bluuebunny/crossref_metadata_2025_split huggingface dataset:
OGBN P16 Pre-operative group and save, is there still a need in the elective and emergency laparoscopic cholecystectomy?
Authors: Hamid Mohammed , Kershaw Marie , Bhakthavalsalan Resya , Shivamurthy Rishika , Davies Sian , Ahmed Zuhair 
Published: December 2022

Abstract

Background
Laparoscopic cholecystectomy is associated with a high safety profile. This study aimed to quantify the rate of blood transfusion in the elective and emergency setting and explore patient outcome and selection for Group and Save (G&S) sampling.

Methods
A retrospective observational study investigating patients who underwent an elective or emergency laparoscopic cholecystectomy at a single Trust in the UK, between December 2019 and May 2021. Outcomes of interest were selected based on their clinical possibility of being influenced by the number of pre-operative G&S samples using multivariate logistic regression models.

Results
There were 959 patients; 631 (65.8%) elective and 328 (34.2%) emergency cholecystectomies. Median age was 48 (35–59) years, and 724 (75.5%) patients were female. Five patients (0.5%) needed blood transfusion post-operatively, with an average time of six hours. Three of these patients had haematological conditions. In adjusted models, male sex was associated with requiring a blood transfusion (OR 11.31, p=0.013); whilst having a pre-operative G&S sample had no impact on any patient outcome.

Conclusions
Blood loss requiring blood transfusion in laparoscopic surgery is very low. Male sex and haematological conditions may present as independent risk factors for blood loss in laparoscopic cholecystectomy. Pre-operative G&S sampling has no impact on patient outcome and could safely be omitted in both elective and emergency cases unless a personalised assessment suggests otherwise.
OGBN P21 A complex case of gallbladder and CBD stones treated with Laparoscopic Cholecystectomy and Trans-Cystic lithotripsy using SpyGlass™ Discover post failed ERCP
Authors: Abdelwahab Sameh , Shaalan Ramy , Kulli Christoph , Tait Ian , Patil Pradeep , Zino Samer , Kher Jan 
Published: December 2022

Abstract

Background
Laparoscopic Cholecystectomy and bile duct exploration remain the gold standard treatment for gallstone disease associated with bile duct stones. However, interval two session management with ERCP followed by Laparoscopic Cholecystectomy should be avoided. It exposes patients to preventable risk of perforation, bleeding, and pancreatitis, especially if the patient is fit and keen for surgery. Trans-Cystic bile duct exploration (TC BDE) appears to have less morbidity than Trans- Ductal bile duct exploration (TD BDE). However, large bile duct stones remain the main challenge for Trans-Cystic approach along with distorted anatomy.

Methods
We present a 48-year-old female with symptomatic gallstone disease and a complex past surgical history.

Results
Trial of ERCP failed despite Needle-knife papillotomy due to large mobile and hard papilla. Unfortunately, the patient suffered post ECRP pancreatitis that was complicated by an abdominal collection around the head of the pancreas. The collection required radiologic drainage through the anterior abdominal wall, 13 days post-pancreatitis. The patient recovered well and was listed for a Laparoscopic Cholecystectomy and bile duct exploration with high risk of conversion to open, 6 weeks after discharge. The operation was challenging due to presence of adhesions and shrunken gallbladder (Nassar grade IV). Trans-Cystic BDE was performed using basket inside catheter (BIC) technique. SpyGlass™ Discover choledochoscopy showed a clear distal CBD and a large 12mm stone in the common hepatic duct. The stone was hard and required a high setting of lithotripsy (30, Max). The stone was fragmented successfully, and all fragments extracted using baskets. The cystic duct was closed by suturing using 3.0 Vicryl and two Robinson abdominal drains were left in the abdomen; one in Morrison's pouch and one in the sub-diaphragmatic space. The patient had an uncomplicated post-operative recovery and was discharged home after 5 days. Follow-up 8 months later was satisfactory.

