bluuebunny/crossref_metadata_2025_split huggingface dataset:
OGBN P17 Preoperative scoring system in predicting difficulty in laparoscopic cholecystectomy
Authors: Adnan Naqqash 
Published: December 2022

Abstract

Background
For a long time now, laparoscopic cholecystectomy (LC) has been the gold standard treatment for gallstone disease. Having said that, approximately 2–15% of attempted LCs have to be converted to an open procedure due to various difficulties faced while performing the procedure. This study has been structured and planned taking into account the various difficult situations a laparoscopic surgeon faces during laparoscopic cholecystectomy and assigns an objective outlook to the difficulty in the form of a difficulty score. The main objective of the study is to evaluate a scoring system in predicting difficulty in laparoscopic cholecystectomy.

Methods
Patients with symptomatic gallstone disease that were admitted in SU-1 of Holy family hospital during the above period were included in the study. For collection of data, a pre-tested questionnaire was used after taking informed oral consent. On admission, one day before the surgery, preoperative points were allotted on basis of patient's history, examination, hematological (CBC), biochemical (LFTs) and ultrasound results. Preoperative scores up to 5 was summed up as easy, scores 6–10 as difficult, 11–16 as very difficult. Calculated sample size was 229. SPSS version 22 and WHO Anthro calculator version 3.2.2 were used for data entry and analysis

Results
Among 230 patients that were included in the study, 188 were female and 42 were male. Various risk factors were found to have significant positive correlation with intraoperative difficulty during cholecystectomy. These are: Previous episodes of cholecystitis and pancreatitis (p=0.00), ERCP (p=0.00), tenderness in right hypochondrium (p=0.002), hepatitis serology (p=0.02), and Total Leukocyte Count (p=0.006). Whereas the following factors had insignificant relation with intraoperative difficult cholecystectomy: ALT and ALP (p&gt;0.05, p=0.06 and 0.26 respectively) and hepatitis serology (p=0.406). A significant correlation was found between preoperative and intraoperative scores of the patients (p=0.003) indicating that preoperative assessment of various risk factors can predict the level of difficulty of cholecystectomy and its conversion to open cholecystectomy.

Conclusions
We may conclude that the scoring system evaluated in our study is a sturdy, reliable and useful benchmark to predict difficult cases. Preoperative prediction of the risk factors of conversion or difficulty of operation is an important point for operative planning and the high-risk patients may be informed accordingly.
OGBN P18 Laparoscopic Deroofing of a Liver Cyst
Authors: Bradley Alison , Kostalas Marcos , Bowling Kirk , Andrews Stuart 
Published: December 2022

Abstract

Background
Laparoscopic deroofing is considered to be part of standard practice for simple nonparasitic liver cysts.

Methods
This “how to” video demonstrates an approach to the laparoscopic deroofing of a large, nonparasitic liver cyst. After the placement of umbilical, epigastric and a working right upper quadrant port, the cyst is aspirated. This allows easier handling of the cyst. A cystostomy is then created and a LOTUS or Harmonic scalpel is used to cut thru the cyst wall.Further suctioning of the cyst contents allows the cyst to collapse which facilitates handling of the tissue. Complete resection of the cyst can be achieved by dissecting close to the cyst wall which is then placed into an endobag prior to removal. It is important to ensure good haemostasis at the liver. Omentum may be placed in larger cavities to reduce dead space and prevent fluid collection.

Results
This patient made a good postoperative recovery and cytology and histology confirmed benign cyst.

Conclusions
This video demonstrates one approach to the laparoscopic deroofing of a large, simple, nonparasitic liver cyst.
EGS P03 Selective non-operative management of high grade splenic injuries is safe in both the short and long term
Authors: Curran Matthew , Lowe Aaron , Jamdar Saurabh 
Published: December 2022

Abstract

Background
Blunt and penetrating splenic injuries represent a significant component of the workload in major trauma centres in the UK. International guidelines recommend intervention for patients suffering high grade injuries. This single centre retrospective cohort study assessed current management of adults with splenic injuries, stratified by World Society of Emergency Surgery (WSES) classification, and compared this to the recommended management proposed by the WSES guidelines.

Methods
Patients admitted between April 2014 to January 2021 to a major trauma centre with splenic injuries were prospectively assessed. Data on AAST grade, WSES class, radiological imaging, definitive interventions performed, length of admission, follow-up imaging and short and long-term outcome were collected.

