1
|
Bekheit M, Grundy L, Salih AK, Bucur P, Vibert E, Ghazanfar M. Post-hepatectomy liver failure: A timeline centered review. Hepatobiliary Pancreat Dis Int 2023; 22:554-569. [PMID: 36973111 DOI: 10.1016/j.hbpd.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 03/10/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Post-hepatectomy liver failure (PHLF) is a leading cause of postoperative mortality after liver surgery. Due to its significant impact, it is imperative to understand the risk stratification and preventative strategies for PHLF. The main objective of this review is to highlight the role of these strategies in a timeline centered way around curative resection. DATA SOURCES This review includes studies on both humans and animals, where they addressed PHLF. A literature search was conducted across the Cochrane Library, Embase, MEDLINE/PubMed, and Web of Knowledge electronic databases for English language studies published between July 1997 and June 2020. Studies presented in other languages were equally considered. The quality of included publications was assessed using Downs and Black's checklist. The results were presented in qualitative summaries owing to the lack of studies qualifying for quantitative analysis. RESULTS This systematic review with 245 studies, provides insight into the current prediction, prevention, diagnosis, and management options for PHLF. This review highlighted that liver volume manipulation is the most frequently studied preventive measure against PHLF in clinical practice, with modest improvement in the treatment strategies over the past decade. CONCLUSIONS Remnant liver volume manipulation is the most consistent preventive measure against PHLF.
Collapse
Affiliation(s)
- Mohamed Bekheit
- Department of Surgery, NHS Grampian, Foresterhill Health Campus, Ashgrove Road, AB252ZN Aberdeen, UK; Institute of Medical Sciences, Medical School, Foresterhill Health Campus, Ashgrove Road, AB252ZN Aberdeen, UK; Hépatica, Integrated Center of HPB Care, Elite Hospital, Agriculture Road, Alexandria, Egypt.
| | - Lisa Grundy
- Department of Surgery, NHS Grampian, Foresterhill Health Campus, Ashgrove Road, AB252ZN Aberdeen, UK
| | - Ahmed Ka Salih
- Department of Surgery, NHS Grampian, Foresterhill Health Campus, Ashgrove Road, AB252ZN Aberdeen, UK; Institute of Medical Sciences, Medical School, Foresterhill Health Campus, Ashgrove Road, AB252ZN Aberdeen, UK
| | - Petru Bucur
- Department of Surgery, University Hospital Tours, Val de la Loire 37000, France
| | - Eric Vibert
- Centre Hépatobiliaire, Paul Brousse Hospital, 12 Paul Valliant Couturier, 94804 Villejuif, France
| | - Mudassar Ghazanfar
- Department of Surgery, NHS Grampian, Foresterhill Health Campus, Ashgrove Road, AB252ZN Aberdeen, UK
| |
Collapse
|
2
|
Tan LJ, Ghazanfar M. HPB P44 Incidence of pancreatitis induced splanchnic venous thrombosis in a tertiary care hospital. Br J Surg 2022. [DOI: 10.1093/bjs/znac404.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abstract
Background
Splanchnic venous thrombosis (SPVT) is a well-recognized vascular complication of acute pancreatitis (AP). Exact incidence is not clear, however in recent years, the incidence of SPVT is on the rise. This is partially attributed by the availability of computed tomography. Most commonly involved veins are splenic vein (SV), superior mesenteric vein (SMV) and portal vein (PV) in the same order of frequency. Systemic anticoagulation is the presumed treatment for SPVT but evidence of benefit is still not clear. Further complications such as gastrointestinal bleeding, intestinal ischemia, anaemia, thrombocytopenia, infection and oesophageal or gastric varices has been documented which may worsen patient's outcomes. Currently, no data on incidence has been documented in Scotland and there are no national guidelines on the anticoagulation management for SPVT in acute pancreatitis.
This study aims to determine the incidence of SPVT complicating AP, the possible aetiological risk factor, the correlation of severity of AP with the development of SPVT, the current practice in management via anticoagulation and outcome of these patients, all in a single health board.