Conclusions
Trans-Cystic bile duct exploration has become increasingly safe and feasible even for large bile duct stones using new technology. ERCP should be avoided in young fit patients, especially females due to the higher risk of post-ERCP pancreatitis.
EGS P02 The long term impact of service re-organisation on outcomes for patients with complicated peptic ulcer disease
Authors: Couper Graeme , Hughes Michael , McKechnie Stuart , Paterson-Brown Simon 
Published: December 2022

Abstract

Background
20 years ago acute surgical services were re-organised in our region to deliver subspecialist care of upper-gastrointestinal emergencies. Improved outcomes were reported as a result. Currently the unit has 24-hour availability for interventional and diagnostic radiology, emergency endoscopy and a specialist oesophago-gastric consultant surgeon. The aims of this study are to determine if, a decade after a major service re-organisation, any further improvements have been achieved in short-term outcomes and to provide long-term survival figures for this group of patients.

Methods
All patients admitted during a 62-month period from January 2010-February 2015, corresponding in duration and exactly a decade later than the previous report following service re-organisation, were identified from a prospectively compiled database.

Results
287 patients were admitted during the study period. 235 patients were admitted with ulcer perforation and 52 patients underwent surgery for bleeding.
Perforation. 8 patients (8/235, 3.4%) received end of life care. 37 patients (37/235, 15.7%) had initial conservative management. 191 (191/235, 81.3%) patients underwent operation (includes 1 patient with failed conservative management). 18 patients (18/191, 9.4%) died post-operatively. No patients selected for conservative management died. Within 5 years following discharge a further 34 patients died. 50% (17/34) of these were due to cancer. Actual 5-year survival was 73.3% (165/225, 10 patients lost to follow up). Comparing with the period following subspecialisation, overall in-hospital mortality was 10.4% vs 11.1% (14/135 vs 26/235) p=0.84, in-hospital mortality following surgery 7.9% vs 9.4% (9/114 vs 18/191) p=0.65 and in-hospital mortality following conservative management 23.8% vs 0% (5/21 vs 0/36) p=0.005.
Bleeding. In-hospital mortality was 25% (13/52). This was not significantly different from the rate reported following service reorganisation, 23.5% (12/51) vs 25% (13/52) p=0.86. Within 5 years following discharge a further 12 patients died. 58% (7/12) of these were due to cancer. Actual 5-year survival was 51.9% (27/52 patients alive).

Conclusions
This study demonstrates that no improvement in surgical outcome in patients with complicated peptic ulcer disease has been achieved despite the delivery of what may be considered an optimal service. A significant improvement in outcome in patients selected as suitable for conservative management has been seen. 5-year survival figures for patients admitted with either perforation or bleeding are poor with cancer the most common cause of death within 5 years following discharge.
EGS P05 Surgical Same Day Emergency Care at a District General Hospital - Our Experience
Authors: Sultan Ahmed , Hussain Mohammad Iqbal , Sellahewa Chaminda , Bird Jonathan , Glover Gemma 
Published: December 2022

Abstract

Background
Surgical Same day emergency care (SDEC) is a new service started at a medium sized district general hospital (DGH) since November 2021. The surgical SDEC service is divided into Theatre (ambulatory theatres) and non-theatre (Hot Clinic) pathways aiming at improving patient experience, and reducing length of stay (LOS), by introducing a pathway through which patients are assessed, diagnosed, and initiated treatment and discharge on the same day for common emergency surgical conditions of gallstone disease, appendectomy, painful hernia, and abscesses. The service delivery planned with the existing facilities leading to structured fewer admissions, increased diagnostics, coordinating the patient flow with preop assessments, day case theatre utilisation and post-operative criteria led discharge. The Surgical SDEC is now established, and we continue to audit to benchmark success, recommend improvement and for quality assurance.

Methods
It's a prospective data collection of patients admitted under general surgery with the above common surgical emergency presentations over 6 months period since the start of the service in November 2021. The inclusion criteria were stable patients of ASA grade 1 and 2, BMI less than 40 kg/m2, and with social support. The unstable patients, ASA 3 or more and without social support were excluded. The postoperative follow up was arranged with virtual ward, clinics and in the event a post-surgery hot clinic review.

Results
From 15th November 2021 to 27th May 2022, 192 surgical operations were carried out. 130 Laparoscopic cholecystectomies, 22 hernia repairs, 13 diagnostic laparoscopies, and 27 abscesses incision and drainage. There were 77 male patients and 115 female patients with age ranging from 20 to 88 years old. About 70% of the patients were successfully discharged on the same day with a readmission rate of 3.6%. The cholecystectomy patients had a mean waiting time of 3.2 days and almost all cases were done within a week of admission. All the other cases including appendectomy were performed either the same day or the following day.

