to the first appointment of 7 weeks (range 0.3 - 124.7), and to decision making of 39 weeks (range 12.1 - 125.6). Completed satisfaction surveys showed more than 95% of patients were either “very satisfied” or “satisfied” with the overall care, explanation of tests, how they were treated, knowledge and skill of nurse and the timing of consultation.

Conclusions
Although there was no significant difference in the waiting time to the first appointment, NLRC helped reduce the overall waiting time to decision making. Introduction of a specialist nurse led-reflux clinic, with surgeon oversight, offers an effective solution for managing patients that may require anti-reflux surgery in a more timely manner, with good patient satisfaction.
OGBN P06 Co-location of pulmonary abnormalities on high resolution CT imaging and pulmonary microaspiration reflux scan: Suggests a causative relationship
Authors: Goonawardhana Dulani , Khoma Oleksandr , Van der Wall Hans , Burton Leticia , Falk Gregory 
Published: November 2023

Abstract

Background
The relationship between micro-aspiration of refluxate as a form of gastro-oesophageal reflux disease (GORD) and pulmonary diseases including bronchiectasis and lung fibrosis has been circumstantially suggested but not proven. Clarification of the role of GORD and microaspiration in pulmonary disease may enable targeted therapies. This study aims to determine whether there is a relationship between anatomical location of aspiration of radiological tracer on scintigraphic imaging and changes associated with pulmonary disease on high resolution computed tomographic imaging of the lung (HRCT-L).

Methods
Data were obtained from a prospectively populated database of patients with treatment resistant typical and atypical GORD and suspected reflux pulmonary microaspiration. Patients who underwent microaspiration studies and had concurrent HRCT-L for chest symptoms were included. Modified novel digital technique of reflux pulmonary microaspiration scintigraphy using a previously validated technique was performed to evaluate the possibility of significant GORD or extra-oesophageal symptoms, including typical symptoms such as heartburn and reflux and atypical symptoms such as throat symptoms, cough, globus, mucous, throat clearing, dysphonia and recurrent respiratory infections. HRCT-L was obtained in clinically indicated patients and compared with scintigraphic findings.

Results
Pulmonary reflux microaspiration scanning was performed in 121 patients (75% female, 25% male). The mean age was 67 years (range: 31 – 91 years). All patients demonstrated reflux microaspiration on scintigraphy in the supine delayed phase and all had intermittent or continuous full column gastro-oesophageal reflux. Lung parenchymal changes were apparent in 66 of 73 patients who underwent HRCT-L. Fibrotic changes were demonstrated in 51% of patients and bronchiectactic changes in 46%. Correlation at anatomical lobar levels with areas of aspiration of isotope on scintigraphic imaging was seen in 97% of fibrosis patients and 85% of bronchiectasis patients.

Conclusions
Modified reflux pulmonary microaspiration scintigraphy demonstrated the presence of pulmonary aspiration on delayed imaging. This is the first imaging technique with the ability to confirm the presence of lung aspiration of gastric content. Given the large proportion of cases showing lobar co-location of pulmonary abnormality on HRCT-L, this study indicates a strong relationship between aspiration of refluxate and parenchymal lung changes associated with pulmonary diseases such as IPF and bronchiectasis. There may be a significant role for modified technique scintigraphy to accurately diagnose the presence of reflux aspiration, allowing further research into pathogenesis and management of pulmonary disease.
OGBN P07 Is Emergency Cholecystectomy safe in the oldest old? A 10-year, single institution Retrospective study
Authors: Ahuja Manish , Soggiu Fiammetta , Goutham Meera , Drymousis Panagiotis , Pore Naresh , Jawad Zaynab , Abdalla Sala , Raje Durgesh , Sheth Hemant 
Published: November 2023

Abstract

Background
The incidence and severity of presentation of cholelithiasis or its complications increases with increasing age. Higher risks of morbidity, longer hospital stay, and mortality are the potential challenges to this emergency procedure in this cohort. There is little UK based data citing outcomes of emergency surgery in this group of population.
The aim of this study was to evaluate the safety of emergency cholecystectomy in patients aged 75 and above.

Methods
Data of consecutive patients aged 75+ undergoing an emergency laparoscopic cholecystectomy for acute cholecystitis at a London district general hospital between January 2013 and April 2023 was analysed. Outcomes of interest were time to procedure, length of hospital-stay, nature of complications and post-operative mortality.