Methods
A cross-sectional study was conducted, including patients admitted to Aberdeen Royal Infirmary (ARI) and Dr. Gray's Hospital (DGH) with the primary diagnosis of AP from 1st January 2017 to 31st March 2018. Data was obtained from the health intelligence as per NHS Grampian protocol. Data collection was conducted retrospectively by assessing patient's electronic records via TrakCare on NHS Grampian computers, then inputted into REDCap software. Variables instruments heading patient background, admission/diagnosis background, pancreatitis severity, microbiology, organ support, feeding and nutrition, imaging/complications, SPVT, inpatient intervention and follow-up was set up. CT severity index (CTSI) was used to stratify pancreatitis severity. These scores were made based on interpretation of CT scans formal reports. Outcomes parameters were measured by length of hospital stay (LOS) in days and death during admission. Lastly, data was exported from REDCap and statistical analyses were conducted in IBM SPSS Statistics Version 27. Mean, standard deviation and range were calculated for continuous variables while frequencies and percentages for categorical variables. Chi-square test was used for correlation between categorical variables. P value of < 0.05 was set as level of significance.
Results
Of 219 patients admitted with AP, 202 had either CT scan or/and ultrasound scan conducted, recording incidence of SPVT to be 16/202(7.92%). Patients without scans were excluded as presence of undiagnosed due to its asymptomatic nature. Among SPVT group, 8/16(50%) were gallstone-related, 4/16(25%) alcohol, 1/16(6.25%) post-instrumental(iatrogenic) and 3/16(18.75%) idiopathic. Location of thromboses categorised into SV only in 7(43.8%), SMV only 2(12.5%), PV only 1(6.3%), SV+SMV 4(25%) and SV+ SMV+PV 2(12.5%). 125 patients received CT scan, SPVT group displayed 6/125(4.8%) CTSI ranging 0–5 and 9/125(7.2%) for 6–10, while non-SPVT group 101/125(80.8%) and 9/125(7.2%) respectively, p=0.000. Mortality rate due to SPVT recorded 1/10(10%) and LOS ranged from 0–360 days, mean:14.91, SD:41.43, p=0.000. 4/16(25%) SPVT patients had therapeutic anticoagulation, 3/16(18.8%) not anti-coagulated and 9/16(56.4%) had no data. In relation to thromboses site, 1/7(14.29%) SV only thrombosis received anticoagulation, ½(50%) for SMV only, ¼(25%) for SV+SMV and ½(50%) for SMV+SV+PV. On discharge, 5(62.5%) received anticoagulation, 3 months for 4 patients and 6 months for 1, 2/5(40%) oral and 3(60%) injectable.
Conclusions
Incidence of pancreatitis induced SPVT was 7.29% during the study period. No aetiological risk factor was determined. Severity of pancreatitis measured by CTSI was directly correlated with increased incidence of SPVT. Besides that, a high rate of idiopathic pancreatitis (37.9%) was found which is not in line with NICE guidance. Hence, further investigations should be offered to establish the aetiology of pancreatitis. In NHS Grampian, we observed mainly supportive management in SV thrombosis while anticoagulation commenced for PV and SMV involvement. Extension of thrombosis also prompted initiation of treatment. For future studies, state of splanchnic circulation after anticoagulation, locations of collaterals, acute and late complications among SPVT can be better analysed.
Collapse
Affiliation(s)
- Lu Jing Tan
- University of Aberdeen , Aberdeen , United Kingdom
| | | |
Collapse
|
3
|
Nessa A, Pawloy K, Ganeshamoorthy K, Tan J, Weston O, Maclean D, Ghazanfar M, Radhakrishnan G. HPB P32 Cancellations of elective theatre on the scheduled day of surgery at a tertiary referral hospital. Br J Surg 2022. [DOI: 10.1093/bjs/znac404.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Background
Cancellations of elective theatre has negative impact on patients, hospital staff and training of surgical trainees. It reduces the efficiency of theatre and causes significant financial loss for the health care system. The cancellation rate in the developed country ranged from 2 to 40%.The objective of current study was to report the rates and reasons for elective theatre cancellation.