Conclusions
Surgical Same Day Emergency Care service proved to be a step forward for improving patient care. It allows the same day diagnostics and treatment, and reduces the length of stay, prevents readmissions, improves the quality of care, and helps recovery following the impacts of the pandemic. Finally, it has a significant financial benefit by decreasing readmissions, and it also utilisation of hospital beds more desired cases.
EGS P11 Ten year experience of treating Boerhaave syndrome: a single centre analysis
Authors: Hawkins Rosalyn , Phillips Benedict , Amalesh Thangadorai , Mukherjee Dipankar , Mukherjee Samrat 
Published: December 2022

Abstract

Background
Boerhaave syndrome is a rare condition characterised by spontaneous barogenic, transmural rupture of the oesophagus. We aimed to examine a ten-year experience of Boerhaave syndrome at our centre.

Methods
Cohort analysis of Boerhaave syndrome over a ten year period (2012–2022). Univariate analysis was employed to determine risk factors associated with inferior patient survival.

Results
During the study period, 40 patients presented with oesophageal perforation, of which 21 (52.5%) were spontaneous transmural rupture. Median age of patients with Boerhaave syndrome was 51 years, in predominantly male (15, 71.4%), non-smokers (13, 61.9%). The most common site of rupture was the lower oesophagus (12, 57.1%), although the exact site of rupture was unknown in 5 (23.8%) patients. 14 (66.7%) patients were treated conservatively with antibiotics. Three (14.3%) patients underwent endoscopic oesophageal stent insertion (either alone or in combination with surgical treatment). Five (23.0%) underwent thoracoscopic washout and drain insertion and 1 (4.8%) underwent open thoracotomy washout and drain insertion. Overall 10-year survival was 80.8%. There was no association between mortality and patient age, sex, smoking status, length of stay, location of perforation, coronavirus status or mode of nutrition on univariate analysis (p&gt;0.05 throughout). Patient age was the greatest predictor of prolonged length of stay beyond 10 days (c-statistic 0.74). Modality of surgery also had no bearing on 1- and 10-year mortality (p=0.95).

Conclusions
Boerhaave syndrome is an uncommon condition which may be treated with an array of approaches, including non-operative measures, endoscopic and surgical intervention, depending on individual patient characteristics. The availability of multimodal treatment at a specialist oesophagogastric centre may have contributed to favourable patient outcomes. Given the rarity of Boerhaave syndrome, identification of risk factors for poor patient outcomes is difficult to determine, due to statistical underpowering.
EGS P29 Improving Quality of Operation Notes in General Surgery – A complete audit cycle
Authors: Mateen Mohammad , Kamran Zen , Mahmud Sajid , Khan Khurram 
Published: December 2022

Abstract

Background
Good quality of operation notes are essential for good post-operative care, patient safety and medico-legal issues. RCSEng have guidelines on items that should be included in all operation notes. RCSEng Guidelines state: Ensure that there are clear (preferably typed) operative notes for every procedure. The notes should accompany the patient into recovery and to the ward and should give sufficient detail to enable continuity of care by another doctor. We re-audited the quality of operation notes in general surgery.

Methods
We re-audited and compared the results with the first cycle. Four months (1st August to 30th November 2021) period of consecutive operation notes were reviewed. Operation notes for endoscopy were excluded. Operations notes were analysed for documentation of the items as per RCSEng guidelines. There were less operations post COVID-19, hence longer study period. After first cycle, departmental presentation given for education and posters displayed in theatres as reminder. Initial plan for 2nd cycle in 2020 but it was not possible due to COVID-19.
Problems/complications, extra procedures and prosthesis used were not included. Additional criteria reviewed was: type of anaesthetic, patient position, indication for procedure and ASA grade.