Results
143 patients with splenic injuries were admitted during the study period. 5 patients were excluded due to inadequate clinical information. 138 patients with splenic injury were analysed. 50 suffered WSES grade 1 injuries, 25 WSES grade 2, 18 WSES grade 3 and 45 WSES grade 4. Patients with WSES grade 3 and 4 injuries were managed as follows: conservative 13, angioembolisation 38 and splenectomy 12. Length of stay did not differ between groups. No patient undergoing non-operative management required salvage splenectomy. One patient undergoing angioembolisation required laparoscopic drainage of splenic abscess secondary to infarction. During the study period 4 patients died (2.7)%. The cause of death in each case was due to other injuries. Long term imaging follow up was organised in 31 patients undergoing angioembolisation. 30 patients (97%) had imaging features suggestive of perfused splenic tissue.

Conclusions
Conservative management of splenic injuries with the addition of angioembolisation for high grade injuries led to a splenectomy rate of less than 10% in this study. This strategy led to low morbidity with only one patient requiring subsequent intervention and no splenic injury related mortality. This study validates the increasing trend towards non-operative management for splenic injuries.
EGS P04 Transgastric drainage of oesophageal perforations: The largest case series
Authors: Lunt Adam , Ariyarathenam Arun , Chan David , Humphreys Lee , Sanders Grant , Wheatley Tim , Berrisford Richard 
Published: December 2022

Abstract

Background
Oesophageal perforation is associated with a high morbidity and mortality. Multiple operative and non-operative management strategies have been described. We first described the novel technique of transgastric drainage of oesophageal injuries in 2008. This has since been adopted across other units in the UK and Ireland. The technique exteriorises the site of the perforation by establishing vacuum drainage of the lumen of the oesophagus, whilst maintaining luminal patency and thereby encouraging healing by secondary intention. We present our 10 year experience with the largest case series in the literature.

Methods
A retrospective analysis was undertaken of all patients with oesophageal perforation treated with transgastric drainage, over the last 10 years, in our specialist unit.
Transgastric drainage was performed using a 36 Fr Chest drain inserted through the stomach, into the oesophageal lumen above the proximal extent of the perforation. This was endoscopically performed with either laparoscopic or open guidance. Gastropexy was performed. Continuous suction of -10cm water was applied to the drain until no leak was noted. Mediastinal decontamination and drainage was performed as needed. Nutrition was provided by total parenteral nutrition or feeding jejunostomy.

Results
35 patients were treated with transgastric drain. 68% (n=24) were male. Median age was 67 (26–84). 60% (n=21) being spontaneous perforations and 31% (n=11) were iatrogenic. Inpatient and 30-day mortality was 14% (n=5). Among patients who survived, the median length to resolution of leak on imaging was 34.5 days (6–80). Median length of stay was 39.5 (16–84) days.

Conclusions
Transgastric drainage can be successfully used to treat oesophageal perforations of varied lengths. The mortality rate of 14% compares favourably with other methods of management for oesophageal perforation.
EGS P09 An Ambulatory General Surgical Service, Reducing the On-Call Burden and Improving Patient Experience
Authors: Boag Katie , Bradley Alex , Toogood Giles , Peckham-Cooper Adam 
Published: December 2022

Abstract

Background
The management of acute General Surgical patients is dramatically changing with the emergence of Emergency General Surgery departments. The trend is moving towards consultant-led services, and managing patients on ambulatory pathways. This prospective study aims to demonstrate the impact of a consultant-led ambulatory surgical clinic and primary care telephone access on the acute surgical take in a busy tertiary hospital.

Methods
Data was collected from March 2021-March 2022. Patients were included via the primary care access line, as well as patient attendances either via surgical assessment unit (SAU), or ambulatory surgical clinic (ASC). Their pathways were recorded i.e. admit, discharge, further ambulatory investigation, listed for surgery.

Results
Consultants took 6,948 calls from primary care from March 2021–22. 43.7% of patients were given an appointment for ASC, 37.3% admitted to SAU, 3.5% directed to ED, and 15.5% given advice or redirected elsewhere. 54.6% of those seen in ASC were discharged without further follow up, the other 45.4% were either admitted, followed up or added to a waiting list. General Surgery patient attendances to SAU fell from an average of 1020 per month between March to October 2021 to 542 attendances November 2021 to present.