Methods
The data of cancelled cases were collected by Department of eHealth. The report was used to identify the cancelled cases and further demographic details and waiting time and outcome were collected and simple descriptive and basic analysis was done.
Results
121 cases were cancelled over 9.5 months from 1/12/2020–16/09/2021. The incidence rate of cancellation is ---. 2 most common cancelled cases were Lap chole (27.3%, n=33) and EUA rectum (8.3%, n=10). 24% (n=20) of the cancelled cases were cancer. Commonest reason for cancellation were unavailability of bed 39% (n=47) and not enough time 32% (n=39). 82%(n=100) reasons for cancellation were deemed avoidable. 7% patients had cancellation twice. The mean waiting time since cancellation to surgery was 52 days, median 35 days. 5% patients were admitted to hospital while awaiting surgery. 3% had passed away while waiting.
Conclusions
This study identified the most common reasons for theatre cancellation at a tertiary hospital in Scotland which include unavailability of beds and not enough time. Improved theatre efficiency and booking schedule can help alleviate cancellation. Identification of the Potential avoidable causes can help conform interventions and formulate further research, influence national policies.
Collapse
Affiliation(s)
- Ashrafun Nessa
- Aberdeen Royal Infirmary , Aberdeen , United Kingdom
- University of Aberdeen , Aberdeen , United Kingdom
| | - Karola Pawloy
- Aberdeen Royal Infirmary , Aberdeen , United Kingdom
| | | | - Jiaying Tan
- Aberdeen Royal Infirmary , Aberdeen , United Kingdom
| | - Oliver Weston
- Aberdeen Royal Infirmary , Aberdeen , United Kingdom
| | | | | | | |
Collapse
|
4
|
Abdelhamid A, Nassar A, Shearer R, Ghazanfar M, Habib M. OGBN O03 Role of Antegrade Stenting in Common Bile Duct Exploration for Biliary Stone Disease; Systematic Review and Metanalysis. Br J Surg 2022. [DOI: 10.1093/bjs/znac404.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abstract
Background
It's estimated that approximately 10–18% of patients who have gall bladder stones have stones in the common bile duct (CBD). CBD stones could be managed either endoscopically, using ERCP, or surgically, using common bile duct exploration (CBDE).
Following CBDE, closure of the CBD could be done by either primary closure, closure over the T tube, or over the antegrade biliary stent. Primary closure alone is usually associated with concerns over a high-pressure biliary system risking a bile leak. In the past the T-tube was the method of choice for CBD decompression following CBDE, however, it causes complications in up to 10% of patients. Antegrade biliary stent use has emerged as a good alternative to the T-tube being placed through the choledochotomy prior to primary closure of the CBD and it is believed to be associated with fewer complications and avoiding the discomfort of the T-tube.
This study aimed to review the published studies for the outcomes of antegrade stenting of the CBD in CBDE for gall stone disease in adult patients.
Methods
The literature search was performed by an expert Information Specialist, Royal College of Surgeons of England Library in the electronic databases of MEDLINE, Embase, and the Cochrane Library to retrieve literature in the English Language up to September 2020 including all related studies except case reports discussing the use of antegrade stenting during CBDE for gall stone disease in adults >18-year-old excluding age<18 years, malignant cases, non-human studies, and non-English language results. Following the PRISMA protocol, studies were identified, and data were extracted. The studies describing the closure method after CBDE were reviewed. Data were extracted regarding the closure method either over T tube, over the antegrade stent, or primary direct closure without T tube or CBD stent. The primary outcome was the incidence of bile leak. Other outcomes were evaluated including mean length of hospital stay, failure of cannulation rate, average operative time, the incidence of cholangitis, acute pancreatitis, readmission and reoperation rates, biliary stent retention or migration, and CBD stones recurrence, and incidence of biliary stenosis requiring intervention. Analysis was performed with Review Manager (RevMan) [Computer program]. Version 5.4.1. The Cochrane Collaboration, 2020.
