Search

Background Emergency cholecystectomy is recommended for all acute admissions with symptomatic gall stones. The Royal College of Surgeons and AUGIS on 25th March 2020 recommended that all laparoscopic procedures should be avoided during the COVID-19 pandemic with the view to minimise the risk of virus transmission from aerosol-generating procedures. This retrospective study compares the outcomes of patients undergoing emergency cholecystectomy during the COVID-19 period with the pre-COVID-19 period. Methods All patients who underwent emergency cholecystectomy (EC) from March 2019 to March 2021 were included. ‘Pre-COVID-19’ period was defined as 25th March 2019 to 24th March 2020, whereas the ‘COVID-19’ period was from 25th March 2020 to 24th March 2021. Mortality was considered as the primary outcome. Secondary outcomes include the 30-day postoperative complications based on the Calvien-Dindo classification (CDC) and the length of stay (LOS). Mortality and postoperative complications were assessed using the Chi-squared test, whilst LOS was studied using the Mann-Whitney U test. A p-value of Results A total of 143patients underwent EC during the 24-month study period (75patients pre-COVID-19 and 68patients during COVID-19). The 30-day mortality was nil. 9patients;12% in pre-COVID-19 period and 11patients;16% in COVID-19 period underwent conversion to open cholecystectomy (p = 0.47). 18patients;24% from pre-COVID-19 and 19patients;27.9% from COVID-19 periods developed postoperative complications (p = 0.59). Grade-2-CDC complications were seen in 12patients;17.6% during COVID-19 period and 5patients;6.7% in pre-COVID-19 period (p = 0.0043). However, grade-3,4 CDC complications requiring intervention (p = 0.39), and ICU-admission (p = 0.62) were comparable in both periods. 1patient developed COVID-19 infection but made a full recovery. Mean LOS was 6-days in both periods, with no statistical difference (p = 0.28). Conclusions This study demonstrated no significant difference in patient outcomes who underwent emergency cholecystectomy during the COVID-19 pandemic compared to the pre-COVID-19 period. Emergency cholecystectomy should be offered to all surgically fit patients with symptomatic gall stones.

Background Chyle leak is a relatively uncommon but well-recognised complication following Oesophagectomy which carries significant morbidity and mortality if not treated actively. Evidence suggests the incidence rate of chyle leak post oesophagectomy can range from 0.4% to 21%. The aim of this study was to describe our experience in managing this complication. Methods This was a retrospective study, using the electronic database, to analyse our incidence of chyle leak in all patients who underwent elective oesophagectomy from April 2009 to December 2019 in a Tertiary Upper GI cancer centre. The diagnosis was confirmed by high persistent chest drain output, the colour of the fluid produced in the chest drain and its ‘content’ including fluid triglyceride levels and the presence of chylomicrons. Results Between 2009-2019, a total of 550 patients underwent Oesophagectomy. The median length of stay was 13 (Range 3 to 148) days. The median age was 63 years (45 to 82) with M:F 2:1. Chyle leak was identified in 24 patients (4.4%); Patients who were managed surgically were 83.3%(n = 20) with a median LOS of 20 days (Range 11 to 148) and mortality of 5%(n = 1). 16.7%(n = 4) were managed conservatively with a median LOS of 31 days (Range 14 to 51) and mortality of 0%. All 24 patients with chyle leak had neoadjuvant chemotherapy as part of treatment with radical intent. Conclusions Low mortality rates with chyle leak can be achieved with a high index of suspicion and early surgical intervention. This is crucial in reducing the length of stay in hospital and morbidity. Conservative management is suitable in low volume chyle leak and cases clinically responding to medical management.

Background Percutaneous cholecystostomy (PC) is performed occasionally in a highly selected group of patients with variable outcomes. The World Society of Emergency Surgery (WSES) updated guidelines(2020) has recommended PC as a treatment modality in patients admitted with ‘acute calculous cholecystitis’(ACC) with who are not fit for surgery, including septic patients and those who show no improvement on conservative management within 48 hours. An audit was organised to review our patient selection for PC in the last 5 years in comparison to the latest WSES recommendations. Methods A retrospective observational study was conducted using a prospectively collected hospital database on patients who underwent PC between March 2016 and March 2021 in a teaching hospital. The patient cohort who underwent PC were compared and analysed against the set WSES guidelines. Results Some 23 patients were included. The median age was 82 years (range-61-90), with 13 females (56.5%) and 10 males (43.5%).19/23(82.6%) patients were at risk of sepsis on presentation, with two or more amber flag symptoms, whereas 4/23(17.4%) patients presented with confirmed sepsis. 19/23 (82.6%) were deemed unfit for surgery against 4/23 who were deemed fit based on the surgeons assessment. Patients unfit for surgery were treated with antibiotics following a diagnosis of ACC. The median time for patients to undergo PC from admission was 4 days. The 30-day mortality rate was 13 % (n = 3/23). Conclusions The study has demonstrated that our current practice for managing patients admitted with ACC and performing PC are mostly in line with the WSES guidelines. Considering individuals presentation and the surgeons clinical judgement into account, the practice was also likely impacted by COVID-19 the global pandemic. Further clinical studies may be required to determine specific patient groups who would benefit from PC.