Conclusions
The introduction of a consultant-led ambulatory service has reduced the on-call burden by half. The dramatic reduction in SAU attendances is likely to be the result of developed ambulatory pathways, improved communication with primary care and Consultant Emergency General Surgeons, and autonomy of Junior Surgical Trainees to redirect ED referrals onto refined and supported ambulatory pathways. A Consultant-led primary care access line has reduced ED attendances and allowed for effective streaming of patients. These changes have improved the patient experience significantly, by directing them straight to specialty with same or next day consultant clinics, and reduced waiting times overall. There has been a significant reduction in complaints and consistent improvement in patient feedback.
EGS P24 Extended Thromboprophylaxis in the Prevention of Postoperative Venous Thromboembolism after Emergency Surgery
Authors: Clements Caterina , Bezzaa Sabrina , Patel Puja , Graham Gemma , Kersey James , Nehra Dhiren , Lewis Trystan , Jamal Karim 
Published: December 2022

Abstract

Background
Venous thromboembolism (VTE) after emergency laparotomy is a significant cause of morbidity and mortality.
Where extended thromboprophylaxis is used in the post-operative care of patients with colorectal malignancy or pelvic surgery, no such guideline exists for the patient undergoing emergency laparotomy.
Arguably emergency laparotomy has one of the highest associated death rates of all types of surgery, greater than that of major elective GI surgery and involves high risk patients.
The objective of this study is to ascertain the incidence of symptomatic VTE after emergency laparotomy within current thromboprophylaxis regimens at a district general hospital and consider the benefits of extended regimes in this patient cohort.

Methods
A database of all patients who underwent emergency laparotomy over a 12 month period from January 2019 to December 2019 was retrospectively analysed. The primary outcome was the incidence of symptomatic VTE within 90 days of emergency laparotomy. This was cross-referenced to known patient risk factors for thromboembolism.

Results
A total of 113 patients underwent emergency laparotomy during this period. Those who had multiple laparotomies and were duplicated or who died were excluded, leaving a total of 94 patients, 55 female and 39 male.
80 patients underwent a VTE prophylaxis regimen using perioperative and postoperative low-molecular-weight heparin (LMWH) based on their weight.
The average length of stay was 18 days. 20 patients had an inpatient stay greater than 28 days and, therefore, received extended prophylaxis during their admission. 21 patients were given prolonged anticoagulation on discharge to complete a total of 28 days, 14 of these had suspected cancer intraoperatively, 6 were previously already anticoagulated.
The postoperative VTE incidence was 6, 4 were diagnosed during admission and so received prolonged anticoagulation on discharge. 2 patients were not given prolonged VTE prophylaxis on discharge.

Conclusions
An extended VTE prophylaxis regimen using low-molecular-weight heparin is simple and effective and an accepted practice in the management of post operative colorectal cancer patients. A randomised control trial is likely needed to further explore the use of extended low molecular weight heparin in the postoperative care of emergency laparotomy patients.
EGS P26 Audit of outcomes of Hiatus hernia repairs done as an emergency procedure in a tertiary care center
Authors: Eadala Haripriya , Abdelhamid Amir , Mekhail Peter , Nanthakumaran Shayanthan 
Published: December 2022

Abstract

Background
Hiatus hernia is the abnormal protrusion of stomach and /or intra-abdominal contents into the chest via a widened space between the diaphragmatic crura. Patients with hiatus hernias can present with a wide spectrum of symptoms ranging from a mild dyspepsia to acute presentations such as obstruction and strangulation. The recurrence rate, morbidity and mortality in patients requiring emergency surgeries in such acute presentations has been reported to be significantly high compared to that of elective hernia repair. We aim to assess the outcomes of hiatus hernia repairs done as an emergency surgery in a tertiary care center.

Methods
A retrospective study of all emergency hiatus hernia repairs done over a span of 10 years was done. Demographic details, BMI, smoking status, past medical history, method of diagnosis and management, duration of inpatient stay and the follow up was collected. The primary outcome of the study was 30 day mortality rate. Secondary outcomes were further surgeries during the same admission and recurrence rate.