Results
Twelve eligible studies were analyzed reporting outcomes following CBDE mainly using T tube or antegrade stenting. Only one study reported outcomes after primary direct closure.
The bile leak was less common in stent group compared to T tube group with risk ratio (RR) of 0.78 [95% CI 0.41, 1.50] (P = 0.46). Although this finding is statistically insignificant, it has clinical significance in minimizing risk of bile leak in the stent group. One study reported less frequent bile leaks in the stent group compared to primary closure of 8.6% and 16.7% respectively. The mean length of hospital stay (LOS) was shorter in stent group compared to T tube group with RR of -3.05 [95% CI -4.03, -2.08] (P < 0.00001). A study reported mean LOS in stent group to be 8.9 days compared to 6.46 days after primary closure. Likewise, the risk of readmission and reoperation favours stent group over T tube group with RR of 0.41 [95% CI 0.15, 1.15] (P = 0.09) and 0.41 [0.15, 1.08] (P = 0.07) respectively.
On the other hand, the risk of pancreatitis is higher in stent group compared to T tube group with RR of 1.64 [95% 0.54, 4.97] (P = 0.38).
Conclusions
The use of antegrade stenting after CBDE offers less frequent bile leaks, shorter hospital stays less risk of readmission and reoperation over T tube use. Despite pancreatitis being more frequent in the antegrade stenting group, they are of variant clinical significance mostly biochemical diagnosis, and can be managed conservatively in the majority of cases. Few literatures report outcomes of primary direct closure after CBDE compared to other techniques, identifying a gap of knowledge requiring further studies in the future.
Collapse
Affiliation(s)
- Amir Abdelhamid
- Aberdeen Royal Infirmary , Aberdeen , United Kingdom
- University of Aberdeen , Aberdeen , United Kingdom
| | - Ahmed Nassar
- Aberdeen Royal Infirmary , Aberdeen , United Kingdom
- University of Aberdeen , Aberdeen , United Kingdom
| | - Rosalyn Shearer
- Aberdeen Royal Infirmary , Aberdeen , United Kingdom
- University of Aberdeen , Aberdeen , United Kingdom
| | - Mudassar Ghazanfar
- Aberdeen Royal Infirmary , Aberdeen , United Kingdom
- University of Aberdeen , Aberdeen , United Kingdom
| | - Mohammad Habib
- Aberdeen Royal Infirmary , Aberdeen , United Kingdom
- University of Aberdeen , Aberdeen , United Kingdom
| |
Collapse
|
5
|
Shameem FJ, Ghazanfar M. HPB P25 Incidence of pancreatitis induced vascular complications in a tertiary care hospital. Br J Surg 2022. [DOI: 10.1093/bjs/znac404.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abstract
Background
Pancreatitis (AP) is a common cause of hospital admission, which can lead to vascular complications such as splanchnic venous thrombosis (SpVT), pseudoaneurysm and haemorhage. These complications can happen with both acute and chronic pancreatitis and can be associated with high morbidity and mortality.
The aim of this study was to assess incidence of vascular complications in acute pancreatitis patients in a tertiary care hospital. Secondary aims included describing patient demographics, length of hospital stay, critical care admission, mortality, and assess the association between SpVT and pancreatic necrosis and mortality.
Methods
This study was done as part of year five elective project in University of Aberdeen Medical School. A retrospective study of acute pancreatitis patients who stayed in Aberdeen Royal Infirmary (ARI) or Dr. Gray's Hospital for ≥2 weeks and cases of mortality from acute pancreatitis irrespective of hospital stay between January 2018 to December 2019.
Cases were identified from Health intelligence central data as per local governance protocol. Hospital electronic system (TrackCare) was used to review the clinical and radiological details and data was entered in SPSS software version 27 for analysis. Frequencies and percentages were shown for the categorical data and chi square test was used to compare the variables. A p value less than 0.05 was taken as statistically significant.
