bluuebunny/crossref_metadata_2025_split huggingface dataset:
EGS P01 Embracing a Paradigm Shift: A Single-Centre Experience with the Chole-QuiC Process
Authors: Bird Jonty , Hamid Mohammed , Sellahewa Chaminda 
Published: November 2023

Abstract

Background
Substantial evidence exists for the superiority ofemergency over delayed cholecystectomy for gallstone disease during primary admission. Despite this, emergency surgery rates in the United Kingdom remain low compared to other developed countries; with great variation in care across the nation. We aimed to describe the local paradigm shift towards emergency surgery and investigate outcomes.

Methods
A prospective observational study examining patients enrolled onto an emergency cholecystectomy pathway, following the hospital’s subscription to the Royal College of Surgeons of England’s Cholecystectomy Quality Improvement Collaborative (Chole-QuIC), between December 2021 and January 2023. Multivariate logistical regression models were used to identify patient and hospital factors associated with post-operative outcomes.

Results
261/307 (85%) of all suitable acute admissions had an emergency cholecystectomy, compared to 5% the preceding four years. Waiting time dropped from 67 to 5 days. 208 (79.7%) patients were primary presentations. 92 (35.2%) were classed Tokyo grade 2 and 142 (54.4%) were obese. 23 (8.8%) patients underwent a preoperative ERCP and 26 (10%) of patients had a subtotal cholecystectomy. Favourable outcomes (Clavien Dindo ≥3) were observed in first presentations (OR 0.35p=0.042) and operation times within 7 days (OR 0.32 p=0.037); with worse outcomes in BMI ≥35 (OR 3.32 p=0.005) and operation time &gt;7 days (OR 3.11 p=0.037).

Conclusions
A paradigm shift towards emergency cholecystectomy benefits both the patient and the service. Positive outcomes are apparent for early operation in patients presenting for the first time and recurrent attendees, with early operation (&lt;7 days) providing the most favourable outcome in a select patient group.
EGS P04 Recent ten year experience of Boerhaave’s Syndrome Management in a tertiary Oesophago-gastric Surgery Centre
Authors: Ramdin Ashling , Doran Sophie L F , Qureshi Yassar A , Mohammadi Borzoueh , Dawas Khaled 
Published: November 2023

Abstract

Background
Oesophageal Perforation (OP) is a low incidence, high complexity gastrointestinal surgical emergency with associated high mortality rates. A consequence of UK centralisation of oesophago-gastric (OG) cancer surgery is passive centralisation of OG surgical emergencies leading to reduced mortality for OP and lower threshold for surgical intervention by high volume OG cancer surgeons. Boerhaave's Syndrome characterised by Mackler’s Triad (vomiting, thoracic pain and subcutaneous emphysema) represents 30% of OP. UCLH has an OG surgery catchment population of 3 million. We present our experience of managing Boerhaave’s syndrome as an OG cancer centre with a dedicated OG Consultant on-call rota.

Methods
A retrospective review of electronic health records of all adult patients with a radiological diagnosis of OP over a 10 year period from 01/01/2013 to 31/12/2022) at our institution was performed. The inclusion criteria were adult patients with a clinical and radiological diagnosis of Boerhaave’s syndrome. Those with OP due to malignancy, endoscopic, or foreign body perforation were excluded from further analysis. The primary outcome measure was 90-day mortality and the secondary outcome measures were length of stay and reintervention rate.

Results
41 patients with Boerhaave’s syndrome were identified (31 male, 10 female) with median age of 62 (46 - 71). 17 (41.5%) patients presented directly to our institution and 24 (58.5%) were transferred from other hospitals. Primary intervention was surgical in 31 (75.6%), endoscopic in 3 (7.3%) and conservative in 7 (17.1%) patients respectively. Overall 90-day mortality was 12.2% but 6.5% in the surgically managed group. Median length of stay was 58 days (22 - 70). 9 patients had reintervention – 7 (17.1%) had a thoracotomy/thoracoscopic surgery for intrathoracic collections and 2 patients (9.8%) had endoscopic intervention.

