Ashford-Wilson, S.

Barwell, J.

Brown, S.

El-Hadi, A.

Koopmans, I.

Lewis, M.

Sudlow, A.

Swafe, L.

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Abstracts / International Journal of Surgery 36 (2016) S31eS132 S121Aim: To evaluate the outcomes of patients diagnosed with acute chole-
cystitis undergoing emergency laparoscopic cholecystectomy, versus
medical management. This was done in the light of a growing body of
evidence suggesting that urgent management is safe and effective in
reducing duration of hospital stay and re-admission.
Method: We collected data on patient demographics, length of stay, re-
admission rates, treatment offered and complication rates over a one year
period and analysed in SPSS. Amultivariate General LinearModel was used
to determine the effect of independent patient variables (demographics,
laboratory and imaging results), on outcome measures.
Result: From a total of 250 admissions, 92 underwent emergency lapa-
roscopic surgery. The average hospital stay was 4.1 days for emergency
laparoscopic cholecystectomy versus 7.87 days for medically managed
patients. Overall readmission rates were comparable between the patients
treated with emergency laparoscopy and those medically managed, but
interestingly, re-admission rates halved for the emergency laparoscopic
cholecystectomy group who had their procedures done after 24hours but
within one week of admission.
Conclusion: Emergency cholecystectomy appears effective in reducing re-
admission rates when performed after the ﬁrst 24 hours. Signiﬁcant
reduction in length of stay indicates that emergency cholecystectomy is
cost effective in an NHS setting.http://dx.doi.org/10.1016/j.ijsu.2016.08.444
1309: THE USE OF OGD IN ROUTINE PREOPERATIVE INVESTIGATION
FOR BARIATRIC SURGERY: FINDINGS AND IMPLICATIONS FOR
MANAGEMENT
A. Misky 1,*, R. Dumbill 1, R. Zakeri 2, S. Gupta 2, M. Howlader 2, P. Suﬁ 2,
A. Alhamdani 2. 1UCL Medical School, London, UK; 2Department of Bariatric
and Upper GI Surgery, The Whittington Hospital NHS Trust, London, UK.
Background: The use of oesophago-gastro-duodenoscopy (OGD) as part of
routine workup for patients undergoing bariatric surgery is controversial.
Some suggest the procedure is necessary as signiﬁcant incidental ﬁndings
are common; others argue that it should be used selectively. Currently,
there is no universal recommendation in the context of bariatric surgery.
Aim: To establish the incidence of positive OGD ﬁndings in preoperative
bariatric surgery patients and identify the incidence of alteration to sur-
gical management, in order to deduce global recommendations for the role
of routine OGD in this cohort.
Method: Endoscopy reports and clinic letters were reviewed for 409 pa-
tients who underwent OGD over a two-year period (1/10/2013-1/10/2015)
in a specialist bariatric unit.
Result: Of the 409 cases, 310 were abnormal (75.7%). The most common
ﬁnding was hiatus hernia (49.4%). 364 patients (89.0%) had surgery. Of
these, 39 (10.7%) experienced change to the surgical procedure planned, 3
(0.08%) had a delay to surgery, and 322 (88.5%) had no change post-OGD.
Conclusion: The majority of patients had abnormal ﬁndings on OGD, with
a large proportion resulting in change to surgical management due to this.
We therefore conclude that routine OGD is an essential and valuable
component of preoperative workup for bariatric surgery.http://dx.doi.org/10.1016/j.ijsu.2016.08.445
1326: BENEFIT OF ROUTINE HISTOPATHOLOGY TESTING FOR SLEEVE
GASTRECTOMY SPECIMENS
D. Dosani 1,*, R. Zakeri 2, S. Gupta 2, A. Alhamdani 2, P. Suﬁ 2, M. Howlader 2.
1UCL Medical School, London, UK; 2Department of Bariatric and Upper GI
Surgery, The Whittington Hospital NHS Trust, London, UK.
Aim: Sleeve gastrectomy (SG) is a popular procedure for morbid obesity.
Literature debates routine versus selective histopathological testing of