Results
Total 293 patients were admitted with acute pancreatitis during the study period. 52 patients met the inclusion criteria for our study.
Of the 52 patients, 50 patients had a CT scan. There were 12 patients (24%) with evidence of vascular complications. 22% of patients had SVT and pseudoaneurysm was seen in 2% of cases. There was no case of haemorrhage. The overall mortality from AP during the study period was 6.5%. There was no statistically significant association between SVT and pancreatic necrosis or mortality.
Conclusions
Splanchnic venous thrombosis was a more frequent complication compared to pseudoaneurysm and haemorrhage in AP. There was no association between SVT and necrosis or mortality.
Collapse
Affiliation(s)
| | - Mudassar Ghazanfar
- NHS Grampian , Aberdeen , United Kingdom
- University of Aberdeen , Aberdeen , United Kingdom
| |
Collapse
|
6
|
Nassar A, Elshahat I, Forsyth K, Shaikh S, Ghazanfar M. Outcome of early cholecystectomy compared to percutaneous drainage of gallbladder and delayed cholecystectomy for patients with acute cholecystitis: systematic review and meta-analysis. HPB (Oxford) 2022; 24:1622-1633. [PMID: 35597717 DOI: 10.1016/j.hpb.2022.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/03/2022] [Accepted: 04/26/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Compare outcomes of early laparoscopic cholecystectomy (ELC) and percutaneous trans-hepatic drainage of gallbladder (PTGBD) as an initial intervention for AC and to compare operative outcomes of ELC and delayed laparoscopic cholecystectomy (DLC). METHODS English-language studies published until December 2020 were searched. Randomised controlled trials (RCTs) and observational studies compared EC and PTGBD with delayed cholecystectomy for patients presented with acute cholecystitis were considered. Main outcomes were mortality, conversion to open, complications and length of hospital stay. RESULTS Out of 1347 records, 14 studies were included. 205,361 (94.7%) patients had EC and 11,565 (5.3%) patients had PTGBD as an initial intervention for AC. Mortality was higher in PTGBD; HR, 95% CI: [3.68 (2.13, 6.38)]. In contrast, complication rate was significantly higher in EC group (47%) vs PTGBD group (8.7%) in patients admitted to ICU; P-value = 0.011. Patients who had ELC were at higher risk of post-operative complications compared to DLC; RR [95% CI]: 2.88 [1.78, 4.65]. Risk of bile duct injury was six folds more in ELC; RR [95% CI]: 6.07 [1.67, 21.99]. CONCLUSION ELC may be a preferred treatment option over PTGBD in AC. However, patient and disease specific factors should be considered to avoid unfavourable outcomes with ELC.
Collapse
Affiliation(s)
- Ahmed Nassar
- The Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, UK; Department of General Surgery, Aberdeen Royal Infirmary, NHS Grampian, UK.
| | | | - Katharine Forsyth
- Department of General Surgery, Aberdeen Royal Infirmary, NHS Grampian, UK
| | - Shafaque Shaikh
- The Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, UK; Department of General Surgery, Aberdeen Royal Infirmary, NHS Grampian, UK
| | - Mudassar Ghazanfar
- The Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, UK; Department of General Surgery, Aberdeen Royal Infirmary, NHS Grampian, UK
| |
Collapse
|
7
|
Nessa A, Pawloy K, Purewal R, Ganeshamoorthy K, Tayo O, Ghazanfar M. 283 Delayed Discharge-a Pitfall for NHS; Can We Improve? Br J Surg 2022. [DOI: 10.1093/bjs/znac269.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Aim
Identify reasons for discharge delays in a tertiary care hospital and find areas of improvement.
Method
Data were collected for seven days, and all inpatients (Elective and Emergency) admissions were included. Patient's demographic data, length of hospital stay, and discharge data were entered on Microsoft Excel and analysed using SPSS.