Conclusions
This is a report of the experience of managing Boerhaave’s syndrome in a high volume tertiary OG centre. A favourable 90-day mortality rate of 12.2% compares to 38.8% described in a previous UK cohort is likely a result of management in a tertiary centre with appropriate multidisciplinary infrastructure to manage complex patients and provide a consistently high level of perioperative care. The lower mortality rate (6.5%) in the operatively managed group is likely due to patient selection and surgical techniques honed from familiarity with complex cancer and benign oesophageal surgery and working as part of an effective multidisciplinary team.
EGS P05 Evaluating the predictive value of NSQIP surgical risk calculator in patients undergoing emergency laparoscopic cholecystectomy at a single UK centre
Authors: Chen Runzhi , Hussain Nadiya , Goutham Meera , Soggiu Fiammetta , Sheth Hemant 
Published: November 2023

Abstract

Background
Machine learning algorithms for surgical risk predictions have been utilised as an informed consent tool for surgeons and patients. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) is a surgical risk calculator utilising machine learning to predict adverse postoperative outcomes with surgeon adjustment of risk. However, there is a paucity of validation studies for laparoscopic cholecystectomy data. This study aimed to evaluate the predictive value of the NSQIP calculator in patients undergoing emergency laparoscopic cholecystectomy at a single UK-based centre.

Methods
Preoperative patient characteristics and postoperative outcome data was collected from patients who underwent emergency laparoscopic cholecystectomy between January 2022 and January 2023. NSQIP surgical risk scores were retrospectively calculated using preoperative characteristics and risk factor data. Surgeon adjustment of risk was set at the default for all patients. The predicted rates of postoperative complications, serious complications (definition as per the NSQIP calculator), and hospital readmission were compared to the observed rates using Brier scores.

Results
Eighty-five patients were analysed. The median age was 50 (range 19-91) and BMI was 29 (range 21-44). The NSQIP predicted an overall complication rate of 4.2%. Overall observed complication rate was 3.7% and included hospital-acquired pneumonia (n=1), pancreatitis (n=1), and postoperative atrial fibrillation (n=1). The predicted and observed complication rates were comparable (4.2% vs 3.7% respectively, Brier score 0.066). Likewise, the observed rate was also lower than predicted rate for serious complications (2.4% vs. 3.4% respectively, Brier score 0.047). The observed rate of hospital readmission was similar to predicted risk (3.7% vs. 4.0% respectively, Brier score 0.033).

Conclusions
In this cohort, the NSQIP surgical risk calculator demonstrated acceptable predictive ability for the risk of postoperative complications after emergency laparoscopic cholecystectomy. There was a propensity of the NSQIP calculator to overestimate the risk of complications, within the limitations of the small sample size and retrospective nature of this study. Further studies are warranted to assess the ability of the NSQIP tool to predict the risk of surgery-specific complications.
EGS P06 Pattern of oesophago-gastric injuries and its outcome in major trauma and tertiary UGI centre
Authors: Ahmed Salman , Turner Paul , Ward Jeremy , Khan Rehan , Pursnani Kish , Shetty Vinutha 
Published: November 2023

Abstract

Background
Oesophago-gastric injuries in major trauma are relatively rare. These injuries are known to be associated with high morbidity and mortality. Major trauma involving oesophagus and stomach are linked with high velocity, high impact blunt or penetrating force. There is also a strong association between oesophago-gastric injuries and other systemic injuries including thoracic, major vessels, skull, brain and abdominal viscerae. In this study we aimed to evaluate the pattern of injury in oesophageal and gastric major trauma its association with widely used injury severity score (ISS), multi organ system involvement, survival and factors affecting mortality.

Methods
Patients presenting between January 2012 and December 2022 as major trauma as moderate / severe trauma (ISS &gt; 9) with oesophageal and gastric injuries were included in this study. Retrospective analysis was carried out on prospectively maintained trauma data base in an urban major trauma centre with specialist tertiary upper GI cover. Mechanism of injury, ISS and mortality were calculated. Analysis was carried out on variables to identify factors contributing to overall index admission mortality. MedCalc ® was used to perform statistical analysis.

Results
A total of 8984 patients presented in urban major trauma centre with moderate to severe trauma (ISS &gt;9). Among them 13 had gastric injuries and 3 had oesophageal injuries (total n=16). Mechanism of injury in gastric patients was blunt force in 8 (61.5%) and penetrating force was in 5 (38.5%) patients whereas all oesophageal injuries were linked with penetrating trauma. Median ISS in gastric injuries was 17 and in oesophageal injuries was 34. Overall mortality was 31.2%(n=5). Variables including high ISS, thoracic injury, diaphragmatic rupture, skull injuries & blood transfusion were linked with mortality on multivariate logistic regression.