Results
A total of 239 operation notes were identified. 169 emergency and 70 elective cases. 193 were handwritten and 46 were typed.The results were compared to the first cycle:

Conclusions
Higher proportion was of emergency procedures during the 2nd cycle. Also, higher proportion of handwritten notes during 2nd cycle. There was improvement in documenting elective/emergency, time, type of anaesthesia, indication, position, operative findings/diagnosis, details of tissue removed/added/altered, blood loss, antibiotics, DVT prophylaxis. However, there was poorer documentation of date, name of assistant, incision, closure, signature remains.
Ongoing education of the surgeons is vital to improve the quality of the operation notes. We suggest addition of further headings on the current op-note as aid-memoire and introduction of digital operation notes.
EGS P30 Minimally Invasive Approach for the treatment of Boerhaaves
Authors: Sarkar Anik , Toh Simon 
Published: December 2022

Abstract

Background
Over the years the teaching has being a radical open approach to boerhaaves. Here at Queen Alexandra Hospital, we wanted to show a minimally invasive approach to boerhaaves and prove to be a feasible option, obviously in selected cases and under a specialist UGI unit.

Methods
A recording was obtained of the case and the endoscopy with permission.

Results
We were able to contain mediastinal contamination while at the same time, primarily repair the laceration transhiatally. Patient was extubated the same evening without any support. Patient was moving around day 1.

Conclusions
In selected patients, a minimally invasive approach to boerhaaves, wether it be thorascopically or laparoscopically should be considered. This should ultimately be performed under a UGI specialist unit.
EGS P32V Laparoscopic transcystic Antegrade Biliary Stenting
Authors: Taggarsi Meghana , Rate Anthony 
Published: December 2022

Abstract

Background
Laparoscopic cholecystectomy is the gold standard treatment for symptomatic cholelithiasis including pancreatitis. Symptomatic gall stones patients have up to 20% risk of having common bile duct (CBD) stones too. Although, guidelines have been laid down for management of suspected CBD stones, in practice there is a lot of variability and lack of standardisation. The waiting list for Magnetic resonance cholangiopancreatography (MRCP) is long, resulting in delayed treatment and increased length of hospital stay. Similarly, pre-operative endoscopic retrograde cholangiopancreatography (ERCP) can also increase the length of hospital stay due to long waiting lists, limited availability and overall risk of complications as high as 30%. Hence, the role of on-table cholangiogram (OTC) while performing laparoscopic cholecystectomy has been explored. The guidelines state that OTC should be performed in fit for surgery patients, without pre-operative investigations for diagnosing CBD stones. We have been practising early cholecystectomy with on-table cholangiogram (during the index admission), with selective insertion of antegrade biliary stent in patients with choledocholithiasis. We facilitate ERCP with stent removal and clearance of CBD stones after 4 weeks post-operatively.
We aim to present our technique of laparoscopic antegrade biliary stent insertion.

Methods
We follow the standard four-port technique for Laparoscopic cholecystectomy. Following dissection of Calot's triangle and visualisation of ‘critical view of safety’, an on-table cholangiogram is performed using a standard technique. If CBD stones are visualised, a transcystic antegrade stenting is done by Seldinger technique (without clearing the CBD of stones). The cholangiogram catheter is removed and flex-tip ureteric catheter is inserted transcystically. Through the ureteric catheter a flex-tip guidewire is inserted into CBD till its tip is visualised in the duodenum, under C-arm guidance. The ureteral catheter is then withdrawn carefully with guidewire placed satisfactorily. A double pig tail end biliary stent is rail-roaded over the guidewire, using a pushing catheter fashioned appropriately. As soon as the tip of the stent is visualised beyond the ampulla (in the X-ray), the guidewire and pushing catheter are withdrawn. The curling up of both ends of the stent is visualised and confirmed through C-arm guidance. Thereafter the procedure of cholecystectomy, as standard, is completed.

Results
The results of this procedure were analysed from 2014 to 2017, and subsequently published in 2018.

Conclusions
This technique does not involve skills required for CBD exploration. Hence, can be performed by general surgeons with expertise in minimal access surgeries, as it does not involve a steep learning curve. This technique is safe, reliable and cost-effective. It also decreases delays in biliary decompression, in-hospital stay and ensures timely treatment.
HPB P08 Exploring Carbon-13 breath delta value and other biomarkers of infection following Liver Transplantation and Hepatopancreatobiliary Surgery
Authors: Jerome Ellen , Wall Thomas , Pinto Tomas , Trovato Francesca , Mujib Salma , Cavazza Anna , Napoli Salvatore , Weidmann Damien , McPhail Mark , Menon Krish 
Published: December 2022

Abstract

Background
Sepsis and infection are the leading cause of morbidity and mortality after surgery, but the inflammatory response to the trauma of surgery can make diagnosis challenging. Carbon-13 breath delta value (13C BDV) has been shown to be discriminant as a novel diagnostic marker for sepsis and infection. We aim to assess biomarkers including BDV following major hepatopancreatobiliary (HPB) surgery to diagnose postoperative infection/sepsis.