Results
Out of 102 total patients, 48 (47.1%) were male and 54 (52.9%) females. Mean age was 60.5 years (min 20 max 91). Clinical frailty score (CFS) was not calculated in more than half of the patients (n=55, 57.4%). 47(46.5%) patients had polypharmacy. 61(59.80%) patients did not have a documented Expected date of Discharge (EDD). Median hospital stay was 10 days (1–161 days).
27(26.47%) patients had delayed discharge (mean 4.93 days, median 1 day). Reasons for delay included unavailability of rehab bed (n=5, 4.9%), stoma nurse review (n=6, 5.88%), and awaiting bloods, diabetic control or discharge hub planning (n=3, 2.94%). Delayed discharges do not seem to be affected by polypharmacy (p=0.067), DNACPR (p=0.926), frailty score (p=0.761) or gender (p=0.518). However, Patients aged 65 or above were more likely to have delayed discharge (p=0.037).
Conclusions
Delayed discharge is more likely in over 65years. We recommend early identification of at-risk patients. Possible interventions to avoid discharge delays are EDD, pre-emptive preparation of discharge letters, early morning bloods and training of ward nurses for stoma care.
Collapse
Affiliation(s)
- A Nessa
- Aberdeen Royal Infirmary , Aberdeen , United Kingdom
| | - K Pawloy
- Aberdeen Royal Infirmary , Aberdeen , United Kingdom
| | - R Purewal
- Aberdeen Royal Infirmary , Aberdeen , United Kingdom
| | | | - O Tayo
- Aberdeen Royal Infirmary , Aberdeen , United Kingdom
| | - M Ghazanfar
- Aberdeen Royal Infirmary , Aberdeen , United Kingdom
| |
Collapse
|
8
|
Nassar A, Cimpean S, Abdelhamid A, Jones RP, Wahba R, Fiorentini G, Aldrighetti L, Teh C, Alikhanov R, Hammond J, Silva M, Abdelmabod A, Truant S, Ferrero A, Sturesson C, Ahmed I, Ghazanfar M, Takemura N, Pawlik TM, Bekheit M. OUP accepted manuscript. BJS Open 2022; 6:6590408. [PMID: 35598157 PMCID: PMC9124362 DOI: 10.1093/bjsopen/zrac051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/05/2022] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ahmed Nassar
- Institute of Medical Sciences, University of Aberdeen, Scotland, UK
- Department of Surgery, NHS Grampian, Scotland, Aberdeen, UK
| | - Sorin Cimpean
- Department of Surgery, CHU - St Pierre, Brussels, Belgium
| | - Amir Abdelhamid
- Institute of Medical Sciences, University of Aberdeen, Scotland, UK
- Department of Surgery, NHS Grampian, Scotland, Aberdeen, UK
| | - Robert P. Jones
- Northwest Hepatobiliary Unit, Department of Surgery, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Roger Wahba
- Departement of General, Visceral, Cancer and Transplantation Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Guido Fiorentini
- Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic Rochester, Rochester, USA
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, San Raffaele Hospital, Milan, Italy
| | - Catherine Teh
- Department of Surgery, Makati Medical Center, Makati Metro Manila, Philippines
- Department of Surgery, National Kidney & Transplant Institute, Quezon, Philippines
- Department of Surgery, St Luke’s Medical Center, Quezon, Philippines
| | - Ruslan Alikhanov
- Moscow Clinical Scientific Center, Department of liver and pancreatic surgery and Transplantation, Russia
| | - John Hammond
- Department of HPB and Transplantation, Freeman Hospital, Newcastle upon Tyne, Newcastle, UK
| | - Michael Silva
- Department of Surgery, Oxford University Hospital, Oxford, UK
| | - Areeg Abdelmabod
- Institute of Medical Sciences, University of Aberdeen, Scotland, UK
- Department of Surgery, NHS Grampian, Scotland, Aberdeen, UK
| | - Stephanie Truant
- Department of Surgery, Centre Hospitalier Régional Universitaire de Lille: Lille, Nord-Pas-de-Calais, Lille, France
| | | | - Christian Sturesson
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Irfan Ahmed
- Institute of Medical Sciences, University of Aberdeen, Scotland, UK
- Department of Surgery, NHS Grampian, Scotland, Aberdeen, UK