Conclusions
Our study finds an association of oesophago-gastric injuries with high impact penetrating and blunt trauma. Presence of oesophageal and gastric injuries are surrogate indicators of severity of trauma, it is not only associated with high ISS but also has relatively high mortality. Therefore, early involvement of specialist senior decision maker in time critical setting is recommended. Due to scarce volume of OG trauma, national UGI trauma collaborative can be helpful to share experience, learn lessons and promote research.
EGS P07 Upper GI Injury trends, rates, and mortality in major trauma centre
Authors: Ahmed Salman , Shetty Vinutha , Date Ravi , Ward Jeremy , Pirsnani Kish , Turner Paul 
Published: November 2023

Abstract

Background
Trauma is one of the leading causes of death in UK. Moderate and severe trauma presents with multi-organ / multi cavity involvement. Robust resuscitation, methodical approach, prompt diagnosis and early surgical intervention have an impact on mortality. Injury severity score (ISS) is widely used across trauma centres to estimate severity. It is found to be linked with mortality and outcome. An ISS of 9-15 classes as moderate and an ISS of &gt; 15 is considered severe trauma. In this study we aimed to evaluate the mortality associated with upper GI injuries I.e., oesophagus, stomach, duodenum, liver, pancreas, spleen and diaphragm.

Methods
Retrospective analysis was carried out on prospectively maintained trauma data base in an urban major trauma centre (MTC) with tertiary upper GI surgical cover. All patients presenting with moderate or severe trauma based on ISS between 1st of January 2012 to 31st of Dec 2022 were included in this study. Proportion of upper GI injuries in reference to overall major trauma cases were analysed. All cause index-admission mortality associated with upper GI injuries was calculated.

Results
A total of 8984 patients presented in this centre with moderate - severe trauma (ISS&gt;9) during study period. Overall mortality was found to be 8.6% (n=780). Liver injuries were seen in 228 (2.5%), splenic injuries in 226 (2.5%), diaphragmatic rupture in 26 (0.29%), oesophago-gastric (OG) trauma in 16 (0.2%) and duodenum and pancreatic injuries in 15 (0.17%) patients. Highest mortality was found in OG trauma with 31.2%, followed by diaphragmatic injures with 19%, liver injuries with 12.7%, splenic injuries with 9.3%. Upper GI injuries are associated with high median ISS of 28.5 and present as polytrauma spectrum.

Conclusions
Although oesophago-gastric injuries are rare but, have relatively high mortality. Early aggressive resuscitation, involvement of oesophago-gastric or HPB surgeons, and multidisciplinary approach is required to deal with such complex injuries to get the best outcome. Robust national collaborative mechanisms across MTCs should be encouraged to share experiences, learn lessons and promote research.
EGS P14 Improving Management of Obstructive Jaundice: A Single-Centre Experience
Authors: Chan Calvin , Jamson Alexander Harry , Cheng Timothy , Patwardhan Maneesha , Brewer James , Galloway Daniel , Collins Carole , Smith Jason , Kamocka Anna 
Published: November 2023

Abstract

Background
Timely management is essential in preventing recurrence of gallstone disease and The National Institute for Clinical Excellence (NICE) recommends that laparoscopic cholecystectomy (LC) should be performed within seven days of admission. However, there remains wide variation between NHS Trusts in managing gallstone disease. As part of an ongoing surgical quality improvement project, a restructured Upper Gastrointestinal Surgery (UGI) firm was created (with three dedicated UGI consultant surgeons, one specialist registrar, one foundation doctor), in close collaboration with interventional gastroenterologists and radiologists. The impact of this new service on gallstone disease management has been closely monitored.

Methods
A prospective database was maintained including patients presenting emergently with obstructive jaundice and/or common bile duct stones at our district general hospital (DGH) in the 6-month timeframe before (September 2021 to February 2022) and after (September 2022 to February 2023) implementation of the new UGI service. Outcomes included time from presentation to magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP) and LC.