Results
123 patients were included. Median age was 80 years (Range 75-93). Median time from presentation to surgery was 4 days (Range 1-45), overall length of stay was 10 days (Range 1-62), and post-procedure stay was 6 days (Range 1-62). Conversion rate was 5% (n=6), overall complication rate was 11% (n=14) and, 4% (n=5) Clavien-Dindo grade 3-4 complications were observed. Bile leak was observed in 2 patients needing ERCP and re-admission rates were 8% (n=10). One patient died within 90 days postoperatively for reasons unrelated to the surgery.

Conclusions
This study shows that an emergency laparoscopic cholecystectomy has acceptable complication and readmission rates, and it should be considered even in the elderly population. Biologic age rather than demographic age influences the perioperative risks and decision for surgery should be multidisciplinary with risks and benefits carefully weighed with the patient case by case.
OGBN P12 Use of Computed Tomographic Scan in Diagnosis and Management of Acute Pancreatitis; A Clinical Audit
Authors: Moti Terngu , Alwani Omneya , Baltatzis Minas , Alasmar Mohamed 
Published: November 2023

Abstract

Background
Acute pancreatitis is a frequently encountered emergency surgical condition, with computed tomography (CT) scans being commonly used for diagnosis and management. This audit was done in an NHS Hospital in Northwest, England with the aim to assess the utilization of CT scans in the diagnosis and management of acute pancreatitis in accordance with local policy.

Methods
Data were collected from all patients admitted with acute pancreatitis between October 2022 and March 2023. The focus of the investigation was on patients who underwent CT scans, with the objective of identifying the indications for their usage.

Results
The audit included a total of 53 patients (mean age 52.75 years, almost equal gender distribution). 64.2% had clinical pancreatitis (typical symptoms and diagnostic amylase levels), while 35.8% did not. 42 patients (79.2%) underwent CT scans. Of these scans, 42.9% were performed in patients without diagnostic amylase levels, 14.3% to rule out complications after 3 days, 9.5% due to a history of pancreatic complications, 1 was based on strong suspicion of another pathology, and another for diagnosing a common bile duct stone in a patient with an MRI incompatible pacemaker. Furthermore, 12 (28.5%) of the scans done were considered unnecessary.

Conclusions
The findings indicate that approximately 8 out of 10 patients with acute pancreatitis underwent at least one CT scan during their hospitalization. However, a significant proportion (28.5%) of these scans were deemed unnecessary.
OGBN P17 Day-Case Fundoplications: a Coastal DGH’s Transition
Authors: Hale Emily , Lowe Rosemary , Platt Timothy 
Published: November 2023

Abstract

Background
Torbay Hospital has a well-established day surgery unit, treating over 9,000 patients a year. Day-case laparoscopic fundoplications (LF) are increasingly common, and equally safe in comparison to inpatient procedures. The purpose of this study was to analyse the difference between day-case and inpatients, to determine reasons for stay, and subsequently facilitate more day-cases in Torbay Hospital.

Methods
This is a retrospective study using electronic records to analyse admission, surgery and 30-days recovery. Patients were identified between 1st January 2020 and 1st April 2023 by searching the following OPCS 4.10 codes in operation notes: G231 – G234, G241 - G243 & G245 (hiatus/oesophageal/diaphragmatic hernia repair). This identified 96 procedures, 1 of which was immediately excluded as incorrectly identified. Parameters examined were as follows: indication for surgery, elective or emergency, length of stay post operatively, reason for stay, plan for daycase or inpatient stay, readmission within 30 days and reason, and hiatus hernia grade.

Results
19 of 95 procedures were day-cases: 5% of cases in 2020, 2021 22%, 2022 19% and 83% so far in 2023. All day-cases were elective, whilst 9% of inpatients were emergency. Indications for day-cases were reflux (79%), atypical symptoms (16%) and stricture (5%). Inpatient indications were: reflux (39%), gastric volvulus (23%), hiatus hernia (12%), atypical (7%) and other (19%). Average Hill Classification of hiatus hernia was type-I in day-case and type-III in inpatients. 4 (21.1%) of day-case patients were readmitted (30 days), 13 (17.3%) of inpatients. The difference was 3.8% (95%CI -12.72 to 24.12), SE for percentage difference 9.2, p0.69.

Conclusions
The majority of LF at Torbay Hospital have been inpatient, although day-cases are increasing. Successful day-cases were always elective, of less severe hiatus hernias, and more commonly for symptomatic reflux as opposed to other pathology. There is no significant difference in the rates of readmission between the two groups. These indicate a pattern to identify future day-case LF and improve our service.