| | - Mudassar Ghazanfar
- Institute of Medical Sciences, University of Aberdeen, Scotland, UK
- Department of Surgery, NHS Grampian, Scotland, Aberdeen, UK
| | - Nobuyuki Takemura
- Department of Surgery, National Center for Global Health and Medicine (NCGM), Tokyo, Japan
| | - Timothy M. Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Ohio, USA
| | - Mohamed Bekheit
- Institute of Medical Sciences, University of Aberdeen, Scotland, UK
- Department of Surgery, NHS Grampian, Scotland, Aberdeen, UK
- Surgical Unit, HPB Integrated Center of Care, Elite Integrated Centers of Excellence, Alexandria, Egypt
- Correspondence to: Mohamed Bekheit, Department of Surgery, Aberdeen Royal Infirmary, Department of Surgery, Foresthill Health Campus, Aberdeen AB252ZN, UK (e-mail: )
| |
Collapse
|
9
|
Jardine R, Abdelmabod A, Habib M, Ghazanfar M. 16 Re-Do of Laparoscopic CBD Exploration Through Cystic Duct Remnant Following Laparoscopic Cholecystectomy; A Case Series. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Common bile duct (CBD) stones are detected in approximately 10-15% of patients with gallstone disease. They can be formed in the absence of gallbladder stones or in patients who underwent previous cholecystectomy. Laparoscopic common bile duct exploration has been documented since 1999, with increasing evidence illustrating the effectiveness of the transcystic approach. There is no review of re-exploration of the CBD, due to retained stones, following laparoscopic cholecystectomy (LC) via this approach. Four cases are presented detailing need for initial intervention, and intra-operative findings.
Method
Review of four cases in 2020 in Aberdeen Royal Infirmary. Each underwent re-do laparoscopic transcystic common bile duct exploration for retained stone, following previous laparoscopic cholecystectomy.
Results
Each case had successful stone clearance and resolution of symptoms.
Conclusions
With increasing laparoscopic technology and surgical skill, re-exploration of the CBD following previous LC due to emergency surgical presentations should be performed. This is feasible and safe. We recommend the transcystic approach due to reduced morbidity and high success rates of stone extraction.
Collapse
Affiliation(s)
- R Jardine
- NHS Grampian, Aberdeen, United Kingdom
| | | | - M Habib
- NHS Grampian, Aberdeen, United Kingdom
| | | |
Collapse
|
10
|
McIntosh S, Jardine R, Ghazanfar M. 389 General Surgery Operative Cancellations Within Aberdeen Royal Infirmary 2019. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Operative cancellation rates can be up to 17.6%, resulting in delays to patient treatment and management. This audit was conducted to assess underlying reasons for operative cancellations with the aim to minimise cancellations in the future.
Method
A retrospective review of General surgery operative cancellations during 2019 at Aberdeen Royal Infirmary was undertaken. Data was obtained from Theatre Management.
Results
28548 operations were performed across all surgical specialities during 2019 with 2664 operations cancelled. Within General Surgery, 447 were cancelled (182 emergency (40.7%), 265 electives (59.3%)). The most common reason was lack of theatre time for elective cases and procedure no longer needed for emergency cases. For cancelled elective surgeries, there was a median time of 29 days before being operated.
Conclusions
We highlight that both elective and emergency operations are susceptible to cancellation. There are clear differences in the reason of cancellation between elective and emergency. Going forward, it is worth discussing booking emergency operations with the on-call consultant to ensure they are necessary. Regarding elective operation cancellations due to lack of theatre time it would be imperative to assess the exact cause of this as to minimise operative cancellations. We plan re-audit once a departmental discussion has been made.