Methods
20 participants undergoing HPB surgery were recruited prospectively. Breath samples were collected from baseline preoperatively, and on postoperative days (POD) 1–9, with plasma and peripheral blood mononuclear cell (PBMC) samples preoperatively, POD1, 4 and 8. Breath samples were analysed using infrared laser spectroscopy to generate BDV (per mil). Plasma was analysed for cytokines using MesoScale Discovery immunoassay, Procalcitonin (PCT) using ELISA, and Cell surface marker expression on monocytes was phenotyped using flow cytometry. Differences between groups who did and did not develop infective complications was analysed using two-way ANOVA and Mann Whitney U test.

Results
5/20 participants developed infective complications, with a mean day of diagnosis POD5. There was no difference between BDV in patients with or without infection. Monocyte count was increased in infected participants at all timepoints, and monocyte expression of PD-L1 on POD1, and CD155 and HLA-DR on POD4 was upregulated, +13.09% (95%CI 1.59 to 24.61, p&lt;0.05), +422.5 MFI (95% CI -770.9 to -73.68, p&lt;0.05), and +19.02% (95% CI 37.58 to 0.45, p&lt;0.05) respectively.

Conclusions
Monocyte expression of PD-L1, HLA-DR and CD155 is associated with infection, +13.09% (p&lt;0.05), +422.5 MFI (p&lt;0.05), and +19.02% (p&lt;0.05) respectively. The innate immune system is dysregulated in infection following major HPB surgery. In this cohort BDV did not predict infection. Further investigation of novel biomarkers including BDV and soluble monocyte markers is required.
HPB P26 C-reactive protein/albumin ratio may be helpful for assessing suitability for resection in patients with pancreatic head malignancy
Authors: Russell Thomas , Labib Peter , Aroori Somaiah 
Published: December 2022

Abstract

Background
Prior studies have suggested that high preoperative C-reactive protein/albumin ratio (CAR) correlates with reduced survival following pancreatoduodenectomy (PD) performed for malignancy affecting the pancreatic head, since this feature is characteristic of a more aggressive tumour. Various cut-off thresholds have been suggested, with a threshold of 0.2 (x10–3) considered in several publications. This study aimed to compare the five-year survival of PD patients with high preoperative CAR (≥0.2) to those with low preoperative CAR (&lt;0.2).

Methods
Data was extracted from the Recurrence After Whipple's (RAW) study, a multicentre retrospective cohort study of outcomes following pancreatoduodenectomy performed for pancreatic head malignancy (29 centres in 8 countries, n=1,484). Patients were grouped by their underlying cancer type and divided into “high” and “low” CAR groups. Five-year survival rates were compared using Fisher's exact test.

Results
Out of 1484 patients, 885 (59.6%) had pancreatic ductal adenocarcinoma (PDAC), 394 (26.5%) had ampullary carcinoma (AA) and 205 (13.8%) had cholangiocarcinoma, and CAR data was available for 48.8%, 42.6% and 44.4% of patients, respectively. In patients with PDAC, the median CAR was 0.2 (range: 0.0–23.8) and low CAR was associated with significantly improved five-year survival (32.6% vs 18.0%, p=0.0006). In those with AA, median CAR was 0.2 (range 0.0–19.5), those with low CAR had improved five-year survival but this was not quite significant (60.3% vs 46.7%, p=0.09). Median CAR was 0.3 in those with CC (range: 0.0–14.3) but this did not appear to affect survival (33.9% vs 30.8%, p=0.7).

Conclusions
In our multicentre study, PD patients with a histological diagnosis of PDAC had significantly improved five-year survival rates if they had a low CAR. CAR is a useful prognostic indicator in these patients and may be helpful for assessing patient's suitability for resection.