gastric remnants. In our unit specimen histopathological testing takes 30
minutes, costing £65, and we perform an average of 100 SG procedures per
year. We aim to evaluate the beneﬁt of routine histopathology for SG
specimens.Method: Retrospective review of SG specimen ﬁndings from November
2010-2015. Case-notes were analysed for demographics, pre-operative
gastroscopy ﬁndings, operation notes and histology reports.
Result: 106 specimens were sent for histopathology, with one non-bar-
iatric case excluded. Median age was 44 years, median BMI 47.5kg/m2
(range 36.1-68.2 kg/m2) and female-to-male ratio 2.7: 1.
Routine pre-operative gastroscopy, performed in 79% of cases, found 32
abnormal cases: gastritis, oesophagitis or duodenitis in 31, 22 hiatus her-
nias, 4 ulcers and 3 polyps, of which one was a neuroendocrine tumour. All
10 patients positive for Helicobacter pylori commenced treatment pre-
operatively.
Histological testing identiﬁed 82 abnormal specimens (78%). Findings
included: gastritis (76%), fundic polyps (4%), gastrointestinal stromal tu-
mours (2%), hyperplasia (4%) and 2 neuroendocrine tumours (2%); both
required MDT discussion, endoscopy and blood tests.
Conclusion: Results justify routine testing of SG specimens, as signiﬁcant
abnormal ﬁndings necessitated deviation from the routine bariatric
pathway.http://dx.doi.org/10.1016/j.ijsu.2016.08.446
1331: ROUTINE CHOLANGIOGRAPHY IN THE MODERN ERA
S. Brown*, L. Swafe, A. El-Hadi, S. Ashford-Wilson, I. Koopmans, J. Barwell,
A. Sudlow, M. Lewis. Norwich and Norfolk University Hospital, Norwich, UK.
Introduction: Performing routine on table cholangiogram (r-OTC) during
laparoscopic Cholecystectomy (LC) remains a subject of debate. Advocates
for r-OTC highlight the reduced risk of injury to the common bile duct
(CBD) visualisation of the biliary tree thereby facilitating the management
of ductal stones.
Aim: We aimed to test the hypothesis that r-OTC reduces the risk of CBD
injury and improves overall management of gallstone disease.
Method: Data of patients undergoing r-OTC over a two year period
(October 2013 to September 2015) was collected.
Result: A total of 1005 patients (75.1% female, mean age 51) were
included. 836 (83.2%) LC were performed electively compared to 169
(16.8%) emergency operations. There was no CBD injury in our study
population. 4 (0.4%) cases were converted to open cholecystectomy. R-
OTC showed ductal stones in 101 patients (10.1%) of which 86 (85.2%)
patients underwent a CBD exploration and stone extraction during the
same operation.
Conclusion: Our study suggests that high volume r-OTC is associated with
a low of risk of bile duct injury and can be performed safely in emergency
as well as elective patients. It also demonstrates the use of r-OTC in ductal
stone detection and hence low re-admissions to hospital with retained
stones.http://dx.doi.org/10.1016/j.ijsu.2016.08.447Urology
0091: FEMALE ARTIFICIAL URINARY SPHINCTERS: EARLY EXPERIENCE
C. Gunner*, S. Reid. Shefﬁeld Teaching Hospitals, Shefﬁeld, UK.
Introduction: Implantation of artiﬁcial urinary sphincters (AUS) in fe-
males is uncommon in the UK. An anticipated increase in female AUS in
our practice prompted this study.
Method: A retrospective review was performed of all female AUS inserted
by a single surgeon over 5 years.
Result: 5 patients were identiﬁed with a median age of 48 years (33-59).
Median follow up was 6 months (2-18). 3 patients had a neurological
diagnosis. The remaining two patients had multiple failed incontinence
procedures. Preoperatively patients used a median of 5 pads/day(2-6). 2
experienced severe ﬂooding and 2 used intermittent self-catheterisation.


Routine cholangiography in the modern era 

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Routine cholangiography in the modern era

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