Collapse
Affiliation(s)
- S McIntosh
- General Surgery, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - R Jardine
- General Surgery, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - M Ghazanfar
- General Surgery, Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| |
Collapse
|
11
|
Saleem M, Mehboob G, Ahmed MS, Khisro SN, Ansar MZ, Mehmood K, Rafiqa-Tul-Rasool, Alamgir MK, Ejaz A, Ghazanfar M, Hussain S, Ahmed A, Ashfaq JM. Electrochemical Properties of Tin Sulfide Nano-Sheets as Cathode Material for Lithium-Sulfur Batteries. Front Chem 2020; 8:254. [PMID: 32411656 PMCID: PMC7199525 DOI: 10.3389/fchem.2020.00254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/17/2020] [Indexed: 11/13/2022] Open
Abstract
Unprecedented self-assembled hierarchical nano-sheets of SnS were synthesized by the hydrothermal method. In a typical reaction, SnCl2.2H2O and Na2S.9H2O were used as reactants. Structural and morphological properties were studied by X-ray diffraction (XRD), and scanning electron microscopy (SEM) while the electrochemical properties were measured by cyclic voltammetry, charge-discharge cycles, and electrochemical impedance spectroscopy (EIS). SEM results showed the 1-D SnS nano-sheets with an average thickness of around 20 nm. Cyclic voltammogram and charge-discharge spectra showed good cycling stability. All these results showed that SnS nano-sheets are promising candidate material to be used as electrode for Li-S batteries.
Collapse
|
12
|
Bekheit M, Smith R, Ramsay G, Soggiu F, Ghazanfar M, Ahmed I. Meta-analysis of laparoscopic transcystic versus transcholedochal common bile duct exploration for choledocholithiasis. BJS Open 2019; 3:242-251. [PMID: 31183439 PMCID: PMC6551404 DOI: 10.1002/bjs5.50132] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 11/21/2018] [Indexed: 02/05/2023] Open
Abstract
Background It is not clear whether laparoscopic transcystic exploration (LTCE) laparoscopic choledochotomy (LCD) is superior in the management of choledocholithiasis. In this meta‐analysis, the success of LTCE versus LCD was evaluated. Methods Cochrane Central Register of Controlled Trials, Web of Science, Trip, PubMed, Ovid and Embase databases were searched systematically for relevant literature up to May 2017. Studies that compared the success rate of LTCE and LCD in patients with choledocholithiasis were included. PRISMA guidelines were followed. Multiple independent reviewers contributed on a cloud‐based platform. Random‐effects model was used to calculate odds ratios (ORs) or standardized mean differences (MDs) with 95 per cent confidence intervals. An a priori hypothesis was generated based on clinical experience that LTCE is as successful as LCD. Results Of 3533 screened articles, 25 studies comprising 4224 patients were included. LTCE achieved a lower duct clearance rate than LCD (OR 0.38, 95 per cent c.i. 0·24 to 0·59). It was associated with a shorter duration of surgery (MD −0·86, 95 per cent c.i. −0·97 to −0·77), lower bile leak (OR 0·46, 0·23 to 0·93) and shorter hospital stay (MD −0·78, −1·14 to −0·42) than LCD. There was no statistically significant difference in conversion, stricture formation or reintervention rate. Conclusion LCD has a higher rate of successful duct clearance, but is associated with a longer duration of surgery and hospital stay, and a higher bile leak rate.
Collapse
Affiliation(s)
- M Bekheit
- Department of Surgery, Aberdeen Royal Infirmary Aberdeen UK
| | - R Smith
- Department of Surgery, Aberdeen Royal Infirmary Aberdeen UK
| | - G Ramsay
- Department of Surgery, Aberdeen Royal Infirmary Aberdeen UK.,Scottish Clinical Research Excellence Development Scheme, Rowett Institute University of Aberdeen Aberdeen UK
| | - F Soggiu
- Department of Surgery Royal Free Hospital London UK
| | - M Ghazanfar
- Department of Surgery, Aberdeen Royal Infirmary Aberdeen UK
| | - I Ahmed
- Department of Surgery, Aberdeen Royal Infirmary Aberdeen UK
| |
Collapse
|