Results
26 and 38 patients with obstructive jaundice were admitted in the 6-month periods before and after UGI firm implementation, respectively. There were significant reductions in time from admission to receiving ERCP (6.6 days versus 40.2 days, p&lt;.001), and outpatient LC (61.8 days versus 194 days, p=.02). There was also marked improvement in obtaining MRCP (2.5 days versus 5.2 days). After UGI firm implementation, 35% of eligible patients were offered an inpatient LC which were all performed within seven days (mean 6.3 days), versus none previously.

Conclusions
A dedicated UGI service significantly improved the treatment process for patients presenting with obstructive jaundice at our DGH. As part of ongoing quality improvement work, solutions such as introducing a ‘golden patient’ to the NCEPOD list, a ‘hot slot’ on the elective gallbladder list or a dedicated weekly ‘hot’ gallbladder list are currently being investigated. Equipment for laparoscopic transcystic common bile duct exploration is also being considered to alleviate the need for ERCP prior to surgery.
EGS P15 Perforated Stomach within an Inguinal Hernia: A Rare Case Report and Surgical Management
Authors: Shalaby Samar , Marinos Spyros , Gammeri Emanuele 
Published: November 2023

Abstract

Background
Inguinal hernias are a common surgical condition requiring urgent medical attention. While complications of inguinal hernias are frequently encountered, the presence of a stomach herniation within this anatomical site is an exceptionally rare occurrence. This rare phenomenon presents diagnostic challenges and necessitates prompt surgical intervention. This case report aims to provide a detailed account of a patient with a perforated stomach within an inguinal hernia, emphasizing the unique clinical presentation, diagnostic dilemmas, and the subsequent surgical management required for such a complex condition.

Methods
We report the case of an 83-year-old male who presented with severe abdominal pain and a tender mass in the left groin. Clinical examination revealed an irreducible inguinal hernia with signs of peritonitis. CT scan confirmed a giant incarcerated inguinal hernia containing part of the stomach with associated gas and fluid collection. An emergency open hernia repair was attempted but swiftly converted to an exploratory laparotomy. The hernia content was reduced intraabdominally, surprisingly revealing a posterior stomach wall perforation. Damage-control suture repair, washout, and laparostomy were performed. Tragically, he succumbed to multiorgan failure soon after in ITU.

Results
The occurrence of a perforated stomach within an inguinal hernia is an exceptionally rare and diagnostically challenging entity. Timely diagnosis and intervention are vital to prevent life-threatening complications. Imaging, particularly CT scan, aids in diagnosis and surgical planning. Prompt surgical management, involving hernia reduction and gastric repair, is crucial for optimal outcomes. play a critical role in identifying the gastric perforation and guiding the surgical approach.

Conclusions
This case underscores the importance of recognizing rare complications, such as stomach herniation in inguinal hernias. Heightened awareness and appropriate use of imaging facilitate accurate diagnosis and guide surgical interventions. Timely surgical intervention is essential in reducing morbidity and mortality associated with this rare presentation.
EGS P17 Expanding the technical armamentarium to treat complex oesophageal perforations with Endoluminal Vacuum Therapy
Authors: Obuekwe Chukwuemeka , Saqib Imad-Ud-Din , Mittring Artur , Gourgiotis Stavros , Hardwick Richard , Sujendran Vijay , Safranek Peter , Bennett John , Noorani Ayesha , Hindmarsh Andrew 
Published: November 2023

Abstract

Background
Endoluminal vacuum therapy (EVT) is increasingly the default treatment modality for oesophageal leaks. If the leak cavity is large or has a dependent element, placement of the endoluminal vacuum device within the leak cavity facilitates healing. However, accessing the leak cavity can be challenging when the oesophageal defect communicating with the leak cavity is small, and it is tempting to default to luminal EVT. This can lead to a EVT failure. We present a case where luminal EVT in the presence of an established leak cavity with a narrow inlet resulted in stagnation of therapy requiring an alternative technical approach.

Methods
An 80-year-old high-risk female with Boerhaave's syndrome presented with a 4cm esophageal defect and a large mediastinal leak cavity. An ad-hoc endovacuum therapy (EVT) device, consisting of V.A.C granufoam (KCI) attached to a 14Fr nasogastric (NG) tube, was placed in the leak cavity at -125mmHg pressure. The EVT device was replaced every 3-8 days. After 101 days, luminal EVT was adopted due to cavity narrowing. Partial closure of the esophageal defect was achieved, but a persistent mediastinal abscess communicated through a residual pinhole defect. Additional luminal EVT and image-guided drainage couldn't resolve the persistent esophageal fistula, confirmed by contrast-enhanced CT.