Results
A total of 25 patients were identified to undergo an emergency hiatus hernia repair. 1 patient was excluded due to transfer to a different health board. 62.5%(n=15) of the patient were females. Duration of stay as inpatient ranged between 3 and 138 days. Of note, there were no deaths during the stay or recorded mortality by 30 days in the cohort.

Conclusions
The mortality rate in our unit is low in comparision with reported studies in literature.
HPB P23 Laparoscopic lumen-guided cholecystectomy in face of the difficult gallbladder
Authors: Lucocq James , Taylor Aaron , Driscoll Peter , Naqvi Syed , MacMillan Alasdair , Bennett Stephen , Luhmann Andreas , Robertson Andrew 
Published: December 2022

Abstract

Background
Where the critical view of safety cannot be established during cholecystectomy, certain salvage techniques are indicated to reduce the likelihood of bile duct injury. The present study describes a salvage technique termed the “laparoscopic lumen-guided cholecystectomy” (LLC) and reports its peri-operative outcomes.

Methods
A summary of the technique is as follows: (1) Hartmann's pouch is incised and stones are evacuated; (2) the cystic anatomy is inspected from the inside of the gallbladder; (3) the lumen is used to guide retrograde dissection towards the cystic pedicle; (4) cystic duct control is achieved if deemed safe. LLC cases performed between June 2020 and January 2022 in a single health board were included. The operative details and peri-operative outcomes of the technique are reported and compared to cases of similar difficulty (Nassar ≥4) where the LLC was not attempted.

Results
LLC was performed in 4.6% (27/587) of cases. In all 27 cases, LLC was performed for a “frozen” cholecystohepatic triangle. Hartmann's pouch was completely excised in all cases (27/27) and cystic duct control was achieved in 85.2% of cases (23/27). No cases of bile leak or ductal injury were reported. Rates of bile leak, post-operative complications and ERCP were lower following LLC compared to the group where LLC was not attempted (p&lt;0.01).

Conclusions
LLC is a safe salvage technique and should be considered in cases where the critical view of safety cannot be established. The technique achieves cystic duct control in the majority of cases and favourable outcomes in the face of a difficult cholecystectomy.
OGC P01 Cost utility analysis of a prehabilitation programme in patients undergoing treatment for oesophageal cancer
Authors: Powell Arfon , Allen Sophie , Casey Patrick , Hunt Julie , Prabhu Pradeep , Jack Sandy , Rockall Timothy , Preston Shaun , Sultan Javed 
Published: December 2022

Abstract

Background
Treatment of oesophageal cancer is associated with significant morbidity which has an impact on longer term survival. Prehabilitation has been shown to reduce post-operative morbidity and mortality. The aim of this study was to undertake a cost-utility analysis to determine if, based on quality adjusted life-years, prehabilitation should be universally implemented in patients undergoing treatment for oesophageal cancer.

Methods
Patients with oesophageal cancer who were recruited to a randomised control trial were retrospectively analysed. Three-years follow-up was available for calculating overall survival. Costs were calculated based on network, staging, and treatment algorithms. QALYs were calculated as a matrix cost of treatment, quality of life, and overall survival. Overall survival was calculated from time of diagnosis to death or censorship at three-years follow up.

Results
Thirty-nine patients were randomised to prehabilitation (n=20, 51%) or standard care (n=19, 49%). The median cost per patient for treatment was £46,770.16 (Inter quartile range (IQR) 41,907.21–58,984.21). The overall cost per patient in the prehabilitation group was lower, £44,382.99 (IQR 42,022.86–54,068.23), when compared with standard care per patient £51,538.07 (IQR41,907.21–68,734.33). The mean survival was 24.7 months in the prehab group compared with 27.7 months in the control group (p=0.523). The cost per-QALY for the prehabilitation group was £24,899.06 compared with £25,781.71 in the standard care group.

Conclusions
In the setting of a randomised control trial, prehabilitation is clinically effective with observed reductions in total treatment costs and a cheaper cost per QALY.
OGC P19 The future insights of evaluating the circumferential resection margin (CRM) status in oesophageal cancer: A 12-year cohort study
Authors: Elshaer Ahmed , Jones Sian , Hayden Jeremy , Mehta Samir , Cockbain A J , Sarela Abeezar , Dexter Simon , Grabsch Heike 
Published: December 2022

Abstract

Background
The definition of CRM (circumferential resection margins) for oesophageal cancers varies among the international pathological bodies with an ongoing controversy about the optimal definition. There is also no enough data about the prognostic relevance of different sites in CRM. In this study, we examined the prognostic impacts of different CRM distances and sites.