Background Staging laparoscopy is performed in all Oesophago-gastric cancer patients suitable for radical treatment with tumour staged ≥T2 prior to neoadjuvant chemotherapy. In response to COVID 19 pandemic, on 25th March 2020, the joint statement issued by the Royal College of Surgeons and AUGIS advised all laparoscopic procedures should be avoided due to the risk of virus transmission associated with aerosol-generating procedures. In accordance with the guidance, a more selective approach on who underwent a staging laparoscopy was followed. This audit explores its impact on patient outcome comparing data from pre COVID period with the COVID period. Methods Retrospective and prospective data was collected for 24months on all OG cancer patients from 25th March2019 to 24th March2021. ‘Pre COVID’ period was defined as 25th March 2019 to 24th March 2020 and ‘COVID’ period was defined as 25th March 2020 to 24th March 2021. All patients with Oesophago-gastric cancer with MDT cancer staged ≥T2, suitable for neoadjuvant chemotherapy were included. Patients with tumour staged Results Pre-COVID Period: 80patients underwent staging laparoscopy. Of these, 9patients(11.6%) with tumour staged as ≥T3 were declined curative surgery due to advanced disease(n = 2), metastatic disease(n = 3) or both(n = 4). In total, 40patients underwent curative surgery and there were 0 open/close laparotomies. COVID Period: Of the 79patients suitable for staging laparoscopy, only 7patients(8.7%) underwent laparoscopy. Of these, 3patients(3.8%) with tumour staged as ≥T3 were declined curative surgery due to advanced disease(n = 2) and metastatic disease(n = 1). In total, 33patients underwent curative surgery and only 1patient had an open/close laparotomy due to a liver metastases. No statistically significant difference was found p = 0.0913 Conclusions Staging laparoscopy is a useful tool for accurate staging of Oesophago-gastric cancers. It helps avoid unnecessary open and close laparotomy due to advanced disease and also allows us to assess patient fitness to major surgery. During the pandemic, the number of staging laparoscopies performed declined significantly but with no statistically significant difference to patient outcome. Thus we conclude, the COVID 19 pandemic has enabled us to have a selective approach to performing staging laparoscopy in Oesophago-gastric patients with advanced disease staged ≥T3 only.

Background Robotic surgery has been increasingly applied in different specialties. The Rosemere Cancer Foundation funded the Da Vinci robot for Upper GI services at our tertiary Upper GI Cancer Centre which serves a population of approximately 1.5 million people. In 2017, two of our UGI surgeons performed the first robotic GIST excision in the UK successfully. The patient was discharged 5 days later after an uneventful recovery. We have subsequently performed increasingly complex benign and malignant Robotic UGI procedures. Our primary and secondary aims looked at the length of stay (LOS) in critical care and the complete hospital admission. Methods Two UGI Consultants observed cases in established centres in Netherlands and Germany. Following this, they undertook 60 hours of simulation practice, online modular training and 3 sessions of wet lab training. Their initial 10 resections were completed under proctorship. A database was designed collecting information from the notes, November 2017 till July 2021 prospectively. This database was compared against a retrospective database on the same outcomes for non robotic cases over the same time period, performed by the same surgeons. LOS was statistically assessed using Mann-Whitney U test. Results As of July 2021, we have completed 73 cases. These are 25 benign and 48 cancer cases. The M:F was 1.5:1 and the median age was 66 years (22-84 years). The primary and secondary outcomes are illustrated below. Conclusions Robotic Upper GI surgery is safe and feasible with good short term outcomes. There is a reasonable learning curve and therefore a structured learning programme is needed before embarking. The main advantage from preliminary data suggests a reduction in the LOS in critical care. The cost-effectiveness in complex benign surgeries remains to be determined with increase volume of cases. P-OGC31 Figure 1

Background Laparoscopic Nissen fundoplication is an effective procedure for the treatment of gastro-oesophageal reflux disease (GORD), but the underlying motility mechanisms that explain the success of this operation remain unclear. Methods Twenty patients with a history of GORD underwent stationary oesophageal manometry and prolonged ambulatory pH monitoring, both before and 3 months after fundoplication. Results Eighteen patients were completely cured of reflux symptoms and stopped all antireflux medication after operation. After fundoplication there was a significant increase (P