Results
Endoluminal access to the leak cavity was re-established by dilating the fistula using a TTS 12mm radial expansion wire-guided balloon catheter enabling re-establishment of intra-cavity EVT. Having regained access, further intra-cavity EVT using an ad-hoc EVT device fashioned from black granufoam (KCI) sutured to a 10Fr or 12Fr ng tube with 125mmHg negative pressure was applied. The EVT device was changed every 3-6 days. After further 25 days of EVT complete healing was observed.

Conclusions
Whilst intraluminal EVT has a role in oesophageal leaks associated with small leak cavities which have no dependent element, larger leak cavities require intra-cavity EVT. If access to the leak cavity is challenging due to the small size of the oesophageal defect, endoscopic measures to facilitate endoluminal access to the leak cavity such as dilation of the defect can be safely employed to enable delivery of intra-cavity EVT. This should be considered when endoluminal access to the leak cavity is prevented due to the small size of the defect obviating the need for other more invasive interventions such as surgery.
EGS P21 Hard to swallow, hard to treat
Authors: Ishak Athanasius , Smith Jacob , Nanda Akriti , Dimaggio Francesco , Thomas Rhys 
Published: November 2023

Abstract

Background
Deliberate foreign body ingestion (DFBI) presents unique medical, surgical, and ethical challenges. Often, patients with psychiatric conditions repeatedly ingest foreign bodies, leading to frequent emergency department visits. Standardised management guidelines are lacking, resulting in high hospitalisation rates, interventions, and complications. This study focuses on recent DFBI cases at our institution, providing insights into this complex condition and holistic management.

Methods
Patients admitted by the surgical team at Croydon University Hospital between 2017 and 2023 with DFBI were included. Data on demographics, clinical presentation, investigations, and management were collected. Complications, hospitalisations, interventions, and cost analysis were recorded.

Results
Eight patients presented a total of 52 times. The incidence of DFBI increased over time. Swallowed objects included knives, needles, magnets, glass, batteries, pencils, gloves, lighters, and screws. Each patient underwent an average of 21 X-rays, 2 CT scans, and 3 OGDs. Eleven laparotomies and 1 laparoscopy were performed. The average length of stay was 44.5 days. Complications included pulmonary embolism, pneumonia, enterotomy, hernia, and infection. The average cost per patient was £30,866.25.

Conclusions
DFBI poses a significant burden on healthcare systems. Patients face radiation exposure and repeated invasive interventions, necessitating a comprehensive approach. Understanding DFBI from a biopsychosocial and ethical perspective is crucial. A multidisciplinary team should be involved early, with clear goals. Further research is needed for optimal management pathways.
EGS P22 Prophylactic PPIs in NOF Fractures to prevent UGI bleed- Can It Be a Lifesaving Intervention?
Authors: Khawaja Zeeshan , Jamal Zohaib , Thakker Vivek , Zafar Nowera , Adnan Naqqash 
Published: November 2023

Abstract

Background
Assess the incidence of UGI bleed in patients with NOF fractures. Develop trust-based guidelines to include PPIs in the management of such patients.

Methods
A total of 119 patients who were admitted with NOF fractures between January and March 2022 were included. All the patients admitted to RAEI with NOF fractures were included in the study. All the patients with a previous diagnosis of GORD, peptic ulcers, or perforated peptic ulcers and those who were already taking PPIs before admission were excluded from the study. Information was collected about the hospital number, age, gender and if there was any gastrointestinal bleeding was noticed in such patients during the hospital admission.

Results
Our results showed that most of the patients who were admitted with NOF fractures were elderly. A total of 5/119 patients had major gastrointestinal bleeding during there hospital admission thus warranting further procedures such as endoscopy, transfusions, and prolonged hospital stay.

Conclusions
Elderly patients with NOF fractures are at an increased risk of stress-related mucosal damage and subsequent UGIB. Due to the devastating and potentially threatening complications of mucosal damage, preventative measures are mandatory. Therefore, PPIs should a routine part of drug prescription in patients admitted with NOF fractures. This can not only help prevent this potential bleeding but can also be cost-effective in terms of preventing prolonged stays and readmissions. A reaudit is planned to be done in 1 month's time after the implementation of the changes.