Methods
This study included patients who had curative oesophagectomy for oesophageal cancer between 2010 till June 2021. Follow up till April 2022 was achieved. CRM status was carefully examined for the distance and site of involved tumour cells. Patients with involved proximal or distal margins were excluded. The outcomes between different CRM margins were retrospectively analysed. The long-term follow up data was obtained via direct contact with the patients during our oncological clinics, cross-checked with our hospital/national patients’ electronic databases.

Results
456 patients were included in this study. Involved tumour cells within 1mm of CRM was observed in 192 patients (42.1%). CRM+ (&lt;1mm) was associated with worse overall (OS) and disease-free survival (DFS) (22.8 and 16.3 months respectively) compared to CRM-negative (47.7 and 45.1 months respectively), (p-value &lt;0.001 for both). CRM+ (0mm) had worse OS and DFS (20.5 and 12 months respectively) compared to CRM+(0.1–1mm) (26.4 and 20 months respectively), (p-values 0.028 and 0.006 respectively). CRM-positive posterior margin was the most common involved site (32%), but was associated with better OS and DFS compared to anterior and lateral sites, (p-values 0.1 and 0.08 respectively).

Conclusions
The site and distance of tumour cells within CRM should be rigorously assessed in oesophagectomy specimens. The presence of tumour cells within 1mm of CRM was an independent factor for OS and DFS. The CRM+(0 mm) had significant lower survival rates compared to other CRM+ distances (0.1–1 mm). The involved margin sites within CRM had different survival rates, with superiority towards posterior resection margins.
OGC P28 Raman Needle Probe Lymph Node Assessment for Oesophageal Cancer: The DOLOMITE Study
Authors: Ireland Philip , Old Oliver , Hornby Steve , Kendall Catherine , Barr Hugh , Shore Angela , Stone Nick 
Published: December 2022

Abstract

Background
Oesophageal cancer (OC) accounts for 3% of all new cancer diagnosis in the UK. Presentation is often late, reflected in a poor 5-year survival rate of 12%. The importance of identifying lymph node (LN) metastases has been demonstrated as the single biggest prognostic factor.
The current ‘gold standard’ diagnosis of LN metastases is from histopathological assessment of the tissue after surgical resection of the primary tumour and surrounding tissue. The use of imaging techniques to try and gain this information preoperatively is standard practice but far from perfect.
Raman spectroscopy (RS) has been investigated as a diagnostic tool to detect cancer and pre-cancerous change in the oesophagus, and preliminary work demonstrating the application of vibrational spectroscopy (Raman and FTIR) to LN analysis has been undertaken. The development of Raman needle probes (RNP) with potential for use in-vivo furthers the clinical impact.
The DOLOMITE study started recruitment in the summer of 2022 to investigate the ability of RNP to identify the presence of malignant deposits in resected lymph nodes.

Methods
Patients identified by the clinical team as needing oesophagectomy to treat their OC were invited to participate in the study. After the specimen has been resected, prior to formalin fixation, three lymph nodes are dissected representing gastric, para-oesophageal and sub-carinal nodes. These are bisected longitudinally with half remaining with the specimen. The half for research is snap frozen in liquid nitrogen until needed for analysis.
Adjacent sections are cut from the nodes to create slides for Raman mapping and conventional H&E staining. The bulk node left is used for Raman probe analysis. Spectral data is then analysed using MATlab.

Results
At this early stage, our initial measurements have provided information used for calibration in advance of completing recruitment. The Raman mapping has been assessed for correlation with the pathology identified in the H&E slides taken from the lymph node block. This data in turn has provided the background for developing interpretation of the Raman probe data, with further samples we will use this to create a classification model.

Conclusions
With ongoing recruitment the study will be able to fully report by September 2023.
References
1. Stone N, Kendall C, Shepherd N, Crow P, Barr H Near-infrared Raman spectroscopy for the classification of epithelial pre-cancers and cancers 2002 33(7):564–573
2. Kong K, Kendall C, Stone N, Notingher I. Raman spectroscopy for medical diagnostics--From in-vitro biofluid assays to in-vivo cancer detection. Adv Drug Deliv Rev. 2015;89:121–34.